malabsorption Flashcards
Celiac is associated with which type of HLA?
HLA B8
The most common presentation (2000-200I) of celiac sprue patients
iron deficiency anemia
dermatological manifestation of celiac?
dermatitis herpetiformis
Diagnosis of celiac sprue:
I) evidence of malabsorption
2) abnormal small bowel biopsy
3) usually (but not necessarily). a positive antiendomysial antibody or tissue transglutarninase antibody test
4) a positive response to a gluten-free diet (clinical, chemical, and histological)
if antiendomysial antibody is negative with strong suspicion of sprue
Since IgA deficiency occurs in 1-2% of U.S. population, if antiendomysial antibody is negative with strong suspicion of sprue, check serum IgA levels.
treatment of celiac disease
Treat with gluten-free diet (GFD) +/-initial corticosteroids. 80% eventually respond to a GFD, although it may take a while in some.
Tropical sprue
causes malabsorption with partial villous atrophy that is probably of an infectious etiology.
treatment of Tropical sprue
tetracycline or TMP/SMX for 3-6 months. Folic acid replacement can also be effective either alone or as adjunctive treatment
etiology of whipple disease
Whipple disease is caused by Tropheryma whippelii, a Gram positive actinomycete
The cardinal tetrad of whipple disease
1) arthralgias—the most common symptom preceding diagnosis! Much more so than abdominal problems!
2) abdominal pain
3) weight loss
4) diarrhea
Dx of whipple dis.
Upper endoscopy with small intestine biopsy is the diagnostic procedure of choice. Small bowel biopsy shows specific foamy macrophages and is positive for PAS staining bacterial remnants. You can also check CSF for T whippelii by PCR which is diagnostic if found
Treatment of whipple dis.
Treat with ceftriaxone or PCN plus streptomycin for 10–14 days and then treat for 1 year with TMP/SMX.
whipple dis. relapse
Relapse often manifests with CNS symptoms
DDx of whipple dis.
These symptoms also may be caused by lymphatic blockage from primary intestinal (or other) lymphoma
Eosinophilic gastroenteritis manifestations
Eosinophilic gastroenteritis can mimic intestinal lymphoma and regional enteritis. Patients have N/V/diarrhea, abdominal pain, weight loss, albumin wasting, and iron deficiency anemia. They often have a peripheral eosinophilia and even though it is thought to be due to an allergy to certain foods
Eosinophilic gastroenteritis treatment
Treat with corticosteroids and avoidance of the causative foods. strongyloides can also cause a peripheral eosinophilia (Giardia does not). so be sure to rule this out before you start the steroids!
when to lifelong TPN in short bowel syndrome?
Lifelong TPN is likely if the remaining small bowel is < 100 cm and there is loss of ileocecal valve
if there is evidence of pancreatic insufficiency in patients > 55 years old
You must rule out pancreatic cancer
Steatorrhea IS the best Indicator of
Steatorrhea is the best indicator of any type of malabsorption because it usually is the most prominent problem. Sudan stain of the stool (for fat) is the best screening test
the “gold standard” for determining steatorrhea
The 3-day, quantitative fecal fat measurement
steatorrhea is defined as
> 14 gr/d of fecal fat.
Steatorrhea from pancreatic insufficiency causes the most fecal fat (can be > 50 gm/d)
Diagnosing etiology of the malabsorption :
First, determine whether it is a small bowel mucosal problem or pancreatic insufficiency (transport vs. digestion), by using the xylose (D-xylose) absorption test.
A normal xylose absorption test
A normal xylose absorption test result (> 4.5 gm of a 25gm oral dose excreted in the urine over 5hr, or patient has a > 20 mg/dl serum level)
Diagnosing etiology of the malabsorption :(summary)
I) Low “anything” suggests small bowel mucosal problem or bacterial overgrowth.
2)Normal xylose absorption test (i.e.,carotene,calcium,and others also normal) suggests pancreatic insufficiency especially if there is very high fecal fat.
Diagnose bacterial overgrowth with
the lactulose breath test and sometimes the Cl4-glycocholate breath test. Contrary to other causes of malabsorption, these patients often have an increased RBC folate level.
Bacterial overgrowth is often treated empirically.
first test for celiac dis.
anti tissue transglutaminase
the most accurate diagnostic test for celiac
small bowel biopsy
bowel biobsy is essential to exclue lymphoma
IS lactolose intolerance associated with weight loss?
NO
Gluten found in…
BROW Barley rye oat wheat
