malabsorption

Question 1

Celiac is associated with which type of HLA?

Answer 1

HLA B8

Question 2

The most common presentation (2000-200I) of celiac sprue patients

Answer 2

iron deficiency anemia

Question 3

dermatological manifestation of celiac?

Answer 3

dermatitis herpetiformis

Question 4

Diagnosis of celiac sprue:

Answer 4

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)

Question 5

if antiendomysial antibody is negative with strong suspicion of sprue

Answer 5

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.

Question 6

treatment of celiac disease

Answer 6

Treat with gluten-free diet (GFD) +/-initial corticosteroids. 80% eventually respond to a GFD, although it may take a while in some.

Question 7

Tropical sprue

Answer 7

causes malabsorption with partial villous atrophy that is probably of an infectious etiology.

Question 8

treatment of Tropical sprue

Answer 8

tetracycline or TMP/SMX for 3-6 months. Folic acid replacement can also be effective either alone or as adjunctive treatment

Question 9

etiology of whipple disease

Answer 9

Whipple disease is caused by Tropheryma whippelii, a Gram positive actinomycete

Question 10

The cardinal tetrad of whipple disease

Answer 10

1) arthralgias—the most common symptom preceding diagnosis! Much more so than abdominal problems!
2) abdominal pain
3) weight loss
4) diarrhea

Question 11

Dx of whipple dis.

Answer 11

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

Question 12

Treatment of whipple dis.

Answer 12

Treat with ceftriaxone or PCN plus streptomycin for 10–14 days and then treat for 1 year with TMP/SMX.

Question 13

whipple dis. relapse

Answer 13

Relapse often manifests with CNS symptoms

Question 14

DDx of whipple dis.

Answer 14

These symptoms also may be caused by lymphatic blockage from primary intestinal (or other) lymphoma

Question 15

Eosinophilic gastroenteritis manifestations

Answer 15

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

Question 16

Eosinophilic gastroenteritis treatment

Answer 16

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!

Question 17

when to lifelong TPN in short bowel syndrome?

Answer 17

Lifelong TPN is likely if the remaining small bowel is < 100 cm and there is loss of ileocecal valve

Question 18

if there is evidence of pancreatic insufficiency in patients > 55 years old

Answer 18

You must rule out pancreatic cancer

Question 19

Steatorrhea IS the best Indicator of

Answer 19

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

Question 20

the “gold standard” for determining steatorrhea

Answer 20

The 3-day, quantitative fecal fat measurement

Question 21

steatorrhea is defined as

Answer 21

> 14 gr/d of fecal fat.

Steatorrhea from pancreatic insufficiency causes the most fecal fat (can be > 50 gm/d)

Question 22

Diagnosing etiology of the malabsorption :

Answer 22

First, determine whether it is a small bowel mucosal problem or pancreatic insufficiency (transport vs. digestion), by using the xylose (D-xylose) absorption test.

Question 23

A normal xylose absorption test

Answer 23

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)

Question 24

Diagnosing etiology of the malabsorption :(summary)

Answer 24

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.

Question 25

Diagnose bacterial overgrowth with

Answer 25

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.

Question 26

first test for celiac dis.

Answer 26

anti tissue transglutaminase

Question 27

the most accurate diagnostic test for celiac

Answer 27

small bowel biopsy

bowel biobsy is essential to exclue lymphoma

Question 28

IS lactolose intolerance associated with weight loss?

Answer 28

NO

Question 29

Gluten found in…

Answer 29

BROW
Barley
rye
oat
wheat