Malabsorption Flashcards
What do you consider with malabsorption
Celiac dx
magnesium deficiency is from
PPI or diuretic use, diarrhea, malabsorption, or renal (alcohol or diuretic losses)
Chronic use of PPI can cause
hypomangesemia by disrupting the intestinal epithelial cells ability to absorb magnesium.
Symptoms of low Mg
fatigue, weakness, neuromsucular hyperexcitability (muscle cramps, tremor, hyperreflexia)
Chronic PPI can cause
check Mg levels periodically, or stop PPI
Increase risk for osteoporosis
C diff risk
Increased risk for aspiration and cap pna
May worsen renal function
Cause leukopenia
Microscopic colitis
jejungal villous atrophy is from
celiacs dx - see iron and vitamin D deficiencies
If pt is on metformin for a long time what do you check?
Vitamin B 12 deficiency; metformin can reduce intestinal absorption by 30% and this is supposed be via impaired calcium depedent binding to intrinsic factor B12 complex to it’s receptor and so it decreases ileal absorption.
Seen with higher doses, older pts, and longer durations of treatment. Seen with neurological symptoms before anemia develops. Small amounts of B12 in daily vitamins are not protective.
pancreatic atrophy presents with
steatorrhea. See fat soluble vitamin deficiency
Celiac disease clinical manifestations
abdominal pain, nausea/ vomiting
diarrhea (rarely constipation)
flatulence and bloating
extraintestinal manifestations of celiac dx
short stature, weight loss
iron deficiency anemia
dermatitis herpetiformis
Diagnosis of Celiac’s dx
increased tissue transglutaminase A
increased antiendomysial antibodies
duodenal biospy showing increased intraepithelial lymphocytes with flattened villi
what is Celiacs dx
immune mediated hypersensitivity to gluten.
do we need to always get total IgA levels with diagnosis of Celiac’s dx?
no. IgA level testing is required only if serological testing is negative and suspect Celiac’s dx.
This is due to high prevalence of IgA deficiency in celiac dx and can cause a false negative.
what is the next step to diagnosis of Celiac’s dx once serology has returned?
regardless if serology is positive or negative, need to get a small bowel enterscopy to get biopsy to establish a diagnosis of Celiacs
when to start a gluten free diet?
after biopsy that establishes Celiac dx as this will have less inflammation and not before biopsy. IF done before, it can decrease biopsy sensitivity.
