Malabsorption & IBS

Question 1

Malabsorption

Answer 1

Disorders in which there is a disruption of digestion and/or nutrient absorption

Question 2

Manifestations of malabsorption

Answer 2

Steatorrhea → loss of fats and soluble vitamins

Paresthesia, tetany, + Trousseau, + Chvostek → Ca, VitD, Mg

Question 3

Lab findings: increased fecal fat, decreased serum cholesterol, decreased serum carotene (VitA), VitD

Answer 3

Steatorrhea

Question 4

Lab findings: decreased serum Ca, Mg

Answer 4

Paresthesia, tetany, + Trousseau, + Chvostek

Question 5

Tests for malabsorption

Answer 5

D-xylose
Alpha-1-antitrypsin

Question 6

D-xylose

Answer 6

readily absorbed; helps differentiate digestion from absorption problems

Question 7

Alpha-1-antitrypsin

Answer 7

quantifies protein loss from the gut

Question 8

Pathogenesis of normal digestion/absorption: intraluminal

Answer 8

Dietary fats, proteins, carbs → hydrolyzed & solubilized by pancreatic & biliary secretions

Question 9

Pathogenesis of normal digestion/absorption: Mucosal

Answer 9

Requires sufficient surface area of intact small intestinal epithelium

Malabsorption of all nutrients

Question 10

Pathogenesis of normal digestion/absorption: Absorptive

Answer 10

Obstruction of the lymphatic system → impaired absorption of chylomicrons & lipoproteins

Question 11

Steatorrhea, significant enteric protein losses, “protein-losing enteropathy”

Answer 11

Obstruction of the lymphatic system

Question 12

Decreased bile salt concentrations

Answer 12

d/t biliary obstruction, cholestatic liver diseases, resection or disease of terminal ileum

Question 13

Destruction/loss of bile salts

Answer 13

Bacterial overgrowth, massive hypersecretion, meds that bind bile salts (cholestyramine)

Question 14

Pancreatic issues: Pancreatic insufficiency

Answer 14

Caused by chronic pancreatitis, cystic fibrosis, pancreatic cancer

Question 15

Pancreatic issues: Pancreatic enzymes inactivated

Answer 15

w/in intestinal lumen by acid hypersecretion (ZE syndrome)

Question 16

Pancreatic issues results in

Answer 16

Triglyceride malabsorption → steatorrhea

Question 17

Celiac Disease cause ….

Answer 17

Immunologic response to gluten → diffuse damage to small intestinal mucosa w/ malabsorption of nutrients

Question 18

Celiac Disease Sx

Answer 18

GI/obvious consequences of malabsorption: diarrhea, steatorrhea, weight loss, ab distension, weakness, muscle wasting, growth retardation

Question 19

Celiac Disease Sx in Older children/adults

Answer 19

Less likely to manifest signs of serious malabsorption, may report less serious ones

Chronic diarrhea
Dyspepsia
Flatulence
Variable WT loss

Question 20

Celiac Disease Atypical Sx

Answer 20

Fatigue, depression, iron-deficiency anemia, osteoporosis, short stature, delayed puberty, amenorrhea/reduced fertility

Question 21

Ddx of Celiac Disease

Answer 21

1. IBS
2. Lactase deficiency, pancreatic insufficiency
   3.Whipple disease (topical sprue, PAS+, foamy macrophages

Question 22

Whipple Disease

Answer 22

Tropical Sprue
PAS+
Foamy Macrohpages
Cardiac sx
Arthralgias
Neuro sx

Question 23

Genetic tests: CBC, PT, albumin, iron, ferritin, calcium, vitamin B12, A, D

Answer 23

Lab tests for celiac disease

Question 24

IgA endomysial; antibody and/or tTG antibody

Answer 24

Serologic testing Celiac disease

**perform in all pts w/ suspected disease

Question 25

Celiac disease genetic testing

Answer 25

HLA DQ2 & HLADQ8 (increase risk just 1% --> 3%)

Question 26

Villous atrophy Crypt hyperplasia Intraepithelial lymphocytosis Mod increased risk of T-cell lymphoma

Answer 26

Dx findings for Celiac dx

Question 27

Treatment for celiac dx

Answer 27

Remove all gluten from diet Avoid dairy until intestines improve Parenteral nutrition & IV corticosteroids for 2+ weeks

Question 28

Celiac Dx: if severe diarrhea, dehydration, electrolyte imbalance, malnutrition

Answer 28

Parenteral nutrition & IV corticosteroids for 2+ weeks

Question 29

Folate, iron, B12, calcium, VitA, D, E supplements

Answer 29

Tx celiac dx

Question 30

Tx celiac dx for osteoporosis

Answer 30

Calcium, VitD, bisphosphate

Question 31

Functional disorder characterized by abd pain or discomfort with alterations in bowel habits

Answer 31

IBS

Question 32

IBS Demo

Answer 32

late teens-early 20s Women>>>

Question 33

IBS diagnostics

Answer 33

no definitive study

Question 34

ROME III criteria

Answer 34

Recurrent abd pain 3 days/month assoc w/ 2+ of --> 1. Relieved by defecation 2. Change in stool frequency 3. Change in stool form/appearance

Question 35

PEx usually normal in celiac disease but...

Answer 35

Somatic/Psych complains common

Question 36

Dx testing NOT required if sx .....

Answer 36

Are compatible w/ IBS OR do not suggest organic disease (no nocturnal diarrhea, hematochezia, WT loss, fever, fam hx of colon cancer/IBD)

Question 37

Warranted in pts who do not improve after 2-4 weeks of empiric therapy

Answer 37

■ CBC, chem panel, albumin, CRP ■ Thyroid fxn tests, Celiac disease serologies ■ O&P for parasites ■H2 breath tests for small bowel bacterial overgrowth

Question 38

IBS Colonoscopy for

Answer 38

>50 yo; or if do not respond to empiric therapy

Question 39

IBS Therapeutic procedures

Answer 39

○ Reassure pt → explain functional nature of sx ○ Behavior modification w/ relaxation techniques, hypnotherapy ○Moderate exercise