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GEMS > Malabsorption & IBS > Flashcards

Malabsorption & IBS Flashcards

1
Q

Malabsorption

A

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

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2
Q

Manifestations of malabsorption

A

Steatorrhea → loss of fats and soluble vitamins

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

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3
Q

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

A

Steatorrhea

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4
Q

Lab findings: decreased serum Ca, Mg

A

Paresthesia, tetany, + Trousseau, + Chvostek

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5
Q

Tests for malabsorption

A

D-xylose
Alpha-1-antitrypsin

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6
Q

D-xylose

A

readily absorbed; helps differentiate digestion from absorption problems

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7
Q

Alpha-1-antitrypsin

A

quantifies protein loss from the gut

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8
Q

Pathogenesis of normal digestion/absorption: intraluminal

A

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

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9
Q

Pathogenesis of normal digestion/absorption: Mucosal

A

Requires sufficient surface area of intact small intestinal epithelium

Malabsorption of all nutrients

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10
Q

Pathogenesis of normal digestion/absorption: Absorptive

A

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

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11
Q

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

A

Obstruction of the lymphatic system

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12
Q

Decreased bile salt concentrations

A

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

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13
Q

Destruction/loss of bile salts

A

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

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14
Q

Pancreatic issues: Pancreatic insufficiency

A

Caused by chronic pancreatitis, cystic fibrosis, pancreatic cancer

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15
Q

Pancreatic issues: Pancreatic enzymes inactivated

A

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

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16
Q

Pancreatic issues results in

A

Triglyceride malabsorption → steatorrhea

17
Q

Celiac Disease cause ….

A

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

18
Q

Celiac Disease Sx

A

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

19
Q

Celiac Disease Sx in Older children/adults

A

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

Chronic diarrhea
Dyspepsia
Flatulence
Variable WT loss

20
Q

Celiac Disease Atypical Sx

A

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

21
Q

Ddx of Celiac Disease

A
  1. IBS
  2. Lactase deficiency, pancreatic insufficiency
    3.Whipple disease (topical sprue, PAS+, foamy macrophages
22
Q

Whipple Disease

A

Tropical Sprue
PAS+
Foamy Macrohpages
Cardiac sx
Arthralgias
Neuro sx

23
Q

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

A

Lab tests for celiac disease

24
Q

IgA endomysial; antibody and/or tTG antibody

A

Serologic testing Celiac disease

**perform in all pts w/ suspected disease

25
Q

Celiac disease genetic testing

A

HLA DQ2 & HLADQ8

(increase risk just 1% –> 3%)

26
Q

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

A

Dx findings for Celiac dx

27
Q

Treatment for celiac dx

A

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

28
Q

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

A

Parenteral nutrition & IV corticosteroids for 2+ weeks

29
Q

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

A

Tx celiac dx

30
Q

Tx celiac dx for osteoporosis

A

Calcium, VitD, bisphosphate

31
Q

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

A

IBS

32
Q

IBS Demo

A

late teens-early 20s
Women»>

33
Q

IBS diagnostics

A

no definitive study

34
Q

ROME III criteria

A

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

35
Q

PEx usually normal in celiac disease but…

A

Somatic/Psych complains common

36
Q

Dx testing NOT required if sx …..

A

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

37
Q

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

A

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

38
Q

IBS

Colonoscopy for

A

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

39
Q

IBS Therapeutic procedures

A

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

GEMS (20 decks)

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