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GI > Malabsorption Syndromes > Flashcards

Malabsorption Syndromes Flashcards

1
Q

What are the two genotypes associated with celiac disease?

A

HLA-DQw2 & HLA-DQ8

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2
Q

What is an extra-intestinal manifestation of celiac disease?

A
  • dermatitis herpetiformis
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3
Q

What is the definition of malabsorption?

A

A condition in which the normal digestion, absorption, or transport of various nutrients and minerals are interrupted, resulting in malnutrition, diarrhea, steatorrhea, and weight loss.

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4
Q

Define assimilation.

A

The process by which ingested food reach body fluid/cells.

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5
Q

Define Malnutrition

A

imbalance between supply of nutrients/energy and the body’s requirements

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6
Q

Define Maldigestion

A

impaired nutrient hydrolysis

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7
Q

What are the three main phases of nutrient absorption

A
  1. Luminal phase
  2. Mucosal phase
  3. Transport phase
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8
Q

What makes intrinsic factor?

A

Gastric parietal cells

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9
Q

Why is intrinsic factor important?

A

Important for B12 Absorption

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10
Q

What happens in the luminal phase?

A

Nutrients are hydrolyzed/solubilized in preparation for absorption

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11
Q

What are 3 abnormalities of the luminal phase?

A
  1. Reduced nutrient availability
  2. Impaired fat solubilization
  3. Defective nutrient hydrolysis
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12
Q

What is necessary for fat solubilization?

A

bile salts (form the micelles)

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13
Q

What are the presenting symptoms of impaired fat solubilization?

A

Steatorrea and Vit A,D,E,K deficiency

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14
Q

What happens in the mucosal phase of absorption?

A

Terminal hydrolysis of carbs & peptides

Fats are processed and packaged for export

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15
Q

What are 2 abnormalities of the mucosal phase?

A
  1. Diffuse mucosal disease or losss

2. Enterocyte defects

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16
Q

What do brush border membrane hydrolases do?

A

Break down carbs (oligosaccharides to monosaccharides

17
Q

What happens with brush border hydrolase deficiency?

A

Carbs cannot be absorbed in the small intestine.
Carbs get metabolized by bacteria in the large intestine
—> results in gaseous distention & diarrhea

18
Q

Name some brush border enzymes

A 
Lactase
Peptidase
Glycoamylase
Maltase
Sucrase
Nucleotidase
Enterokinase
Phosphatase
19
Q

What is the most common brush border membrane hydrolysis deficiency?
What are the effects of this deficiency?

A

Lactase

Results in milk intolerance (diarrhea, …)

20
Q

What tests would be used to assess malabsorption?

A
  • CBC, ESR, INR
  • Fe, folate, & B12 levels
  • albumin, prealbumin, transferrin
  • Ca, PO4, Mg
  • Fat malabsorption: fecal fat excretion, Sudan III stain, 14C-Triolein breath test
21
Q

What is the Sudan III stain?

What is its purpose?

A

A quantitative examination of the stool for undigested muscle fibers, neutral and split fats.
It screens for steatorrhea

22
Q

What is the 14C-Triolein breath test?

A

A test that measures radiolabelled 14C in CO2 that gets exhaled. This CO2 was produced from hydrolysis of the tryglyceride, Triolein.

23
Q

What main symptom will a pt with carbohydrate malabsorption present with? Describe the mechanism for this.

A

Watery diarrhea
Carbs are not absorbed in small intestine, carbs reach large intestine and are metabolized by gut bacteria into short-chain fatty acids –> increase in osmotic load.

24
Q

Name two tests for carbohydrate malabsorption.

A

D-Xylose test

Lactose/Hydrogen breath test

25
Q

How is exhaled Hydrogen produced?

A

Only by bacterial metabolism of carbs.

26
Q

What is the D-xylose test?

A

A test that measures maximal intestinal absorption area.
Xylose is absorbed in duodenum and jejunum.
Test measures blood [D-xylose] 2 hrs after ingestion.

27
Q

What is an ERCP test?

A

Endoscopic Retrograde Cholangiopancreatogram

  • looks at pancreatic duct for obstruction (stone, tumuor, mass, pancreatitis)
  • will also assess biliary tree for presence of strictures or psuedocyst
28
Q

What does a biopsy (histology) of Celiac disease look like?

A

Loss of villi on top of intestinal epithelium - lumenal side appears flat

29
Q

What is terminal ileitis?

A

Inflammation of the terminal colon

30
Q

If a patient is found to have terminal ileitis, what is the most likely diagnosis?

A

Crohn’s disease

GI (13 decks)

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