Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year2 GI Exam II > Malabsorption Syndromes CIS - Darrow > Flashcards

Malabsorption Syndromes CIS - Darrow Flashcards

1
Q

chronic diarrhea

A

4 weeks

watery - pourable - osmotic or secretory

fatty - fat on sudan stain

inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

watery diarrhea

A

pourable

osmotic or secretory

secretory - consider bile acids**

osmotic - carbohydrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

sudan stain

A

for fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

fatty diarrhea

A

steatorrhea

malabsorpion
maldigestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

inflammatory diarrhea

A

blood and puss

positive hemoccult and fecal leukocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

niacin deficiencys

A

3 Ds

diarrhea, dermatitis, dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

carcinoid syndrome

A

order urine for 5 hydroxy indol acetic acid

tryptophan shunted to serotonin
-not available for niacin synthesis

so you see the 3 Ds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

osmotic gap >100

A

osmotic watery chronic diarrhea**

from carbs

lactase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

osmotic gap <50

A

interrupts sleep as well**

secretory watery chronic diarrhea**

from bile acids, neuroendocrine tumor, increased motility, villous adenoma, microscopic colitis, infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

malabsorption

A

fatty chronic steatorrhea

celiac, tropical sprue, short bowel, lymph obstruction, tropheryma whipplei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

maldigestion

A

fatty chronic steatorrhea

pancreatic insufficiency
bile acid deficiency
bacterial overgrowth - deconjugation of bile acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

inflammatory chronic diarrhea

A

blood and pus

positive hemoccult and fecal leukocytes

fever

CMV, herpes, c dif, campylovacter, balantidium coli (pigs), colon cancer, lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Case 36yo M crohns watery diarrhea

  • history of bloody diarrhea with steatorrhea
  • cleared with infliximab

sore on right leg

sudan stain negative
hemoccult/leukocytes negative
stool for O and P negative
stool Na 90
stool K 50
stool osmolality 290

treatment?

A

osm gap - 290 - 2(90 + 50)

290-280 = 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

pyodermic gangrenosum

A

with inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

stool osmotic gap calculation

A

290 − 2 x (stool Na + stool K)

The 290 is the value of the stool osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

secretory diarrhea causes

A 
bile acids
increased motility
infection
villous adenoma
neuroendocrine tumors
microscopic colitis
17
Q

less than 100cm of ileal involvement or resection**

A

liver able to keep up with bile acid synthesis

enough bile acid for fat absorption

bile lost to colon produces secretory diarrhea - so it needs to be bound to control diarrhea** - bile acid binding agent

18
Q

greater than 100cm of ileal involvement**

A

not enough micelle formation - steatorrhea

so need low fat diet, vit replacement , medium chain triglycerides**

19
Q

Case 45yo M right kidney stone and gallstone on CT

  • hemoglobinuria, hemosiderinuria, LDH elevation
  • iron deficiency anemia
  • prior DVT of left arm
  • bowel resection 2 months ago bc of blood clot of small intestine

steatorrhea, weight loss, easy bruising, back pain, paresthesias

A

hemoglobinuria - hemolysis intravascular

venous and arterial blood clots - paroxysmal nocturnal hemoglobinuria

stone formation - no bile acids and hemolysis

kidney stones - FA bind calcium - increased oxalate absorption

20
Q

short bowel syndrome

A

malabsorption

21
Q

Case 25yo F recurrent loose stool when stressed, no pain while sleeping

sudan 3 negative

A

tx - irritable bowel syndrome

change in bowel flora

3lbs in gut

increased fecal serine potease activity

22
Q

36yo F weakness and fatigue and pruritic rash, occasional diarrhea

skin biopsy - granular deposits if IgA

A

rash - dermatitis herpetiformis
-IgA deposits in the rash

IgA in bowel - celiac**

23
Q

IgA diseases

A

deficiency - bronchitis, diarrhea, transfusion rxn

GI disease - celiac

renal disease - IgA nephropathy or henoch schonlein

24
Q

Case 46yo F, depression, fatigue, weight loss, miscarriages, hypothyroid, IBS takes Ca with Vit D, iron deficiency, sudan 3 positive

what lab test to order?

A

sudan 3 - steatorrhea

celiac**

so test to order - IgA tTG**

25
Q

IgA tTG

A

test for celiac

26
Q

fat steatorrhea

A

malabsorption - celiac disease

27
Q

celiac disease

A

malabsorption steatorrhea

can have dermatitis herpetiformis

28
Q
  • elevated liver and pancreatic enzymes
  • miscarriages
  • iron deficiency
  • DM I
  • addisons
  • osteopenia
  • steatorrhea
  • weight loss
  • villous atrophy of mucosa
A

celiac disease

osteoporosis and malignancy (B cell lymphomas) are complications

29
Q

genetics of celiac

A

HLA-DQ2 and DQ8

MHC class II molecules

Ag presentation to CD4 cells

production if IgA against EMA and tTG**

30
Q

celiac disease

A

gluten free diet that get worse all of a sudden

-think B cell lymphoma

31
Q

Case 66yo M diabetic

  • nonerosive atrophic gastritis
  • bloating and chronic watery diarrhea
  • weight loss
  • anemia macrocytosis

stool osmolality 350
stool Na 30
stool K 75
stool pH 3.5

sudan positive

A

pernicious anemia

stool osm gap
350 - 2(30 + 75) = 140

osmotic diarrhea**
-carbohydrates

low stool pH -

32
Q

low stool pH

A

osmotic diarrhe

-carb breakdown by colonic bacteria - releases free fatty acids that are organic anions

33
Q

bacterial overgrowth

A

watery diarrhea** - due to osmotic load of unabsorbed carbohydrates
-proteases from bugs destroy brush border diasaccharidases

lower pH of stool less than 5 because of release of free-fatty acids with carb breakdown

bacteria consume B12 and nutrients - deconjugate bile acids**

results in malabsorption of fat with steatorrhea - lack of micelle formation
-results in secretory diarrhea**

34
Q

to prove bacterial overgrowth

A

d-C14 xylose breath test
gut anaerobes metabolize oral d-xylose to CO2 measured in expired air at 30 minutes with small intestine bacterial overgrowth

also - hydrogen breath test

  • give lactose and measure breath hydrogen
  • 90 minutes - will have >20ppm hydrogen - earlier peak indicates bacterial overgrowth
35
Q

Case 45yo M asthenic, HIV positive, fever, arthralgia, diarrhea, weight loss, blurred vision, lethargy, back pain, jerking paresthesias

murmurs, pedal edema

PAS positive positive macrophages

A

rules of 3s - fever of undetermined origin

PAS positive macrophages - whipple disease - tropheryma whippeli from MAC

36
Q

tropheryma whippelii

A

multiple organ involvement

37
Q

Case 30yo F watery diarrhea 6 weeks duration, weight loss

stool osmolar gap 200

fasted didnt help

A

not osmotic - bc fasting didnt help

but stool osm gap suggests secretory

taking laxative - Mg

Year2 GI Exam II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions