Malabsorption syndromes- Pales Flashcards

Question

Lactase deficiency (Lactose intolerance) testing

Answer 1

Hydrogen breath test - after ingestion of 50 g of lactose, a rise in breath hydrogen of more than 20 ppm within 90 minutes is a positive test Empiric trial of a lactose-free diet for 2 weeks. - Resolution of symptoms is suggestive of lactase

Answer 2

Serologic tests - IgA tissue transglutaminase (IgA tTG) antibody 95% sensitivity and 95% specificity - Antigliadin antibodies have low specificiity and sensitivity and not recommended - IgA antiendomysial antibodies are no longer recommended due to the lack of standardization among laboratories. - Endoscopic mucosal biopsy of duodenum (gold standard)

Answer 3

Endoscopic mucosal biopsy of duodenum – golden standard for diagnosis Usually shows - intraepithelial lymphocytosis - extensive infiltration of the lamina propria with lymphocytes and plasma cells - hypertrophy of the intestinal crypts - blunting or complete loss of intestinal villi Partial or complete reversion of these abnormalities occurs within 3–24 months after the start of gluten-free diet

Answer 4

Dermatitis Herpetiformis

Answer 5

Tropical sprue

Answer 6

associated with the overgrowth of predominantly coliform bacteria In residents or travelers to the tropics Diarrhea is associated with megaloblastic anemia secondary to vitamin B 12 and folate deficiency Treatment is a prolonged course of tetracyclines, folic acid, and vitamin B 12 injections (1000 µg weekly)

Answer 7

Whipple’s Disease

Answer 8

Caused by Tropheryma whipplei. Symptoms include arthralgias, diarrhea, abdominal pain, weight loss, intermittent low-grade fever, generalized lymphadenopathy. Myocardial or valvular involvement may lead to heart failure or valvular regurgitation. Central nervous system involvement may cause dementia, lethargy, coma, seizures, myoclonus or cranial nerve palsy.

Answer 9

Functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of a specific and unique organic pathology Prevalence -- 10-20% ``` some thoughts: Increased fecal serine protease activity, probably from an altered fecal flora!” You have 23,000 genes, but your microbiome has 8,000,000 genes. Increased bowel permeability - LPS. Associated with flu like symptoms, e.g.. fatigue, myalgia, arthralgia, fogginess. ```

Answer 10

Hydrogen or methane breath test (LBT) – will rise before 90 minutes when given lactulose (normal rise at 120 – 180 minutes). Indicates SIBO partially from decreased phase III intestinal housekeeper wave.

Answer 11

Obesity – altered fat absorption and storage –fecal transplant – the new bacteria produce more LPL = fat storage. high fat diet – different microbiome increases LPS absorption – endotoxemia, inflammation, metabolic disorder (metabolic syndrome) Red meat – carnitine – altered microbiome produces trimethylamine N-oxide (TMAO) – atherosclerosis Anxiety Medication malabsorption Aging – bacterial overgrowth

Answer 12

Bacterial antigen --> visceral hypersensitivity. Hypersensitivity in IBS similar to hypersensitivity of chronic fatigue syndrome and interstitial cystitis. Bacterial translocation immune activation (CD25), -->increased sympathetic activity, anxiety.

Answer 13

Diarrhea, constipation, or both Abdominal pain and distention, usually diffuse, worse after meals, better after defecation, dull or sharp Postprandial urgency Clear or white mucorrhea of a noninflammatory etiology Dyspepsia, heartburn Nausea, vomiting Sexual dysfunction (including dyspareunia and poor libido) Urinary frequency and urgency Worsening of symptoms in the perimenstrual period Comorbid fibromyalgia Stressor-related symptoms

Answer 14

``` Onset in middle age or older Acute, rather than chronic, symptoms Progressive symptoms Nocturnal symptoms Anorexia or weight loss Fever Rectal bleeding Painless diarrhea Steatorrhea Gluten intolerance ```

Answer 15

Recurrent abdominal pain or discomfort at least 3 days per month during the previous 3 months associated with 2 or more of the following: - Relieved by defecation - Onset associated with a change in stool frequency - Onset associated with a change in stool form or appearance - Altered stool passage (straining and/or urgency) - Mucorrhea - Abdominal bloating or subjective distention Four bowel patterns - IBS-D (diarrhea predominant) - IBS-C (constipation predominant) - IBS-M (mixed diarrhea and constipation) - IBS-U (unclassified; the symptoms cannot be categorized into one of the above three subtypes)

Answer 16

Psychological support - cognitive-behavioral therapy, dynamic psychotherapy, and hypnotherapy Dietary measures - Fiber supplementation may improve the symptoms of constipation and diarrhea - Judicious water intake is recommended in patients who predominantly experience constipation - Caffeine avoidance may limit anxiety and symptom exacerbation - Legume avoidance may decrease abdominal bloating - Lactose, fructose, and/or FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) should be limited or avoided in patients with these contributing disorders - Probiotics Pharmacologic agents: Anticholinergics (e.g., dicyclomine, hyoscyamine) Antidiarrheals (e.g., diphenoxylate, loperamide) Tricyclic antidepressants (e.g., imipramine, amitriptyline) Prokinetics Bulk-forming laxatives Serotonin receptor antagonists (e.g., alosetron) Chloride channel activators (e.g., lubiprostone) Guanylate cyclase C (GC-C) agonists (e.g., linaclotide) Antispasmodics (e.g., peppermint oil, pinaverium, trimebutine, cimetropium/dicyclomine) [4] Potentially, rifaxamin (this is still investigational and not FDA approved)

Answer 17

test for carcinoid tumor

Answer 18

After surgeries - distal esophagectomy - - Nissan wrap - Gastrojejunostomy - Roux-en-Y gastric bypass - Duodenal switch gastric bypass Delivery of concentrated sugars and food into the duodenum and jejunum Results in - altered insulin regulation - Maldigestion - osmotic movement of fluid into the intestinal lumen - rapid transit insufficient for absorption of nutrients.

Answer 19

Early dumping: abdmonial cramping and diarrhea (fatigue, sweating, rapid heart rate, decreased blood pressure, flushing, dizziness, shortness of breath) Late dumping (shakiness, cold sweats, fatigue, decreased blood pressure, headache)

Answer 20

Less than 100 cm of ileal involvement or resection – liver able to keep up with bile acid synthesis, so enough bile acid for fat absorption. But, the bile lost to the colon produces a secretory diarrhea, so it needs to be bound to control the diarrhea. * Treated with Bile Acids Binders Greater than 100 cm of ileal involvement – not enough micelle formation (steatorrhea), so treated with * low fat diet, vitamin replacement, and medium-chained triglycerides.