module 13 malabsorption

Question 1

malabsorption syndromes

Answer 1

inadequate digestion 
pancreatic insufficiency
lactase deficiency
bile salt deficiency
gluten-sensitive enteropathy

Question 2

pancreatic insufficiency

Answer 2

dec. pancreatic enzyme production
- lipase, amylase, trypsin, or chymotrypsin
- > fat maldigestion, fatty stools and wt loss.

Question 3

causes of pancreatic insufficiency

Answer 3

pancreatitis
pancreatic carcinoma
pancreatic resection
cystic fibrosis

Question 4

lactase dificiency

Answer 4

inability to break down lactose to monosaccharides -> no lactose digestion/monosaccharide absorption
Fermentation of lactose by bacteria -> cramps, flatulence, gas, and osmotic diarrhea

Question 5

bile salt deficiency

Answer 5

dec. conjugated bile salts needed to emulsify and absorb fats
- synthesized from cholesterol in liver
- > poor absorption of lipids -> fatty stools, diarrhea, loss of fat-soluble vitamins (ADEK)

Question 6

bile salt deficiency r/t

Answer 6

liver disease

bile obstructions

Question 7

fat-soluble vitamin deficiencies

Answer 7

must have fat substance to be absorbed

Question 8

vitamin A deficiency

Answer 8

night blindess

Question 9

vit. D deficiency

Answer 9

dec. Ca absorption
bone pain
osteoporosis
fractures

Question 10

Vit K. deficiency

Answer 10

prolonged PT time
purpura
petechiae

Question 11

gluten sensitive enterophaty

Answer 11

celiac disease
gluten: structural protein component in cereal grains: wheat, rye, barley, oat, malr
Loss of villous epithelium in intestinal tract: gluten protein acts as toxin
Dietary, genetic, and immunologic factors

Question 12

celiac and autoimmunity

Answer 12

T-cell mediated injury to small intestine epithelial cells 
Antibodies produced
- antitissue transglutaminase (tTG)
- antiendomysium (EMA) 
- antideamidated gliadin peptides (DGP)

Question 13

celiac s/s

Answer 13

children fail to grow/thrive
malabsorption s/s
- rickets, bleeding, anemia 
Celiac crisis: 
- severe diarrhea
- dehydration 
- malabsorption
- protein loss

Question 14

gluten intolerance primary effects

Answer 14

T-cell, antibody, and complement activator

• > villus injury
• > dec. surface area
• > dec. carb, protein, fat absorption, and inflammatory enteritis
• > osmotic diarrhea
• > secretory diarrhea
• > dec. electrolytes and proteins
• > malnutrition

Question 15

gluten intolerance secondary effects

Answer 15

T-cell, antibody, and complement activator

• > mucosal damage
• > dec. intestinal hormones
• > dec. pancreatic function
• > dec. carb, protein, and fat absorption
• > malnutrition

Question 16

inflammatory bowel diseases

Answer 16

chronic, relapsing disorders of unknown origin 
- genetics
- alteration of epithelial barrier 
- immune reactions to intestinal flora
- abnormal T-cell responses 
Life-altering dx
usually dx in peds-early adulthood

Question 17

crohn’s disease

Answer 17

granulomatous colitis, ileocolitis, or reginal enteritis
idiopathic inflammatory disorder
affects any part of digestive tract
affects all layers of intestinal wall
Skip lesions
Ulcerations can cause longitudinal and transverse fissures: extend into lymphatics
- become blocked
-> engorgement, inflammation and surrounding tissue, ulcers, fibrous scar tissue
fissures -> fistulas

Question 18

crohn’s s/s

Answer 18

result of bowel incapable of absorbing contents

• perianal fissures
• fistulas
• abscesses
• strictures

Question 19

ulcerative colitis

Answer 19

chronic inflammatory disease with ulceration of colonic mucosa
- sigmoid colon and rectum
continuous, no skip lesions
Infectious, immunologic, dietary, genetic components

Question 20

UC s/s

Answer 20

diarrhea (10-20/day)
- dec. ability to absorb H2O and Na
bloody stools
cramps 
rectal bleeding

Question 21

appendicitis

Answer 21

inflammation of the vermiform appendix 
possible causes
- obstruction 
- ischemia
- inc. intraluminal pressure
- infection
- ulceration

Question 22

appendicitis s/s

Answer 22

epigastric and RLQ pain (McBurney)
rebound tenderness
N/V
fever
leukocytosis
< 45, peak 10-19 y/o
male
diarrhea

Question 23

hirshsprung disease

Answer 23

congenital 
distened sigmoid colon
fills up r/t
- aganglionic portion (usually rectosigmoid area): no nerve innervation 
-> always constricted 
male>female

Question 24

hirshsprung s/s

Answer 24

infants
- fecal stagnation -> enterocolitis with bacterial overgrowth 
profuse diarrhea
hypovolemic shock
intestinal perforation

Question 25

Cleft palate

Answer 25

variations in clefts of the lip and palate

• notch in vermilion border (line above lip)
• unilateral cleft lip and palate
• bilateral cleft lip and palate
• cleft palate (not visible without opening mouth)

Question 26

esophageal atresia and tracheoesophageal fistulae

Answer 26

5 types

• simple esophageal atresia: proximal and distal esophagus enid in blind pouches, no tracheal communication (food/water goes nowhere, regurgitated)
• proximal and distal esophagus end in blind pouches, fistula connects proximal esophagus to trachea (food/water enters lungs)
• proximal esophagus with blind pouch, fistula connect trachea to distal esophagus (air enters stomach, regurgitated content -> lungs)
• fistula connects proximal and distal esophageal segments to the trachea (air, food/fluid enter the stomach and lungs)
• simple tracheoesophageal fistula between otherwise nml esophagus and trachea (air, food/fluid enters lungs and stomach)