PATH - Malabsorption syndromes

Question 1

Malabsorption syndromes

Answer 1

Can cause diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral deficiencies.

Screen for fecal fat (eg, *Sudan stain).

Question 2

Celiac disease

Answer 2

Gluten-sensitive enteropathy, *celiac sprue

Autoimmune-mediated intolerance of *gliadin (gluten protein found in wheat)

SX: malabsorption and steatorrhea

DEC mucosal absorption primarily affects *distal
duodenum and/or *proximal jejunum.

Associated with *HLA-DQ2, *HLA-DQ8, *dermatitis herpetiformis, DEC bone density

• IgA anti-tissue transglutaminase
• anti-endomysial
• anti-deamidated gliadin peptide antibodies

villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis

Moderately INCvrisk of malignancy (eg, T-cell lymphoma

Question 3

Lactose intolerance

Answer 3

*Lactase deficiency

Osmotic diarrhea with DEC stool pH (colonic bacteria ferment lactose).

Lactose hydrogen breath test: ⊕ for lactose
malabsorption

Question 4

Pancreatic insufficiency

Answer 4

Due to chronic pancreatitis, cystic fibrosis, obstructing cancer.

Causes malabsorption of
fat and fat-soluble vitamins (A, D, E, K) as well as vitamin B12.

DEC duodenal pH (bicarbonate) and fecal elastase

Question 5

Tropical sprue

Answer 5

Similar findings as celiac sprue (affects *small
bowel), but responds to antibiotics

seen in residents of or recent visitors to tropics

DEC mucosal absorption affecting *duodenum and
*jejunum but can involve *ileum with time.

Associated with megaloblastic anemia due to
folate deficiency and, later, B12 deficiency.

Question 6

Whipple disease

Answer 6

Infection with Tropheryma whipplei (intracellular gram ⊕)

PAS ⊕ foamy macrophages in intestinal lamina propria, mesenteric node

Cardiac sx, Arthralgias, and Neurologic symptoms are common.

“Foamy Whipped cream in a CAN”

Most often occurs in older men