Small Bowel Disease

Question 1

Define Celiac Disease

Answer 1

An immune disorder that is triggered by an environmental agent (gliadin) in genetically predispose individuals

Question 2

Gluten consists of what 2 proteins

Answer 2

Gliadin

Glutenin

Question 3

What serologic studies are used to follow the course of celiac disease (CD)

Answer 3

IgA antibodies to gliadin

IgA antibodies to endomysium

Question 4

How does gluten affect the mucosa of the small bowel?

Answer 4

Gluten triggers a protein zonulin which controls gut permeability
Intestinal lining are pried apart by zonulin
Undigested food enters bloodstream
Immune system cells react releasing cytokines

Question 5

Classic Clinical Manifestations of Celiac Disease

Answer 5

Diarrhea with bulking, foul smelling, floating stools due to steatorrhea
Weight loss
Vitamin deficiencies: B, A, D, E vitamins, iron, copper, zinc, & magnesium
Villous atrophy

Question 6

Atypical Clinical Manifestations of Celiac Disease

Answer 6

Minor GI symptoms
Can have anemia, osteoporosis, arthritis
Increased LFTs, neurological symptoms, or infertility
Severe mucosal damage & possess the CD antibody pattern

Question 7

Silent Celiac Disease

Answer 7

Recognized incidentally
Some changes in mucosa
Do NOT show clinical symptoms
Fatigue

Question 8

Which malignancies do patients with CD have a slight increase risk of?

Answer 8

Non-Hodgkin's lymphoma
Hodgkin lymphoma
Small intestinal adenocarcinoma
Hepatocellular CA
GI CA
Lymphoproliferative disease

Question 9

Which malignancy do patients with CD have a decreased risk of?

Answer 9

Breast CA

Question 10

Associated Conditions with Celiac Disease

Answer 10

Dermatitia herpetiformis
Type 1 DM
Down syndrome
Liver disease
Autoimmune thyroid disease
GERD
IBD
Menstrual & reproductive issues
Infertility in men

Question 11

Dermatitis Herpitiformis

Answer 11

Not itchy
Slightly raised
Steroids used
Recur due to being autoimmune

Question 12

What is the single preferred tests for detection of CD?

Answer 12

IgA anti-tissue transglutaminase (TTG)

Question 13

What is the IgA anti-tissue transglutaminase (TTG)?

Answer 13

Auto-antibodies against the bodies own tranglutiminases

Question 14

If IgA serology is negative and a high probability of disease what else should you test?

Answer 14

Total IgA

IgG-deaminated gliadin peptides (DGP)

Question 15

What should patients with positive serology undergo?

Answer 15

Small bowel biopsy

Question 16

If a patient on a gluten free diet has a negative serology test, what should they have tested?

Answer 16

HLA/DQ1/DQ8 testing (genetic testing)

Question 17

What is the MOST specific serology to test for CD?

Answer 17

IgA anti-tissue transglutaminase

Question 18

Define Gluten Sensitivity

Answer 18

Having diarrhea, feel ill and bloated when they eat gluten

Question 19

Treatment- 6 Key Elements

Answer 19

Consultation with a skilled dietitian
Education about the disease
Lifelong adherence to a gluten free diet
Identification & treatment of nutritional deficiencies
Access to an advocacy group
Continuous ongoing follow-up by a multidisciplinary team

Question 20

General Rules for Gluten Free

Answer 20

Avoid wheat, rye, & barley
Soybean/tapioca flours, rice, corn, buckwheat, & potatoes are safe
Read labels
Distilled alcohol, vinegar, & wine OK
Avoid beers, ales, lagers, & malt vinegars
Dairy may not be well tolerated
Oats should be introduced with caution

Question 21

Symptoms of Lactose Intolerance

Answer 21

Diarrhea
Abdominal pain
Flatulence

Question 22

Etiology of Lactose Malabsorption

Answer 22

Genetically regulated reduction in lactase activity
Maintained elevated lactase levels as adults
Lactase activity normal until age 5

Question 23

Developmental Lactase Deficiency

Answer 23

Results from low lactase levels as result of prematurity

Need soy milk or pre-digested formulas

Question 24

Congenital Lactase Deficiency

Answer 24

Rare autosomal recessive disorder

Absence of lactase activity in the sm. intestine

Question 25

Secondary Lactase Malabsorption

Answer 25

Bacterial overgrowth or stasis associated with increased fermentation of lactose
Seen with any mucosal injury to the small bowel

Question 26

CLinical Manifestations of Lactose Intolerance

Answer 26

Abdominal pain- crampy
Bloating
Flatulence
Diarrhea
Vomiting

Question 27

Diagnosis of Lactose Intolerance (rarely used)

Answer 27

Lactose tolerance test

Lactose breath hydrogen test

Question 28

Treatment of Lactose Intolerance

Answer 28

Dietary restriction of lactose intake
Substitution of alternative sources to maintain energy & protein intake
Lactaid
Maintenance of calcium & vitamin D

Question 29

Define Ileus

Answer 29

Temporary absence of the normal contractile movements to the intestinal wall

Question 30

Etiologies of Ileus

Answer 30

Postoperative
Drugs: opiods & anticholinergics
Hypothyroidism
Electrolyte disorders: hypokalemia, hypercalcemia
Intestinal peritonitis
Kidney failure
Pancreatitis

Question 31

Clinical Manifestations of Ileus

Answer 31

Bloating
N/V
Crampy abdominal pain
Severe constipation
Loss of appetite

Question 32

Differential Diagnoses of Ileus

Answer 32

Adynamic (Paralytic) Ileus
Intestinal obstruction
Acute abdomen
Post-op adhesive disease

Question 33

Diagnostics of Ileus

Answer 33

X-rays
Lytes
CBC
CMP
Magnesium

Question 34

Treatment of Ileus

Answer 34

NPO
NG tube
Don't give opioids
Get them moving
Surgery
IV fluids