Small Bowel Disease Flashcards
Define Celiac Disease
An immune disorder that is triggered by an environmental agent (gliadin) in genetically predispose individuals
Gluten consists of what 2 proteins
Gliadin
Glutenin
What serologic studies are used to follow the course of celiac disease (CD)
IgA antibodies to gliadin
IgA antibodies to endomysium
How does gluten affect the mucosa of the small bowel?
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
Classic Clinical Manifestations of Celiac Disease
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
Atypical Clinical Manifestations of Celiac Disease
Minor GI symptoms
Can have anemia, osteoporosis, arthritis
Increased LFTs, neurological symptoms, or infertility
Severe mucosal damage & possess the CD antibody pattern
Silent Celiac Disease
Recognized incidentally
Some changes in mucosa
Do NOT show clinical symptoms
Fatigue
Which malignancies do patients with CD have a slight increase risk of?
Non-Hodgkin's lymphoma Hodgkin lymphoma Small intestinal adenocarcinoma Hepatocellular CA GI CA Lymphoproliferative disease
Which malignancy do patients with CD have a decreased risk of?
Breast CA
Associated Conditions with Celiac Disease
Dermatitia herpetiformis Type 1 DM Down syndrome Liver disease Autoimmune thyroid disease GERD IBD Menstrual & reproductive issues Infertility in men
Dermatitis Herpitiformis
Not itchy
Slightly raised
Steroids used
Recur due to being autoimmune
What is the single preferred tests for detection of CD?
IgA anti-tissue transglutaminase (TTG)
What is the IgA anti-tissue transglutaminase (TTG)?
Auto-antibodies against the bodies own tranglutiminases
If IgA serology is negative and a high probability of disease what else should you test?
Total IgA
IgG-deaminated gliadin peptides (DGP)
What should patients with positive serology undergo?
Small bowel biopsy
If a patient on a gluten free diet has a negative serology test, what should they have tested?
HLA/DQ1/DQ8 testing (genetic testing)
What is the MOST specific serology to test for CD?
IgA anti-tissue transglutaminase
Define Gluten Sensitivity
Having diarrhea, feel ill and bloated when they eat gluten
Treatment- 6 Key Elements
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
General Rules for Gluten Free
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
Symptoms of Lactose Intolerance
Diarrhea
Abdominal pain
Flatulence
Etiology of Lactose Malabsorption
Genetically regulated reduction in lactase activity
Maintained elevated lactase levels as adults
Lactase activity normal until age 5
Developmental Lactase Deficiency
Results from low lactase levels as result of prematurity
Need soy milk or pre-digested formulas
Congenital Lactase Deficiency
Rare autosomal recessive disorder
Absence of lactase activity in the sm. intestine
Secondary Lactase Malabsorption
Bacterial overgrowth or stasis associated with increased fermentation of lactose
Seen with any mucosal injury to the small bowel
CLinical Manifestations of Lactose Intolerance
Abdominal pain- crampy Bloating Flatulence Diarrhea Vomiting
Diagnosis of Lactose Intolerance (rarely used)
Lactose tolerance test
Lactose breath hydrogen test
Treatment of Lactose Intolerance
Dietary restriction of lactose intake
Substitution of alternative sources to maintain energy & protein intake
Lactaid
Maintenance of calcium & vitamin D
Define Ileus
Temporary absence of the normal contractile movements to the intestinal wall
Etiologies of Ileus
Postoperative Drugs: opiods & anticholinergics Hypothyroidism Electrolyte disorders: hypokalemia, hypercalcemia Intestinal peritonitis Kidney failure Pancreatitis
Clinical Manifestations of Ileus
Bloating N/V Crampy abdominal pain Severe constipation Loss of appetite
Differential Diagnoses of Ileus
Adynamic (Paralytic) Ileus
Intestinal obstruction
Acute abdomen
Post-op adhesive disease
Diagnostics of Ileus
X-rays Lytes CBC CMP Magnesium
Treatment of Ileus
NPO NG tube Don't give opioids Get them moving Surgery IV fluids
