Small Bowel Dz Flashcards
Celiac Dz:
- what is this?
- MC in who?
- what is gluten comprised of?
- serologic studies
WHat;
-immune disorder that is triggered by an environmental agent (gliadin component of gluten) in genetically predisposed individuals
MC in whites of northern european ancestry
Gluten comprised of Gliadin* and glutenin.
Serologic Studies:
- IgA abys to gliadin
- IgA abys to endomysium; structure of smooth CT muscle, presence is nearly pathognominic for CD.
celiac dz:
- classic clinical manifestations
- atypical dz manifestations
Classic sx:
- diarrhea w/ bulking. foul-smelling, floating stools d/t steatorrhea
- weight loss
- vitamin deficiencies - A,B,D,E iron, copper, zinc, mangesium
- on small bowel bx = villious atrophy
Atypical Sx:
- minor GI sx
- anemia, osteoporosis. arthritis
- increased LFT, neuro sx, or infertility
- most show severe mucosal damage and possess the CD aby pattern
- “silent CD”; recognized incidentally based upon screening for abys, DO NOT show clinical sx but may c/o fatigue.
CD:
- is there risk for malignancies?
- associated conditions
slight increase of malignancies found in pts with CD
- -non-hodgkins lymphoma
- -small intestinal adenocarcinoma
- -hepatocellular carcinoma
- -GI caner
- -Hodgkins lymphoma
***DECREASED risk of breast cancer.
Associated conditions:
- Dermatitia herpetiformis (flat, crusty, red rash, not typically itchy?)
- DM1
- Liver dz
- GERD
- IBD
- infertility in men
- menstrual and reproductive issues in women
CD;
-Dx
Dx:
- begin with IgA anti-tissue transglutaminase (TTG)**; auto-abys against bodies own transglutiminases
- single preferred test for detection of CD
-patients with positive serology should undergo a small bowel bx; 1-2bx from duodenal bulb and at least 4 from 2nd and 3rd section of duodenum
Gluten sensitivity:
- what is this?
- sx
What; when people are sensitive to gluten without having CD. Allergy type rxn, IgE mediated.
Sx: get diarrhea and feel “ill” and bloated and find if they eliminate gluten from their diet they feel better.
Celiac Dz
-tx
Tx:
- education about dz
- lifelong adherence to gluten free diet
- tx of nutritional deficiencies
- access to advocacy group
Foods to avoid:
- wheat, rye, barley
- beers, ales, lagesr, malt vinegars
Safe food:
- soybean, tapioca flour, rice, corn, buckwheat, and potatoes
- distilled alcohol, vinegar, and wine
- dairy products may not be well tolerated initially since many pts w/ CD also have lactose intolerance.
- oats introduced into diet with caution.
Lactose Intolerance:
- MC in who?
- sx
- etiology of lactose malabsorption & deficiency
MC in Native americans
sx: diarrhea, abd pain, flatulence
Etiology:
Malabsorption
-genetically regulated reduction in lactase activity determined by ethnic factors
-*in US lactase activity is normal in all healthy children until age 5yo
-bacterial overgrowth or stasis may be associated w/ increased fermentation of dietary lactose in small bowel
-gastroenteritis (temporarily wipes out gut mucosa and lactase)
Deficiency :
- low lactase levels result from prematurity
- infants born 28-32wks gestation have reduced lactase activity
- congential; autosomal recessive disorder
Lactose Intolerance:
- clinical manifestations
- dx
Manifestations:
- abd pain; crampy, usually periumbilical and lower quadrants
- bloating
- flatulence
- diarrhea
- vomiting
Dx:
- Dx:
- Lactose tolerance test:
- -50g test dose in adults
- -blood glucose drawn at 0,60, and 120mins
- an increase in blood glucose by less than 20mg/dL plus sx is diagnostic*****
Lactose breath hydrogen test:
- oral lactose given in fasting state
- breath hydrogen levels measured at baseline and 30min intervals for 3 hrs after lactose ingestion
- values over 20pp, diagnostic***
Lactose Intolerance:
-tx
dietary restriction of lactose intake
substitution of alternative sources to maintain energy and protein intake
administration of enzyme substrate; lactaid*
maintenance of calcium and Vit D intake
Ilius
- Definition
- etiologies
- clinical manifestations
- dx
- tx
Definition
-temporary absence of the normal contractile movements to the intestinal wall
Etiologies
- postop (esp abd when intestines have been manipulated)
- drug (opiods and antichol)
- hypothyroidism
- electrolyte disturbances
- intestinal peritonitis
- kidney failure
- pancreatitis
Clinical manifestations
- bloating, n/v
- crampy abd pain…pain preceeds vomiting when associated with acute surgical etiology
- severe constipation
- loss of appetite
Dx
- Xray
- Lytes
- CBC
- CMP including Mag
Tx
- NPO advancing to clear liquids as tolerates
- IV fluids to maintain hydration and correct electrolyte abnormalities
- stop drugs that make the ilius worse
- occasionally NG tube to suck out stomach contents
- try to get the up and walking
- if obstruction, fix it