Small Bowel Dz Flashcards

1
Q

Celiac Dz:

  • what is this?
  • MC in who?
  • what is gluten comprised of?
  • serologic studies
A

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.
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2
Q

celiac dz:

  • classic clinical manifestations
  • atypical dz manifestations
A

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.
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3
Q

CD:

  • is there risk for malignancies?
  • associated conditions
A

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
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4
Q

CD;

-Dx

A

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

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5
Q

Gluten sensitivity:

  • what is this?
  • sx
A

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.

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6
Q

Celiac Dz

-tx

A

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.
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7
Q

Lactose Intolerance:

  • MC in who?
  • sx
  • etiology of lactose malabsorption & deficiency
A

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
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8
Q

Lactose Intolerance:

  • clinical manifestations
  • dx
A

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***
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9
Q

Lactose Intolerance:

-tx

A

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

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10
Q

Ilius

  • Definition
  • etiologies
  • clinical manifestations
  • dx
  • tx
A

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
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