Uw revision celiac 01-04 (1)

Question 1

D-xylose is a monosaccharide that can be absorbed in proximal small intestine without degradation by pancreatic or brush border enzymes.

Answer 1

.

Question 2

D-xylose is given per os, then goes to blood and urine

Answer 2

.

Question 3

If proximal small intestine disease (eg celiac disease). What D xylose in blood and urine?

what levels in feces?

Answer 3

LOW

High fecal excretion

Question 4

If malabsorbtion due to enzyme deficiences (eg chronic pancreatitis). What D xylose in blood and urine?

what levels in feces?

Answer 4

NORMAL

Minimal fecal excretion

Question 5

what is false-positive D xylose test?

Answer 5

low urinary D xylose level despite normal mucosal absorption

Question 6

false-positive D xylose test in 3 cases?

Answer 6

Delayed gastric emptying
Impaired glomerular filtration
Small intestinal bacterial overgrowth (SIBO) –> bacterial leads to fermentation of D xylose before it can be absorbed. SIBO - treated with rifaximin.

Question 7

Lactase deficiency. CP?

Answer 7

Diarrhea, abdominal pain, flatulence after consuming milk

Question 8

Lactase deficiency. what would be normal?

Answer 8

Fecal fat, D xylose

Question 9

Celiac. CP?

Answer 9

Chronic diarrhea, steatorrhea, weight loss

Question 10

Celiac. what would be ABnormal?

Answer 10

increased fats in stools
low D xylose

Question 11

Crohn disease. Whats about D xylose?

Answer 11

NORMAL - since it is absorbed in proximal small bowel.

in Crohn most affected is terminal ileum

Question 12

Biopsy?

Answer 12

villous atrophy

Question 13

Celiac disease highly correlates with serology: IgA anti-tissue transglutaminase and IgA anti-endomysial antibodies.

Answer 13

.

Question 14

HOWEVER, many patients with biopsy -confirmed celiac disease will have negative results on IgA antibody due to and associated selective IgA deficiency, which is common in celiac disease.

Answer 14

If IgA serology is negative but the suspicion for celiac disease is high, total IgA should be measured (of IgG-based serologic testing should be done)

Question 15

Features of malabsorption in celiac disease table. General symptoms?

Answer 15

Bulky, foul-smelling, floating stools

Question 16

Features of malabsorption in celiac disease table. Fat and proteins symptoms?

Answer 16

Loss of muscle mass, loss of subcutaneous fat, fatigue

Question 17

Features of malabsorption in celiac disease table. iron symptoms?

Answer 17

Pallor (anemia), fatigue

Question 18

Features of malabsorption in celiac disease table. Calcium and Vit. D symptoms?

Answer 18

Bone pain (osteomalacia), fracture (osteoporosis)

Question 19

Features of malabsorption in celiac disease table. vit. K symptom?

Answer 19

easy bruising

Question 20

Features of malabsorption in celiac disease table. Vit A symptom?

Answer 20

hyperkeratosis

Question 21

In lactose - malabsorption of other nutrients are not typical (as in celiac)

Answer 21

.

Question 22

Celiac disease is autoimmune disorder triggered by gluten ingestion.

Answer 22

Gliadin –> inflammation –> atrophy of vili –> malabsorption

Question 23

Celiac disease CP table. GI?

Answer 23

Diarrhea, steatorrhea, weight loss
Abdominal pain
Flatulence/bloating
Late manifestation: ulcerative jejunitis, enteropathy associated with T lymphoma

Question 24

Celiac disease CP table. skin? 2

Answer 24

dermatitis herpetiformis, atrophic glositis

Question 25

Celiac disease CP table. endocrine?2

Answer 25

Vit. D deficiency
Secondary hyperparathyroidism

Question 26

Celiac disease CP table. bone? 2

Answer 26

osteomalacia/osteoporosis (adults)
Rickets (children)

Question 27

Celiac disease CP table. hemo?1

Answer 27

IDA

Question 28

Celiac disease CP table. neuro?

Answer 28

Peripheral neuropathy
depression/anxiety

Question 29

Axonal polyneuropathy/peripheral neuropathy = seen in 50 proc patients.

Answer 29

.