W9 Case Studies - Alcoholism, malabsorption, CD Flashcards
What of the following are alert signs to probe for chronic alcohol ingestion?
a. neurologic symptoms
b. anemia
c. gynecomastia
d. ascites
e. cardiomyopathy
f. abnormal liver function tests
g. a and f
h. all of the above
h. all of the above - neurologic signs combined with fatigue, gynecomastia (enlargement of breast tissue in men), ascites (buildup of fluid in abdomen), enlarged liver, possible gastroesophageal reflux, anemia, cardiomyopathy and abnormal liver function tests all alert the clinician to probe for chronic alcohol ingestion
Hark, p. 310
What is the CAGE test?
a. a diagnostic tool for alcoholism
b. a diagnostic tool for liver function
c. a diagnostic tool for neuropathy
d. a diagnostic tool for assessing iron status
a. a diagnostic tool for alcoholism
CAGE Test:
Have you ever felt you should CUT down on your drinking?
Have people ANNOYED you by criticizing your drinking?
Have you ever felt bad or GUILTY about your drinking?
Have you ever had a drink the first thing in the morning (EYE OPENER) to steady your nerves or to get rid of a hangover?
True or false: Chronic alcoholism is considered the most common cause of malnutrition in the western world.
True - Alcohol provides 7kcal/g, which can be utilized and metabolized when substituted for calories from food, but provides no protein, vitamins, or minerals. Patients with chronic alcohol
consumption consume a disproportionate amount of calories from alcohol. Drinking causes a decrease in appetite that generally is proportional to the amount of ingested calories from alcohol and can significantly affect the nutritional adequacy of a patient’s diet.
Not only does alcohol displace nutrients, but it can impact the absorption of nutrients - High concentrations of alcohol can disrupt the gastric and duodenal mucosa, affect the digestive and absorptive processes, and as a consequence, significantly reduce the absorption of vitamins.
Hark. p. 311
Malabsorption is common in those who have had __________.
A. Gastric bypass surgery
B. Pancreatic surgery
C. Ileal resection
C. Ileal resection
Bile salt loss through the stool increases because these salts are no longer being absorbed. The liver increases bile salt production in an attempt to compensate for the losses, but often fails to adequately accommodate them. As a result, absorption of fat, fat-soluble vitamins (A, D, E, and K), calcium, and magnesium decreases as the bile salt pool becomes depleted.
A serum albumin level of ___________ is an indication of a moderate degree of visceral protein depletion caused by decreased protein absorption.
A. 2.1 to 2.7 g/dL
B. 2.3 to 2.9 g/dL
C. 3.4-5.4 g/dL
A. 2.1 to 2.7 g/dL
What are the most important vitamins to replete in those with chronic alcoholism? Select all that apply:
a. thiamin
b. riboflavin
c. pantothenic acid
d. folate
THIAMIN: One of the most important vitamin supplements routinely given to alcoholics is thiamin, since alcohol interferes with thiamin absorption, even in healthy individuals. Thiamin is important in carbohydrate metabolism. Its predominant form, thiamin pyrophosphate (TPP), functions as a coenzyme for pyruvate dehydrogenase, which converts pyruvate to acetyl CoA. Inadequate thiamin intake forces pyruvate to be converted to lactate, further contributing to the development of lactic acidosis. Thiamin deficiency manifests as anorexia, irritability, fatigue, and decreased memory. Later stages present with peripheral neuropathy, confusion, and tachycardia.
FOLATE: Chronic alcohol consumption has also been associated with folate deficiency; however, the etiol- ogy is unclear. Alcohol may affect folate levels by decreasing dietary intake, impairing absorption and metabolism, increasing urinary excretion of folate, and may also be directly toxic to bone marrow and other cells….Folate deficiency alters red blood cell production, resulting in enlarged, oval erythrocytes, manifested as megaloblastic anemia (elevated MCV = large RBCs, which is characteristic of megaloblastic anemia).
Which of the below are neurologic signs and symptoms associated with prolonged alcohol abuse?
a. Decreased lower extremity reflexes
b. Decreased lower extremity vibratory sensation
c. Paresthesias
Decreased lower extremity reflexes, decreased lower extremity vibratory sensation, and paresthesias are all neurologic signs and symptoms associated with thiamin deficiency due to prolonged alcohol abuse (when alcohol abuse is chronic/prolonged, thiamin deficiency is considered a medical emergency bc if untreated, can progress quickly and cause irreversible damage).
Aside from the basics, what additional lab tests should be checked before giving an alcoholic with megaloblastic anemia folate supplementation? Select all that apply.
a. serum folate
b. RBC folate
c. serum B12
d. homocysteine
a, b, c - Serum and RBC folate and serum vitamin B12 levels should be checked
Serum folate levels are greatly affected by current diet intake; however, RBC folate levels are a better measure of tissue folate status. Although alcoholics are not usually vitamin B12 deficient, it is important to check for vitamin B12 deficiency because if megaloblastic anemia is due to vitamin B12 deficiency, prescribing folate without vitamin B12 will improve the anemia but mask the vitamin B12 deficiency and its progression with the associated neurologic damage. It is important to remember that neurologic impairments due to vitamin B12 deficiency do not respond to folate supplementation alone and are not reversible; however, hematologic abnormalities respond to both folate and to vitamin B12
Hark. p. 313
True or False. Someone experiencing malabsorption from short bowel syndrome should consume three large meals to help increase the net nutrient absorption.
False.
Studies indicate that multiple SMALL meals per day can help increase the net nutrient absorption in short bowel syndrome.
True or false? The most appropriate diagnostic test for celiac disease is Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody.
True.
The sensitivity and specificity of TTG-IgA for the detection of untreated CD are both approximately 95%.
A total serum IgA level should also be obtained due to the association of CD and selective IgA deficiency.
True or false? Upper endoscopy with multiple duodenal biopsies while on a gluten-containing diet is required to confirm a diagnosis of CD.
True.
