B5-072 CBCL: Malabsorption Flashcards
(144 cards)
1
Q
associated with enterotoxin traveler’s diarrhea
A
secretory diarrhea
2
Q
not affected by prolonged fasting
A
secretory diarrhea
3
Q
ceases during prolonged fast
A
osmotic diarrhea
4
Q
what kind of diarrhea does lactase deficiency cause?
A
osmotic
5
Q
primary functions of bile acids
A
- promote bile flow
- breakdown cholesterol/phospholipids in gallbladder via mixed micelles
- enhance dietary lipid digestion and absorption in proximal intestine via mixed micelles
6
Q
decreased bile acid synthesis due to decreased hepatic functions
A
cirrhosis
7
Q
decreased biliary secretion due to defective canalicular excretion of organic anions
A
primary billiary cirrhosis
8
Q
failure of maintenance of conjugated bile acids due to bacterial overgrowth
A
jejunal diverticulosis
9
Q
decrease in the reabsorption of bile acids due to decreased delivery to the large intestine
A
Crohn’s or surgical resection
results in fatty acid diarrhea
10
Q
bile acid diarrhea is due to […] ileal disease
A
limited
11
Q
fatty acid diarhhea is due to […] ileal disease
A
extensive
12
Q
in fatty acid diarrhea, the fecal-bile acid loss is not compensated by hepatic synthesis causing in impaired micelle formation and resulting in
A
steatorrhea
13
Q
does bile acid diarrhea respond to cholestyramine?
A
yes
14
Q
does fatty acid diarrhea respond to cholestyramine?
A
no
can make it worse
15
Q
does bile acid diarrhea respond to a low fat diet?
A
no
16
Q
does fatty acid diarrhea respond to a low fat diet?
A
yes
17
Q
dietary fat is composed exclusively of
A
long chain triglycerides
18
Q
assimilation of dietary lipids requires 3 phases:
A
- intraluminal (digestive)
- mucosal (absorptive)
- delivery (post absorptive)
abnormality of any of these may cause steatorrhea
19
Q
an issue in the digestive phase with lipolysis due to decreased pancreatic lipase
2
can be due to gastrinoma or increased bicarb
A
chronic pancreatitis
cystic fibrosis
20
Q
an issue in the absorptive phase with mucosal uptake and re-esterfication due to impaired movement of mixed micelles
can be due to bacterial overgrowth
A
celiac
21
Q
issue in the post-absorptive phase with chylomicron formation due to impaired synthesis of B-lipoproteins
A
Abetalipoproteinemia
22
Q
issue in the post absorptive phase with lipid delivery from the intestine due to abnormal intestinal lymphatics
A
intestinal lymphangiectasia
23
Q
- present in coconut oil
- often used as nutritional supplement
A
medium chain fatty acids
24
Q
is micelle formation necessary for the digestion of MCTs?
A
no
absorbed directly into cell
25
* synthesized by colon bacterial enzyme from non-absorbed carbohydrates
* rapidly absorbed and stimulat colon NaCl and fluid absorption
short chain fatty acids
26
most antibiotic diarrhea (except C. diff) is caused by a suppression of colonic bacteria resulting in a decrease of
SCFAs
27
lactose requires digestion by
brush border lactase
28
only clinical important disorder of carbohydrate absorption
lactose malabsorption
29
genetically determined decrease or absence of lactase while all other aspects of intestinal absorption and brush border enzymes are normal
primary lactase deficiency
30
caused by diseases that destroy the lining fo the small intestine along with the enzymes
secondary lactase deficiency
31
secondary lactase deficiency is often see in what conditions?
| 4
* celiac
* crohn's
* UC
* chemo/long antibiotics
32
persistence of symptoms in an individual who exhibits lactose intolerance after adhering to a strict lactose free diet indicates
IBS
33
most individuals with primary lactase deficiency do not have
symptoms
34
due to a congenital absence of brush border SGLT1
glucose and galactose malabsorption
35
due to absence of the enzyme that converts trypsin to trypsinogen
enterokinase deficiency
36
associated with diarrhea, growth retardation, and hypoproteinemia
enterokinase deficiency
37
* due to a defect in nonpolar amino acids
* pellagra-like rash, neuropsych symptoms
hartnup's syndrome
38
* due to a defect in dibasic amino acid transport
* renal calculi and chronic pancreatitis
cystinuria
39
symptoms of malabsorption in a patient who has recently undergone bowel resection
short gut syndrome
40
steatorrhea in a patient with longstanding alcohol abuse and chronic pancreatitis
assess pancreatic exocrine function
41
gold standard in establishing a diagnosis for steatorrhea
timed quantitative stool-fat determination
42
qualitative test for steatorrhea
Sudan III staining
| rapid and inexpensive but not as precise
43
what laboratory studies should be ordered in a patient with suspected malabsorption disorder?
CBC
PTT
serum protein
alkaline phosphatase
44
fat soluble vitamins
ADEK
45
evidence of metabolic bone disease with elevated alkaline phosphatase and/or reduced calcium
vitamin D malabsorption
46
elevated PTT in an individual without liver disease that is not taking anti-coags might indicate
vitamin K deficiency
47
macrocytic anemia might indicate
cobalmin or folic acid malabsoprtion
48
iron deficiency anemia in the absence of occult bleeding might indicate
| 2
iron malabsorption
celiac
49
* test performed to determine the cause of cobalamin malabsorption
* establishes pernicious anemia
Schilling
50
* test to assess proximal small-intestinal mucosal function
* reflects duodenal/jejunal mucosal disease
urinary d-Xylose test
51
* autoimmune disorder
* reaction to gluten
* causes malabsorption
celiac
52
* anemia
* osteopenia
* infertility
* neurologic symptoms
| may indicate...
atypical celiac disease
53
* abnormal small-intestinal biopsy with proximal-to-distal severity
* responds to elimination of gluten from diet
celiac
54
absence of HLA-DQ2/8 excludes the diagnosis of
celiac
55
association with gliadin
celiac
56
a 4 week course of [...] can induce remission in celiacs
prednisolone
57
failure to responds to all treatments of celiac may indicate
intestinal T cell lymphoma
autoimmune enteropathy
58
associated diseases with celiac
* dermatitis herpetiformis
* DM1
* IgA deficiency
* Down syndrome
* Turner's syndrome
59
3 situations that may mandate intestinal resection
1. mesenteric vascular disease
2. Crohn's
3. trauma
60
most bile acids are reabosorbed in the
ileum
61
* abdominal pain
* fever
* weight loss
* increased bile acids in large intestine
crohns
62
bacterial overgrowth in the small intestine will results in a fast conversion of [...] bile acids to [...] bile acids
conjugated to
unconjugated
63
* leads to increases in the thickness of the unstirred water layer in the small intestine
* results in impaired movement of mixed micelles aross
bacterial overgrowth syndromes
64
* steatorrhea due to abnormal intestinal lymphatics
* deficiency in delivery of digested fatty acids from the intestine to the lymphatics
intestinal lymphangiectasia
65
* failure to thrive
* photosensitivity
* intermittent ataxia
* nystagmus
* tremor
Hartnup syndrome
66
defect in transport of neutral amino acids
hartnup syndrome
67
* characterized by deficienct transport of tryptophan
* pellagra-like rash
* neuropsych symptoms
hartnup syndrome
68
deficiency in chylomicron formation due to impaired synthesis of B-lipoproteins
abetapoproteinemia
69
defect in transport of dibasic amino acids
cystinuria
70
due to absence of brush border enzyme that converts trypsinogen to trypsin
enterokinase deficiency
71
test performed for pernicious anemia
Schilling
| B12 deficiency
72
* depression
* irritability
* abnormal sensations
* poor muscle function
* glossitis
* decreased taste
symptoms of B12 deficiency
73
performed to diagnose conditions that prevent the small intestine from absorbing nutrients in food
urinary D xylose
74
flat small intestinal mucosal biopsy
celiac
75
will celiac have a positive D-xylose test?
yes
76
things necessary to establish celiac diagnosis
1. **improvement of symptoms on gluten free diet**
2. antibody test
3. biopsy of small intestine
77
secondary to diminished absorption of one or more dietary nutrients
osmotic diarrhea
78
condition when stool fat excretion increases >6% of dietary fat intake
steatorrhea
79
diarrhea due to small or large intestinal fluid and electrolyte secretion
secretory diarrhea
80
what kind of diarrhea would cease during a prolonged fast?
osmotic
81
cobalamin and bile acids are absorbed in the
ileum
82
calcium, iron, and folic acid are absorbed in the
proximal small intestine
| especially duodenum
83
why does steatorrhea not generally occur in short bowel syndrome?
hepatic synthesis of bile acid increases to compensate for the rate for fecal bile acid losses
84
[...] develops if the degree of ileum resected is extensive
fatty acid diarrhea
| hepatic synthesis can no longer maintain bile acid pool
85
steatorrhea with decreased pancreatic lipase secretion
chronic pancreatitis
86
deficiency in delivery of digested fatty acids from the intestine to the lymphatic vesicles
intestinal lymphangiectasia
87
steatorrhea results from impaired synthesis of B-lipoproteins and impaired chylomicron function
abetalipoproteinemia
88
steattorhea occurs due to increased thickness of unstirred water layer in small intestine and impaired movement of micelles
bacterial overgrowth syndromes
89
catalyzes the hydrolysis of starch into sugars
pancreatic amylase
90
SGLT1 transports..
glucose
galactose
91
fructose comes into the cell via facillitated diffusion with what transporter?
GLUT5
92
* bowed legs
* bone pain
* trouble sleeping
* elevated alk phos
| suggests what deficiency
vitamin D
93
macrocytic anemia suggests what deficiency
cobalamin or folic acid
94
elevated PTT suggests what deficiency
vitamin K
95
* weight loss
* diarrhea
* joint pain
* arthritis
* foamy macrophages in lamina propria
whipple's
96
foamy macrophages in lamina propria that are seen on acid-Schiff staining
whipple's
97
* short/absent villi
* mononuclear infiltrate
* epithelial cell damage
* hypertrophy of crypts
celiac
98
responds to pancreatic enzyme treatment
chronic pancreatitis
99
which HLA types are associated with celiac?
HLA-DQ2
HLA-DQ8
100
changes in intestinal anatomy leading to anatomic stasis can cause
bacterial overgrowth syndrome
101
direct communication between the small bowel and large intestine can cause
| due to ileocolonic resection
bacterial overgrowth syndrome
102
impaired peristalsis leading to functional stasis can cause
bacterial overgrowth syndrome
103
most common bacteria in SIBO
bacteroides or E. coli
104
bile acid diarrhea in the absence of ileal inflammation/resection will have an abnormal [...] study
755eHCAT retention
105
bile acid diarrhea in the absence of ileal inflammation/resection will have an reduced ileal release of [...]
FGF19
(negative regulator of bile acid synthesis )
| causes excessive bile acid synthesis
106
diarrhea in patient with abnormal 755eHCAT retention and reduced FGF19 will responsd to
cholestyramine
107
persistent of lacose intolerance symptoms even after elminating lactose from diet may indicate
IBS
108
defect in transport of dibasic amino acids
cystinuria
109
associated with renal calculi and chronic pancreatitis
cystinuria
110
what vitamin deficiencies does celiac often present with?
iron
folate
vitamin D
Ca+
111
what condition is a celiac particularly at risk for?
osteoporosis
112
what is the underlying cause of malabsorption in SIBO?
deconjugation of bile acid, preventing reabsorption in ileum and depleting normal bile acid pool
113
what deficiency can cause neuropathies and sensory ataxia
B12
114
what deficiency can cause night blindness?
vitamin A
115
what deficiency can cause hypocalcemia?
vitamin D
116
what deficiency can cause nerve and muscle damage resulting loss of body movement control, weakness, vision problems, and weakened immune system?
vitamin E
117
what deficiency can cause anemia?
iron, B12
118
what deficiency can cause beriberi?
B1
119
what deficiency can cause pellagra?
B3
120
patients with celiac may be deficient in [...] because they are often found in wheat products
B vitamins
121
dietary fat is usually composed of
long chain triglycerides
122
synthesized by colonic enzymes from unabsorbed carbohydrates
short chain triglycerides
123
digestion of long chain triglycerides requires
pancreatic lipolysis and micelle formation
124
medium/short chain triglycerides do not require
lipolysis
125
steatorrhea is defined as a condition when stool fat excretion increases to what percentage?
>7%
126
what kind of diarrhea will not respond to a prolonged fast?
secretory
127
gram positive actinobacteria
T. whipplei
128
both anatomical and functional stasis can contribute to
bacterial overgrowth syndromes
129
initial treatment of short-bowel syndrome includes
* establishing effective diet
* judicious use of opiates to reduce stool output
130
removal of the ileocecal valve causes severed diarrhea due to
| 3
* increased bile acids
* decreased transit time
* bacterial overgrowth from colon
131
test used to determine intestinal lesions, as well as cellular and histological abnormalities
biopsy of small intestine mucosa
132
test for pernicious anemia
detects cobalamin malabsorption
schilling test
133
test for carbohydrate absorption
D-xylose test
134
what deficiency can cause night blindness, dry kin, dry eyes, frequenct infections?
vitamin A
135
what deficiency can cause macrocytic anemia?
cobalamin
136
what deficiency can cause elevated alk phos and reduced calcium levels?
vitamin D
137
absence of SGLT1 causes malabsorption of
glucose
galactose
138
fructose is absorbed by
GLUT5
139
most individuals with lacotse deficiency do not have
symptoms
140
chronic pancreatitis patients often develop steatorrhea due to impairment of
lipolysis
141
removes bile acids by forming insoluble complexes with bile acids to be excreted in feces
cholestyramine
142
steatorrhea in bacterial overgrowth syndrome is a result of
failure to maintain duodenal conjugated bile acid concentrations
143
conjugate bile acids have a lower crictical micellar concentration than unconjugates and area more effective in
micelle formation
144
bile acids are absorbed in the
ileum
