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Flashcards in Bowel Diseases I Deck (92)
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Malabsorption diseases

Celiac disease
Whipple disease
Bacterial overgrowth
Short bowel syndrome
Lactase Deficiency


Celiac disease (aka- sprue, celiac sprue, and gluten enteropathy)

-a permanent dietary disorder caused by an immunologic response to gluten (a storage protein found in certain grains)

-it results in diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients


S/S of celiac disease depend on the length of small intestine involved and the patient’s age

“Classic” symptoms are....


Diarrhea, steatorrhea, weight loss, abdominal distention, weakness, muscle wasting, or growth retardation (kids)


Skin finding associated with Celiacs is


Dermatitis herpetaformus

-red blotches, itchy, uncomfortable (seen all over body, butt, back, shoulders)


Lab findings associated with Celiac's (list 10)

1. Microcytic anemia due to iron deficiency
2. Megaloblastic anemia due to folate or vitamin B12 deficiency
3. Low serum calcium
4. Elevated alkaline phosphatase
5. Elevations of prothrombin time
6. Decreased vitamin A & D
7. Low serum albumin
8. Nonanion gap acidosis
9. Hypokalemia
10. Mild elevations of aminotransferases


If patient has Steatorrhea (bulky, light-colored stools), lab findings will show ________


-Increased fecal fat; decreased serum cholesterol; decreased serum carotene, vitamin A, vitamin D

Malabsorbed: Triglycerides, fatty acids, phospholipids, cholesterol, fat soluble vitamins: A, D, E, K


If patient has Diarrhea (increased fecal water), lab findings will show ________


-Increased stool volume and weight; increased fecal fat; increased stool osmolality gap

Malabsorbed: Fat, carbs


If patient has Weight loss; muscle wasting, lab findings will show ________


-Increased fecal fat; decreased carbohydrate (D-xylose) absorption

Malabsorbed: Fat, protein, carbs


If patient has Microcytic anemia, lab findings will show ________


Low serum Iron

Malabsorbed: Iron


If patient has Macrocytic anemia, lab findings will show ________


Decreased serum vitamin B12 or red blood cell folate

Malabsorbed: Vitamin B12 or folic acid


If patient has Paresthesia; tetany; positive Trousseau and Chvostek signs, lab findings will show ________


Decreased serum calcium or magnesium

Malabsorbed: Calcium, vitamin D, magnesium


If patient has Bone pain; pathologic fractures; skeletal deformities, lab findings will show ________


Osteopenia on radiograph; osteoporosis (adults); osteomalacia (children)

Malabsorbed: Calcium, vit D


If patient has Bleeding tendency (ecchymoses, epistaxis), lab findings will show ________


Prolonged prothrombin time or INR

Malabsorbed: vit K


If patient has Bleeding tendency (ecchymoses, epistaxis), lab findings will show ________


Decreased serum total protein and albumin; increased fecal loss of alpha-1-antitrypsin

Malabsorbed: protein


If patient has Milk intolerance (cramps, bloating, diarrhea), lab findings will show ________


Abnormal lactose tolerance test

Malabsorbed: lactose


Antibody for Celiacs

IgA tissue transglutaminase (IgA tTG) antibody

-Antigliadin antibodies and
IgA antiendomysial antibodies are NOT recommended


Gold standard method for confirmation of the diagnosis in patients with a positive serologic test for celiac disease or patients with negative serologies when symptoms and laboratory studies are strongly suggestive of celiac disease

Endoscopic mucosal biopsy of the proximal duodenum (bulb) and distal duodenum


With celiacs, what is observed in endoscopic mucosal biopsy of proximal and distal duodenum?

-Atrophy or scalloping of the duodenal folds may be observed (see less folding, looks smooth, google image)
-Histology reveals abnormalities ranging from intraepithelial lymphocytosis alone to extensive infiltration of the lamina propria with lymphocytes and plasma cells with hypertrophy of the intestinal crypts and ***blunting or complete loss of intestinal villi***
(CLASSIC- know histo image for this FOR EXAM!)


Treatment for Celiacs

-Removal of all gluten from the diet is essential to therapy: all wheat, rye, and barley
-Most patients with celiac disease also have lactose intolerance either temporarily or permanently and should avoid dairy products
-Dietary supplements (folate, iron, calcium, and vitamins A, B12, D, and E) initially
-Confirmed osteoporosis may require long-term calcium, vitamin D, and bisphosphonate therapy
-Excellent prognosis


Celiacs is associated with other autoimmune disorders including

Addison disease, Graves disease, type 1 diabetes mellitus, myasthenia gravis, scleroderma, Sjögren syndrome, atrophic gastritis, and pancreatic insufficiency

-Celiac disease that is truly refractory to gluten withdrawal occurs in less than 5% and generally carries a poor prognosis


Whipple Disease

-Rare multisystem illness caused by infection with the bacillus Tropheryma whippelii

-Most commonly affects white men in the fourth to sixth decades


Symptoms associated with Whipple Disease

-Arthralgias (80%, migratory, nondeforming)
-Diarrhea, abdominal pain (75%)
-Weight loss (almost 100%) with protein-losing enteropathy, hypoalbuminemia and edema
-Intermittent low-grade fever (50%) of cases
-Generalized lymphadenopathy


Cardiac involvement of Whipples

Heart failure
Valvular regurgitation


CNS involvement of Whipples

-Dementia, lethargy, coma, seizures, myoclonus, or hypothalamic signs
-Ophthalmoplegia, nystagmus


Common S/S of Whipples

-Low-grade fever
-Heart murmurs
-Peripheral joints edema, erythema
-Neurological findings
-Hyperpigmentation on sun-exposed areas
-Hypotension** (VERY late manifestation)


Endoscopic biopsy of the duodenum with histologic evaluation during Whipples shows

-Infiltration of the lamina propria with PAS-positive (“foamy”) macrophages that contain gram-positive bacilli (which are not acid-fast) and dilation of the lacteals

"Foamy whipped cream in a CAN" (cardiac, arthralgias, neuro)


Whipple bacillus has a characteristic ________ appearance on electron microscopy

trimellar wall


Because asymptomatic central nervous system infection occurs in 40% of patients, ___________

examination of the cerebrospinal fluid by PCR for T whippelii should be performed routinely


Treatment of Whipple Disease

-Antibiotic therapy results in a dramatic clinical improvement within several weeks
-Complete clinical response usually is evident within 1–3 months
-Relapse may occur in up to one-third of patients after discontinuation of treatment
-Prolonged treatment for at least 1 year is required
-Drugs that cross the blood-brain barrier are preferred
-If untreated, the disease is fatal
-Prevent neurological progression


Overgrowth- Bacterial deconjugation of bile salts may lead to inadequate micelle formation, resulting in

decreased fat absorption with steatorrhea and malabsorption of fat-soluble vitamins (A, D)