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Flashcards in Bowel Diseases I Deck (92)
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1

Malabsorption diseases

Celiac disease
Whipple disease
Bacterial overgrowth
Short bowel syndrome
Lactase Deficiency

2

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

3

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

“Classic” symptoms are....

*Malabsorption*

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

4

Skin finding associated with Celiacs is

KNOW FOR EXAM

Dermatitis herpetaformus

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

5

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

6

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

(Celiacs)

-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

7

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

(Celiacs)

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

Malabsorbed: Fat, carbs

8

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

(Celiacs)

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

Malabsorbed: Fat, protein, carbs

9

If patient has Microcytic anemia, lab findings will show ________

(Celiacs)

Low serum Iron

Malabsorbed: Iron

10

If patient has Macrocytic anemia, lab findings will show ________

(Celiacs)

Decreased serum vitamin B12 or red blood cell folate

Malabsorbed: Vitamin B12 or folic acid

11

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

(Celiacs)

Decreased serum calcium or magnesium

Malabsorbed: Calcium, vitamin D, magnesium

12

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

(Celiacs)

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

Malabsorbed: Calcium, vit D

13

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

(Celiacs)

Prolonged prothrombin time or INR

Malabsorbed: vit K

14

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

(Celiacs)

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

Malabsorbed: protein

15

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

(Celiacs)

Abnormal lactose tolerance test

Malabsorbed: lactose

16

Antibody for Celiacs

IgA tissue transglutaminase (IgA tTG) antibody

-Antigliadin antibodies and
IgA antiendomysial antibodies are NOT recommended

17

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

18

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!)

19

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

20

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

21

Whipple Disease

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

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

22

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

23

Cardiac involvement of Whipples

Heart failure
Valvular regurgitation

24

CNS involvement of Whipples

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

25

Common S/S of Whipples

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

26

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)

27

Whipple bacillus has a characteristic ________ appearance on electron microscopy

trimellar wall

28

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

29

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

30

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)