Celiac and Lactose Flashcards Preview

Clin Med 2 > Celiac and Lactose > Flashcards

Flashcards in Celiac and Lactose Deck (17):
1

Patho celiac

-immunologic/ inflammatory response to ingested gluten affecting the GI mucosa

2

Gluten is

wheat, rye, barley

3

Area most affected by gluten

proximal small bowel

4

Clinical Celiac

- diarrhea
- flatulence
- borborygmus
- weight loss, failure to thrive and growth retardation
- weak/fatigue
- severe abdominal pain
- iron deficient anemia
- osteopenia/porosis
- neuro sx
- dermatitis herpetiformis
- amenorrhea, delayed puberty, infertility

5

PE celiac

- protuberant, tympanic abdomen
- weight loss
- orthostatic hypotension
- peripheral edema(protein malab)
- ecchymosis (vit K def)
- hyperkeratosis (vit A def)
- cheilosis and glossitis (iron def)
- peripheral neuropathy (B12 def)
- Trousseau sign, tetany (Ca2+ def)

6

Lab testing celiac

CBC
CMP
Coags- PT prolonged
Stool- fat malabsorption
Oral tolerance- lactose

7

Serologic testing in Celiac

IgA TTG- 95% sensitive and specific
IgA- if IgA TTG negative but high suspicion
Less than 2= IgATTG + IgG- deaminated gliadin peptides

8

When do antibodies become undetectable in celiac

within 3-12mo gluten avoidance

9

Gold standard tx for celiac

endoscopy and mucosal biopsy

10

Endoscopy and celiac results

atrophy/ scalloping of duodenal folds

11

Histology for celiac

villi atrophic/absent
hypertrophy of crypts
increased cellularity of lamina propria
proliferation of plasma cells and lymphocytes

12

Tx celiac

- diet: remove all gluten and improve in 2 weeks
- supplements in initial stages
- steroids (prednisone or budesonide ) get dz under control

13

Patho lactose intolerance

- inability to digest lactose
- high levels of lactase at birth but decline steadily with aging, especially people of non-European descent

14

What is lactase

brush border enzyme that digests lactose into galactose and glucose

15

Clinical lactose intolerance

- abdominal bloating and cramping
- flatulence
- diarrhea
- nausea
- borborygmia
- sx due to ingestion of lactose

16

Lab for lactose intolerance

hydrogen breath test- ingest 50g of lactose and a rise in breath H+ greater than 20ppm within 90min

17

Tx lactose intolerance

- determine threshold of intake for when sx occur
- spread lactose intake throughout the day in quantity less than 12g
- lactase enzyme replacement
- Ca2+ supplement