Malabsorption Syndromes CIS - Darrow Flashcards Preview

Year2 GI Exam II > Malabsorption Syndromes CIS - Darrow > Flashcards

Flashcards in Malabsorption Syndromes CIS - Darrow Deck (37):
1

chronic diarrhea

4 weeks

watery - pourable - osmotic or secretory

fatty - fat on sudan stain

inflammatory

2

watery diarrhea

pourable

osmotic or secretory

secretory - consider bile acids**

osmotic - carbohydrates

3

sudan stain

for fat

4

fatty diarrhea

steatorrhea

malabsorpion
maldigestion

5

inflammatory diarrhea

blood and puss

positive hemoccult and fecal leukocytes

6

niacin deficiencys

3 Ds
diarrhea, dermatitis, dementia

7

carcinoid syndrome

order urine for 5 hydroxy indol acetic acid

tryptophan shunted to serotonin
-not available for niacin synthesis

so you see the 3 Ds

8

osmotic gap >100

osmotic watery chronic diarrhea**

from carbs

lactase deficiency

9

osmotic gap <50

interrupts sleep as well**

secretory watery chronic diarrhea**

from bile acids, neuroendocrine tumor, increased motility, villous adenoma, microscopic colitis, infections

10

malabsorption

fatty chronic steatorrhea

celiac, tropical sprue, short bowel, lymph obstruction, tropheryma whipplei

11

maldigestion

fatty chronic steatorrhea

pancreatic insufficiency
bile acid deficiency
bacterial overgrowth - deconjugation of bile acid

12

inflammatory chronic diarrhea

blood and pus

positive hemoccult and fecal leukocytes

fever

CMV, herpes, c dif, campylovacter, balantidium coli (pigs), colon cancer, lymphoma

13

Case 36yo M crohns watery diarrhea

-history of bloody diarrhea with steatorrhea
-cleared with infliximab

sore on right leg

sudan stain negative
hemoccult/leukocytes negative
stool for O and P negative
stool Na 90
stool K 50
stool osmolality 290

treatment?

osm gap - 290 - 2(90 + 50)

290-280 = 10

14

pyodermic gangrenosum

with inflammatory bowel disease

15

stool osmotic gap calculation

290 − 2 x (stool Na + stool K)

The 290 is the value of the stool osmolality

16

secretory diarrhea causes

bile acids
increased motility
infection
villous adenoma
neuroendocrine tumors
microscopic colitis

17

less than 100cm of ileal involvement or resection**

liver able to keep up with bile acid synthesis

enough bile acid for fat absorption

bile lost to colon produces secretory diarrhea - so it needs to be bound to control diarrhea** - bile acid binding agent

18

greater than 100cm of ileal involvement**

not enough micelle formation - steatorrhea

so need low fat diet, vit replacement , medium chain triglycerides**

19

Case 45yo M right kidney stone and gallstone on CT
-hemoglobinuria, hemosiderinuria, LDH elevation
-iron deficiency anemia
-prior DVT of left arm
-bowel resection 2 months ago bc of blood clot of small intestine

steatorrhea, weight loss, easy bruising, back pain, paresthesias

hemoglobinuria - hemolysis intravascular

venous and arterial blood clots - paroxysmal nocturnal hemoglobinuria

stone formation - no bile acids and hemolysis

kidney stones - FA bind calcium - increased oxalate absorption

20

short bowel syndrome

malabsorption

21

Case 25yo F recurrent loose stool when stressed, no pain while sleeping

sudan 3 negative

tx - irritable bowel syndrome

change in bowel flora

3lbs in gut

increased fecal serine potease activity

22

36yo F weakness and fatigue and pruritic rash, occasional diarrhea

skin biopsy - granular deposits if IgA

rash - dermatitis herpetiformis
-IgA deposits in the rash

IgA in bowel - celiac**

23

IgA diseases

deficiency - bronchitis, diarrhea, transfusion rxn

GI disease - celiac

renal disease - IgA nephropathy or henoch schonlein

24

Case 46yo F, depression, fatigue, weight loss, miscarriages, hypothyroid, IBS takes Ca with Vit D, iron deficiency, sudan 3 positive

what lab test to order?

sudan 3 - steatorrhea

celiac**

so test to order - IgA tTG**

25

IgA tTG

test for celiac

26

fat steatorrhea

malabsorption - celiac disease

27

celiac disease

malabsorption steatorrhea

can have dermatitis herpetiformis

28

-elevated liver and pancreatic enzymes
-miscarriages
-iron deficiency
-DM I
-addisons
-osteopenia
-steatorrhea
-weight loss
-villous atrophy of mucosa

celiac disease

osteoporosis and malignancy (B cell lymphomas) are complications

29

genetics of celiac

HLA-DQ2 and DQ8

MHC class II molecules

Ag presentation to CD4 cells

production if IgA against EMA and tTG**

30

celiac disease

gluten free diet that get worse all of a sudden

-think B cell lymphoma

31

Case 66yo M diabetic
-nonerosive atrophic gastritis
-bloating and chronic watery diarrhea
-weight loss
-anemia macrocytosis

stool osmolality 350
stool Na 30
stool K 75
stool pH 3.5

sudan positive

pernicious anemia

stool osm gap
350 - 2(30 + 75) = 140

osmotic diarrhea**
-carbohydrates

low stool pH -

32

low stool pH

osmotic diarrhe
-carb breakdown by colonic bacteria - releases free fatty acids that are organic anions

33

bacterial overgrowth

watery diarrhea** - due to osmotic load of unabsorbed carbohydrates
-proteases from bugs destroy brush border diasaccharidases

lower pH of stool less than 5 because of release of free-fatty acids with carb breakdown

bacteria consume B12 and nutrients - deconjugate bile acids**

results in malabsorption of fat with steatorrhea - lack of micelle formation
-results in secretory diarrhea**

34

to prove bacterial overgrowth

d-C14 xylose breath test
gut anaerobes metabolize oral d-xylose to CO2 measured in expired air at 30 minutes with small intestine bacterial overgrowth

also - hydrogen breath test
-give lactose and measure breath hydrogen
-90 minutes - will have >20ppm hydrogen - earlier peak indicates bacterial overgrowth

35

Case 45yo M asthenic, HIV positive, fever, arthralgia, diarrhea, weight loss, blurred vision, lethargy, back pain, jerking paresthesias

murmurs, pedal edema

PAS positive positive macrophages

rules of 3s - fever of undetermined origin

PAS positive macrophages - whipple disease - tropheryma whippeli from MAC

36

tropheryma whippelii

multiple organ involvement

37

Case 30yo F watery diarrhea 6 weeks duration, weight loss

stool osmolar gap 200

fasted didnt help

not osmotic - bc fasting didnt help

but stool osm gap suggests secretory

taking laxative - Mg