Nutrition

Question 1

What are the classifications of malabsorption disorders?

Answer 1

1. Impaired intraluminal digestion dominant
2. Impaired mucosal digestion, uptake and transport dominant
3. Impaired post-mucosal transport dominant

Question 2

Name three specific malabsorption disorders.

Answer 2

1. Lactose intolerance
2. Celiac disease
3. Tropical sprue

Question 3

What is the primary cause of lactose intolerance?

Answer 3

Lack of brush border enzyme lactase

Question 4

What are common symptoms of lactose intolerance?

Answer 4

• Abdominal cramps
• Bloating
• Diarrhea
• Flatus

Question 5

How is lactose intolerance diagnosed?

Answer 5

Hydrogen breath test

Question 6

What is Celiac disease also known as?

Answer 6

Gluten enteropathy

Question 7

What is the prevalence of Celiac disease among Caucasians of European descent?

Answer 7

1%

Question 8

List two autoimmune diseases associated with Celiac disease.

Answer 8

• Dermatitis herpetiformis
• Diabetes mellitus type 1

Question 9

What is the characteristic immune sensitivity in Celiac disease?

Answer 9

IgA directed against gliadins, hordeins, secalins, and triticale

Question 10

What are the common diagnostic tests for Celiac disease?

Answer 10

• Anti-tissue transglutaminase IgA
• Antiendomysial antibody IgA
• Small bowel biopsy

Question 11

What is the main treatment for Celiac disease?

Answer 11

Dietary gluten restriction

Question 12

What defines tropical sprue?

Answer 12

Generalized malabsorption syndrome associated with geographic exposure

Question 13

What are symptoms of tropical sprue?

Answer 13

• Diarrhea
• Steatorrhea
• Weight loss
• Nausea
• Anorexia

Question 14

How is Whipple’s disease diagnosed?

Answer 14

Biopsy showing infiltration of lamina propria with glycoprotein-laden, ‘foamy’ macrophages

Question 15

What is the primary causative agent of Whipple’s disease?

Answer 15

Tropheryma whipplei

Question 16

What are common symptoms of Whipple’s disease?

Answer 16

• Fever
• Weight loss
• Abdominal pain
• Diarrhea
• Skin pigmentation

Question 17

What are some tests for diagnosing malabsorption?

Answer 17

• Qualitative fecal fat
• Stool ova & parasites
• Complete blood count and smear
• Serum albumin
• Serum iron, ferritin

Question 18

What does a D-xylose absorption test measure?

Answer 18

Differentiates small intestinal mucosal disease from impaired intraluminal digestion/lymphatic obstruction

Question 19

What is the purpose of the Schilling test?

Answer 19

Measures B12 absorption and intrinsic factor deficiency

Question 20

What is a possible cause of significant malabsorption related to infections?

Answer 20

Giardiasis, cryptosporidiosis, microsporidiosis

Question 21

What type of anemia can result from Celiac disease?

Answer 21

• Microcytic anemia (iron deficiency)
• Macrocytic anemia (folate or B12 deficiency)

Question 22

What is the typical management for Whipple’s disease?

Answer 22

Ceftriaxone followed by Trimethoprim-sulfamethoxazole for 1-3 years

Question 23

What is a common complication for untreated Celiac disease?

Answer 23

Increased incidence of lymphoma

Question 24

Fill in the blank: The most common symptoms of Celiac disease are _______.

Answer 24

nonspecific ill health

Question 25

a pt. undergoes a jejunumectomy. what Vit. deficiencies should you be particularly concerned about for this pt.

Answer 25

Vit. B5 & 6

Question 26

a pt. presents to your clinic w/ a 2 week h/o worsening tingling & numbness in her feet and hands; MSK PE revealed absent deep tendon reflexes & weakness of extremity muscles. Additionally, the pt. has had aggressive bouts of diarrhea & emesis. When inquired about PMH, the pt. states they had a jejunectomy 7 months ago. What Vit. deficiency is most likely contributing to this pt.s symptoms?

Answer 26

this pt. is presenting w/ symptoms of both dry & GI beriberi both of which are caused by Vit. B1 deficiency Pathogenesis: Vit. B1 is a crucial component of myelin synthesis TPP (active form of Vit. B1) is also critical for glucose metabolism; this leads to colonic lactic acidosis

Question 27

a pt. presents to the urgent care clinic w/ a CC of pre-syncope & peripheral edema. PE revealed cardiomegaly & labs showed increased serum levels of BNP & ADH. When the pt. is asked about their PMH, the pt. states she was diagnosed w/ DMII 5 yrs ago and had a jejunectomy 1 yr. ago. What Vit. deficiency is most likely contributing to this pt.'s CV symptomes

Answer 27

this pt.s has symptoms of wet beriberi caused by a deficiency of Vit. B1. Clinical hallmarks of wet beriberi are heart failure, increased Na/H2O retention and peripheral edema

Question 28

A pt. who has been seeing you for over 20 yrs. w/ no significant PMH, presents to your clinic w/ a CC of progressive pruritis & a sore-itchy throat. She states that these episodes started 2 years ago and was intermittent for a long time until recently. PE revealed angular cheilitis, rudor discoloration of the sclera, magenta tongue, & BL seborrheic dermatitis of the posterior scapula. Knowing this pt. has been a staunch vegetarian for decades, what vit. deficiency do you think is most likely causing this pts. symptoms?

Answer 28

this pt. is presenting w/ signs of ariboflavinosis pathogenesis: Vit. B2 is the precursor of FAD which is a coenzyme for an array of biochemical reactions including the recycling of antioxidants and production of uric acid; hyperemia results when Vit. B2 is depleted b/c the body responds to impaired cellular metabolism via inducing vasodilation of affected tissue.

Question 29

A pt. presents to the UCC with a CC of diarrhea, excessive sweating, and bronchospasms. PMH is significant for a diagnosis of duodenal PUD/ZES 15 yrs. ago w/ successful remission. PE is remarkable for a palpable mass in the proximal anterior neck underneath the chin, rudor discoloration of the skin w/ signs of scaleley dermatitis; GA: pt. is delirious & demented. Labs revealed Vit. B3 deficiency & low levels of tryptophan. Describe what is going on w/ this pt.

Answer 29

Given the pts.'s h/o PUD/ZES, the disease has likely progressed to Chronic Atrophic Gastritis Type B and beyond: this pt. is currently presenting w/ signs & symptoms pellagra dermatitis secondary to carcinoid syndrome Carcinoid syndrome is notorious for chewing up circulating tryptophan & niacin

Question 30

What Vit. B derivative will have similar manifestations as Vit. B2 deficiency

Answer 30

Vit. B6; PLP (active form); AKA Pyridoxine generation of PLP is riboflavin dependent

Question 31

a pt. presents to your clinic w/ loss of scalp & body hair, conjunctivitis, brittle nails & paresthesias. What Vit. B deficiency is assoc. w/ these symptoms

Answer 31

Biotin Vit. B7 deficiency