Duke PA Chronic Diarrhea, Malabsorption, and Celiac Disease
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| you never see blood with __ | secretory or osmotic diarrhea
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| chronic diarrhea + weight loss + nutritional deficiencies = __ | malabsorption
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| chronic blood diarrhea = __ | ulcerative colotis
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| chronic diarrhea without nutritional deficiencies = __ | lactose intolerance, IBS, laxative overuse/abuse
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| always consider __ in patients 40 years and older with chronic diarrhea | colon cancer
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| malabsorption can be caused by __ | impaired digestion/absorption/transit
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| steatorrhea is a hallmark symptom of __ | malabsorption
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| __ is ideal screen for malabsorption (gold standard) | stool test for fat
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| most useful for diagnosing lactase deficiency | hydrogen breath test
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| aka, non-tropical sprue, gluten-sensitive enteropathy | celiac disease
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| inflammatory response of small bowel to ingestion of gluten proteins found in wheat, rye and barley | celiac disease
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| protein malabsorption have | wasting, edema
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| carbohydrate malabsorption have | ab cramping and bloating, weight loss/growth retardation, soft diarrhea
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| classic malabsorption | fat malabsorption
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| complication of untreated celiac disease | lymphoma
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| clinical syndromes associated with malabsorption | lactase def., giardiasis, celiac dz, tropical sprue, amyloidosis, lymphoma, whipple's dz, bacterial overgrowth, short gut syndrome
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| classic test for malabsorption is __ | fecal fat
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| drugs and foods associated with malabsorption | cholestyramine, high fiber diets, tetracycline, antacids, sorbitol, fructose, Xenical, metformin, colchicine, methotrexate, sulfasalazine, phenytoin
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| celiac disease is an __ disorder. It also has a genetic component HLA-DQ2, HLA-DQ8 association | autoimmune disorder
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| this disease can often present with everything but GI symptoms | Celiac disease
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| classical presentation of __ is diarrhea with steatorrhea, weight loss, nutritional deficiencies | Celiac disease
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| celiac disease extra-intestinal manifestations | short stature, fatigue, amenorrhea, decrease fertility, arthropathy, iron def. anemia, folate/vit K def, osteopenia, osteoporosis, muscle atrophy, neurologic, dental enamel hypoplasia
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| celiac disease patients with mild proximal disease may have only __ without any GI symptoms | anemia and osteoporosis
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| celiac disease patients with significant distal disease involvement usually have __ | persistent diarrhea
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| cutaneous variant of celiac disease. Only seen in 10% of those with celiac but everyone with this has celiac | dermatitis herpetiformis
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| intensely pruritic papulovesicular rash of trunk, scalp, and extremities associated with celiac disease | dermatitis herpetiformis
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| physical exam for celiac disease-check | teeth for enamel loss, muscle atrophy, kyphosis, bruises, increased abdominal signs
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| laboratory evaluation of celiac disease | CBC, PT, iron, B12, folate, calcium, alk phosphatase, albumin, beta carotene, ESR
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| accurate serological tests for __ are now widely available. anti-endomysial IGA (most specific), anti-tTGA (cheaper, less difficult, test of choice) | celiac disease
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| still the gold standard confirmation test for celiac disease | duodenal mucosal biopsy
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| pathognomonic findings with duodenal mucosal biopsy in celiac disease | villous atrophy, crypt hyperplasia, lympocytic infiltration of lamina propria, increased intraepithelial lymphocytes
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| __ cures celiac disease symptoms | gluten free diet
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| complications of celiac disease | malignancy (lymphoma, but also squamous cell ca of esophagus, colon and hepatocellular ca), other autoimmune disease, nutritional def., musculoskeletal injuries, deformities
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| inflammatory disease of small bowel secondary to overgrowth of coliforms |
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