02b: Malabsorptive Disorders Flashcards Preview

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Flashcards in 02b: Malabsorptive Disorders Deck (51)
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1
Q

Worldwide, (X) is the most common cause of malabsorption.

A

X = Infestation (Giardia and other organisms)

2
Q

In industrialized societies, the common causes of malabsorption are: (star the two most common)

A
  1. Lactose intolerance*
  2. Celiac disease*
  3. Pancreatic insufficiency
  4. Bacterial overgrowth
3
Q

Chronic pancreatitis causes malabsorption via which mechanism? Which other diseases have this similar effect?

A

Lack of pancreatic enzymes/HCO3 (failure of digestion)

CF, pancreatic cancer

4
Q

Bacterial overgrowth causes malabsorption via which mechanism? Which other diseases have this similar effect?

A

Lack of bile salts (defective micelle formation)

Obstructive jaundice, cholestatic liver disease, bile salt loss (ex: resection of terminal ileum)

5
Q

List some disease states that cause malabsorption due to loss of villi surface in small bowel.

A
  1. Celiac
  2. Post-infectious
  3. Whipple’s disease
  4. Crohn’s
6
Q

Patient describes stool as light-colored and sticky to the toilet bowl. This is suggestive of (X) from (Y) malabsorption.

A
X = steatorrhea
Y = fat
7
Q

CHO malabsorption: you would expect diarrhea to be (secretory/osmotic).

A

Osmotic (unabsorbed osmoles promote water movement into lumen)

8
Q

Fat malabsorption: you would expect diarrhea to be (secretory/osmotic).

A

Secretory (lipids metabolized by bac in colon to produce FA that promote secretion)

9
Q

Patient with diarrhea and night blindness is likely deficient in (X).

A

X = Vit A

10
Q

Patient with diarrhea and easy bruising is likely deficient in (X).

A

X = Vit K

11
Q

Patient with diarrhea and peripheral neuropathy is likely deficient in (X).

A

X = Vit B12

12
Q

Edema is a common physical finding in malabsorption of:

A

Protein

13
Q

Clubbing of fingers is a finding suggestive of which GI issue?

A

IBD

14
Q

What is angular stomatitis? It’s suggestive of (X) deficiency.

A

Inflammation on sides of mouth;

X = Iron

15
Q

Glossitis is suggestive of (X) deficiency.

A

X = Iron and vitamin B

16
Q

Aphthous ulcers are commonly found in which malabsorptive disease(s)?

A

Celiac’s and Crohn’s

17
Q

ZES causing (low/high) duodenal pH will cause (CHO/fat) malabsorption via which mechanisms?

A

Low; fat

  1. Inhibits fat digestion by pancreatic lipase
  2. Decrease bile salt solubility
18
Q

Bacterial overgrowth occurs in (small/large) bowel and is clinically diagnosed by (X).

A

Small;

X = breath test (orally administered CHO metabolized by intraluminal bac and CO2/H measured)

19
Q

What would constitute an “abnormal” breath test, indicating bacterial overgrowth?

A

H2 exhaled in breath detected earlier than normal (since overgrowth occurs in small bowel and normal bacteria is colonic)

20
Q

T/F: Pts with bacterial overgrowth are treated with antibiotics.

A

True - rifaximin, tetracycline, and ciprofloxacin for a week or so

21
Q

Protein losses/malabsorption is more common in (pancreatic/intestinal) diseases.

A

Intestinal (absorption);

Both protein and CHO digestion can be maintained until over 90% of pancreatic function (protease/amylase secretion) is lost

22
Q

CHO maldigestion is often the result of defective (X).

A

X = brush border hydrolases (convert oligos into monosacc)

23
Q

Why would hyperthyroidism cause CHO malabsorption?

A

Rapid transit states don’t allow brush border enzymes enough time for adequate digestion

24
Q

T/F: Lactase is a brush-border enzyme.

A

True

25
Q

(X) is a non-absorbable CHO used to treat constipation.

A

X = lactulose

26
Q

Celiac disease: etiology?

A

Enteropathy resulting from mucosal sensitivity to gliadin proteins of gluten (in wheat, barley, rye)

27
Q

Celiac disease primarily affects (proximal/distal) (small/large) bowel.

A

Proximal small bowel

28
Q

(X) deficiency is very common in celiac disease.

A

X = Fe

29
Q

Most Celiac patients present with (X) complaint. What other symptoms may they complain of?

A

X = diarrhea (and maybe steatorrhea)

Weight loss, malaise, anemia, osteoporosis

30
Q

Children with Celiac disease will present with:

A

failure to thrive or growth retardation

31
Q

Virtually all patients with (X) skin finding have Celiac disease.

A

X = dermatitis herpetiformis

32
Q

Which autoimmune disorders are common in Celiac disease?

A

DM and thyroid diseases

33
Q

How is Celiac diagnosis confirmed (gold standard)?

A

Small bowel biopsies (before and on treatment)

34
Q

Classic histo findings of Celiac disease biopsy.

A

Absent villi, crypt hyperplasia;

Increase in intra-epithelial lymphocytes

35
Q

T/F: Histo changes in Celiac disease are specific to it.

A

False - but small bowel should return to normal after complete gluten withdrawal (hence need to re-biopsy during treatment)

36
Q

Which serological test has super high sensitivity and specificity for diagnosing Celiac disease?

A

IgA tissue transglutaminase

37
Q

An elevated INR, aka (X), suggests (Y) deficiency. How do you treat?

A
X = prothrombin time (suggests coagulopathy)
Y = vitamin K 

Parenteral administration of vitamin K

38
Q

(X) cancer is strongly associated with celiac sprue, especially in patients who have long-standing untreated disease or disease refractory to Rx.

A

X = malignant lymphoma (usually of T cells)

39
Q

T/F: Carcinoma incidence is increased in patients with Celiac sprue.

A

True - small intestine adenocarcinoma

40
Q

Which histological findings are characteristic of Whipple’s disease?

A

Lamina propria of villi distended by large macrophages with PAS-positive granules (actinomyces bacilli on EM)

41
Q

You suspect your patient with IBD has infectious colitis. Which test do you run to verify it isn’t just an IBD flare?

A

Biopsy

42
Q

You suspect your patient with IBD has infectious colitis. Which findings on biopsy suggest cause is infectious, not IBD flare?

A

preservation of non-branched normal crypt architecture in the face of active inflammation and repair

43
Q

(X) colitis is seen in early acute ischemic injury and characterized by the presence of multiple (Y) on the mucosa.

A
X = pseudomembrane
Y = white patches (of mucus and polys) with adjacent patches of normal mucosa
44
Q

(X) infectious agents induce a histologic abnormality similar to pseudomembrane colitis. Briefly describe this type of colitis.

A

X = cytotoxin of E. coli (0157: H7) and C. dificle

Severe ISCHEMIC necrotizing-type colitis

45
Q

Pt presents with watery diarrhea. Endoscopy reveals normal colon and rectum. Biopsy shows degenerative changes of the surface epithelium associated with lymphocytic infiltration. What’s the diagnosis?

A

Microscopic colitis

46
Q

Surgical resection specimen from a patient with UC shows a (X) mucosa, (shallow/deep) ulcers and the rectum (always/sometimes/never) involved. The bowel is (shortened/lengthened) wish loss of (Y) due to muscle (hyper/hypo)-trophy.

A
X = red, bloody
Shallow
Always
Shortened
Y = haustra
Hypertrophy
47
Q

The most common parasitic infestation in humans, often encountered in biopsy of (X) portion of GI tract.

A

Giardia Lamblia

X = small intestine

48
Q

How would colonic glands microscopically differ in acute v chronic UC?

A

Acute: branching glands (manifestation of injury and repair)

Chronic: GLAND ATROPHY

49
Q

Patchy inflammation with “skip” areas is characteristic of which IBD?

A

Crohn’s

50
Q

PAS stain is used to diagnose (X) malabsorptive disorder. Characteristic finding is bright (Y)-color due to staining of:

A
X = Whipple's disease (T. whipplei infection)
Y = magenta

Glycoproteins on cell wall of bacteria

51
Q

PAS stain in Whipple’s disease will characteristically show (X) cells in (Y) tissue layer of intestines.

A
X = PAS-positive foamy macrophages
Y = lamina propria