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Flashcards in Small Bowel Disease Deck (34)
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1

Define Celiac Disease

An immune disorder that is triggered by an environmental agent (gliadin) in genetically predispose individuals

2

Gluten consists of what 2 proteins

Gliadin
Glutenin

3

What serologic studies are used to follow the course of celiac disease (CD)

IgA antibodies to gliadin
IgA antibodies to endomysium

4

How does gluten affect the mucosa of the small bowel?

Gluten triggers a protein zonulin which controls gut permeability
Intestinal lining are pried apart by zonulin
Undigested food enters bloodstream
Immune system cells react releasing cytokines

5

Classic Clinical Manifestations of Celiac Disease

Diarrhea with bulking, foul smelling, floating stools due to steatorrhea
Weight loss
Vitamin deficiencies: B, A, D, E vitamins, iron, copper, zinc, & magnesium
Villous atrophy

6

Atypical Clinical Manifestations of Celiac Disease

Minor GI symptoms
Can have anemia, osteoporosis, arthritis
Increased LFTs, neurological symptoms, or infertility
Severe mucosal damage & possess the CD antibody pattern

7

Silent Celiac Disease

Recognized incidentally
Some changes in mucosa
Do NOT show clinical symptoms
Fatigue

8

Which malignancies do patients with CD have a slight increase risk of?

Non-Hodgkin's lymphoma
Hodgkin lymphoma
Small intestinal adenocarcinoma
Hepatocellular CA
GI CA
Lymphoproliferative disease

9

Which malignancy do patients with CD have a decreased risk of?

Breast CA

10

Associated Conditions with Celiac Disease

Dermatitia herpetiformis
Type 1 DM
Down syndrome
Liver disease
Autoimmune thyroid disease
GERD
IBD
Menstrual & reproductive issues
Infertility in men

11

Dermatitis Herpitiformis

Not itchy
Slightly raised
Steroids used
Recur due to being autoimmune

12

What is the single preferred tests for detection of CD?

IgA anti-tissue transglutaminase (TTG)

13

What is the IgA anti-tissue transglutaminase (TTG)?

Auto-antibodies against the bodies own tranglutiminases

14

If IgA serology is negative and a high probability of disease what else should you test?

Total IgA
IgG-deaminated gliadin peptides (DGP)

15

What should patients with positive serology undergo?

Small bowel biopsy

16

If a patient on a gluten free diet has a negative serology test, what should they have tested?

HLA/DQ1/DQ8 testing (genetic testing)

17

What is the MOST specific serology to test for CD?

IgA anti-tissue transglutaminase

18

Define Gluten Sensitivity

Having diarrhea, feel ill and bloated when they eat gluten

19

Treatment- 6 Key Elements

Consultation with a skilled dietitian
Education about the disease
Lifelong adherence to a gluten free diet
Identification & treatment of nutritional deficiencies
Access to an advocacy group
Continuous ongoing follow-up by a multidisciplinary team

20

General Rules for Gluten Free

Avoid wheat, rye, & barley
Soybean/tapioca flours, rice, corn, buckwheat, & potatoes are safe
Read labels
Distilled alcohol, vinegar, & wine OK
Avoid beers, ales, lagers, & malt vinegars
Dairy may not be well tolerated
Oats should be introduced with caution

21

Symptoms of Lactose Intolerance

Diarrhea
Abdominal pain
Flatulence

22

Etiology of Lactose Malabsorption

Genetically regulated reduction in lactase activity
Maintained elevated lactase levels as adults
Lactase activity normal until age 5

23

Developmental Lactase Deficiency

Results from low lactase levels as result of prematurity
Need soy milk or pre-digested formulas

24

Congenital Lactase Deficiency

Rare autosomal recessive disorder
Absence of lactase activity in the sm. intestine

25

Secondary Lactase Malabsorption

Bacterial overgrowth or stasis associated with increased fermentation of lactose
Seen with any mucosal injury to the small bowel

26

CLinical Manifestations of Lactose Intolerance

Abdominal pain- crampy
Bloating
Flatulence
Diarrhea
Vomiting

27

Diagnosis of Lactose Intolerance (rarely used)

Lactose tolerance test
Lactose breath hydrogen test

28

Treatment of Lactose Intolerance

Dietary restriction of lactose intake
Substitution of alternative sources to maintain energy & protein intake
Lactaid
Maintenance of calcium & vitamin D

29

Define Ileus

Temporary absence of the normal contractile movements to the intestinal wall

30

Etiologies of Ileus

Postoperative
Drugs: opiods & anticholinergics
Hypothyroidism
Electrolyte disorders: hypokalemia, hypercalcemia
Intestinal peritonitis
Kidney failure
Pancreatitis