Medicine Marrow Pg 21-30 (GIT)
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Questions and Answers

Which of the following is the most prominent deficiency in global malabsorption?

  • Vitamin B12
  • Folic acid (correct)
  • Vitamin D
  • Iron

    • Bile acid diarrhea is also known as cholera.

    True

    What is the daily dosage of folic acid recommended for treatment in cases of global malabsorption?

    5mg

    In global malabsorption, stool examination is performed to rule out ______.

    <p>giardiasis</p> Signup and view all the answers

    Match the following clinical features with their descriptions:

    <p>Chronic diarrhea = Watery and voluminous stools Steatorrhea = Presence of excess fat in stools Weight loss = Reduction in body mass Hyperpigmentation = Skin discoloration due to vitamin deficiency</p> Signup and view all the answers

    What is a common symptom of malabsorption related to bacteria in the lumen?

    <p>Steatorrhea</p> Signup and view all the answers

    Vitamin K deficiency is prominent in Tropical Sprue.

    <p>True</p> Signup and view all the answers

    What is the gold standard for investigating bacterial overgrowth in the small intestine?

    <p>Jejunal fluid aspirate</p> Signup and view all the answers

    The first-line antibiotic for bacterial overgrowth is __________.

    <p>Rifaximin</p> Signup and view all the answers

    Match the following deficiencies with their associated conditions:

    <p>Vitamin B12 = SIBO Folate = Tropical Sprue Vitamin K = Tropical Sprue Macrocytic anemia = Vitamin B12 deficiency</p> Signup and view all the answers

    What characterizes bile acid diarrhea?

    <p>Response to cholestyramine</p> Signup and view all the answers

    Fatty acid diarrhea is associated with increased bile acid absorption.

    <p>False</p> Signup and view all the answers

    What is the primary condition leading to short bowel syndrome in adults?

    <p>Mesenteric vascular disease</p> Signup and view all the answers

    Short bowel syndrome is diagnosed when the length of the small intestine (SI) is less than ______ cm.

    <p>200</p> Signup and view all the answers

    Match the types of diarrhea with their characteristics:

    <p>Bile acid diarrhea = Response to low-fat diet Fatty acid diarrhea = Steatorrhea greater than 20g</p> Signup and view all the answers

    Which antibody type is most crucial for the diagnosis and monitoring of global malabsorption?

    <p>Anti-TTG antibody</p> Signup and view all the answers

    The Anti-Endomysial antibody has a poor sensitivity of 73%.

    <p>False</p> Signup and view all the answers

    What is the feature of the mucosal biopsy findings indicative of global malabsorption?

    <p>Total villous atrophy</p> Signup and view all the answers

    The ______________ is a scoring system associated with the diagnosis of malabsorption.

    <p>Marsh score</p> Signup and view all the answers

    Match the serology tests with their specific features:

    <p>Anti-TTG antibody = High sensitivity (92%) Anti-Endomysial antibody = High specificity (98%) Anti-deamidated glutamine dipeptide = Used in IgA deficiency Anti-gliadin = Obsolete test with low sensitivity</p> Signup and view all the answers

    What is one of the deficiencies caused by the absence of the jejunum?

    <p>Vitamin K</p> Signup and view all the answers

    SIBO is primarily caused by the absence of the ileocecal valve.

    <p>True</p> Signup and view all the answers

    What is the recommended protein intake for a patient with a present colon?

    <p>1 g/kg/day</p> Signup and view all the answers

    Which condition is most commonly associated with the complications of refractory celiac disease?

    <p>Enteropathy associated T-cell lymphoma</p> Signup and view all the answers

    In the proximal small intestine, there are __________ present.

    <p>no bacteria</p> Signup and view all the answers

    Match the following conditions with their related symptoms:

    <p>Irritable bowel syndrome (IBS) = Defective migratory motor complex Scleroderma = Motility disorders Diabetes mellitus = Can lead to SIBO Amyloidosis = Functional disorders</p> Signup and view all the answers

    Whipple's disease primarily affects females over males.

    <p>False</p> Signup and view all the answers

    What dietary components are recommended for the treatment of celiac disease?

    <p>Rice, corn, maize, potato, soybean</p> Signup and view all the answers

    The gram-positive actinobacterium responsible for Whipple's disease is called ______.

    <p>Tropheryma whipplei</p> Signup and view all the answers

    Match the following diseases with their diagnostic techniques:

    <p>Celiac disease = Serology and biopsy Whipple's disease = Biopsy Abetalipoproteinemia = Biopsy Agammaglobulinemia = Biopsy</p> Signup and view all the answers

    What is the most consistent gastrointestinal symptom of Whipple's disease?

    <p>Diarrhoea</p> Signup and view all the answers

    Oculofacial myorhythmia is a neurological manifestation of Whipple's disease.

    <p>True</p> Signup and view all the answers

    What condition can lead to weight loss, diarrhea, and abdominal pain in Whipple's disease?

    <p>Whipple's tetrad</p> Signup and view all the answers

    The predominant joint symptom in Whipple's disease is __________.

    <p>migratory arthralgia</p> Signup and view all the answers

    Match the following cardiovascular complications with their descriptions:

    <p>Mitral valve = Culture negative endocarditis Myocarditis = Inflammation of the heart muscle Pericarditis = Inflammation of the pericardium HACEK group = Bacteria associated with culture negative endocarditis</p> Signup and view all the answers

    What clinical feature is caused by impaired carbohydrate digestion in the small intestine leading to excessive fermentation in the colon?

    <p>D-lactic acidosis</p> Signup and view all the answers

    Hyperoxaluria occurs due to excessive absorption of calcium in the intestines.

    <p>False</p> Signup and view all the answers

    What condition is characterized by low magnesium absorption from the ileum?

    <p>Hypomagnesemia</p> Signup and view all the answers

    The absence of the ileum results in reduced absorption of bile acids and vitamin ______.

    <p>B12</p> Signup and view all the answers

    Match each clinical feature of global malabsorption with its corresponding condition:

    <p>Hypergastrinemia = Increased gastric emptying Cholesterol gallstones = Supersaturation due to bile acids D-lactic acidosis = Bacterial overgrowth due to fermentation Hypomagnesemia = Decreased magnesium absorption</p> Signup and view all the answers

    Which of the following are entities included in inflammatory bowel disease?

    <p>All of the above</p> Signup and view all the answers

    Microscopic colitis is characterized by bloody diarrhea.

    <p>False</p> Signup and view all the answers

    What are the two patterns seen in biopsy for microscopic colitis?

    <p>Collagenous colitis and lymphocytic colitis</p> Signup and view all the answers

    Diversion colitis is seen in patients using __________ bags after surgery for bowel malignancies.

    <p>colostomy</p> Signup and view all the answers

    Match the following features with the types of colitis:

    <p>Collagenous colitis = Collagen band in mucosa Lymphocytic colitis = Intra-epithelial lymphocytes Ulcerative colitis = Continuous inflammation of the colon Crohn's disease = Transmural inflammation affecting any segment of the GI tract</p> Signup and view all the answers

    What is considered the best treatment regimen for the induction phase of Tropical Sprue?

    <p>IV Ceftriaxone 2g x 14 days</p> Signup and view all the answers

    Tropical Sprue affects the small intestine with a pan-intestinal involvement lasting 2-3 weeks.

    <p>True</p> Signup and view all the answers

    What is the drug of choice for the maintenance treatment of Tropical Sprue?

    <p>Co-trimoxazole</p> Signup and view all the answers

    The major fermentation product associated with the pathogenesis of Tropical Sprue is ______.

    <p>ethanol</p> Signup and view all the answers

    Match the following treatment phases with their characteristics:

    <p>Induction = Initial treatment phase to eliminate infection Maintenance = Long-term treatment to prevent relapse</p> Signup and view all the answers

    Study Notes

    Global Malabsorption

    • This is a condition that affects the small intestine, leading to decreased absorption of nutrients.
    • It is characterized by watery diarrhea, steatorrhea (fat in stool), weight loss, and deficiencies in nutrients like folic acid and vitamin B12.
    • Investigations may include biopsies to rule out celiac disease and stool examination to rule out giardiasis.
    • Treatment involves increasing the intake of folic acid and using tetracycline.
    • Some cases (20%) might relapse.
    • In cases of small intestinal bacterial overgrowth (SIBO), bacteria compete for folic acid.
    • Treatment may take 3-6 months.

    Bile Acid Diarrhea

    • Occurs due to defective FGF-19 which regulates bile acid release from the liver.
    • Defective FGF-19 leads to increased bile acid release, which causes diarrhea.
    • It is seen in tropical sprue.
    • It doesn't cause steatorrhea or malabsorption.

    Fatty Acid Diarrhea

    • Occurs due to severe ileal disease, leading to reduced absorption of bile acids and fat.
    • In the colon, fatty acids cause steatorrhea.
    • Steatorrhea is defined as > 20g of fat in stool.
    • It is characterized by increased ileal bile acid absorption, decreased fecal bile acid excretion, and a decrease in the bile acid pool size.

    Limited Ileal Disease

    • Any ileal disease produces some FGF-19, but it is not enough. In this case, the liver compensates by producing excess bile acid.
    • Bile acid can remove sodium, chloride, and potassium from the intestinal epithelium, leading to diarrhea.
    • Limited ileal disease does not cause steatorrhea or malabsorption.

    Short Bowel Syndrome

    • Defined as < 200 cm length of the small intestine (SI).
    • Very severe short bowel syndrome is defined as < 100 cm length of the SI.
    • Most common etiologies in adults include mesenteric vascular disease, resections, and Crohn's disease.
    • Most common etiologies in children include necrotizing enterocolitis.

    Small Intestinal Bacterial Overgrowth (SIBO)

    • SIBO occurs when bacteria in the small intestine become overpopulated.
    • This can be caused by anatomical defects, functional motility disorders (e.g., IBS), or other conditions like scleroderma and diabetes.
    • SIBO can lead to various complications, including hyperoxaluria, cholesterol gallstones, D-lactic acidosis, hypergastrinemia, hypomagnesemia, and increased gastric emptying.
    • Treatment includes antibiotics, such as rifaximin, to control bacterial growth.

    Tropical Sprue

    • Tropical sprue is a malabsorption condition prevalent in regions like India, Bangladesh, and Pakistan.
    • It presents with features similar to celiac disease, including intestinal damage and impaired absorption.
    • This is a condition that primarily affects the small intestine and causes malabsorption of multiple nutrients.
    • Typically, there is a history of an infectious diarrhea episode before the onset of malabsorption symptoms.
    • Treatment includes antibiotics like ceftriaxone or meropenem for induction and co-trimoxazole for maintenance, as it prevents relapse and has good CNS penetration.
    • Microscopic features show PAS-positive foamy macrophages in the epithelium, lamina propria, and submucosa, as well as enlarged villi.

    Celiac Disease

    • This is an autoimmune disorder triggered by gluten consumption.
    • It causes damage to the small intestine, leading to malabsorption.
    • Serology tests, including anti-TTG, anti-endomysial, and anti-deamidated glutamine dipeptide antibodies, are used for diagnosis.
    • Biopsy findings show characteristic changes such as total villous atrophy, crypt hyperplasia, lymphocytic infiltrates, and vascular degeneration of surface epithelium.
    • Complications include refractory celiac disease and increased risk for certain cancers, such as enteropathy-associated T-cell lymphoma, small intestinal adenocarcinoma, and esophageal squamous cell carcinoma.
    • Treatment involves a gluten-free diet and steroids for refractory cases.

    Whipple's Disease

    • This is a rare multisystemic infection caused by the bacterium Tropheryma whipplei.
    • It can affect multiple organs, including joints, gut, central nervous system, and cardiovascular system.
    • The most common symptom is joint involvement, particularly large joints like the knees.
    • Neuro-Whipple's is a complication that can lead to rapidly progressive dementia.
    • Diagnosis is usually made by biopsy.

    Inflammatory Bowel Disease (IBD)

    • IBD is a group of chronic inflammatory conditions that affect the digestive tract.
    • The two main forms of IBD are ulcerative colitis (UC) and Crohn's disease (CD).
    • Microscopic colitis, although sometimes considered an IBD variant, is characterized by chronic watery diarrhea.
    • Diversion colitis is a form of colitis that occurs in patients with colostomy bags.

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    Description

    Explore various conditions related to malabsorption, including global malabsorption, bile acid diarrhea, and fatty acid diarrhea. Learn about their characteristics, causes, and treatment options. This quiz will test your understanding of how these disorders affect nutrient absorption and lead to diarrhea.

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