Malabsorption and Celiac Disease

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the recommended management for celiac disease?

Administer gluten supplements

Lifelong gluten-free diet (correct)

Start a high-carb diet

Periodic gluten intake

What is the primary concern related to patients with splenic atrophy?

Enhanced immune response

Increased risk of osteoporosis (correct)

High blood pressure

Frequent respiratory infections

How is dermatitis herpetiformis related to celiac disease?

It is a direct cause of celiac disease.

It does not respond to a gluten-free diet.

It is a skin condition linked to gluten sensitivity. (correct)

It affects only patients with a severe form of the disease.

What is a primary characteristic of tropical sprue?

Malabsorption and megaloblastic anemia Signup and view all the answers

What test can help diagnose bacterial overgrowth in the intestines?

Hydrogen breath test after oral lactulose Signup and view all the answers

What is the primary immune response associated with celiac disease?

Immune response to gluten leading to mucosal inflammation Signup and view all the answers

Which of the following is a treatment option for short bowel syndrome?

Parenteral nutrition Signup and view all the answers

Which of the following symptoms is most commonly associated with celiac disease?

Mild abdominal pain and diarrhea Signup and view all the answers

What is the definitive method for diagnosing celiac disease?

Intestinal biopsy showing subtotal villous atrophy Signup and view all the answers

What is the main characteristic of Whipple disease?

Caused by Tropheryma whipplei Signup and view all the answers

Which statement about intestinal resection and its effects is correct?

Ability to cope without IV nutrition is influenced by the amount of resected bowel. Signup and view all the answers

Which complication is NOT commonly associated with celiac disease?

Hyperthyroidism Signup and view all the answers

Among these, which condition is a differential diagnosis for subtotal villous atrophy?

Giardiasis Signup and view all the answers

Which sign might indicate malnutrition related to celiac disease?

Angular stomatitis Signup and view all the answers

Which gastrointestinal condition is NOT characterized by impaired mucosal function leading to malabsorption?

Irritable bowel syndrome Signup and view all the answers

Which test has a very high sensitivity and specificity for diagnosing celiac disease?

IgA transglutaminase antibodies test Signup and view all the answers

What is a common symptom associated with Whipple's disease?

Eroded, red, friable patches in the duodenum Signup and view all the answers

Which of the following treatments is used for Whipple's disease?

160 mg trimethoprim and 800 mg sulphamethoxazole daily Signup and view all the answers

What kind of inflammatory process is typically seen in the small bowel biopsy of a Whipple's disease patient?

PAS-positive macrophages Signup and view all the answers

Which symptom is not commonly associated with chronic radiation enteritis?

Sudden weight gain Signup and view all the answers

What is a common complication of untreated Whipple's disease?

Mortality Signup and view all the answers

What specific finding is seen on electron microscopy for Whipple's disease?

Trilaminar cell wall of T. whipplei Signup and view all the answers

Which of the following statements about radiation enteritis is true?

Symptoms can last for three months or more in chronic cases. Signup and view all the answers

What type of antibodies are associated with the diagnosis of Whipple's disease?

T. whipplei antibodies Signup and view all the answers

Study Notes

Malabsorption

Malabsorption is a condition where the small intestine does not absorb nutrients properly.
There are three main causes:
- Secretory insufficiency
- Impaired motility with bacterial overgrowth and bile salt inactivation
- Impaired mucosal function

Major Disorders Of The Small Intestine

Celiac disease (gluten-sensitive enteropathy)
Dermatitis herpetiformis
Tropical sprue
Bacterial overgrowth
Intestinal resection
Whipple's disease
Radiation enteritis
Parasite infestation: Giardia intestinalis and Cryptosporidiosis

Celiac Disease

An autoimmune disorder triggered by gluten.
Inflammation of the small intestine.
Two age peaks are seen.
Symptoms include diarrhea, steatorrhea, abdominal discomfort, bloating, and pain.
Signs include anemia, malnutrition, mouth ulcers, angular stomatitis, infertility, anxiety, and depression.
Complications include tetany, osteomalacia, gross malnutrition with peripheral edema, neurological issues like ataxia, muscle weakness, paraesthesia, and polyneuropathy, increased malignancy, and ulcerative jejunitis.
Associated diseases include autoimmune disorders, Down syndrome, Turner syndrome, inflammatory bowel disease, IgA deficiency, and epilepsy.

Investigations For Celiac Disease

Serology: IgA transglutaminase antibodies and IgA endomysial antibodies.
Intestinal biopsy: used to confirm diagnosis, showing subtotal villous atrophy.
Blood count: reveals mild anemia, often with iron, folate, and rarely B12 deficiency.
Small bowel radiology or capsule endoscope: used to investigate suspected complications.
HLA typing: helpful for ruling out the disease in individuals already on a gluten-free diet.
Bone densitometry: assesses for increased osteoporosis risk.

Management Of Celiac Disease

Lifelong gluten-free diet.
Correction of vitamin deficiencies.
Pneumococcal vaccinations (due to splenic atrophy) every 5 years.
Monitoring includes assessing response and compliance to the diet through symptoms and serology, and re-biopsy for no response or diagnostic uncertainty.

Dermatitis Herpetiformis

Uncommon, pruritic blistering subepidermal eruption of the skin.
A gluten-sensitive enteropathy similar to celiac disease.
Most patients with celiac disease do not develop this condition.
Skin condition improves with dapsone, and a gluten-free diet helps both the enteropathy and skin lesions.

Tropical Sprue

Progressive small intestinal disorder.
Characterized by chronic diarrhea, malabsorption, and megaloblastic anemia.
Occurs in tropical areas.
Etiology unknown, likely infectious.
Diagnosis is based on evidence of malabsorption, mucosal biopsy, and excluding infectious causes of diarrhea.
Treatment includes folic acid, tetracycline, and addressing nutritional deficiencies.

Bacterial Overgrowth

Occurs due to stasis of intestinal contents, related to abnormal motility or structure.
Clinical features include diarrhea, steatorrhea, mild B12 deficiency, and symptoms related to the underlying small bowel pathology.
Diagnosis: therapeutic trial of antibiotics and hydrogen breath test.
Management involves addressing the underlying cause and rotating courses of antibiotics like tetracycline and metronidazole.

Intestinal Resection

Consequences depend on the extent and level of resection.
Short bowel syndrome: managed with parenteral nutrition and occasionally intestinal transplantation.
The ability to manage without supplemental IV nutrition depends on the amount of resected bowel, location of resection, colon status, and health of residual intestine.

Whipple Disease

Rare infectious bacterial disease caused by Tropheryma whipplei.
Characterized by weight loss, diarrhea, intestinal pain, hyperpigmentation of skin, skin rash, pleuritis, pneumonitis, lymphadenopathy, encephalopathy, steatorrhea, interstitial nephritis, eye disease, arthropathy, subcutaneous nodules, and endocarditis.
Arthritis and arthralgia are common.
Blood tests are usually normal.
Endoscopy reveals pale, shaggy duodenal mucosa with eroded, red, friable patches.
Diagnosis is confirmed by small bowel biopsy showing PAS-positive macrophages, nonspecific.
Electron microscopy identifies characteristic trilaminar cell walls of T. whipplei in macrophages.
T. whipplei antibodies and PCR-based assays are available.
Untreated Whipple disease is fatal.
Treatment: antibiotics, specifically trimethoprim and sulfamethoxazole (co-trimoxazole), for 1 year.

Radiation Enteritis

Acute effects: nausea, vomiting, diarrhea, and abdominal pain, typically resolving within 6 weeks.
Chronic effects: muscle fiber atrophy, ulcerative changes, and fibrotic strictures, persisting for 3 months or more.
Treatment is symptomatic and often ineffective for chronic radiation enteritis.
Surgery is avoided if possible, reserved for obstruction or perforation.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the complexities of malabsorption and its major disorders, including celiac disease. This quiz covers causes, symptoms, and complications associated with these conditions, providing a comprehensive overview for better understanding. Test your knowledge on the functioning of the small intestine and related disorders.