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28 Cards in this Set
- Front
- Back
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What does the term malabsorption denote? |
Disorders in which there is a disruption of digestion and nutrient absorption |
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Fats are ________ by bile then hydrolyzed by _______ ________. |
emulsified; pancreatic lipase |
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Where is most dietary lipids absorbed? |
In the proximal 2/3 of the jejunum |
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Where and what starts protein digestion? |
It begins in the stomach with gastrin pepsin |
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What does amino acids released from gastric digestion stimulate? |
Release of CCK in the duodenum, which releases pancreatic proteases |
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What converts trypsinogen to trypsin? |
Enterokinase |
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What does trypsin do? |
Catalyzes the conversion of all pancreatic enzymes to their active form |
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What disease of the GI will affect fat absorption far more than protein and carbohydrate absorption? |
Pancreatic insufficiency |
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What is the etiology of pancreatic insufficiency? |
Chronic pancreatitis Cystic fibrosis Pancreatic cancer Zollinger Ellison Syndrome (very low pH in the proximal duodenum can inactivate pancreatic enzymes and precipitate bile salts so that malabsorption occurs) |
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What are signs and symptoms of Pancreatic insufficiency? |
Steatorrhea Weight loss Gaseous distention/Bloating Flatulence Foul smelling stool |
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What is the etiology for decreased bile salt concentrations? |
Biliary obstruction Cholestatic liver disease Resection of the terminal ileum Crohn's disease Bacterial overgrowth Hypersecretion Medications i.e. cholestyramine (Questran) |
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What are signs and symptoms of a patient with decreased bile acid concentration? |
Mild steatorrhea Minimal weight loss Vit ADEK insufficiency Diarrhea |
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What does the mucosal phase of small intestinal absorption require? |
Sufficient surface area Brush border enzymes (Glucoamylase {Maltase}, Sucrase-Isomaltase, Lactase, Peptidases) |
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When can malabsorption occur? |
Enzyme deficiency Primary mucosal disease (Cystic Fibrosis) Extensive intestinal resections Lymphoma |
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What does the absorptive phase of small intestinal absorption require? |
An intact lymphatic system |
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True or False Malabsorption occurs when there is an obstruction in the lymphatic system. |
True |
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What are signs and symptoms of malabsorption due to an obstruction in the lymphatic system? |
Steatorrhea Significant enteric protein loss |
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What is Celiac disease? |
A permanent dietary disorder caused by an immunologic response to gluten |
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What does the malabsorption of gluten result in? |
Results in diffuse damage to the proximal small intestine mucosa with malabsorption of nutrient |
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How is Celiac disease diagnosed? |
By duodenal biopsy |
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In which population is Celia disease more prevalent? |
1:100 whites of Northern European ancestry |
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What is gluten? |
Gluten is the composite of a gleaned and a glutelin, which is conjoined with starch in the endosperm of various grass related grains (wheat, barley, rye) |
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What is the clinical Hx findings for Celiac's disease? |
Diarrhea Steatorrhea Weight loss Bloatedness Weakness Dyspepsia Flatulence Upper abdominal pain/discomfort |
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What will you find on a physical examination of a patient with Celiac's disease? |
"Normal" Muscle wasting, Pallor (anemia) Easy bruising (Vit K def) Hyperkeratosis (Vit A def) Osteomalasia, Ataxia Paresthesia (Vit K def) Abdominal distention Hyperactive bowel sounds
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What testing should be done on patients with whom you suspect Celiac's disease? |
Serological testing of IgA endomysial antibody and IgA t Transglutaminase antibody Both have >90% sensitivity and >95% specificity |
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What is the method for confirmation of Celiac's disease in pt.'s whom serological test is positive? |
Endoscopic mucosal biopsy of the distal duodenum and proximal jejunum |
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What is the Ddx for Celiac's disease? |
Irritable bowel syndrome Tropical sprue (FL,LA, TX) Viral gastroenteritis Hypersecretory state i.e. gastrinoma |
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What is the treatment for Celiac's disease? |
Eliminate gluten from diet Initially, remove gluten from diet and vitamin supplement once malabsorption is resolved, then vit suppl. may be discontinued |
