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22 Cards in this Set
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- Back
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diarrhea:
criteria water excretion/absorption |
- 3 or more BM
- stool greater than 200gm/d - 10 L fluid enter jejunum - SI absorbs 90% - colon receives 1L/d & absorbs 90% - 100mL excreted |
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2 types of diarrhea**
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- osmotic: indigestion of poorly absorbed substances that remain in lumen
- secretory: disordered electrolyte transport |
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2 types of osmotic diarrhea
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excess Mg
Carb malabsorption - lactase deficiency |
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osmolar gap
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290 mosm/kg - (2x [Na] + [K])
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osmotic gap:
osmotic vs. secretory diarrhea |
osmotic: >50mosm/kg
secretory: <50 mosm/kg |
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diagnosis of osmotic diarrhea
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- stool analysis:
low pH (carb malab; dietery;lactase) high Mg (inadvert ingest; laxitive abuse; biopsy/breath test for lipase activity) |
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secretory diarrhea
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r/o all other causes
disordered electrolyte transport** |
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secretory diarrhea:
mechanism |
net secretion of anions or inhibition of net sodium absorption
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microscopic colitis
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- biopsy: collagen band or active inflamm w/ lymphocytes
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secretory diarrhea diagnostics
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open parasite stool
C dip |
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celiac disease:
general |
1-250 americans
under dx'd celiac sprue |
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what is celiac disease?
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chronic malabsorptive disorder of small bowel caused by exposure of genetically susceptible individuals to gluten protein
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celiac ds:
prevalence genetic aspects |
higher in western Europe
- short arm of chromosome 6: --HLA DQ2 - 95% --HLA DQ8 - 5% |
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scalloping
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ridging
classic sign in celiac ds |
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clinical presentation of celiac ds
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dermatitis herpetiforms
rash is pruritic, vesicular, symmetrical itch and burn intensely |
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celiac ds gold standard
serology |
endoscopy w/ biopsy of SI
anti: - gliadin ab; -endomysial ab tissue transglutaminase ab (TTG) - most sensitive |
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always test for what?
why? |
IgA
IgA deficiency present due to celiac ds then Abs will not be produced |
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tx of celiac ds
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wheat, rye, barley
- steroids - regular immune sys |
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fat soluble vitamins
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DEAK
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B12 def vs. folic acid def
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B12 - megaloblastic anemia WITH neuro symptoms
folic acid - megaloblastic anemia |
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B12 absorption
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animal products -> stomach (adequate pH & acid) -> protein + B12 -> intrinsic factor grabs B12 -> duodenum -> B12 complex degraded here by enzymes -> ileum
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different causes of B12 def
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1. dietary insuff (yrs; rare)
2. decreased pH (B12 can't get R protein) 3. pernicious anemia (no intrinsic factor; can't absorb; **high risk of gastric malig) 4. small bowel overgrowth bacT -->bacT de-complex IF+B12 --> digest B12 --> malabsorption 5. lumenal defects in terminal ilium |
