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IM GI Malabsorption USMLE 2


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Gluten-induced enteropathy in susceptible persons affecting the small bowel
Celiac Sprue
What HLA is Celiac sprue?

Malabsorption (diarrhea, bloating, abd pain, steatorrhea, weight loss), vitamin deficiency (high PT/INR, low iron and calcium), Rash
Celiac sprue
Pathology Bx of small bowel:
flattened intestinal villi, infiltration of lymphocytes, hyperplasia and lengthing of the intestinal crypts
Celiac sprue
what does Antiendomysial Ab test?
What other test accompanies this one?

When is it performed?

What is the most accurate test for this Dx?
Confirms Dx of Celiac Sprue

(also Antigliadin Ab test)

After a Sudan Black stain confirms Malabsorption

Most Accurate: Small Bowel Bx
(must be done to Dx the disease and to R/O Lymphoma)
A pruitic rash associated w/ Celiac sprue, responds to Tx of topical Sulfone, resolves w/ regression of disease
Dermatitis Herpetiformis
Tx for Celiac sprue
All grains are eliminated from diet except Rice and Corn
(no wheat rye or barley)
*Patient has chronic pale, greasy, malodorous diarrhea and no evidence of infection.

Initial test?
Sudan Black stain
Pathology Bx:
mildly flattened intestinal villi w/ jejunal infiltration of monocytes
Tropical sprue
malabsorption signs, megaloblastic anemia, decreased calcium, B-12, iron, folic acid, cholesterol, albumin and magnesium
Tropical sprue
Tx for Tropical sprue
Vitamin B-12 and Folate supplements

Tetracycline (for a few months)
Difference b/t Whipple's disease and Sprue
Whipple's has CNS involvement
If there is the presence of a normal jejunal Bx, what malabsorption disease is ruled-out?
Tropical sprue
54-yo farmer who has been suffering w/ diarrhea, weight loss, and arthralgias for the past few months is brought in by his wife for memory deficits that have been occurring for the past 3 weeks.
Whipple's dz
devastatingly profound malabsorption syndrome due to destruction of the intestinal lamina due to a gram-negative rod of the Actinomyces genus
Whipple's Dz
arthralgia, abdominal pain, malabsorption, fever, inc skin pigment, uveitis, confusion, CNS palsies, nystagmus, heart failure
Whipple's Dz
*Most accurate test for Whipple's Dz

Other test?
Most accurate:
PAS positive macrophages in the lamina propria;

PCR of peripheral blood for T. whippelii (Actinomyces strain)
Abx Tx of Whipple's Dz
(2 steps)
1. initial course of Ceftriaxone
2. TMP-SMZ and Tetracycline for 1 year
Albumin lost to the GI lumen in excess
Protein-losing Enteropathy
Diarrhea, edema, steatorrhea, low albumin
Protein-losing Enteropathy
Dx test for Protein-losing Enteropathy
Alpha-1-Antitrypsin comparison in serum vs stool
Similar look to gastric cancer on barium study
Menetrier's Dz
Protein-losing enteropathy that causes mucosal thickening due to hyperplasia of glandular cells replacing chief and parietal cells leading to enlarged, tortuous rugae
Menetrier's Dz
epigastric pain, diarrhea, edema, steatorrhea, decreased gastric acid secretion, low albumin
Menetrier's Dz
Dx Tests for Menetrier's Dz
Endoscopy w/ deep mucosal Bx

Barium swallow will reveal large gastric folds
Rx Tx for Menetrier's Dz
(2 plus MOA of each specific to this)
(reduce width of tight junctions b/t gastric mucosal cells)

H-2 Blockers
(reduce protein loss)
Stool frequency < 3 times per week
Etiology of Constipation
OLD MD Farts:
Low thyroid(hypothyroidism);
Disturbed colonic motility;
Fluid and fiber intake is low
what amount should you increase your fiber to, if your are constipated?
30 g/day

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