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Small Intestinal Disorders/Malabsorption

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Small Intestinal Disorders/Malabsorption Ralph Giannella, M.D. Important Disorders of the Small Intestine MALABSORPTION Celiac disease, tropical sprue, Whipple s ... – PowerPoint PPT presentation

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Title: Small Intestinal Disorders/Malabsorption


1
Small Intestinal Disorders/Malabsorption
  • Ralph Giannella, M.D.

2
Important Disorders of the Small Intestine
  • MALABSORPTION
  • Celiac disease, tropical sprue, Whipples
    disease, bacterial overgrowth
  • INFECTIONS
  • Giardia, Salmonella, parasites, tuberculosis
  • VASCULAR DISORDERS
  • Thrombosis, ischemia
  • INFLAMMATORY
  • Crohns disease, radiation
  • TUMORS
  • Adenocarcinoma, lymphoma, carcinoids, benign
    tumors

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Signs and Symptoms Suggestive of Malabsorption
  • Sign or Symptom
  • Wasting, edema
  • Weight loss, oily-bulky stool
  • Parasthesias, tetany, bone pain
  • Ecchymosis, petechiae, purpura
  • Anemia - macrocytic - microcytic
  • Initial Lab Finding
  • Serum albumin
  • Stool fat
  • Serum carotene
  • Serum ca, alk.phos.
  • Mineralization of bone
  • Prothrombin time
  • Serum folate or vit B12
  • Serum iron

11
Classification of Malabsorption
  • PANCREATIC ENZYMES
  • Chronic pancreatitis, Zollinger-Ellison syndrome
  • BILE SALTS
  • Biliary obstruction, bacterial overgrowth, ileal
    disease
  • MUCOSAL DISEASE
  • Resection, radiation enteritis, ischemia
  • Celiac sprue, Whipples disease
  • LYMPHATIC DISEASE
  • Lymphagiectasis, lymphoma
  • OTHER
  • Diabetes, throtoxicosis, drugs, post-gastrectomy

12
Screening Tests in Malabsorption
  • Microscopic exam of feces for fat
  • Serum carotene
  • Prothrombin time
  • Hemoglobin, erythrocytes, smear
  • Plasma protein
  • Serum calcium

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D-Xylose Test in Malabsorption
  • 5-Carbon Sugar Absorbed in Small Intestine
  • Impairment of absorption indicates Small
    Intestine Disease
  • False Low Values
  • Renal Disease
  • Massive Ascites
  • Bacterial Overgrowth
  • Vomiting
  • Delayed Gastric Emptying

16
D-Xylose Test Helpful in Distinguishing
Maldigestion from Malabsorption
17
Small Bowel Biopsy and Malabsorption
  • Diseases with Continuous Involvement
  • Normal Biospy Excludes Diagnosis
  • Celiac Disease
  • Tropical Sprue
  • Whipples Disease
  • Agammaglobulinemia
  • Other Diseases with Diagnostic Biopsies
  • Intestinal Lymphoma
  • Parasites (Giardia, Crytosporidia)
  • Viral (CMV, Herpes)
  • Amyloidosis
  • Eosinophilic Gastroenteritis

18
Disorders in Which Biopsy is Diagnostic
  • Whipples Disease
  • Agammaglobulinemia
  • Abetalipoprotienemia

19
Disorders in Which Biopsy May Be Diagnostic
  • Lymphoma
  • Lymphangiectasia
  • MAI
  • Crytosporidiosis
  • Coccidiosis
  • Giardiasis
  • Collagenous sprue
  • etc.

20
Diseases Affecting the Ileum
  • Regional Enteritis
  • Ileal Resection
  • Jejuno-Ileal Bypass
  • Radiation Enteritis
  • Carcinoid Tumors
  • Tuberculosis
  • Lymphoma etc.

21
Consequences of Ileal Disease and/or Resection
  • Vitamin B12 Malabsorption and Deficiency
  • Steatorrhea
  • Diarrhea
  • Gall Stones
  • Renal Stones
  • Small Bowel bacterial overgrowth

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Renal Calculi in Ileal Disease
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Bacterial Overgrowth Syndrome
  • Macrocytic Anemia (Vit B12 def)
  • Steatorrhea
  • Diarrhea

29
Pathogenesis of Bacterial Overgrowth Syndromes
  • Small Bowel Lesions

Intestinal Stasis
Vit B12 Malabsorption
Steatorrhea
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Small Intestinal Bacterial Overgrowth
Primary Motility Disturbances
  • Intestinal scleroderma
  • Diabetic enteropathy
  • Intestinal pseudo-obstruction
  • SBBO of the elderly
  • ? AIDS enteropathy

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