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Kultur Dokumente
malabsorption syndrome
Cell death
and sloughing
Villus
Region
Turnover time 48-72 hr
Functional Organic
Mucosal enterochromaffin cell
Mechanical or chemical
stimulation
5-HT4R: increas
and motility
Symptom Rome
- Based Diagnostic
III Diagnostic Algorithm
Criteria for IBS for IBS
At least 3 months, with onset at least 6 months previously of recurrent abdominal
pain or discomfort** associated with 2 or more of the following :
Improvement with defecation; and/or
Onset associated with a change in frequency of stool; and/or
Onset associated with a change in form (appearance) of stool
Microspora Albendazole
Or
Biopsy/EM Metronidazole
HIV-associated chronic inflammatory diarrhea
A. Infectious
Protosoa
E.histolytica
Bacteria
Clostridium diffieile
Salmonella
Shigella
Campylobacter
MAC/M tuberculosis
Viral
CMV
Herpes simplex
Fungus
Histoplasmosis
B. Neoplasm
Lymphoma
Kaposi sarcoma
Organism Diganosis Treatment
CMV Ganciclovir,
Foscarnet
MAC Amikacim,Ethabutal,
Rifampin,
Clarithromycin,
Ciprofloxacin
M.TB Anti-TB
HIV associated malabsorption
syndrome
Giardia
Lymphoma
TB
AIDS enteropathy
Chronic pancreatitis
Bacterial overgrowth
Chronic organic diarrhea (non-HIV)
Malabsorption
Watery Inflammatory Syndrome
Chronic watery diarrhea
Osmotic Secretory
Endocrine Infection
ZE syndrome Aeromanas/pleisiomanas
Vipoma Inflammatory
Glucagonoma Microscopic colitis
Carcinoid syndrome
Bile acid diarrhea
Medullary CA of thyroid
Tumor
Mastocytoma
Villous adenoma
Pheochromocytoma
Idiopathic
Motility
Dumping syndrome Laxative abuse
Diabetic autonomic neuropathy
Chronic secretory diarrhea
Diseases Manifestation Diagnosis
ZE syndrome Secretory diarrhea serum gastrin>
Malabsorption 1,000 pg/ml
Severe peptic ulcer with increase serum
complications gastrin <50% after
test meal
Vipoma Severe watery diarrhea fasting plasma VIP
Hypokalemia >190 pg/ml
Achlorhydria
Hypokalemia
Stool analysis
Dietary review
Breath H2 test
(lactose)
Lactase assay
Chronic organic diarrhea (Non
HIV)
Inflammatory Secretory
Malabsorption
Chronic inflammatory diarrhea
Fever
Abnormal pain
Mucus / Bloody
Stool leukocytes
ESR
Chronic inflammatory diarrhea
Small-bowel Radiography /
Capsule endoscopy
Standard Other pathogens
Bacterial Parasites :strongyloid Sigmoidoscopy
Pathogens: E histolytica, Or colonoscopy
Shigella Viruses: CMV With biopsy
C difficile
Salmonella
CT scan
Campylobacter
of abdomen
Tuberculosis
Small-bowel
biopsy
Chronic organic diarrhea (Non
HIV)
Inflammatory Secretory
Malabsorption
Malabsorption
syndrome
Malnutrition
Maldigestion or malabsorption
Diarrhea
CARBOHYDRATE
DIGESTION AND
ABSORPTION
DIETARY CARBOHYDRATES
Starch
Digestible: amylopectin,
glycogen, amylose
Indigestable: cellulose
and beta linked forms
Disaccharides: sucrose,
Brush border enzymes
Enzyme Substrate Products
Lactase Lactose Glucose
Galactose
Sucrase Glucose
Sucrose Fructose
Gastrointestinal symptoms
Diarrhea Osmotic activity of carbohydrates or short-chain fatty
acids
Secretory activity of bile acids, fatty acids
Decreased absorption surface
Abdominal distension, Bacterial gas production from carbohydrates in the
flatulence colon or small bowel bacterial over-growth
Foul smelling flatulence or Malabsorption of proteins or intestinal protein loss
stool
Pain Flatulence
Ascites Protein loss or malabsorption
Musculoskeletal symptoms
Tenany, muscle weakness, Malabsorption of vitamin D, calcium, magnesium and
paresthesias phosphate
Bone pain, osteomalacia, Protein, calcium or vitamin D deficiency, secondary
fractures hyperparathyroidism
SYMPTOM AND SIGN IN MALABSORPTIO
Symptom or sign Pathophysiologic background
Stool test
Stool fat :
Qualitative,
Quantitative
Stool pH<5.5
Fat Malabsorption Syndrome
Steatorrhea
Malnutrition
Mechanism of fat malabsorption
Mechanism Example
Intraluminal
Bile acid deficiency Hepatobiliary diseases
Pancreatic insufficiency Bacterial overgrowth
Terminal ileal disease
Chronic pancreatitis
Pancreatic tumors
Inactivation of pancreatic enzyme
Mucosal
Reduced mucosal absorption Sprue (Caeliac, Tropical)
Parasite
(Giardia,C.phillipenesis,
Strongyloid, Isospora)
Infectrative, (Lymphoma,
Eosinophilic)
Inflammatory : Crohns disease
Mechanism of fat malabsorption continue
Mechanism Example
Mixed Fistula
Short bowel
Fecal fat test
Qualitative test
diet 80-100 gm (72 hrs)
stool sample is placed on a glass + glacial
acetic acid and sudan III
boil
> 100 globules/high power field
Quantitative test
diet 80-100 gm (72 hrs)
Collect stool 48-72 hrs
Lymphoma
Eosinophilic DDX.Parasites
Autoimmune
gastroenteritis Food allergy
Small intestinal biopsy
Diagnostic histology, patchy
Strongyloidiasis
Small intestinal biopsy
Abnormal but not diagnostic
Caeliac /
tropical sprue
Bacterial
overgrowth
Malabsorption test
D-xylase + - +/-
Schilling - + +
H2 breath +/- - +
14C tricelcin breath + + +
Bile acid breath test
Hints for diagnosis chronic diarrhea (1)
General history of diarrhea: onset and duration of diarrhea, stool
character, frequency, amount & volume of stool, relationship with meals
Associated symptoms : nausea vomitting, tenesmus, abdominal pain,
constipation, etc.
Symptoms of malnutrition : anemia, edema, bruise
Social history: diet (lactose, food allergy), occupation, environment,
travelling, contact with diarrhea
Past history & underlying illness : DM. PU, thyrotoxicosis,
autoimmune disease, unsafe sex, radiation, pancreatitis, etc.
Family history : IBD, polyposis syndrome, MEN1, MEN2
Systemic enquiry : fever, weight loss, amenorrhea, impotence, change
of voice, polyuria, polydipsia, arthralgia/arthritis, rashes, eye symptoms,
paresthesia, difficulty walking, sweating, tremor, proteinuria, bone pain,
etc.
Drugs history : antibiotics, magnesium compounds, laxatives, etc.
Hints for diagnosis chronic diarrhea (2)
Anemia, dry, grey hair
Glossitis, cheilitis, angular stomatitis, oral
ulcer,
Eczema, dermatitis herpetiformis,
pyoderma gangrenosum, vasculitis,
Goiter, exophthalmos, uveitis, episcleritis
etc
Edema, ascites, bruise, muscle wasting
Peripheral neuropathy
Arthritis, ankylosing spondylitis,
Perianal lesions
Hints for diagnosis chronic diarrhea (3)
Flushing carcinoid syndrome
Tachycardia thyrotoxicosis, carcinoid
syndrome
Peripheral neuropathy DM, amyloidosis
Peptic ulcer ZE syndrome
Proteinuria amyloidosis, SLE
Postural hypotension DM, Addisons
disease
Dermatitis herpetiformis coeliac disease
Ataxia Abetalipoproteinemia