Celiac’s DIsease, Whipple’s Disease, Tropical Sprue and Abetalipoproteinemia for USMLE
Disorders related to the Small Intestine for the USMLE. Malabsorption Syndrome
1. Malabsorption Sydrome can lead to steatorrhea due to lack of fat absorption, wasting and nutritional deficiencies. Low calcium may also lead to osteomalacia. Lack of Vitamin K can lead to frequent bleeding. And deficiency of B12 and Folate may lead to macrocytic Anemia. Also I provide with acronyms for memorizing the various etiological factors.
Tropical Sprue, Celiac, Disaccharadise, Abetallipoproteinemia, Pancreatitis.
1. Tropical Sprue – Occurs in the tropic, unknown bacteria, but relieved with antibiotics.
2. Whipples – Caused by tropheryma Whipplei which is a gram and PAS positive causing foamy macrophages in lamnia propia and mesenteric nodes. This leads to three symptoms Cardiac, Athralgia and Neurologic
3. Celiac DIsease – Anti-endomysial antibodies, anti-tissue transglutaminase, Anti-gliadin antibodies. Also associated with HLA-DQ2 and HLA-DQ8. Primarily it effects the duodenum and jejunum. There is also an increased risk of malignancy (T Cell lymphoma) and Dermatitis Herpetiformis. Treat by having patient avoid wheat/rye and other food with gliadin.
4. Abetalipoproteinemia – Decreased apoprotein B which is necessary for VLDL and chilomycrons and therefore there will be increased fat accumulation in enterocytes and decreased fat absorption. This leads to neurologic manifestation
5. Pancreatitis – loss of enzymes necessary to absorb fat and fat soluble vitamins.