Unknown 172
Download
1 / 16

Unknown 172 - PowerPoint PPT Presentation


  • 315 Views
  • Uploaded on

Unknown #172. Case Presentation. 33-year-old woman has a 6-month history of increasing diarrhea without bleeding or a sense of urgency. She has three or four bowel movements daily compared with her previous pattern of one or two bowel movements each day. PMHx – hypothyroidism

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Unknown 172' - EllenMixel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Case presentation l.jpg
Case Presentation

  • 33-year-old woman has a 6-month history of increasing diarrhea without bleeding or a sense of urgency. She has three or four bowel movements daily compared with her previous pattern of one or two bowel movements each day.

  • PMHx – hypothyroidism

  • Soc Hx – no smoking, ETOH, no travel hx, has a dairy-free diet

  • Fam Hx – non-contributory


Slide3 l.jpg
ROS

  • 4.7 kg (10 lb) weight loss during this time.

  • The patient has regular menses

  • No rectal bleeding, melena, or hematochezia


Physical and studies l.jpg

Gen – NAD

CV – RRR, S1, S2

Pulm – CTA B

Abd – soft/NT/ND/normoactive BS, no HSM

Ext – slight rash on arms, no c/c/e

9.8

6.5 250

MCV – 75

RDW – 19 (nml 11.5-14.5)

Fe – 8 (nml > 10)

Anti-tissue transglutaminase IgA- positive

Chem – wnl

LFT’s – wnl

Stool Cx – no growth to date

Bone density - osteopenia

Physical and studies


Question l.jpg
Question

Which of the following diagnostic studies should be scheduled next?

  • Urea breath test

  • Serum calcitonin measurement

  • Upper endoscopy with small bowel biopsies

  • Serum gastrin measurement


Answer l.jpg
Answer

Which of the following diagnostic studies should be scheduled next?

  • Urea breath test

  • Serum calcitonin measurement

  • Upper endoscopy with small bowel biopsies

  • Serum gastrin measurement


Celiac sprue l.jpg
Celiac Sprue

  • Autoimmune disorder precipitated by the ingestion of gluten, found in wheat, barley, and rye

  • Affects approximately 1% of the population

  • Immune response to gliadin causes inflammatory reactions, mostly in the upper small intestine

  • Also called gluten-sensitive enteropathy and nontropical sprue also called gluten-sensitive enteropathy and nontropical sprue


Clinical manifestations l.jpg
Clinical Manifestations

  • In adults, women>men

  • Diarrhea

  • Abdominal pain or discomfort

  • Iron-deficiency anemia

  • Osteoporosis

  • Others – constipation, neurologic symptoms, dermatitis herpetiformis, hypoproteinemia, hypocalcemia



Diagnosis l.jpg
Diagnosis

  • Serologic testing (ELISA for IgA)

    • Antigliadin antibodies (33% PPV)

    • Antiendomysial antibodies (100% PPV) – endomesium is smooth muscle connective tissue (presence pathognemonic)

      • Anti tissue transglutaminase antibodies (autoantigen compontent of endomesium) - highly sensitive (95%) and specific (94%)

  • Small bowel biopsy

    • Intraepithelial lymphocytosis, mucosal inflammation

    • Crypt hyperplasia

    • Villous atrophy

  • Response to gluten-free diet


Diagnosis11 l.jpg
Diagnosis

  • Gold-standard for diagnosis is endoscopic intestinal bx with characteristic features PLUS CD assoc positive serologies

World Gastroenterology Organisation (WGO-OMGE). WGO-OMGE practice guideline: celiac disease. Paris (France): World Gastroenterology Organisation (WGO-OMGE); 2007. 18 p.



Treatment l.jpg
Treatment

  • Nutritional therapy (gluten-free diet)

  • Assess for vitamin deficiencies

  • Osteoporosis screening


Complications l.jpg
Complications

  • Intestinal adenocarcinoma

  • Enteropathy associated T-cell lymphoma

  • Refractory sprue


Slide16 l.jpg

OBJECTIVE: Confirm a suspected diagnosis of celiac sprue.


ad