Malabsorption Syndrome MCQs

Once on a full replacement dose, thyroid-stimulating hormone (TSH) levels should be checked at intervals of 1-3 years, depending on their stability. Fluctuating or elevated TSH levels in a previously stable patient, or thyroxine requirements in excess of 200 mg/day, usually indicate compliance problems. It is important to rule out malabsorption or abnormal thyroxine kinetics caused by drugs: cholestyramine, ferrous sulphate, lovastatin, aluminium hydroxide, rifampicin, amiodarone, carbamazepine, and phenytoin all alter the absorption or clearance of thyroxine. Reference: Harrison’s Principles of Internal Medicine 20 th edition Ch:377 Pg:2705-07

This patient has type 1 diabetes – an autoimmune condition. She now presents with iron deficiency anemia along with weight loss. So the possibility of celiac disease should be ruled out as people with type 1 diabetes are at up to six times greater risk of having celiac disease. Dietary deficiency of iron and heavy menstrual loss will not cause weight loss there is no abdominal pain or blood in stools to suggest a Chron's Disease. Antibodies to gliadin should be sent and the diagnosis of celiac disease can be confirmed by a biopsy of small intestine which will show villous atrophy. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 325, Pg: 2463

The haematological picture is that of macrocytic anemia (most commonly due to vitamin B12 or folate deficiency). Folate deficiency occurs in the majority of binge-drinking alcoholics and is a common cause of anemia. Inadequate dietary intake, intestinal malabsorption, and impaired folate storage in the liver all contribute to folate deficiency. Reference : Harrison's Principles of Internal Medicine21 st ed, ch: 99, Pg: 773

Patients who fulfil the diagnostic criteria for irritable bowel syndrome should be screened for other conditions with- Complete blood count to rule out anemia Erythrocyte sedimentation rate and C reactive protein to rule out inflammatory etiology Anti-endomysial antibodies, Tissue transglutaminase (TTG) antibodies to rule out celiac disease. Some patients with IBS-D may have undiagnosed celiac sprue. Because the symptoms of celiac sprue respond to a gluten-free diet, testing for celiac sprue in IBS may prevent years of morbidity and attendant expense Other tests can be done to rule out any other suspected pathology depending on the presenting symptoms. Reference: Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 327 Pg: 2493

Colonoscopy is necessary to exclude a colonic carcinoma. There is a relatively high prevalence of colorectal neoplasia among older patients with coeliac disease who can present with iron deficiency or altered bowel habit. Reference: Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 325 Pg: 2464

Dermatitis herpetiformis is the most common extraintestinal manifestation of celiac disease. It presents as an intense pruritic rash consisting of papules and vesicles. Commonly presents on the extensor surface of extremities, buttocks and neck. Occurs due to granular IgA deposits in epidermal basement membrane. Treatment – Dapsone and gluten free diet. Reference: Harrison's Principles of Internal Medicine, 21 st ed Ch: 325, Pg: 2463

Answer is B (Celiac Disease) Celiac Disease is associated with Steatorrheal diarrhoea from mucosa! malabsorption. Secretory Diarrhea Certain Bacterial Infection Vibrio Cholera Enterotoxigenic E.Coli Non Osmotic Stimulant Laxatives Hormone Producing Endocrine Tumors Carcinoid, VlPomas, Gastrinomas, Medullary Carcinoma Thyroid (Calcitonin) Bile acids (endogenous laxatives) Bowel resection / disease or fistula Addison's Disease Congenital Electrolyte Absorption defects Chronic Alcohol Ingestion Diabetic Diarrhea Steatorrheal Diarrhea Intraluminal maldigestion Pancreatic exocrine insufficiency, Bacterial overgrowth, Bariatric surgery, Liver disease Mucosal malabsorption Celiac sprue, Whipple's disease, Infections, Abetalipoproteinemia, Ischemia Postmucosal obstruction (1° or 2° lymphatic obstruction)

Whipple's disease characteristically occurs in middle-aged men, who present with weight loss, fever, abdominal pain, arthralgias and intestinal symptoms of diarrhea and malabsorption. CNS and cardiac system are commonly involved. Confusion, memory loss, or uncontrolled eye movements indicate that the infection has travelled to the CNS. Trimethoprim - sulfamethoxazole is recommended; treatment is continued for one year. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 325, Pg: