mkodumagulla
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A 27 yr old woman presents with the complaint of diarrhoea for 14 months. No other complaints. Examination normal other wise. Lab results show Fe def anaemia and low phosphorous. Malabsorption is considered as dx. What should u do next
I think Small bowel Biopsy Please correct if I am wrong.
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| Kevin
Forum Newbie
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sound good - need to rule out celiac diseases (can also do antibodies)
what about crohns - ? colonoscopy
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Kevin
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| mkodumagulla
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Yes.Crohns is a possibility. But it is said that she has no constitutional symptoms.If it were to be crohn's she should be having abd pain, fever wt loss ect. So I eliminated crohns. Does it sound reasonable? Anti glaiden Abs for celiac makes good sence.
Please correct me if wrong.
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| goneskuba
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anti-endomysial Ab + anti-gliadian Ab are needed from the biopsy...ur both right
also d-xylose
but the reason u get a biopsy is to r/o small bowel lymphoma
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| mkodumagulla
Forum Senior
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Do we still need to do d -xylose test after the dx of malabsorption is made?
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| goneskuba
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to make a diagnosis of celiac disease....that is what we are talking about...
1st) u would have a h/o steatorrhea and a papalo-vesicular rash (derm
herpitiformis)...also incl are vitamin def from small bowel malabsorp
like iron, folate, b12, all fat soluble vit(a,d,e,k), and poss of
hypoalbuminemia.
2nd) u do d-xylose to make sure it is small bowel and not pancreatic
insuff as these can be mistaken for one another.
3rd) when u know it is sb, then do the Ab screen
4th) to r/o sb lymphoma, do a biopsy
*of course...in real life u would get a 24 hour fecal fat b4 all this to really verify fat in the feces...but that is not what there looking for
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| mkodumagulla
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Thanks .So I go with D xylose test as it is Small bowel ansuff. This question is from KAplan Internal Med book. He has not mentioned any multiple choices. No H/o rash or any thing So we can consider doing Dxylose I think.
Thanks once again.
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| Moozy
Forum Guru
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I guess the workup for 14yrs diarrhea with no const. symptoms should begin with a fecal fat estimation first to diff b/w the staetorrhea accompanied malabsorption( celiac sprue, panc insuff) and the ones not associated with steatorhea( vit B12 def and lactase defeciency). I see that most of you have not mentioned the #1 cause of chronic diarrhea in adults that is Lactase defeceincy. A person with relatively no constitution symptoms might have lactase def.... why not start with the workupo for that first.
Just an opinion.. correct me if wrong.
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| goneskuba
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of course lactase def is the number one cause of diarrhea in adults...i should know, im one of the inflicted!!!
but the question stem doesnt tell u that it is precipitated by drinking milk or dairy products...also the fact that there is iron def already and low phosphorus....it leads me to believe that i am dealing with small bowel or poss pancreatic insuff
also...the fact that they mention steatorrhea and malabsorption.....we move right along...lactase def ppl are not malabsorping...most are well nourished like myself.. there is no steatorrhea......and get this, 14 months of drinking milk and having exploding bowel movements would make ppl stop in like 2 days max of 7....(more an acute attack of diarrhea...not constant)
therefore....first i would do d-xylose to differ btwn panc insuff and sb
once u can narrow it down to sb
u do anti-ab tests to compulsively confirm ur diag and also to r/o sb lymphoma....
MAT (most accurate test) = biopsy of sb showing anti-ab
BIT (best initial test) = d-xylose
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