malabsorption michael wilschanski michael wilschanski pediatric gastroenterology unit pediatric...
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MALABSORPTIONMALABSORPTION MICHAEL WILSCHANSKIMICHAEL WILSCHANSKI
PEDIATRIC GASTROENTEROLOGY PEDIATRIC GASTROENTEROLOGY UNIT UNIT
HADASSAH UNIVERSITY HOSPITALHADASSAH UNIVERSITY HOSPITAL
FOURTH YEAR STUDENTS 2013
3 MAJOR TYPES of chronic 3 MAJOR TYPES of chronic diarrheadiarrhea
Impaired Intraluminal DigestionImpaired Intraluminal Digestion
Impaired Intestinal MalabsorptionImpaired Intestinal Malabsorption
Diarrhea due to FermentationDiarrhea due to Fermentation
10-15% of patients Meconium ileus rare Diagnosis in
childhood/adulthood Nutritionally normal Milder lung disease Liver disease rare 15-20% pancreatitis
85-90% of patients 10-25% meconium ileus Diagnosis in infancy/
childhood Risk of malnutrition More severe lung disease 5-7% overt liver disease No pancreatitis
Pancreatic Function Status
Pancreatic Insufficiency Pancreatic Sufficiency
Porcine pancreatin Microencapsulated
Pancreatic enzyme preparationsPancreatic enzyme preparations
To allow for gastric To allow for gastric emptying together emptying together with meal nutrientswith meal nutrients
TTo prevent o prevent acidic acidic denaturationdenaturation
Administered with / at start of the meal In young children contents mixed with acidic food (apple sauce) < 10,000 U/kg!
The Celiac IcebergThe Celiac IcebergSymptomatic
Celiac Disease
Silent Celiac Disease
Latent Celiac Disease
Genetic susceptibility: - DQ2, DQ8 Positive serology
Manifest mucosal lesion
Normal +/- Mucosa
Celiac
Hepatology
OrthopedicsEndocrinology
Gynecology
Dermatology
Oncology
Dentistry
Neurology
Psychiatry
Involve the secondary dentitionMay be the only presenting sign of Celiac Disease
Dental Enamel DefectsDental Enamel Defects
Celiac Disease Complicated by Celiac Disease Complicated by Enteropathy-Associated T-cell Enteropathy-Associated T-cell
Lymphoma (EATL)Lymphoma (EATL)
Rubio–Tapia A et al. Gastroenterology NOVEMBER 2009;137:88–93
Increased Prevalence and Mortality in Undiagnosed Celiac Disease
Diagnostic Testing (cost-Diagnostic Testing (cost-effective )effective )
CBCCBC albumin, electrolytes , LFT, albumin, electrolytes , LFT, vitamin Evitamin E etc etc stool stool
wbc/rbc/fatwbc/rbc/fat
ova / parasitesova / parasites
elastaseelastase breath test/ sweat testbreath test/ sweat test