RT Book, Section
A1 Trier, Jerry S.
A2 Greenberger, Norton J.
A2 Blumberg, Richard S.
A2 Burakoff, Robert
SR Print(0)
ID 1119987702
T1 Intestinal Malabsorption
T2 CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071837729
LK accessmedicine.mhmedical.com/content.aspx?aid=1119987702
RD 2024/04/24
AB ESSENTIALS  OF  DIAGNOSISCeliac  disease—characteristic  though  not  specific  small  bowel  mucosal  lesion,  positive  anti–tissue  transglutaminase  test  (anti-tTGA)  or  antiendomysial  antibody  test  (anti-EMA),  and  clinical  response  to  gluten  withdrawal.  HLA-DQ2  and/or  HLA-DQ8  present  in  >99%.Tropical  sprue—appropriate  geographic  exposure;  exclude  other  mucosal  diseases  (eg,  celiac  disease  and  protozoal  infestation),  exclude  small  intestinal  bacterial  overgrowth,  and  assess  response  to  antibiotics  and  folate.Eosinophilic  gastroenteritis—histologic  demonstration  of  increased  gastric,  intestinal,  or  colonic  mucosal  or  mural  eosinophilic  infiltration  or  eosinophilic  ascites.Systemic  mastocytosis—demonstration  of  increased  mucosal  mast  cells  (>20  per  high-power  field)  in  stomach,  small  bowel,  colon;  elevated  serum  tryptase.Radiation  enteritis—history  of  radiation  with  mucosal  telangiectasias,  obliterative  endarteriolitis,  fibrosis,  and  strictures;  small  intestinal  bacterial  overgrowth  may  develop.Whipple  disease—demonstrates  Tropheryma  whipplei  and  characteristic  periodic  acid–Schiff-positive  macrophages  in  intestinal  mucosa  or  other  tissue.Small  intestinal  bacterial  overgrowth—document  evidence  of  malabsorption,  positive  breath  test  (lactulose,  glucose)  or  culture  of  jejunal  aspirate  if  available,  response  to  antibiotics.Short  bowel  syndrome—history  of  small  bowel  resection  and  confirmation  by  imaging  (barium  contrast  small  bowel  series  or  computed  tomographic  enterography).Intestinal  lymphangiectasia—hypoproteinemia,  lymphopenia,  evidence  of  protein-losing  enteropathy,  increased  fecal  loss  of  α1-antitrypsin.