Unknown

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Unknown 114
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Case Presentation

• A 53-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 two
  or three bowel movements each day.
• PMHx hypothyroidism
• Soc Hx no smoking, ETOH, no travel hx, has a
  dairy-free diet
• Fam Hx non-contributory

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R.O.S

• 2.7 kg (6 lb) weight loss during this time.
• The patient is postmenopausal, no abnormal
  vaginal bleeding.
• No rectal bleeding, melena, or hematochezia

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Physical and studies

• 9.8
• 6.5 250
• MCV 85
• RDW 19 (nml 11.5-14.5)
• Fe 8 (nml gt 10)
• Anti-tTg IgA- negative
• Chem wnl
• LFTs wnl
• Stool Cx wnl
• Bone density - osteopenia

• Gen NAD
• CV RRR, S1, S2
• Pulm CTA B
• Abd s/nt/nd,no w/r/r
• Ext no c/c/e

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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

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Answer
7
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

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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

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Clinical Manifestations

• In adults, womengtmen
• Diarrhea
• Abdominal pain or discomfort
• Iron-deficiency anemia
• Osteoporosis
• Others constipation, neurologic symptoms,
  dermatitis herpetiformis, hypoproteinemia,
  hypocalcemia

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Diagnosis

• Serologic testing
• Antigliadin antibody
• Antiendomysial antibodies
• Anti tissue transglutaminase antibodies
• Small bowel biopsy
• Intraepithelial lymphocytosis
• Crypt hyperplasia
• Villous atrophy
• Response to gluten-free diet

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Duodenal mucosa in celiac
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Treatment

• Nutritional therapy
• Assess for vitamin deficiencies
• Osteoporosis screening

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Complications

• Intestinal adenocarcinoma
• Enteropathy associated T-cell lymphoma
• Refractory sprue

OBJECTIVE Confirm a suspected case of celiac
sprue