MALABSORPTION MICHAEL WILSCHANSKI MICHAEL WILSCHANSKI PEDIATRIC GASTROENTEROLOGY UNIT PEDIATRIC GASTROENTEROLOGY UNIT HADASSAH UNIVERSITY HOSPITAL HADASSAH.

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Presentation transcript:

MALABSORPTION MICHAEL WILSCHANSKI MICHAEL WILSCHANSKI PEDIATRIC GASTROENTEROLOGY UNIT PEDIATRIC GASTROENTEROLOGY UNIT HADASSAH UNIVERSITY HOSPITAL HADASSAH UNIVERSITY HOSPITAL FOURTH YEAR STUDENTS 2013

3 MAJOR TYPES of chronic diarrhea  Impaired Intraluminal Digestion  Impaired Intestinal Malabsorption  Diarrhea due to Fermentation

CF Pancreatic Pathobiology

Cystic Fibrosis Pancreas Plugged Duct Inflammation Fibrosis

Range of Pancreatic Function (% of Control Mean) 100% Control PI PS 1-20

l 10-15% of patients l Meconium ileus rare l Diagnosis in childhood/adulthood l Nutritionally normal l Milder lung disease l Liver disease rare l 15-20% pancreatitis l 85-90% of patients l 10-25% meconium ileus l Diagnosis in infancy/ childhood l Risk of malnutrition l More severe lung disease l 5-7% overt liver disease l No pancreatitis Pancreatic Function Status Pancreatic Insufficiency Pancreatic Sufficiency

Porcine pancreatin Microencapsulated Pancreatic enzyme preparations To allow for gastric emptying together with meal nutrients To prevent acidic denaturation Administered with / at start of the meal In young children contents mixed with acidic food (apple sauce) < 10,000 U/kg!

Endoscopic Features

The Celiac Iceberg Symptomatic Celiac Disease Silent Celiac Disease Latent Celiac Disease Genetic susceptibility: - DQ2, DQ8 Positive serology Manifest mucosal lesion Normal +/- Mucosa

Celiac Hepatology Orthopedics Endocrinology Gynecology Dermatology Oncology Dentistry Neurology Psychiatry

Involve the secondary dentition May be the only presenting sign of Celiac Disease Dental Enamel Defects

Celiac Disease Complicated by Enteropathy-Associated T-cell Lymphoma (EATL)

Rubio–Tapia A et al. Gastroenterology NOVEMBER 2009;137:88–93 Increased Prevalence and Mortality in Undiagnosed Celiac Disease

Diagnostic Testing (cost- effective )  CBC  albumin, electrolytes, LFT, vitamin E etc  stool wbc/rbc/fat wbc/rbc/fat ova / parasites ova / parasites elastase elastase  breath test/ sweat test

Thanks

OBAMAS HEALTH PLAN Gastroenterological perspectives