Name
SPRUE, TROPICAL
DESCRIPTION
DETAIL
D.D. : 1. INADEQUATE DIGESTION - POSTGASTRECTOMY - DEFICIENCY OR INACTIVATION OF PANCREATIC LIPASE - EXOCRINE PANCREATIC INSUFFICIENCY - CRO PANCREATITIS - PANCREATIC CARCINOMA - CYSTIC FIBROSIS - PANCREATIC INSUFFICIENCY- CONGENITAL OR ACQUIRED - GASTRINOMA - ACID INACTIVATION OF LIPASE - DRUGS LIKE ORLISTAT 2. REDUCED INTRADUODENAL BILE ACID CONCENTRATION / IMPAIRED MICELLE FORMATION -* LIVER DISEASES - PARENCHYMAL LIVER DISEASE - CHOLESTATIC LIVER DISEASE * BACTERIAL OVERGROUTH IN SMALL INTESTINE - ANATOMIC STASIS LIKE AFFERENT LOOP STASIS, BLIND LOOP STASIS, STRICTURE , FISTULA - FUNCTIONAL STASIS LIKE DIABETES , SCLERODERMA, INTESTINAL PSEUDOOBSTRUCTION * INTERRUPTED INTEROHEPATIC CIRCULATION OF BILE SALTS - ILEAL RESECTION - CROHNS DISEASE * DRUGS WHICH BIND OR PRECIPITATE BILE SALTS LIKE NEOMYCIN, CHOLESTYRAMINE, CAL CARBONATE 3. IMPAIRED MUCOSAL ABSORPTION / MUCOSAL LOSS OR DEFECT * INTESTINAL RESECTION OR BYPASS * INFLAMMATION, INFILTRATION OR INFECTION - CROHNS DISEASE - AMYLOIDOSIS - SCLERODERMA - LYMPHOMA - EOSINOPHILIC ENTERITIS - MASTOCYTOSIS - TROPICAL SPRUE - CELIAC DISEASE - COLLAGENOUS SPRUE - WIPPLES DISEASE - RADIATION ENTERITIS - FOLATE & VIT B12 DEFICIENCY - INFECTIONS LIKE SALMONELLA, GIARDIASIS - GRAFT VS HOST DISEASE * GENETIC DISEASES - DISACCHARIDASE DEFICIENCY - AGAMMAGLOBULINEMIA - ABETALIPOPROTEINEMIA - HARTNUP DISEASE - CYSTINURIA 4. IMPAIRED NUTRIENT DELIVERY TO AND / OR FROM INTESTINE * LYMPHATIC OBSTRUCTION - LYMPHOMA - LYMPHANGIECTASIA * CIRCULATORY DISORDERS - CONGESTIVE HEART FAILURE - CONSTRICTIVE PERICARDITIS - MESENTERIC ARTRY ATHEROSCLEROSIS - VASCULITIS 5. ENDOCRINE & METABOLIC DISORDERS - DIABETES - HYPOPARATHYROIDISM - ADRENAL INSUFFICIENCY - HYPERTHYROIDISM - CARCINOID SYNDROMEOTHER TESTS : * CBC - MEGALOBLASTIC ANEMIA - 60% * SERUM B 12 LEVELS - REDUCED IN 60% * SERUM FOLATE LEVELS - REDUCED IN 60% * STOOL FAT CONTENT - This measures fat content over 72 hours on a diet of 80-100 g of fat. A result of more than 6 g in 24 hours is abnormal (positive for fat malabsorption). * D-Xylose absorption test - 25 g D-xylose is administered orally. In well-hydrated patients with normal renal function, abnormal results (ie, positive for mucosal malabsorption) include a 5-hour urine collection of less than 4 g and a 1-hour serum collection of less than 20 mg/dL. * BARIUM FOLLOW THROUGH - may reveal increased caliber and thickening of mucosal folds or flocculation and segmentation of barium, depending on the type of barium used * IGA ANTIENDOMYSIAL ANTIBODIES - PRESENT * SMALL INTESTINAL BIOPSY - ABSENCE OR REDUCED HEIGHT OF VILLI & INCREASED LOSS OF VILLUS CELLS.
TYPENOTES
Medical Care: " Patients with TS rarely present to the ED with the following symptoms. Unless folate or vitamin B-12 deficiencies are noted, the diagnosis will probably be made later. The symptoms require urgent evaluation and initiation replacement of deficient nutrients, fluid, and electrolytes. Hospital admission is indicated in complicated cases. Symptoms include the following: o Acute diarrhea o Volume depletion o Electrolyte imbalance o Symptomatic anemia " Without treatment, TS runs a relapsing course and can result in severe malnutrition. " Useful therapeutic interventions involve antibiotics and replacement of nutrients (eg, folic acid, vitamin B-12, iron), deficient fluid, and sometimes blood. However, despite success reported in other regions, antibiotic therapy for TS is not useful in patient populations of southern India. " Generally, administer a combination of antibiotics and folic acid to patients for 3-6 months. Patients with symptoms persisting longer than 6 months may be administered the combination for as long as a year. " Assess patients' responses by improvement of symptoms, weight gain, and correction of anemia. The duration of treatment depends on the duration of symptoms. DRUG TREATMENT : 1. VITAMINS : - FOLIC ACID - VIT B12 2. ANTIBIOTICS : - TETRACYCLINE 3. MINERALS : PATIENT WITH ANEMIA NEED IRON
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY BARIUM FOLLOW THROUGH, COMPLETE BLOOD COUNT, BIOPSY, D-XYLOSE ABSORPTION