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HN 612 Chapter 27 - Chapter 27 Lower GI Disorders part 2 1...

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Chapter 27: Lower GI Disorders part 2 1. Diseases of the Small Intestine a. Celiac Disease: Gluten-sensitive Enteropathy i. Causes: Adverse reaction to gluten, gliadin fraction 1. Inappropriate T cell-mediated autoimmune response to ingestion of gluten by genetically predisposed people 2. Antigen-presenting molecules HLA-DQ2 and HLA-DQ8 haplotypes are expressed and bind to gluten peptides 3. T Cells a. Present gluten peptide molecules b. Produce cytokines that start inflammatory and autoimmune reaction c. Stimulate plasma cells to produce antibioties to gliadin, transglutaminase, and endomysium ii. Prevalence: 1 in 133 persons in US iii. Diagnosis: 1. Combination of clinical, laboratory, and histologic evaluations 2. Small bowel biopsy: upper GI endoscopy – final confirmation 3. New technology using swallowed capsules that provide images of mucosa 4. Peak Diagnosis: 30-60 years of age 5. Diagnosis delayed by silent forms of disease 6. May be misdiagnosed for years as: a. Irritable bowel b. Lactase deficiency c. Gallbladder disease iv. Results of the autoimmune inflammatory response: 1. Intestinal mucosa damage 2. Malabsorption of nutrients a. Become deficient in disaccharidases and peptidases and carriers 3. Iron deficiency 4. Osteomalacia 5. Growth failure
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6. Projectile vomiting v. Characteristics: 1. Celiac disease is a complex health disorder that has six characteristics vi. Chronic: 1. Requires lifelong omission of gluten from diet vii. Digestive: 1. inflames and damages small bowel viii.Autoimmune: 1. Produces self-destructive antibiodies ix. Malabsorptive: 1. Interferes with nutrient absorption x. Multi-systemic: 1. May harm any part of our body 2. MNT for Celiac Disease a. Omit sources of gluten: wheat, rye, barley, and perhaps oats b. Use uncontaminated corn, potato, rice, soybean, tapioca, amaranth, quinoa, millet, and buckwheat c. Major life change d. Label reading necessary e. Clinical symptoms abated within weeks f. Antibiodies undetectable in 3-6 mo g. Strict adherence to diet is important i. Gluten causes mucosal changes within hours ii.
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