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

13. 3 MAJOR TYPES of chronic diarrhea  Impaired Intraluminal Digestion  Impaired Intestinal Malabsorption  Diarrhea due to Fermentation

16. CF Pancreatic Pathobiology

17. Cystic Fibrosis Pancreas Plugged Duct Inflammation Fibrosis

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

19. 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

20. 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!

25. Endoscopic Features

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

30. Celiac Hepatology Orthopedics Endocrinology Gynecology Dermatology Oncology Dentistry Neurology Psychiatry

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

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

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

37. 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

39. Thanks

41. OBAMAS HEALTH PLAN Gastroenterological perspectives