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  #1  
Old 07-22-2013
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Default Malabsorption question

A 15 month old girl is brought to the physician because of a 3 month history of poor weight gain and foul-smelling, greasy, loose stools. She was hospitalized for bacterial pneumonia at the age of 1 year. Her diet consists of cow's milk and table food. She is at the 25th percentile for length and 10th percentile for weight.
Hct 32%
leukocyte count 11,100
seg 55%
lympho 40%
mono 5%
plt 325,000

Na 140
Cl 100
K 3.8
Hco3 22
BUN 10
glucose 80
Cr 0.4
Total protein 6
albumin 3.6

72-hour fecal fat 1.8g/24h

'which of the following is the most likely underlying mechanism for this patient's poor weight gain?'

a. absence of bowel wall ganglion cells
b. absence of small bowel villi
c. bowel ischemia
d. decrerased bilirubin conjugation
e. decreased pancreatic enzyme secretion
f. dilation of intestinal lymphtic vessels
g. hypertrophy of pyloric sphincter
h. increeased cilirunin production
i. increased bowel motility
j. osmotic diarrhea
k. secretory diarrhea






Now apparently the answer is E, due to cystic fibrosis. But my doubt is, is 1 bout of bacterial pneumonia enough to think its most likely cystic fibrosis? I think its equally likely to be celiac disease (option B), because with celiac malabsorption, there will be failure to thrive, and that will explain the bacterial pneumonia too.
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Old 07-22-2013
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Fecal fat gives it away dont you think?
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Old 07-22-2013
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Sorry just checked fecal fat is also seen in Celiac disease...
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Old 07-22-2013
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they are looking at the MCC of malabsorption in a kid with fecal fat - statistically it is CF.
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Old 07-22-2013
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Its CF!

pneumonia + fat malabsorbtion + low percentiles + low hct
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Old 07-22-2013
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Quote:
Originally Posted by Sadde View Post
they are looking at the MCC of malabsorption in a kid with fecal fat - statistically it is CF.
Hmm that sounds fair. If statistically it is CF then i guess i can't complain :-D
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Quote:
Originally Posted by DocSikorski View Post
Its CF!

pneumonia + fat malabsorbtion + low percentiles + low hct
All of the above you mentioned could be seen in celiac disease too. There was only one bout of pneumonia, which can happen in celiac disease when the child shows failure to thrive as well.

But as Sadde said, statistically it is the MCC of malabsorption in children. So thats why CF is the answer.
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Old 07-23-2013
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It should has several bouts of pneumonia but its age too young. If there is no that occurrence of pneumonia, the answer will be colic disease, including other s/s of it and diagnostic antibodies.
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Old 07-23-2013
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Embarrassed MCC

As what was told above, they mainly look for whats the MCC - in this case CF.

Just the same as when they ask a Q --> a 2yr old kid presenting with dark brown stool so u need to think -> MCC is meckels diverticulum
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Quote:
Originally Posted by rohit39 View Post
All of the above you mentioned could be seen in celiac disease too. There was only one bout of pneumonia, which can happen in celiac disease when the child shows failure to thrive as well.

But as Sadde said, statistically it is the MCC of malabsorption in children. So thats why CF is the answer.

Correct me if I'm wrong - but I do not see celiac disease (or tropical sprue) in your answer choices...
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Quote:
Originally Posted by DocSikorski View Post
Correct me if I'm wrong - but I do not see celiac disease (or tropical sprue) in your answer choices...
Option B) Absence of small bowel villi. Thats Celiac disease.
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blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts.

Blunting, not absence*
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Quote:
Originally Posted by DocSikorski View Post
blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts.

Blunting, not absence*
You are quite an observant person dear sir/madam! I doff my hat to you.
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  #14  
Old 07-23-2013
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Default CF

CF leads to both poor weight gain and decrease in length, if they want you to answer celiac disease, they have to give you either family history or skin lesions or biopsy.
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