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Food Allergies

Gluten intolerance

• Gluten – a protein found in some grains like wheat, barley and rye
• Celiac disease occurs in 1-2% – https://www.physicianassistantexamreview.com/e85-small-bowel-and-a-job-hunt-tip/
• Gluten sensitivity or intolerance 0.5-13%
• Gluten intolerance does create an immune response, but it does not obviously damage the vili in the small intestine.

Clinical Presentation

• Bloating
• Gas
• Abdominal pain
• Diarrhea
• Fatigue
• Recurring headaches
• Unexpected weight loss
• Muscular aches and pains
  • Often diagnosed as fibromyalgia
• Dermatitis

Labs and Studies

• There are no labs to or studies available to confirm the diagnosis
• A good patient history
• Eliminating gluten from the diet

Treatment

• A strict gluten free diet should reduce symptoms

Lactose Intolerance (Lactase deficiency )

• Lactose is a carbohydrate found in dairy products
• Lactase is the enzyme that breaks down lactose into glucose and galactose for absorption
• If the lactose is not broken down it does not get absorbed in the small intestine
• The bacteria in the large bowel will happily ferment lactose

Clinical Presentation

• After I eat dairy I get
  • Diarrhea
  • Bloating
  • Flatulence
  • Nausea
  • Abdominal cramps
  • Excessive borborygmi

Labs and Studies

• Good patient history
• Lactose challenge
  • Measure serum glucose
  • Oral lactose ingested
  • Monitor for symptoms
  • Measure serum glucose at one and two hours post ingestion
    • Lactose intolerant patients will not have a rise in serum glucose
• Hydrogen breath test
  • Oral lactose ingested
  • Measure expired hydrogen at 2,3 and 4 hours post ingestion
    • Lactose intolerant patients will elevated expired hydrogen

Treatment

• Strict non dairy diet

Nut Allergies

Clinical Presentation

• Young children – Atopic dermatitis – Nausea – Vomiting – Diarrhea
  • Older children and adults
    • Explosive urticaria
    • Anaphylaxis
    • Syncope

Labs and Studies

• Good history
• Food diary
• Allergen specific serum Ige testing
• Skin testing
• Eliminating foods from the diet

Treatment

• Eliminating foods from the diet
• Antihistamines
• Corticosteroids for acute reactions
• Epinephrine for severe reactions

Vitamins

• Vitamins are covered in other areas of the blueprint including Neurology and Hematology. I am not, therefore, listing all of the vitamins here with the vitamins presenting symptoms for both a deficiency and an overdose. I do not think that would be the best use of your time and resources as it applies to passing your exams.

Obesity

• BMI > 30
• BMI > 35 is severe obesity
• BMI > 45 is super obesity
• The leading cause of preventable death worldwide

Correlated with

• Cardiovascular disease
• Type 2 DM
• Sleep Apnea
• Cancer
• Osteoarthritis
• Cholelithiasis
• Cirrhosis
• Depression

Treatment

• Changes in diet
• Changes in physical activity
• Bariatric surgery