TASK: Identify a digestive disorder that is closely linked to a particular time

Question

TASK:

Identify a digestive disorder that is closely linked to a particular time or place.

For example, a lower incidence of colorectal cancer has been documented in parts of the world where the local diet consists primarily of fresh fruits and vegetables with low consumption of cooked red meat. (Note: colorectal cancer is an example—please do not use this disorder in your discussion.)

CONTENT:

Discuss the causes and symptoms of your chosen disorder and possible treatment options.

Include information on the role of diet in mitigating or treating symptoms of the disorder

Explanation / Answer

Digestive disorder: Whipple disease

Whipple disease is a rare (less than 1 million cases in a year) bacterial infection caused by Tropheryma whipplei that affects the small intestine. It can spread to any organ in the body but commonly affects the joints, CNS, heart, eyes, and lungs and can be fatal if left untreated.

Tropheryma whipplei is found in soil and sewage wastewater. Even healthy individuals may have this bacterium in their body but they do not get sick. This disease is not transmitted by humans.

It is characterized by lesions (internal sores) in the small intestine. The brush border of the intestine (the villi) gets damages and absorption of nutrients is impaired, causing malnutrition and diarrhoea.

Whipple disease is more common in Caucasian men between 40 and 60 years old. The condition seems to be more common in farmers and other people who work outdoors and have frequent contact with soil and sewage wastewater.

Some people may be more likely to develop Whipple disease because of genetic factors—related to genes, or traits passed from parent to child—that influence the body’s immune system. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

Symptoms, other than diarrhea and malnutrition, including

·        abnormal yellow and white patches on the lining of the small intestine

·        joint pain, with or without inflammation, that may appear off and on for years before other symptoms

·        fatty or bloody stools

·        abdominal cramps or bloating felt between the chest and groin

·        enlarged lymph nodes—the small glands that make infection-fighting white blood cells

·        loss of appetite

·        fever

·        fatigue, or feeling tired

·        weakness

·        darkening of the skin

People with a more advanced stage of Whipple disease may have neurologic symptoms—those related to the central nervous system—such as

·        vision problems.

·        memory problems or personality changes.

·        facial numbness.

·        headaches.

·        muscle weakness or twitching.

·        difficulty walking.

·        hearing loss or ringing in the ears.

·        dementia—the name for a group of symptoms caused by disorders that affect the brain. People with dementia may not be able to think well enough to do normal activities such as getting dressed or eating.

Less common symptoms of Whipple disease may include

·        chronic cough.

·        chest pain.

·        pericarditis—inflammation of the membrane surrounding the heart.

·        heart failure—a long-lasting condition in which the heart cannot pump enough blood to meet the body’s needs. Heart failure does not mean the heart suddenly stops working.

·        malabsorption. When the damaged villi do not absorb certain nutrients from food, the body has a shortage of protein, calories, and vitamins. Blood tests can show shortages of protein, calories, and vitamins in the body.

·        abnormal levels of electrolytes. Electrolytes—chemicals in body fluids, including sodium, potassium, magnesium, and chloride—regulate a person’s nerve and muscle function. A patient who has malabsorption or a lot of diarrhea may lose fluids and electrolytes, causing an imbalance in the body.

·        anemia. Anemia is a condition in which the body has fewer red blood cells than normal. A patient with Whipple disease does not absorb the proper nutrients to make enough red blood cells in the body, leading to anemia.

·        T. whipplei DNA. Although not yet approved, rapid polymerase chain reaction diagnostic tests have been developed to detect T. whipplei DNA and may be useful in diagnosis.

Doctors prescribe antibiotics that treat the infection in the small intestine and cross the blood-brain barrier—a layer of tissue around the brain. Using antibiotics that cross the blood-brain barrier ensures destruction of any bacteria that may have entered the patient’s brain and central nervous system.

Intravenous antibiotics used to treat Whipple disease may include

·        ceftriaxone (Rocephin)

·        meropenem (Merrem I.V.)

·        penicillin G (Pfizerpen)

·        streptomycin (Streptomycin)

After a patient completes the IV antibiotics, the doctor will prescribe long-term oral antibiotics. Patients receive long-term treatment—at least 1 to 2 years—to cure the infection anywhere in the body. Oral antibiotics may include

·        trimethoprim with sulfamethoxazole (Septra, Bactrim)—a combination antibiotic

·        doxycycline (Vibramycin)

People with Whipple disease require a diet high in calories and protein, vitamins, nutritional supplements.

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