28. Cases

Question 1

What are the main sx of celiac disease?

Main extraintestinal manifestation?

Answer 1

FTT, fatigue, diarrhea, flatulence, weight loss

Dermatitis herpetiformis

Question 2

Diagnosis of celiac disease?

Answer 2

Anti-deaminated gliadin, tissue trans-glutaminase, endomysial IgA (also IgG for deam gliadin)
Confirmatory biopsy

Question 3

Celiac disease increases the risk for what malignancy?

Answer 3

T cell lymphoma

Question 4

What HLA is associtated with celiac disease?

Answer 4

HLA DQ2

HLA DQ8

Question 5

What marker identifies T cell specificity in celiac disease?

Answer 5

NKG2D

Question 6

Definitive dx of celiac sprue must include:

Answer 6

1. Clinical documentation of malabsorption
2. Small bowel biopsy
3. Improvement in sx in and histology with GFD

Question 7

What is the drug that is most commonly used for IBD?

Answer 7

Infliximab (anti-TNFalpha)

Question 8

Who more commonly gets crohn’s disease?

Association with smoking

Answer 8

Caucasians and women

Smoking is a risk factor

Question 9

What is the gross morphology of an intestine with Crohn disease?

Answer 9

Creeping fat
Wall thickening and narrowed lumen
Linear ulcers
Cobblestone mucosa

Question 10

What are the microscopic features seen in Crohns

Answer 10

Skip lesions 
Crypt acscess
Architectural distortion
Transmural inflammation
Granulomas (50%)

Question 11

What are the main complications of Crohn’s disease?

Answer 11

Fibrosing strictures 
Fistulas 
Protein losing enteropathy
Malabsoprtion and pernicious anemia
Steatorrhea
Increased risk for GI cancer

Question 12

What are the extraintestinal manifestations of Crohn’s

Answer 12

Migratory polyarthritis 
Sacroilitis 
Ankylosing spondylatitis 
Erythema nodosum
Uveitis 
Systemic amyloidosis

Question 13

UC is limited to the colon with __% having backwash ileitis in severe pancolitis

Answer 13

10%

Question 14

Gross morphology of UC

Answer 14

Reg, granular, friable mucosa
Ulceration
Pseudopolyps
Non-thickened wall **

Question 15

Microscopic features of UC

Answer 15

Cryptitis and crypt abscesses
No granulomas
Inflammation limited to mucosa and submucosa
Architectural distortion

Question 16

What are the main complications of UC?

Answer 16

Toxic megacolon
Bowel perforation
Uncontrollable C. diff infection
GI carcinoma

Question 17

What does inflammation in UC progress through to carcinoma?

Answer 17

Dysplasia

Question 18

What are the extraintestinal manifestations of UC?

Answer 18

Migratory polyarthritis 
Sacroilitis
Ankylosing spondylitis 
Uveitis 
Pericholangitis
Primary sclerosing cholangitis **

Question 19

Does Crohn’s or UC have skip lesions?

Answer 19

Crohns

Question 20

Does Crohn’s or UC have the potential for toxic megacolon?

Answer 20

UC

Question 21

Does Crohn’s or UC have the potential for perianal fistula?

Answer 21

Crohns

Question 22

Does Crohn’s or UC have the potential for fat/vitamin malabsorption?

Answer 22

Crohns

Question 23

Does Crohn’s or UC have recurrence after surgery?

Answer 23

Crohns

Question 24

Does Crohn’s or UC have inflammation limited to the mucosa?

Answer 24

UC

Question 25

Does Crohn’s or UC have wall thickening?

Answer 25

Crohns

Question 26

Does Crohn’s or UC have strictures?

Answer 26

Crohns

Question 27

What is a pseudomembrane?

Answer 27

Plaque-like adhesion of fibrinopurulent necrotic debris overlying sites of mucosal injury

Question 28

How is the diagnosis of pseudomembranous colitis made?

Answer 28

Detection of the toxin in the stool