28. Cases Flashcards
What are the main sx of celiac disease?
Main extraintestinal manifestation?
FTT, fatigue, diarrhea, flatulence, weight loss
Dermatitis herpetiformis
Diagnosis of celiac disease?
Anti-deaminated gliadin, tissue trans-glutaminase, endomysial IgA (also IgG for deam gliadin)
Confirmatory biopsy
Celiac disease increases the risk for what malignancy?
T cell lymphoma
What HLA is associtated with celiac disease?
HLA DQ2
HLA DQ8
What marker identifies T cell specificity in celiac disease?
NKG2D
Definitive dx of celiac sprue must include:
- Clinical documentation of malabsorption
- Small bowel biopsy
- Improvement in sx in and histology with GFD
What is the drug that is most commonly used for IBD?
Infliximab (anti-TNFalpha)
Who more commonly gets crohn’s disease?
Association with smoking
Caucasians and women
Smoking is a risk factor
What is the gross morphology of an intestine with Crohn disease?
Creeping fat
Wall thickening and narrowed lumen
Linear ulcers
Cobblestone mucosa
What are the microscopic features seen in Crohns
Skip lesions Crypt acscess Architectural distortion Transmural inflammation Granulomas (50%)
What are the main complications of Crohn’s disease?
Fibrosing strictures Fistulas Protein losing enteropathy Malabsoprtion and pernicious anemia Steatorrhea Increased risk for GI cancer
What are the extraintestinal manifestations of Crohn’s
Migratory polyarthritis Sacroilitis Ankylosing spondylatitis Erythema nodosum Uveitis Systemic amyloidosis
UC is limited to the colon with __% having backwash ileitis in severe pancolitis
10%
Gross morphology of UC
Reg, granular, friable mucosa
Ulceration
Pseudopolyps
Non-thickened wall **
Microscopic features of UC
Cryptitis and crypt abscesses
No granulomas
Inflammation limited to mucosa and submucosa
Architectural distortion
What are the main complications of UC?
Toxic megacolon
Bowel perforation
Uncontrollable C. diff infection
GI carcinoma
What does inflammation in UC progress through to carcinoma?
Dysplasia
What are the extraintestinal manifestations of UC?
Migratory polyarthritis Sacroilitis Ankylosing spondylitis Uveitis Pericholangitis Primary sclerosing cholangitis **
Does Crohn’s or UC have skip lesions?
Crohns
Does Crohn’s or UC have the potential for toxic megacolon?
UC
Does Crohn’s or UC have the potential for perianal fistula?
Crohns
Does Crohn’s or UC have the potential for fat/vitamin malabsorption?
Crohns
Does Crohn’s or UC have recurrence after surgery?
Crohns
Does Crohn’s or UC have inflammation limited to the mucosa?
UC
Does Crohn’s or UC have wall thickening?
Crohns
Does Crohn’s or UC have strictures?
Crohns
What is a pseudomembrane?
Plaque-like adhesion of fibrinopurulent necrotic debris overlying sites of mucosal injury
How is the diagnosis of pseudomembranous colitis made?
Detection of the toxin in the stool
