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Gastroenterology > Celiac Disease & Inflammatory Bowel Disease > Flashcards

Celiac Disease & Inflammatory Bowel Disease Flashcards

1
Q

what is the primary site of absorption?

A

small intestine

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2
Q

permanent dietary disorder characterized by an inappropriate immunologic response to gluten that results in diffuse damage to proximal small intestines with malabsorption of nutrients and extra-GI symptoms

A

celiac disease

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3
Q

when does celiac disease become symptomatic?

A

when gluten stimulates inappropriate response against the intestinal mucosa

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4
Q

a 1 yo patient presents with diarrhea, steatorrhea, weight loss, abdominal distention, weakness, muscle wasting, or growth retardation. Dx?

A

celiac disease

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5
Q

what 4 symptoms can a child >2 yo or adult present with if they have celiac disease?

A

chronic diarrhea
dyspepsia
flatulence
malabsorption

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6
Q

what are 9 extra-intestinal symptoms that can present in celiac disease?

A

fatigue
rash
depression
iron deficiency anemia
osteoporosis
short stature
delayed puberty
amenorrhea
reduced fertility

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7
Q

how does vit K deficiency caused by malabsorption of celiac disease present?

A

easy bruising

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8
Q

how does calorie deficiency caused by malabsorption of celiac disease present?

A

loss of muscle and subcutaneous fat

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9
Q

how does iron, folate, and vit B12 deficiencies caused by malabsorption of celiac disease present? (2)

A

pallor
anemia

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10
Q

how does vit A deficiency caused by malabsorption of celiac disease present?

A

hyperkeratosis

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11
Q

how does calcium deficiency caused by malabsorption of celiac disease present? (2)

A

bone pain + osteomalacia

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12
Q

how does vit B1, B12 or vit E deficiencies caused by malabsorption of celiac disease present? (3)

A

peripheral neuropathy
ataxia
encephalopathy

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13
Q

what is an atypical skin finding in celiac disease?

A

dermatitis herpetiformis

pruritic, erythematous maculopapular rash over extensor surfaces of extremities, trunk, scalp and neck

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14
Q

what’s important to note about almost all patients with a rash?

A

have evidence of celiac disease on intestinal biopsy

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15
Q

what is the preferred lab to diagnose celiac disease?

A

IgA tTG

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16
Q

what is a second choice lab to diagnose celiac disease?

A

EMA-IgA

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17
Q

levels of IgA tTG and EMA-IgA become undetectable how long after removal of gluten from diet?

A

3-12 months

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18
Q

what is the confirmatory test for celiac disease in patients with a + serological test?

A

endoscopic mucosal biopsy of proximal duodenum

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19
Q

when can an endoscopic mucosal biopsy of the proximal duodenum give a false negative?

A

if the patient has been on gluten-free diet for 3-12 months

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20
Q

what are the treatment options for celiac disease? (2)

A

removal of all gluten from diet
steroids + immunomodulator meds if refractory

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21
Q

which patients with celiac disease have an increase in intestinal lymphoma and cancers of the mouth, pharynx, and esophagus? (3)

A

maintain a normal diet
only adhere to reduced gluten diet
have refractory disease

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22
Q

what are the 2 major disorders of inflammatory bowel disease (IBD)?

A

ulcerative colitis
crohn disease

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23
Q

what are 2 risk factors for IBD?

A

genetics
NSAID use

24
Q

cigarette smoking has an increased association with __________

A

crohn disease

25
Q

cigarette smoking has a decreased association with __________

A

ulcerative colitis

26
Q

diet high in processed, fried, and sugary foods increases the risk for _____

A

crohn disease

27
Q

obesity increases _______ severity

A

crohn disease

28
Q

insidious, chronic inflammatory condition with transmural inflammation and skip lesions most commonly throughout the ileum and proximal large intestine

A

crohn disease

29
Q

a patient presents with fatigue, weight loss, rash, eye problems, SOB, diarrhea +/- blood, abdominal pain, mouth, joint, and anal pain. Dx?

A

crohn disease

30
Q

where is abdominal tenderness felt in a patient with crohn disease? why?

A

RLQ
involves the proximal small bowel

31
Q

what will labs show in a patient with crohn disease? (3)

A

electrolyte/nutritional deficiency
elevated CRP/ESR
+ fecal leukocytes

32
Q

what is the 1st line diagnostic for crohn disease?

A

colonoscopy

33
Q

what will a colonoscopy show in a patient with crohn disease?

A

patchy, skip lesions of inflammation in large and distal small intestine

34
Q

in which case should a colonoscopy be avoided in a patient with crohn disease and ulcerative colitis?

A

in severe acute cases d/t possible perforation

35
Q

what is the 2nd line diagnostic for crohn disease?

A

CT / MR enterography

36
Q

what is the diet treatment for crohn disease? (4)

A

small, frequent meals
refer to nutritionist
avoid fatty foods
maintain hydration

37
Q

what is the 1st line induction medication for mild-moderate crohn disease of the ileum/proximal colon?
alternative?

A

PO budesonide (steroid)

PO mesalamine (5-ASA)

38
Q

what is the 1st line induction medication for mild-moderate crohn disease of the left colon or diffuse colitis?
alternative?

A

PO prednisone

PO sulfasalazine (pro-5-ASA)

39
Q

what are the 1st line induction medications for moderate-severe crohn disease? (3)

A

infliximab + methotrexate +/- PO prednisone

40
Q

what is the 1st line maintenance medication for mild-moderate crohn disease?

A

PO mesalamine (5-ASA)

41
Q

what is the 1st line maintenance medication for mild-moderate crohn disease of the left colon or diffuse colitis?

A

PO sulfasalazine (pro-5-ASA)

42
Q

what is the 1st line maintenance medication for moderate-severe crohn disease?

A

infliximab

43
Q

what are 5 indications for surgery in crohn disease?

A

no response to therapy
abscess formation
massive bleeding
fistula
obstructions

44
Q

what is the recurrence of crohn disease of patients within 1 year post surgery?

A

60%

45
Q

chronic inflammatory condition with relapsing and remitting inflammation limited to the mucosal layer of the colon; involves the rectum and extends proximally to involve other parts of the colon

A

ulcerative colitis

46
Q

a patient presents with bloody diarrhea, abdominal pain/cramping, fecal urgency and tenesmus, +/- weakness and fatigue from blood loss. Dx?

A

ulcerative colitis

47
Q

where would abdominal tenderness be present in a patient with ulcerative colitis?

A

LLQ

48
Q

what will labs show in a patient with ulcerative colitis? (4)

A

anemia
increased CRP + ESR
decreased albumin
+ fecal leukocytes

49
Q

what is the 1st line diagnostic for ulcerative colitis? what will it show?

A

colonoscopy

diffuse mucosal inflammation involving the colon

50
Q

what is a 2nd diagnostic to diagnose ulcerative colitis?

A

sigmoidoscopy

51
Q

what is the 1st line induction treatment for mild-moderate ulcerative colitis of the distal colon?

A

topical mesalamine (5ASA)

52
Q

what is the 1st line induction treatment for mild-moderate ulcerative colitis of the extensive colon? (2)

A

topical + PO mesalamine (5-ASA)

53
Q

what is the treatment for ulcerative colitis that is refractory to 5-ASA?

A

steroids

54
Q

what is the treatment for ulcerative colitis that is refractory to steroids?

A

infliximab

55
Q

what is the maintenance treatment for ulcerative colitis?

A

topical mesalamine (5-ASA)

56
Q

what are 4 complications of ulcerative colitis?

A

perforation
colon infection
toxic megacolon
colon cancer

57
Q

what provides complete cure of ulcerative colitis but requires ileostomy?

A

total proctocolectomy

Gastroenterology (26 decks)

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