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Clin Med II - GI > Celiac, IBS, Polyps Maclary > Flashcards

Celiac, IBS, Polyps Maclary Flashcards

1
Q

What is celiac disease?

A

Malabsorption disorder caused by an immunologic response to gluten

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2
Q

What is gluten?

A

Storage protein found in wheat, barley, rye

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3
Q

What is the problem with gluten?

A

Gliadin (a component of gluten)

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4
Q

What populations are most affected by celiac disease?

A

Whites of Northern European ancestry

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5
Q

Etiology of celiac disease?

A
  • Cause unknown
  • Environmental (gluten)
  • Genetics (10% in first degree relatives)
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6
Q

What do symptoms of celiac disease depend on?

A
  • How much of SI is affected (delayed diagnosis results in more of intestine affected)
  • Age at diagnosis
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7
Q

Fatigue and pallor may relate to which nutrient deficiency?

A

Iron deficiency anemia

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8
Q

Easy bruising may indicate which nutrient deficiency?

A

Vit K deficiency

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9
Q

Hyperkeratosis may indicate which nutrient deficiency?

A

Vit A deficiency

skin cell turnover

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10
Q

Peripheral neuropathy may indicate which nutrient deficiency?

A

Vit B12 deficiency

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11
Q

Define steatorrhea

A

Presence of a lot of fat in the stool

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12
Q

What condition may coincide with celiac disease?

A

Lactose intolerance

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13
Q

What is a cutaneous variant of celiac disease?

A

Dermatitis herpetiformis

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14
Q

How does dermatitis herpetiformis present?

A
  • Pruritic papulovesicles over extensors of extremities, trunk, scalp, neck
  • Little to no GI symptoms
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15
Q

What does a small intestine biopsy of dermatitis herpetiformis show?

A

Histology consistent with celiac

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16
Q

How is dermatitis herpetiformis treated?

A

Dapsone

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17
Q

What is the gold standard for diagnosing celiac disease?

A

Small intestine biopsy (taken from proximal and distal duodenum)

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18
Q

Describe celiac serology

A

Blood test to check for:

  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
  • Both are highly sensitive and specific SO
  • If negative, celiac disease is ruled out
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19
Q

Treatment of celiac disease

A
  • Strict elimination of gluten from the diet
  • Correct any nutritional deficiencies
  • Support groups
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20
Q

When will symptoms of celiac disease improve after eliminating gluten from diet?

A

Within a few weeks

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21
Q

When do antibody levels become undetectable after removing gluten from diet?

A

3-12 months

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22
Q

What does celiac disease increase the incidence of?

A
  • GI and non GI cancer

- Intestinal lymphoma

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23
Q

What is celiac disease associated with?

A
  • T1DM
  • Down Syndrome
  • Turner’s Syndrome
  • Other autoimmune diseases
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24
Q

What is IBS characterized by?

A

Abdominal pain and altered bowel habits

25
Q

What are the criteria required to diagnose IBS?

A
  • ROME criteria
  • Must have abdominal pain AND 2 out of 3 below:
    1. Relief with defecation
    2. Onset a/w a change in BM frequency
    3. Onset a/w change in BM appearance
  • Symptoms must be present for at least 3 months
26
Q

What populations are most affected by IBS and when is onset typically?

A
  • Females

- Onset late teens, early 20s

27
Q

Etiologies of IBS?

A

Could be:

  • Abnormal motility (primary motility disorder or secondary reaction to stress)
  • Visceral hypersensitivity (low pain tolerance)
  • Enteric infection (after episode of bacterial gastroenteritis)
  • Psychosocial
28
Q

What is the psychosocial aspect of IBS?

A

More than 50% of IBS patients have underlying depression, anxiety, somatization

29
Q

How long must symptoms be present for before diagnosing IBS?

A

At least 3 months

30
Q

How does abdominal pain present in IBS?

A
  • Intermittent
  • Crampy
  • Lower abdomen
  • Relieved by defecation
31
Q

Types of IBS

A
  • Diarrhea
  • Constipation
  • Mixed
32
Q

When should stool be collected in your workup for possible IBS?

A

If a pt has traveled recently

33
Q

IBS symptoms that should be cause for concern of something more serious:

A
  • Acute onset after 40-50 yo
  • Nocturnal diarrhea
  • Hematochezia
  • Weight loss and fever
  • Fam hx colon cancer, IBD, celiac disease
34
Q

If someone has predominantly diarrhea IBS, evaluate for:

A

Celiac disease

35
Q

Supportive treatment of IBS

A
  • Educate and support pt
  • Reinforce chronic nature
  • Move away from trying to find a cause
  • Make a plan for pt to cope with symptoms
  • Diet therapy
36
Q

What is the diet therapy for IBS?

A
  • Avoid fatty foods and caffeine
  • Address lactose intolerance if present
  • Certain carbs, fruits, veggies can worsen gas and bloating
37
Q

When is pharmacotherapy used in IBS?

A

Reserved for patients with severe symptoms

38
Q

Pharmacotherapy of IBS

A
  • No standard drug and meds are aimed to tx symptoms
  • Anti spasmodics, anti cholinergics (dicyclomine)
  • Anti diarrheal (immodium)
  • Anti constipation, osmotic laxatives (MOM, linaclotide)
  • Tricyclic antidepressants
  • Probiotics
39
Q

Define lactose intolerance

A

Inability to digest lactose due to a shortage of lactase

40
Q

What is lactose?

A

Sugar primarily found in milk and dairy products

41
Q

What is lactase?

A

Enzyme found in small intestine that is necessary for lactose digestion

42
Q

How do levels of lactase vary in humans?

A

High levels present at birth but steadily decline over time

43
Q

Which populations are more likely to have lactose intolerance?

A

Mostly NON European ancestry (Asians, AAs, Native Americans, Mexican, Jewish)

44
Q

Etiology of lactose intolerance

A
  • Genetic

- Secondary to GI disease or surgery affecting proximal small intestinal mucosa (Crohn’s, Celiac, trauma)

45
Q

Pathophys of lactose intolerance

A
  • Malabsorbed lactose is fermented by intestinal bacteria producing gas and organic acids
  • Non metabolized lactose and organic acids increase stool osmotic load (resulting in diarrhea)
46
Q

How is lactose intolerance diagnosed?

A
  • Trial of lactose free diet

- Hydrogen breath test

47
Q

What is the hydrogen breath test?

A
  • To diagnose lactose intolerance
  • Pt ingests 50g lactose
  • Positive test is a rise in breath hydrogen of 20+ ppm within 90 mins
48
Q

What does a positive result of hydrogen breath test indicate?

A

Bacterial carbohydrate metabolism

49
Q

Treatment of lactose intolerance

A
  • Lactose free diet
  • Milk pretreated with lactase
  • Lactase enzyme replacement (Lactaid)
  • Consider Ca supplement for pts with a very lactose restrictive diet
50
Q

Describe complete lactose intolerance

A

Complete intolerance is rare, so many pts can tolerate a small intake of lactose

51
Q

Define colon polyp

A

Small clump of cells that form in lining of colon

52
Q

Which populations are at greater risk of developing colon polyps?

A
  • Men
  • Developed nations (high fat diet, red meat, low fiber, cigs, obesity)
  • Genetic predisposition
53
Q

Define hyperplastic colon polyps

A
  • Small
  • Located in rectum or sigmoid colon
  • No malignancy potential
54
Q

Define adenomatous colon polyps

A
  • MC type of colon polyp

- Larger lesion is higher risk for cancer

55
Q

Which type of colon polyp is MC?

A

Adenomatous

56
Q

How are types of colon polyps differentiated?

A

Need a biopsy!

57
Q

What is the best way to visualize and remove suspicious polyps?

A

Colonscopy

58
Q

Define polypectomy and risks

A
  • Removal of polyp via colonoscopy

- Risks of perforation and bleeding

Clin Med II - GI (17 decks)

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