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GI 2 > Clin Med - Celiac Dz and Diarrhea > Flashcards

Clin Med - Celiac Dz and Diarrhea Flashcards

1
Q

NCGS

A
  • non-celiac gluten sensitivity
  • diagnosis of exclusion
  • gluten reaction in which there is no allergic or autoimmune component
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2
Q

What is celiac dz?

A
  • intolerance to gluten

- autoimmune condition triggered and sustained by the ingestion of gluten in genetically predisposed individuals

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3
Q

gluten

A

general name for storage protein found in wheat, rye, barley

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4
Q

What does celiac dz lead to?

A
  • inflammatory damage of the mucosa of the small intestine

- results in mucosal villous atrophy and malabsorption of nutrients

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5
Q

Who does celiac dz affect?

A
  • mainly people of northern european descent
  • F>M
  • onset is generally in childhood
  • 10-20% first degree relatives
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6
Q

Who is at risk of celiac dz?

A
  • lymphocytic colitis
  • Down Syndrome
  • DM type 1
  • Hashimoto thyroiditis
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7
Q

general S/S of celiac dz

A
  • variable
  • some are asymptomatic or have only signs of nutritional deficieny
  • other have significant GI sx
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8
Q

What are the s/s in children after cereal is introduced to the diet?

A
  • failure to thrive
  • abdominal distension
  • muscle wasting
  • stools: soft, bulky, clay colored and foul smelling
  • older children may present w/ anemia or failure to grow
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9
Q

S/s of celiacs in adults

A
  • mild-intermittent diarrhea
  • steatorrhea
  • weight loss
  • bloating/abd pain
  • flatulence
  • anemia
  • vit. D and Ca deficiencies
  • reduced fertility
  • amenorrhea in women
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10
Q

What is a dermatological manifestation of celiacs?

A
  • dermatitis herpetiformis
  • intensely pruritis papulovesicular rash that is symmetrically distributed over the extensor areas of elbows, knees, butt, shoulders and scalp
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11
Q

What should be on your ddx when working up a celiac pt?

A
  • IBS
  • NCGS
  • inflammatory bowel dz
  • lactose intolerance
  • other carb intolerance
  • eosinophilic gastroenteritis
  • SIBO
  • intestinal lymphoma
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12
Q

How do you diagnose celiac dz?

A
  • suspected clinically and by evidence of malabsorption
  • fam hx is valuable
  • should be strongly considered in a pt w/ iron deficiency w/o obvious GI bleeding
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13
Q

confirmation of celiac dz diagnosis

A
  • seriologic markers:
  • IgA anti-tissue transglutaminase antibody (tTG)
  • IgA anti-endomysial antibody (EMA)
  • if either test is + the pt needs small bowel biopsy
  • if both are - celiac dz is unlikely
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14
Q

endoscopic markers suggestive of celiac dz (4)

A
  • loss or reduction in duodenal Kerkring’s folds
  • mosaic mucosal pattern
  • scalloped configuration of duodenal folds
  • micronodular pattern of the mucosa
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15
Q

What additional lab work can be done in the diagnosis of celiacs?

A
  • CBC w/ diff
  • iron panel, serum ferritin, folate
  • CMP: albumin, Ca, K, alk phos
  • malabsorption tests
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16
Q

possible complications of celiacs dz

A
  • refractory dz
  • intestinal lymphomas (6-8%)
  • incidence of other GI cancers increases
  • adherence to GF diet can significantly reduce the risk of cancer
17
Q

Tx of celiac dz

A
  • GF diet (response is rapid, 1-2 weeks)
  • dietician consult
  • support group
  • repeat biopsy after 3/-4 mos of GF diet
  • serial serological markers
18
Q

What if the celiac pt responds poorly to GF diet?

A
  • diagnosis is wrong

- or dz has become refractory

19
Q

tx for refractory celiac dz

A

corticosteroids can control sx

20
Q

define diarrhea

A
  • increased stool frequency, liquidity, volume

- objectively defined as passing a stool weight or vol. greater than 200 g or ml per 24 hrs

21
Q

What is important to consider w/ diarrhea?

A
  • it is a symptom or a sign, not a dz
  • can be caused by numerous conditions
  • eval and tx can be hard
22
Q

first steps in the approach to diarrhea

A
  • do they really have it?
  • r/o med causes
  • distinguish acute vs chronic
  • categorize it (inflammatory, fatty, watery)
  • consider factitious diarrhea
23
Q

What is the MC cause of diarrhea?

A

viral gastroeneteritis (self-limited)

24
Q

time cut off for acute vs chronic diarrhea

A
  • acute: <4 weeks

- chronic: > 4 weeks

25
Q

Acute diarrhea

A
  • good H&P is key
  • most don’t need lab w/u
  • routine stool cultures NOT recommended
26
Q

what is the tx focus for acute diarrhea

A

-preventing and treating dehydration

27
Q

hx in acute diarrhea

A
  • onset, duration, severity and frequency
  • ask about constipation
  • character of stool
  • evaluate for dehydration
  • n/v
  • fever, tenesmus, blood
  • food and travel hx
  • sick contacts, recent abx use, sex
  • hx of GI dz or surgery
  • immunosuppression
  • meds
28
Q

what populations are at high risk of infectious diarrheal illness?

A
  • day care
  • nursing home
  • food handlers
  • recently hospitalized
29
Q

What are some examples of meds that cause diarrhea?

A
  • abx
  • PPI
  • antidepressants
  • lithium
  • NSAIDs
  • metformin
  • ACEs
  • bisphosphonates
  • statins
  • mag. supplements
30
Q

PE in acute diarrhea

A
  • assess degree of dehydration
  • ill appearance, dry mucous membranes, delayed cap refill, tachy, orthostatic vitals
  • abdominal exam
  • rectal exam may be helpful (blood, tenderness, consistency)
31
Q

When is diagnostic testing indicated in acute diarrhea?

A
  • lasting > 2 weeks
  • severe dehydration
  • more severe illness
  • persistent fever
  • bloody stool
  • immunosuppression
  • nosocomial infection or outbreak
32
Q

What diagnostic testing is used when indicated for acute diarrhea?

A
  • occult blood
  • leukocytes and lactoferrin
  • stool cultures
33
Q

when is c. diff testing indicated

A
  • unexplained diarrhea after 3 days of hospitalization
  • while using abx or w/i 3 mos of dc abx
  • immunocompromised
34
Q

ova and parasite testing

A
  • not cost effective in acute diarrhea
  • indicated if persistent diarrhea > 7 days, esp. infants in daycare or travel to mountains
  • community waterborne outbreaks, blood diarrhea w/ few fecal luekocytes, AIDS, MSS
35
Q

When to consider endoscopy for acute diarrhea

A
  • if diagnosis is unclear after routine blood and stool tests
  • in empiric therapy is ineffective
  • if sx persist
36
Q

tx of acute diarrhea

A
  • BRAT or liquid diet
  • rehydration (orally)
  • antimotility agents UNLESS stool is bloody
  • probiotic may shorten duration
  • abx for infectious diarrhea
37
Q

acute diarrhea prevention

A
  • adequate handwashing
  • safe food prep
  • access to clean water
  • vaccinations

GI 2 (11 decks)

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