D&C@

Question 1

If IgA def, what is best next step for celiac dz w/u?

Answer 1

deaminated gliadin IgG +/- TTG IgG

Question 2

Which celiac test has best NPV?

Answer 2

HLA DQ2 and 8 testing

Question 3

Pt with slow transit constipation - trial secretagogue and no improvement, what next?

Answer 3

Repeat transit study on meds and if abnormal consider GES to check for possible UGI motility issue

Question 4

T/F: Should be careful when using methylnaltrexone in pts with diverticulosis due to perf risk

Answer 4

True

Question 5

What is the path of solitary rectal ulcer?

Answer 5

fibromuscular obliteration of LP

Question 6

If SRU, what should be done testing wise?

Answer 6

Defecography to determine why and treat that cause

Question 7

What is best ppx for travelers diarrhea?

Answer 7

Rifaximin

Question 8

Fatty stool with neg CT for CP or panc mass, what test to get?

Answer 8

13 C breath test with med chain TG

Question 9

Which type of bariatric surg has highest risk of constipation?

Answer 9

Gastric banding - 39% of pts

Question 10

Which bariatric surg has risk of diarrhea?

Answer 10

Roux, biliopanc diversion

Question 11

Which bariatric surg do not change bowel habits?

Answer 11

Vertical banded gastropplasty, sleeve gastrectomy

Question 12

What is ancylostoma duodenale or necator americanus?

Answer 12

Hookworm

Question 13

Classic hookworm findings

Answer 13

Eos, IDA, travel to endemic area, pruritic rash that precedes sxs

Question 14

Stages of hookworm

Answer 14

Initial rash, pulm stage (many asxatic), GI phase (upper SI)

Question 15

T/F: Hookworm is located in upper SI and not colon.

Answer 15

True

Question 16

T/F: Given poor testing, if suspect hookworm should just treat for it.

Answer 16

True

Question 17

What to use to tx hookworm?

Answer 17

Albendazole 3 day course

Question 18

T/F: Probiotics can be used in tx of IBS.

Answer 18

False, not recommended based on Rome

Question 19

What is the fecal osmotic gap and how is it useful?

Answer 19

290 - 2 (Fecal Na + Fecal K).
Secretory diarrhea has gap < 50
Osmotic diarrhea has gap > 100

Question 20

What would be expected on stool studies in factitious diarrhea?

Answer 20

Stool mag > 90

Stool Phos > 33

Question 21

List the types of bile acid diarrhea

Answer 21

Type 1 - Ileal dysfcn
Type 2 - Idiopathic
Type 3 - AW other GI DOs (SIBO, celiac CPanc, etc)
Type 4 - Med induced inc in bile acid synthesis

Question 22

How to proceed? Pt with dysenergia on ARM undergoes 8 weeks of biofeedback but does not improve - what is the best next step and then what to do after that based on results?

Answer 22

Repeat ARM testing - if now normal, do colon transit time. If still abnormal, consider defecography.

Question 23

Pt with colonic slow motility on marker study started on meds and does not improve. What to do next?

Answer 23

Repeat marker study on meds. If now improved, consider GES to check for systemic dz.

Question 24

Pt with slow transit constipation does not improve despite all measures. What is next step?

Answer 24

Colonic manometry - if abnormal consider IRA

If normal, consider loop and if benefit then, proceed with IRA

Question 25

Intact recto-anal inhibitory reflex is code for what?

Answer 25

NOT Hirschsprungs

Question 26

If balloon testing and ARM are discordant, what should be done next to clarify dx?

Answer 26

Defecography

Question 27

What is MOA of linaclotide?

Answer 27

minimally absorbed peptide agonsit of guanylate cyclase C receptor that stims intestinal fluid secretion and transit

Question 28

What is MOA of lubiprostone?

Answer 28

Cl channel inhibitor

Question 29

Best px med for travelers diarrhea?

Answer 29

Rifaximin

Question 30

Who tends to get MAI of the gut?

Answer 30

HIV with CD4 < 75

Question 31

Which infxn has ferritin > 10K and high LDH?

Answer 31

Histoplasmosis

Question 32

How to tx MAI of the gut?

Answer 32

Azithromycin and ethambutol

Question 33

How to treat histo of the gut?

Answer 33

Ampho and itraconazole

Question 34

Which med to use for diarrhea due to HIV meds?

Answer 34

Crofelemer

Question 35

HIV, weight loss, pain - what to consider?

Answer 35

Lymphoma - should get CT CAP

Question 36

Which vitamin def can be seen in carcinoid syndrome?

Answer 36

Niacin (causes 4 D's) - due to tryptophan being used to go to serotonin so less available for niacin

Question 37

Acarbose can cause CHO malabs - this can cause what stool study finding in pt with diarrhea?

Answer 37

Low stool pH and high osm gap (>100)

Question 38

SIBO breath test - what to use for substrate?

Answer 38

Lactulose

Question 39

SIBO - what blood/urine test can be done and what will it show?

Answer 39

D-xylose of urine and blood - will be negative in both bc SB cannot absorb xylose in SIBO; in nl pts will be in urine in 4-5 hours

Question 40

T/F: Prochlorperazine can lead to constipation.

Answer 40

False, ondansetron can

Question 41

T/F: Phenytoin can lead to constipation.

Answer 41

True

Question 42

WHat dz is AW mi-2 AB?

Answer 42

Dermatomyositis

Question 43

If pt has normal pelvic floor fcn, how long to expel balloon?

Answer 43

< 60 sec

Question 44

What is the best tx of constipation in pregnancy?

Answer 44

Lactulose, preg cat B

Question 45

Overall mechanisms for stool osmotic gap?

Answer 45

``` HIGH gap (>100) = LOW absorption (celiac, IBD, CP, laxative use) LOW gap (<50) = HIGH secretion of elecrolytes (infxn, VIPoma, glucagonoma, etc) ```