diarrhea, malabsorption and small intestinal neoplasia

Question 1

inflammatory diarrhea

Answer 1

1. small volume
2. frank or occult blood
3. rectal urgency
4. abdominal pain
5. nocturnal diarrhea

Question 2

watery diarrhea usually after a meal, resolves without eating

Answer 2

osmotic diarrhea

Question 3

large volume watery diarrhea, minimal resolution with fasting and may be nocturnal

Answer 3

secretory diarrhea

Question 4

intermmittent, small volume, watery diarrhea

Answer 4

dysmotility

Question 5

foul smelling, floating stoll, oil droplets

Answer 5

steatorrhea- fatty diarrhea

Question 6

fatty diarrhea can be caused by (3)

Answer 6

1. impaired fat solubilization
2. defective nutrient hydrolysis
3. mucosal disease

Question 7

not all disorders that lead to malabsorption cause diarrhea

Answer 7

yep think of atrophic gastritis and vit. B12 deficiency

Question 8

immune mediated enteropathy triggered by ingestion of gluten in genetically susceptible patients

Answer 8

celiac

Question 9

celiac is considered a ____ hypersensitivity reaction

Answer 9

IV

Question 10

autoimmune features of celiac

Answer 10

production of ab to tissue transgrlutaminase leadingto chronic T-cell chronic inflammation

Question 11

genetic celiac association

Answer 11

HLADQ2 and HLADQ8

Question 12

pathogenesis of celiac

Answer 12

TTG deamidates gliadin altering the charge of gliadin fragments and enhancing immunogenicity with greater stimulation of CD4 T helper cells

Question 13

dermatitis herpetiformis

Answer 13

IgA deposits in skin causing pruritic blister this is associated with celiac

Question 14

severe risk associated with celiac

Answer 14

small intestinal lymphoma and small intestinal adenocarcinoma

Question 15

what do we see in children who have celiac

Answer 15

growth failure

Question 16

extraintestinal manifestations of celiac disease 4

Answer 16

1. dermatitis herpetiformis
2. amenorrhea, infertility and impotence
3. anemia
4. osteopenia

Question 17

what do see in celiac with histo

Answer 17

1. flattened villi
2. intraepithelial lymphocytes
3. hyperplastic crypts
4. inflammation in lamina propria

Question 18

what predisposes small intestinal bacterial overgrowth syndrome

Answer 18

1. intestinal stasis

2. abnormal connections between proximal and distal bowel

Question 19

pathophysiology of malabsorption of bacterial overgrowth

Answer 19

1. reduced nutrient availability because bacteria consumes nutrients
2. bile salt inactivation due to bacteria deconjugating bile salts leading to fat malabsorption

Question 20

hydrogen breath testing

Answer 20

1. early peak- bacteria overgrowth

2. late peak- lactose intolerance

Question 21

increased bile salt loss

Answer 21

due to either crohn, resection of ileum or overwhelming of ileum leading to bile acids in colon which induces secretion of sodium and water, colonic motility, mucus secretion and damage to the mucosa leading to cholerrheic diarrhea or bile acid diarrhea

Question 22

treatment for bile acid diarrhea

Answer 22

bile acid sequestrants

Question 23

fatty diarrhea- maldigestion or malabsorption (3)

Answer 23

1. impaired reabsorption due to ileal disease or resection
2. small intestinal bacterial overgrowth
3. celiac disease

Question 24

pancreatic enzyme deficiency leads to what type of diarrhea

Answer 24

fatty diarrhea

Question 25

tests for pancreatic insufficiency

Answer 25

fecal elastase level which is supposed to be low in pancreatic exocrine insufficiency

Question 26

lactose intolerance leads to what type of diarrhea

Answer 26

osmotic diarrhea

Question 27

fecal osmotic gap

Answer 27

290 - 2 x (Na + K)

Question 28

secretory diarrhea is due to

Answer 28

abnormal ion transport in intestinal epithelial cells

Question 29

electrolytes account for most of luminal osmolality

Answer 29

yep

Question 30

fecal osmotic gap:

1. osmotic
2. secretory

Answer 30

1. osmotic >125

2. secretory <50

Question 31

fatty acids does what to the colon

Answer 31

stimulate colon secretion

Question 32

bile acids does what to the colon?

Answer 32

stimulate fluid and electrolyte secretion in colon

Question 33

carcinoid tumor

Answer 33

arises from cells of neuroendocrine origin that synthesizes bioactive (5HT), chromogranin A, tachykinins

Question 34

common sites of carcinoid tumors

Answer 34

small intestine>rectum>appendix

Question 35

GI neuroendocrine tumors:

1. type 1
2. Type 2
3. Type 3

Answer 35

1. type 1- associated with atrophic gastritis
2. type 2- associated with multiple endocrine neoplasia syndrome
3. type 3- sporadic no underlying risk factor

Question 36

carcinoid syndrome is often seen in

Answer 36

liver metastatic disease

Question 37

carcinoid treatment

Answer 37

surgical resection

Question 38

when carcinoid secretes serotonin where can it might to and what happens?

Answer 38

it can go to the heart and lead to cardiac valvuar disease but only on the right side

Question 39

fistula occurs in three big diseases

Answer 39

1. crohn
2. cancer
3. radiation

Question 40

ampullary carcinoma

Answer 40

occurs at the ampulla of vater leading to jaundice, pancreatitis and melena

Question 41

dysmotility diarrhea occurs in (4)

Answer 41

1. autonomic diabetic neuropathy
2. hyperthyroidism
3. after vagotomy- peptic ulcer surgery
4. IBS

Question 42

functional GI disorder with abdominal pain and laterd bowel habits but no biochemical or structural abnormalities

Answer 42

IBS

Question 43

IBS associated disorders

Answer 43

1. fibromyalgia
2. anxiety/depression
3. chronic pelvic pain

Question 44

therapeutic option for IBS

Answer 44

antibiotic- rifaximin