Disorders of small intestine and large intestine

Question 1

Infectious causes of chronic diarrhea

Answer 1

Amebiasis
Giardiasis
Clostridium difficile
HIV enteropathy
Yersinia
Campylobacter
Cryptosporidium
Cyclospora
Intestinal schistosomiasis

Question 2

Hormonal abnormalities/tumors of chronic diarrhea

Answer 2

Diabetes
Hyperthyroidism
Adrenal insufficiency
Vasoactive intestinal peptide tumors (VIPomas)
Carcinoid syndrome
Medullary thyroid cancer
Gastrinoma
Mastocytosis

Question 3

infectious agent for tropical sprue

Answer 3

klebsiella

Question 4

treatment of tropical sprue

Answer 4

tetracycline and folate

unresponsive to a gluten-free diet

Question 5

infectious agent for Whipple Disease

Answer 5

gram-positive bacillus (Tropheryma whippelii)

Question 6

Diagnosis of Whipple Disease

Answer 6

periodic acid–Schiff (PAS)-positive macrophages containing the small bacillus

Question 7

Treatment of Whipple Disease

Answer 7

trimethoprim-sulfamethoxazole for 1 year

Question 8

treatment of bacterial overgrowth syndrome

Answer 8

Nonabsorbable options: rifaximin, neomycin

Absorbable options: ciprofloxacin, tetracycline, metronidazole

Question 9

diagnosis of bacterial overgrowth syndrome

Answer 9

gold standard is small-bowel aspirate demonstrating bacterial overgrowth (greater than 105 colony-forming units/mL)

Question 10

Microscopic colitis is associated with certain drugs

Answer 10

nonsteroidal antiinflammatory drugs (NSAIDs). Other drugs implicated include ticlodipine, olmesartan, ranitidine, lansoprazole, and several others.

Question 11

Histologic criteria for diagnosing microscopic colitis

Answer 11

Increased chronic inflammatory infiltrate in the lamina propria

▪Increased number of intraepithelial lymphocytes (more than 15 to 20 lymphocytes per 1000 epithelial cells)

▪Damage of the surface epithelium with flattening of the epithelial cells

Question 12

medical therapy for microscopic colitis

Answer 12

First-line treatment is budesonide

▪Other choices: 5-aminosalicylic acid (5-ASA) like mesalamine or sulfasalazine, bismuth, prednisone, and rarely, strong immune-suppressive agents or biologics

Question 13

Diagnostic Criteria for Irritable Bowel Syndrome (Rome III)

Answer 13

Symptoms of recurrent abdominal pain or discomfort and a marked change in bowel habit for at least 6 months, with symptoms experienced on at least 3 days of at least 3 months. Two or more of the following must apply:

• Pain is relieved by a bowel movement
• Onset of pain is related to a change in frequency of stool
• Onset of pain is related to a change in the appearance of stool