Disorders Of The Intestines Flashcards
What are the complications of celiac disease (5)?
- Nutritional deficiency and anemia
- Osteopenia/osteoporosis
- Elevated liver enzymes
- dermatitis herpetiformis
- enteropathy-associated T-cell lymphoma (EATL)
What nutritional deficiencies would you expect in celiac disease?
Vitamin B12
Vitamin D
Iron
Calcium
What are the risk factors for celiac disease (7)?
Northern European descent Family history T1DM Autoimmune thyroid disease Down & Turner’s syndrome 1st degree relative IgA deficiency
Which foods contain gluten?
Barley
Rye
Oats (contaminated)
Wheat
What investigation should be done in follow up for patients with celiac disease?
Follow up serology in 6-12 months post diagnosis, then annually.
What are the biological used in therapy for Crohn’s disease (4)?
Anti-TNF: Infliximab, adalimumab
Anti-Integrin: Vedolizumab
Anti-IL12/23: Ustekinumab
Which treatment should be used upfront for fistulizing Crohn’s?
Anti-TNF
Which treatment should be used upfront in perinatal Crohn’s disease (after antimicrobial therapy if infection is present)?
Anti-TNF
What is the definition of proctitis?
Inflammation within 18 cm of the anal verge.
Which biologic agents can be used in ulcerative colitis therapy?
Anti-TNF: infliximab, adalimumab, golimumab
Anti-Integrin: Vedolizumab
Anti-IL-12/23: Ustekinumab
JAK-Inhibitor: Tofacitnib
What are the criteria for toxic mega colon?
Radiographic mega colon (>6 cm) PLUS at least 3 of: - fever (>38C) - HR > 120 bpm - neutrophils > 10.5 - anemia PLUS at least 1 of: - dehydration - altered sensorium - electrolyte disturbances - hypotenstion
What are the indications for colectomy in fulminant ulcerative colitis?
- Toxic Megacolon
- Colonic Perforation
- Severe Refractory Hemorrhage
- Refractoriness to medial therapy after 3-5 days
When does bile-salt diarrhea occur?
Occurs with ileitis in Crohn’s or after ideal resection. Always treat active IBD before treating for bile salt diarrhea with cholestyramine, a bile acid sequestrant.
What is Type I IBD arthropathy?
Pauciarticular arthritis, usually self limiting attacks in large joints (ankles, knees, elbows, wrists, shoulders) that parallels disease activity.
What is Type 2 IBD arthropathy?
Polyarticular arthropathy of small joints and axial disease, typically independent of activity.
How long do high-risk lesions resulting in UGIB require PPI therapy for?
72 hours post-endoscopy
When is indefinite PPI therapy recommended post-UGIB?
For patients requiring ongoing anti-platelet therapy for secondary prophylaxis or if unclear cause of PUD.
Which patients should you test for H. Pylori?
PUD MALT Lymphoma Gastric Cancer Long term NSAID/ASA use Otherwise unexplained iron deficiency ITP
DO NOT test GERD patients
What are the options for H. Pylori diagnosis?
Stool Antigen Histology (Best) Biopsy Culture Urea Breath Test (2nd Best) IgG Serology (sensitive but not specific for acute infection)
What are the recommended treatment options for H. Pylori?
First Line - 14 days of: - PPI/Bismuth/Metronidazole/Tetracycline - PPI/Amoxicillin/Metronidazole/Clarithromycin Treatment Failure of above options: PPI/amoxicillin/levofloxacin
When should you do a test of eradication in patients treated for H. Pylori?
Confirm eradication in all patients:
- Wait at least 4 weeks after completing antibiotic therapy and at least 1-2 weeks after PPI therapy before testing for H. Pylori to ensure the test is accurate.
What are the classic features of a somatostatinoma?
Classic triad of:
- Diabetes/Glucose Intolerance
- Cholelithiasis
- Diarrhea/Steatorrhea
How do you calculate a stool osmotic gap?
290 (expected stool osmolality) - 2 x (stool Na + stool K)
A normal gap = 50 to 100
What are the causes of a low stool osmotic gap?
Secretory diarrhea:
Infection - Cholera, ETEC
VIP, Gastrinoma
Non-osmotic Laxative Abuse
What are the causes of a high stool osmotic gap?
Suggestive of osmotic diarrhea: Celiac, lactulose intolerance, lactase deficiency Chronic pancreatitis Whipple’s Osmotic Laxative Abuse
What is the treatment for microscopic colitis?
Imodium
Stop NSAIDs and offending medications
Budesonide PO