Gastro Jan Flashcards
FTT What are causes of Failure to Thrive?
1.Decreased Intake (common)
- Social (food security)
- Central (satiety signaling)
2.Malabsorption*
3.Hypermetabolism
- Inflammatory (catabolic)
- Neoplastic (consumptive)
- Chronic Disease (combination) IBD, ..
FTT What are the causes of protein malabsorbtion?
1. Pancreas: proteases
- SI: AA transporters e.g. CF, Schwachman- Diamond
FTT What are the causes of Fat malabsorbtion?
Biliary:bile emulsifies
Ileum: reabsorbs bile
e.g. cholestasis, CF,
Crohn’s disease
FTT What are the causes of Carbohydrate malabsorbtion?
Primary causes: enzyme deficiencies rare
e.g. Sucrase-isomaltase, treholase, lactase*
Dietary causes: saturation of normal enzyme levels
e.g. Toddler’s diarrhea
Malabsorption
Duodenum: brush
border hydrolysis
e.g. primary causes vs
dietary causes
FTT What are the causes of Panmalabsorption ?.
Generalized intestinal inflammation/resection
e.g. Celiac, IBD, lymphangiectasia, immunodeficiency,
intestinal resection
Celiac disease What is the cause for Celiac Disease?
Autoimmune enteropathy caused by systemically acting antibodies that are formed against gluten ( NOT allergy…causes problems long after substance is removed)
Celiac What are the Extraintestinal Manifestations of
Celiac Disease?
Celiac What Conditions are Associated with Celiac Disease?
- IgA Deficiency 30 % chance if IGA in celiac
• 2. Syndromic: Down, Turner Syndrome & Williams
Syndrome
• 3. Autoimmune: T1 DM; Thyroid, liver, arthritis
Celiac Transmission risk in families?
First Degree Relative with Celiac (1:20 risk)..all have
about 20% risk
Celiac What are the Dietary Triggers for Celiac Disease?
Celiac How do the Screening Bloodwork Test
Compare (TTG IGA vs EMA-IgA)
Celiac Recommendations for DGP in < 2 and > 2 yrs ?
Deamidated Gliadin Peptide
*Must send DGP in patients <2yo (TTG-IgA poor accuracy in this age group)
• >2yo, many false positive DGP tests
• ie. TTG-IgA negative, DGP-IgG positive, biopsy negative - NOT celiac disease
Celiac DDx for Patients who report feeling better off gluten?
- Nothing
- Celiac Disease (must have 12wk
intake)
• 3.Food intolerances/allergies:
a.Non-Celiac Gluten Sensitivity (NCGS)
b. Wheat allergy
c. Difficulty digesting highly fermentable carbohydrates
FODMAPS
Celiac What are FODMAPS?
IBD How do clinical Fx of CD and UC compare?
IBD How do Endoscopic Fx of CD and UC compare?
IBD How do Pathology Fx of CD and UC compare?
IBD What are the extraintestinal manifestations of IBD?
- Eye
- Skin and Rheum
- GIT: Liver, pancreas & biliary
- MSK and hematological
- Oncology and Urologic
IBD What are the Eye extraintestinal manifestations of IBD?
IBD What are the Skin and Rheum extraintestinal manifestations of IBD?
IBD What are the GIT and MSK extraintestinal manifestations of IBD?
BD What are the Hem/Oncology and Urologic extraintestinal manifestations of IBD?
IBD Which Sx correlate with disease activity?
peripheral arthritis, Erythema nodosum, anemia
IBD Which Sx DO NOT correlate with disease activity?
primary sclerosing cholangitis (PSC), sacroiliitis, ankylosing spondylitis
IBD What are the inv steps for IBD?
1. Laboratory evaluation
a. Typical biochemical abnormalities: leukocytosis, anemia, thrombocytosis, hypoalbuminemia, LFT’s
b. Serum inflammatory markers: erythrocyte sedimentation rate (ESR) and CRP often elevated
c. Stool:
- Rule out enteric infections, including Clostridium difficile, before endoscopy
- Fecal calprotectin
2. Endoscopy: Endoscopy (OGD and colonoscopy) with confirmatory biopsies demonstrating chronic inflammatory changes is diagnostic gold standard
3. Imaging
SBFT, CT/CTE, MRI/MRE
US/CE, VCE (video capsule endoscopy)
IBD What is the relevance of -Fecal calprotectin?
Elevated concentrations in the stool if GI inflammation is ongoing
Cut off of >200 to 300 μg/g has been suggested as optimal combination of sensitivity and specificity
Fecal calprotectin cannot distinguish between inflammation from IBD versus infection, malignancy, or nonsteroidal antiinflammatory drug (NSAID) use; cannot determine the location of disease in the bowel; and has been found to be elevated in healthy infants and toddlers
Valuable as a noninvasive marker of disease activity after diagnosis
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IBD What serologies can be used for UC and Crohns?
Atypical perinuclear antineutrophil cytoplasmic antibodies (pANCA) in UC and
anti-Saccharomyces cerevisiae antibodies (ASCA) in CD
N.B. No sufficient data to support IBD serologic testing for screening evaluation of suspected IBD
IBD What Rx can be used to reduce remission?
Induce Remission
- Tube feeds (common; Crohn’s only), less benefit in uC
- Corticosteroids - both, esp in UC, oral budesonide
-
OTHER
a. Mild: 5-ASA (Mesalamine, sulfasalazine) 1st line in UC less efficacy in Crohns
b. Severe: Biologics (BOTH) Infliximab > Adalimumab -
Antibiotics: Decrease inflammation by decreasing pro-inflammatory bacteria in the GI tract
Perianal disease, abscess, postoperative prophylaxis
IBD How to maintain remission?
- 5-ASA - mild; UC, less clear in Crohns
- Tube Feeds (Crohn’s only)
3. Immunosuppresive;
a. Azathioprine & Methotrexate (moderate)
b. Biologics (severe)
IBD What is the DDx for terminal ileitis?
- 1.Crohn’s & Chronic CGD
- Lympho’s; Lymphoma & Lymphoreticularhyperplasia( LN)
- Infection: Yersinia Infection…r& TB
- Severe Eosinophilic Gastroenteropathy
Constipation What are the pathological causes?
Idiopathic
- Disease:
Hypothyroidism
• Celiac Disease, CF
- Chem: Lead Poisoning; Medications (chemo)
- Elect:High Ca, Low K
- CNS disorders
o Hirschprung’s
o Cerebral palsy
o Neural tube defects
Constipation What are the 4 categories of constipation meedications?
GERD What are the DDx for Gastroesophageal Reflux &
Dysphagia?
Physiologic….more relaxation than 4% of the time
- Eosinophilic Esophagitis
- Hiatal Hernia (LES angle affected)
- Gastroparesis (delayed gastric emptying)
- Medications
- Dysmotility
- Gastritis/gastroparesis
Physiologic….more relaxation than 4% of the time
- Eosinophilic Esophagitis
- Mechanical: Hiatal Hernia (LES angle affected)
- Pathophysio:
Gastroparesis (delayed gastric emptying)
Dysmotility
Gastritis
- Medications
GERD What are the causes for Delayed Gastric Emptying?
- Idiopathic
- Intestinal effect:
a. Ileus: Post infectious/Post surgery
b. Constipation
c. Inflamatory/immune
d. Neurological
3. Medication
GERD What are the treatment guidelines for GERD?
What are the DDx for Dysphagia & Odynophagia?