GI Case Study Discussion - Westra

Question 1

Which liver enzyme is more specific for liver damage?

Answer 1

ALT - primarily in the liver

AST- can also be found in skeletal muscle and erythrocytes

Question 2

What is an acceptable bile duct diameter status-post cholecystectomy?

Answer 2

4mm

Question 3

What is the management for Non-Fatty Liver Disease?

Answer 3

• Diet (increased fiber) → Weight loss
  
  • abstain from EtOH use
  • consult dietician
• Orlistat (Xenical)
• Exercise
• Statin
• Metformin
• Betaine → works on methionin to reduce steatosis
• Test/Follow fasting glucose, HDL, and LDL
• Surgical weight loss options
  
  • gastric bypass
  • gastric sleeve/banding

Question 4

What is NASH?

Answer 4

Non-alcoholic steatohepatitis

Question 5

What is the pathology of Non-alcoholic fatty liver disease similar to?

Answer 5

Alcoholic steatosis and alcoholic steatohepatitis

Question 6

How often does non-alcoholic fatty liver disease progress to cirrhosis?

Answer 6

10%+

Question 7

What is the disease continuum in Non-Alcoholic Fatty Liver Disease?

Answer 7

Obesity ⇒ Elevated AST/ALT ⇒ Fatty Liver Disease Dx ⇒ Cirrhosis ⇒ Liver Failure

(Progression is reversible if proper weight/diet control. Damage is permanent.)

Question 8

What are the specific tests to order when diagnosing Celiac Disease?

Answer 8

• IGA tests
  
  • Tissue transglutaminase
  • Endomysial antibody
  • IgA deficiency
    
    • will cause false negative TTG and biopsy
• Endoscopy
  
  • scalloped folds, blunted vili, intraepithelial lymphocytes
• HLA typing
  
  • DQ2 and DQ8 are predictive of celiac sprue, helpful if equivocal and biopsy

Question 9

What clinical associations should you be aware of in treating a patient with Celiac Disease?

Answer 9

• Iron deficiency anemia
• Thyroid disease
• Pediatric Celiac Sprue