GI/Endocrinology Flashcards
What occurs with Lactose Intolerance?
- Deficiency in Lactase = Accumulation of Lactose
- Bacteria metabolizes Lactose into Hydrogen Gas
= Pain, bloating, farting and diarrhea after eating dairy
What are 2 ways to diagnose Lactose Intolerance?
- Hydrogen Breath test
- Removal of dairy and symptoms resolve
What is Irritable Bowel Syndrome?
Recurrent abdominal pain relieved by defecation with changes in stool form/frequency and NO CAUSE
What is Irritable Bowel Syndrome?
Recurrent abdominal pain relieved by defecation with changes in stool form/frequency and NO CAUSE
Does Irritable Bowel Syndrome present with diarrhea or constipation?
Both are possible subtypes!
What is the mainstay treatment for Irritable Bowel Syndrome? (2)
Lifestyle modifications + Psyllium (fiber)
What rash is associated with Celiac Disease?
Dermatitis Herptiformis
= papulovesciular rash on EXTENSOR surfaces
Dermatitis Herpetiformis
Papulovesicular rash on EXTENSOR surfaces
– seen with Celiac Disease
What are the symptoms of Celiac Disease?
- Foul smelling and floating stools
- Fatigue and Iron Deficient Anemia
What are the symptoms of Celiac Disease?
- Foul smelling and floating stools
- Fatigue and Iron Deficient Anemia
What is diagnostic of Celiac Disease?
Small bowel biopsy = Villous atrophy
What is diagnostic of Celiac Disease?
Small bowel biopsy = Villous atrophy
What antibody may be (+) with Celiac Disease?
IgA Anti-Tissue Transglutaminase
What is the physiology behind Urge Incontinence?
Sudden detrusor muscle contraction causing urge to void = leakage of urine
What are 2 possible treatments for Urge Incontinence?
- Oxybutynin
- Mirabegron
MOA for Oxybutynin and Mirabegron for the treatment of Urge Incontinence?
Oxybutynin = M3 Antagonist (blocks detrusor)
Mirebegron = Beta3 Agonist (detrusor relax)
Acromegaly is due to elevated GH. How will it present in kids and why?
Gigantism due to incomplete closure of growth plates
How will Acromegaly present in adults?
Large hands, feet, face and visceral organs
High Glucose
CHF
How will Acromegaly present in adults?
Large hands, feet, face and visceral organs
High glucose
CHF
What should you check if you suspect Acromegaly?
ILGF-1
– This is (+) by GH which then (+) glucose
If ILGF-1 is elevated, what should be done next if you suspect Acromegaly?
Glucose suppression test
= Will FAIL to suppress with Acromegaly
What is the treatment for Acromegaly?
Surgery of Anterior Pituitary tumor
If you do not see a pituitary gland on brain imaging, what should be done?
Nothing
= Empty Sella Syndrome (pituitary ectopically functioning)
What is secreted by the Posterior Pituitary?
ADH
Oxytocin
With SIADH, what occurs?
Too much ADH tells kidney to reabsorb too much water
What are the levels of the Urine and Serum Osm with SIADH?
Urine = HIGH
Serum = LOW
What are the levels of the Urine and Serum Na+ with SIADH?
Urine = HIGH
SIADH = LOW
What 2 things can cause SIADH?
Small cell lung cancer
Brain lesion
What is Diabetes Insipidus?
LOW levels of ADH which cause urine to be super dilute
Central Diabetes Insipidus
Low production of ADH
Nephrogenic Diabetes Insipidus
Kidney non-responsive to ADH
What are the levels of Urine and Serum Osm with Diabetes Insipidus?
Urine = LOW
Serum = HIGH
What are the levels of Urine and Serum Na+ with Diabetes Insipidus?
Urine = low
Serum = HIGH
What test should be done if you suspect Diabetes Insipidus and what is the result?
Water deprivation test
= Urine Osm will NOT correct
If you suspect Diabetes Insipidus and it corrects with ADH, what is the diagnosis? If it does not?
If it corrects = Central
If it does not = Nephrogenic
Treatment for Central and Nephrogenic Diabetes Insipidus?
Central = DDAVP
Nephrogenic = Diuresis
What is Addison’s Disease? 2 major causes?
Low Cortisol production
1. Autoimmune
2. TB
2 signs of Addison’s Disease? (low cortisol)
- Hyperpigmentation
- Orthostatic Hypotension
What antibodies are present with Graves disease?
TSH receptor antibodies
What 2 other signs besides hyperthyroid signs will be present with Graves?
Exophthalmos
Pretibial myxedema
Result of the RAIU scan with Graves? What is the treatment?
Increased uptake everywhere
= PTU or Methimazole to stop new thyroid hormone production
Signs of a Thyroid storm?
Fever > 104
Afib/shock
AMS
Hypotension
Signs of a Thyroid Storm?
Fever > 104
Afib/shock
Hypotension
AMS
3 things to give if Thyroid storm is present?
Propranolol
PTU/Methimazole
Steroids to stop conversion to T3
3 things to give if Thyroid storm is present?
Propranolol
PTU/Methimazole
Steroids to stop conversion to T3
What is Struma Ovarii?
Ovarian tumor that releases T4
What precedes Subacute Thyroiditis?
Viral infection
Signs of Subacute Thyroiditis?
PAINFUL goiter
Fever
Hyperthyroid signs
What antibodies are positive with Painless and Postpartum Thyroiditis?
(+) TPO (thyroid peroxidase)
Describe the evolution of Painless or Postpartum Thyroiditis
Hyperthyroid phase
Hypothyroid phase
Resolution
Describe Hashimoto Thyroiditis
Permanent Hypothyroidism
Are goiters often present with Thyroiditis? Painful?
Yes
- Painful = Subacute Thyroiditis
