GI misc COPY Flashcards
What is the main difference between a food allergy and a food intolerance?
Food allergy is IgE mediated
Food allergies are the main reason for _____ presenting in the ED
anaphylaxis
What are the MCC of food allergies in adults?
fish/seafood
peanuts/tree nuts
Food allergy or intolerance?
- Hives
- angioedema
- N/V/D, cramping
Allergy
(intolerance you would just have sxs like D, bloating, abd cramping,etc)
How do you tx food allergies (3)?
- Epinephrine autoinjector
- Food avoidance
- Allergist referral
Lowest rate of lactose intolerance in what 2 racial/ethnic groups?
European and European American
Highest rate of lactose intolerance in what 5 racial/ethnic groups?
- African American
- Hispanic
- Asian
- Asian American
- Native American
Lactose intolerance is uncommon under what age?
6
T/F: prevalence of lactose intolerance decreases with age
FALSE
prevalence increases with age
What causes lactose intolerance
Deficiency of lactase enzyme or less efficient lactase enzyme
What are the main causes of lactose malabsorption?
Primary (developmental, congenital)
Secondary (Celiacs, IBD, etc)
Clinical presentation of what?
- Abd pain
- bloating
- flatulence
- Diarrhea
- Borborygmi
*symptoms affected by diet*
Lactose intolerance
What are the 3 components of diagnosing lactose intolerance
- Sxs after lactose ingestion
- Sxs resolve w/ avoidance of lactose
- Lactose hydrogen breath test
(only need 1 and 2 to diagnose)
How do you treat lactose intolerance? (3)
- Lactose-free diet or lactose restrictions
- Enzyme replacement- lactase
- Monitor calcium, vit D
Definition of Glucose-6-phosphate dehydrogenase (G6PD) deficiency:
Genetic defect in G6PD, a RBC enzyme that generates ______ and protects RBCs from _____ injury
Genetic defect in G6PD, a RBC enzyme that generates NADPH and protects RBCs from oxidative injury
Is G6PD deficiency genetic?
yes.
X-linked
G6PD deficiency is associated with what?
hemolytic anemia
Clinical presentation of which condition?
- Jaundice
- pallor
- dark urine
- abdominal/back pain
- normochromic, normocytic anemia
G6PD deficiency
Which condition is usually asymptomatic until a trigger (meds, food, acute illness) causes acute hemolysis
G6PD deficiency
What type of anemia is seen in G6PD deficiency?
normochromic, normocytic
What 2 things are seen on peripheral smear in G6PD deficiency?
“bite cells”
Heniz bodies
Will the anemia seen in G6PD deficiency resolve?
Yes. Spontaneous resolution and reversal of anemia
(anemia stimulates erythropoiesis, younger RBCs can withstand the oxidative stress so get resolution)
The following meds carry the risk of causing clinical hemolysis in persons with which condition?
- Sulfamethoxazol (TMP-SMX)
- Nitrofurantoin
G6PD deficiency
How do you treat G6PD deficiency? (4)
- Avoidance of oxidative stress to RBCs
_2. Removal of offending agent*_
_3. Hydration*_
- Transfusion for severe anemia
The following describes which disease?
- Localized area of increased bone turnover causing overgrowth of bone
- Unknown etiology, possibly genetic
Paget disease of bone
Pathophys of paget disease of bone:
- Increased ______ activity–>
- ______ in bone–>
- Incr. _____ activity–>
- Disorganized bone formation
- Abnl bones w/ enlarged skeletal deformity
- Increased osteoclast activity–>
- Lytic lesions in bone–>
- Incr. osteoblast activity–>
- Disorganized bone formation
- Abnl bones w/ enlarged skeletal deformity
What are the 5 MC locations of Paget Disease of bone?
“Some Have Fun Visiting Paris”
1. Pelvis
2. Vertebrae
3. Femur
4. Humerus
5. Skull
(MC polyostotic but can be monostotic)
Paget Disease of bone affects 2-3% of people > what age?
55
What is characteristically seen on labs in Paget Disease of bone?
_Elevated alk phos**_
What 5 bone changes are seen in Paget disease of bone?
1. Bowed tibias
- Kyphosis
3. “chalkstick” fractures w/ minimal trauma
- Increased hat size
Clinical presentation of what disease?
- Usu. asymptomatic, discovered incidentally
- aching, deep pain that is worse at night and with weight bearing
Paget disease of bone
What is seen on a radiographs in a patient with Paget disease?
osteolytic lesions
What 4 diagnostic tests are used in Paget Disease of bone?
- bone turnover markers
2. serum calcium
- Serum 25-OH vitamin D
- Bone scintigraphy
Will serum calcium be high or low in Paget Disease of bone?
High b/c of bone resorption
How do you treat someone with Paget disease that is asymptomatic?
monitor
What is pharmacologic tx for Paget disease of bone?
IV Zoledronate (bisphosphonate)
The following are complications of what condition?
- Hypercalcemia
- Renal calculi
- Bone tumors (sarcoma, giant cell tumors)-rare
- high output heart failure
- cranial nerve palsies
- arthritis
- vascular steal syndrome
- Radiculopathy or paralysis
Paget disease of bone
Definition of Rickets:
Deficiency in _____ or _____ leading to altered bone growth and mineralization
Deficiency in calcium or phosphate leading to altered bone growth and mineralization
What are the 4 typical locations of Rickets?
- Distal forearm
- Knee
- Costochondral junctions
Clinical presentation of what?
- _Bowing of weight bearing extremities**_
- Skeletal fractures
- Proximal myopathy
Rickets
Etiology of what?
Decreased intake, malabsorption, or increased excretion of calcium, phosphate or vitamin D
Rickets
What are the 3 main things seen on labs in Rickets?
1. Elevated Alk phos
2. Low phosphorus
- low or normal calcium
What is seen on radiology in Rickets? (2)
- widened growth plate at long bones and costochondral junction
- Decreased radiopacity of long bones
What is seen on radiology in Rickets if disease occurs after growth plate closure? (2)
- Decreased cortical thickness
- Relative radiolucency of skeleton
What are the 3 treatments for Rickets?
- Treat underlying disorder
_2. Vit D replacement*_
- Calcium supplementation
