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OSD_GI > Intestines > Flashcards

Intestines Flashcards

1
Q

3 potential complications of Celiac Disease?

A
  • Refractory Sprue
    (persisting symptoms and histological injury despite being on diet for 12 months)
  • Intestinal Adenocarcinoma
  • T cell lymphoma
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2
Q

Gliadin is deaminated by ___a___ in the __b__ of the small intestine which facilitates gliadin’s ability to interact w/ __b__ & __b__ located on the surface of Antigen Presenting Cells

A

a) Tissue Transglutaminase (TTG)

b) HLA-DQ2 & HLA-DQ8

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3
Q

Celiac Disease: Clinical Presentation?

A
  • Diarrhea
  • Weight loss
  • Failure to thrive
  • Short stature
  • Anemia (Iron, Folate, B12 deficiencies)
  • Bone disease (vit. D deficiency)

(many patients remain asymptomatic

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4
Q

Celiac Disease: Treatment?

A
  • Gluten-free diet (70-90% respond)
  • Vitamins & Minerals (iron, folate, Vitamins D, B12)
  • Screen for Bone Injury: densiometry
  • Screen Family for Celiac Disease (DQ2, DQ8)
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5
Q

Celiac Disease: Diagnosis

Endoscopy findings?

A
  • Scalloping of duodenal folds
  • Flattened/absent villi
  • Mosaic appearing surface of mucosa
  • May be normal appearing (always take 4-6 biopsies when suspicious)
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6
Q

Celiac Disease: Diagnosis Histopathologic findings?

A
  • Increased intraepithelial lymphocytes
  • Increased lymphocytes and plasma cells in the lamina propria
  • Absent or blunted villi
  • Elongated Intestinal crypts
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7
Q

Celiac Disease: Diagnosis

Serology findings?

A
  • Anti-endomyoseal IgA antibody *
  • TTG IgA antibody**
  • Anti-gliadin IgA &/or IgG antibody
  • Deaminated gliadin peptide
  • HLA-DQ2, DQ8
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8
Q

Define the following:
1. Gluten
2. Gliadin
3. Alfa fraction

A
  1. Gluten: the protein component of wheat, barley and rye.
  2. Gliadin: the alcohol soluble portion of digested gluten.
  3. Alfa fraction: the portion of gliadin able to pass the mucosal barrier of the intestine.
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9
Q

Folic acid deficiency results in _____ anemia.

A

macrocytic

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10
Q

A gluten free diet results in the resolution of which of the following?
a. patient’s symptoms b. positive serology
c. abnormal histology

A

All of them

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11
Q

T or F? Iron deficiency may be the only sign of Celiac disease.

A

True

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12
Q

Vitamin A deficiency results in..?

A

Night blindness, conjunctival dryness, and keratomalacia

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13
Q

Vitamin D deficiency results in..?

A

Osteomalacia: Clinically manifests as muscle weakness and musculoskeletal pain
- Osteopenia and osteoporosis

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14
Q

Vitamin E deficiency results in..?

A

Hemolytic anemia, gait disturbance, and neuropathy

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15
Q

Vitamin K deficiency results in..?

A

Prolonged prothrombin time, resulting in decreased synthesis of clotting factors II, VII, IX, and X

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16
Q

Sucrose = ____ & ____

A

Glucose & Fructose

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17
Q

Lactose = ____ & ____

A

Glucose & gaLACTOSE

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18
Q

Absorbed products of lipolysis, once in the enterocytes, are synthesized into __(a)__ and exit as __(b)__ into lymph lacteals.

A

a) Triglycerides
b) Chylomicrons

(Chylomicron = Triglyceride + Apolipoproteins)

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19
Q

Once chyme reaches the cecum, _____ is released & this stops the process of CCK release.
What are some effects of this further inhibition of CCK release?

A

Peptide YY

Decreased:

  • Gastric acid secretion & Gastric emptying
  • Pancreatic secretion
  • Colonic motility
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20
Q

3 functions of intestine in between meals?

A
  1. Propulsion- Motilin stimulates migrating motor complexes to move stuff out of SI
  2. Retention- Luminal distention triggers stretch receptors to initiate the anorectal inhibitory reflex to preserve continence
  3. Defecation- Involuntary (internal anal sphincter is relaxed) & Voluntary (external relaxed)
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21
Q

D-xylose test is most helpful in distinguishing..?

A

Maldigestion (pancreatic insufficiency) from Malabsorption (celiac sprue)

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22
Q

How do you interpret a d-Xylose test?

A

d-Xylose Excretion:

  • Normal in Maldigestion
  • Dec’d in Malabsorption

Fecal Fat:
- Inc’d in Maldigestion & Malabsorption

Jejunal Biopsy:

  • Normal in Maldigestion
  • Abnormal/”flat” in Malabsorption
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23
Q

Schilling Test evaluates..?

A

possible B12 deficiency

24
Q

Schilling Test, for each step:
What is done?
If B12 corrects @ this step, Dx is..?

A
  1. Give parenteral B12 for loading, then radio-labeled B12
    Dx = Dietary deficiency
  2. Radio-labeled B12 given w/ Intrinsic Factor
    Dx = Pernicious Anemia
  3. Repeat w/ enzymes
    Dx = Pancreas problem
  4. Repeat w/ antibiotics
    Dx = Bacterial overgrowth
  5. Ileum problem
25
Q

Diarrhea definition by stool weight or stool water is an increase in how much?

A

Increase in stool weight or water > 150-200 gm/24hr

WHO definition: “Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual.”

26
Q

Lower GI bleed- dDx?

A
  • Neoplasm (Polyps, Colorectal adenocarcinoma)
  • Colitis
  • Infectious Diarrhea (E.coli, Shigella, Salmonella, C. jejuni)
  • Diverticular Disease
  • Hemorrhoids
27
Q

Diarrhea:

Classification/Types?

A
  • Secretory
  • Osmotic
  • Exudative
  • Malabsorptive
  • Abnormal motility
28
Q

Water absorption occurs due to the osmotic gradient established by __(a)__ - which itself is dependent on absorption of __(b)__ & __(c)__.

A

a) Sodium
b) Glucose
c) Amino Acids

(primary mechanism of Na+ absorption is cotransport w/ glucose & AAs)

29
Q

Simplified diarrhea classifications involved in:

  • Watery diarrhea
  • Bloody diarrhea
  • Fatty diarrhea
A

Watery:

  • Osmotic
  • Secretory
  • Motility Disorders
  • Infectious

Bloody:

  • Exudative/inflammatory
  • Infectious

Fatty:

  • Malabsorptive
  • Motility disorders
30
Q

Secretory Diarrhea - Features?

A
  • Stool isotonic w/ plasma
  • Large volume diarrhea (>1L/day)
  • Diarrhea persists when fasting
  • Electrolytes account for most of stool osmolality (which is small, <50)
31
Q

_______ is the classic secretory diarrhea (etiology)

A

Vibrio Cholera

32
Q

Vibrio Cholera - does organism colonize intestinal cells?

A

No, it sticks to the surface of small bowel cells, w/out ever penetrating the mucosal surface, & produces its enterotoxin

33
Q

How does Vibrio Cholera cause diarrhea?

A
  • Produces an enterotoxin (protein) that enters enterocytes in the SI
  • Irreversibly activates Adenylate Cyclase
  • Na/Cl absorption is inhibited & anions are secreted, causing Secretory diarrhea
34
Q

Does Vibrio Cholera cause intestinal damage?

A

No, it does not invade cells – its toxin does but does not destroy them

35
Q

Diagnosis?

Severe “rice water” stool output (>1L/day)

A

Vibrio Cholera

36
Q

Tx for Vibrio Cholera that dramatically improves mortality?

A

Oral solution w/ glucose (& pinch of sodium)

- enhances sodium absorption via sodium-glucose cotransport

37
Q

Hormone producing tumors that cause secretory diarrhea?

A
  1. Carcinoid (5HT, Prostaglandins, Bradykinin)
  2. VIPoma (VIP)
  3. Gastrinoma (Gastrin)
  4. Medullary Carcinoma of Thyroid (Calcitonin, Prostaglandins)
  5. Ganglioneuroma (probably VIP)
38
Q

Carcinoid Syndrome- what type of diarrhea can this cause & how?

A

Secretory diarrhea, caused by increased production & metabolism of Tryptophan, leading to increased 5HT
- 5HT causes secretory diarrhea via anion secretion & Na/Cl inhibition

39
Q

Osmotic diarrhea- pathophysiology?

A

Poorly absorbed solutes creates osmotic gradient that draws water into intestinal lumen
- Failure to transport osmotically active solute

40
Q

Osmotic diarrhea- Causes?

A
  • Magnesium (in laxatives)

- Lactose ingestion w/ lactase deficiency

41
Q

Osmotic diarrhea- Features?

A
  • Stool volume typically 125
  • Acidic stool pH from carbohydrate malabsorption
  • Unmeasured non-electrolytes account for most of stool osmolality (which is large, >125)
42
Q

3 Diagnostic methods of Lactase deficiency?

A
  1. Trial of milk produce ingestion w/ & w/out lactase enzyme supplement
  2. Hydrogen breath test: Lactose hydrogen (H2) absorbed into portal circulation & excreted in breath (rise in exhaled hydrogen >20ppm)
  3. Lactose Tolerance Test: Ingest 50 mg lactose, blood glucose rises <20 mg/dL
43
Q

Examples of Motility disorders causing diarrhea?

A
  • IBS
  • Scleroderma
  • Intestinal surgery predisposing to bacterial overgrowth syndrome
44
Q

Examples of Edudative diarrhea?

A

IBD:

  • Crohn’s Disease
  • Ulcerative Colitis

Infectious:

  • Shigella
  • Clostridium dificile
  • Entamoeba Histolytica
45
Q

Classic malabsorptive diarrhea symptoms?

A

Steatorrhea & weight loss

  • Large volume stools
  • Malodorous & fat droplets
46
Q

Complications of malabsorptive diarrhea?

A
  • Fat soluble vitamin deficiencies

- Edema &/or ascites

47
Q

Giardia causes a ______ diarrhea

A

malabsorptive

48
Q

Giardia diarrhea- Features?

A

Trophozoites

  • attach via adhesive disk on ventral surface
  • reside in proximal small bowel
  • no cellular invasion or necrosis
  • Inflammatory response causes changes to villous & crypt architecture
  • Disruption of microvilli & brush border enzymes
  • No cleare enterotoxin
49
Q

Whipple’s Disease- etiology?

A

Chronic systemic infection
- Tropheryma whippelii

  • PAS-positive, bacteria-laden macrophages in lamina propria of small intestine
  • Macrophage infiltration of mucosa & obstruction of mesenteric lymph nodes leads to malabsorption
  • SI most commonly affected
  • – Joints, CV system, CNS
50
Q

3 types of diarrhea-causing E. coli?

A

Bloody diarrhea:

  • Enterohemorrhagic E. coli (EHEC)
  • – O157:H7 strain in US, usually affects children
  • – Shiga-like toxin, can cause HUS
  • Enteroinvasive E. coli (EIEC)
  • – invades colonic mucosa

Watery diarrhea:

  • Enterotoxigenic E. coli
  • – Traveler’s diarrhea & Infantile diarrhea
  • – Produces ST & LT Toxins
  • – Cramps, occasional vomiting, low-grade fever
51
Q

Causative Organism?

  • Bloody diarrhea
  • Comma or S-shaped organisms, growth @ 42F
A

Campylobacter

52
Q

Causative Organism?

- Bloody diarrhea caused by Protozoan

A

Entamoeba Histolytica

53
Q 
Causative Organism(s)?
- Watery diarrhea caused by Protozoa
A
  • Giardia (cysts in stool, Tx = Metronidazole or Nitazoxanide)
  • Cryptosporidium (immunocompromised – must order specific exam for Dx; Tx = Nitazoxanide)
54
Q

Causative organism?

  • Bloody diarrhea
  • Day-care outbreaks, psuedoappendicitis
A

Yersinia enterocolitica

55
Q

It is appropriate to obtain endoscopic biopsies looking for celiac disease in patients w/ what 4 symptoms/conditions?

A
  1. Positive Serologic test
  2. Iron deficiency Anemia
  3. Chronic diarrhea
  4. Weight loss
56
Q

Villous atrophy is found in a number of GI diseases.

Name 5 of them.

A
  1. Celiac Disease
  2. Whipple’s Disease
  3. Tropical Sprue
  4. Intestinal Lymphoma
  5. Crohn’s Disease

OSD_GI (13 decks)

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