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Gastrointestinal II Exam 1 > McGowan DSA Week 2 > Flashcards

McGowan DSA Week 2 Flashcards

1
Q

How do upper GI bleeds present typically?

How do lower GI bleeds present?

A

Melena, hematochezia if rapid onset

Hematochezia

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2
Q

What are several causes of upper GI bleeds?

A

PUD

Varices

Gastritis

MW tear

Boerhaave syndrome

Aortoenteric fistula

AV malformations

Cancer

Swallowed blood

Anticoag Drugs

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3
Q

What are several causes of lower GI bleeds?

A

IBD

Ischemic Colitis

Diverticulosis

Anal Fissures

Polyps

Cancer

Infectious colitis

AV malformations

Varices

NSAID ulcers

Rectal ulcers

Intussusception

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4
Q

What is an occult GI bleed?

What is the etiology of an occult GI bleed?

A

Bleeding that is not apparent to the patient

chronic GI blood loss of less than 100ml per day with no visible change in stool

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5
Q

What is the H/P of occult GI bleed?

A

Fatigue

bleed can come from anywhere in GI tract

Common cause: Neoplasm, vascular abnormalities, Chron’s Disease

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6
Q

How is an occult GI bleed diagnosed?

A

+ Fecal Occult blood test

+ Fecal imunochemical test

Iron deficient anemia

Colonoscopy if asymptomatic

Colonoscopy and EGD if symptomatic

IgA anti-tissue transglutaminase or duodenal bx (Celiac’s)

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7
Q

In a patient under 60 with unexplained occult bleeding or iron deficiency what further examination should be done?

A

examination of the small intestine to exclude a small intestine neoplasm or IBD

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8
Q

In patients over 60 with occult bleeding and normal endoscopy and no other concerning sx, what is the likely diagnosis?

A

blood loss due to angioectasias

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9
Q

In a person over 45 with IDA, what is your main concern?

A

Colon Cancer

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10
Q

What is the treatment for occult GI bleed?

A

supportive, transfusion if indicated

treat underlying cause

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11
Q

What are the DDx for a Lower GI bleed in someone under age 50?

A

Infectious colitis

Anorectal Disease (fissures, hemorrhoids)

IBD

Meckel Diverticulum

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12
Q

What are the DDx for Lower GI bleed in patients over 50?

A

Malignancy

Diverticulosis

Angiectasis

Ischemic Colitis

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13
Q

What percentage of hematochezia is due to upper GI source?

A

10%

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14
Q

What is the H/P for lower GI bleed?

A

possible hematochezia or pain

history of NSAID/anticoag use

Red Dye and beets (pink/red stool, no blood)

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15
Q

How is a lower GI bleed diagnosed?

A

Colonoscopy in stable patients

vitals/CBC/anoscope

massive bleeds require sigmoioscopy, EGD, angiography or nuclear bleeding scan

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16
Q

What is the treatment for Lower GI Bleed?

A

CBC/Chem, INR,PT, PTT, Type+screen+cross

Fluids (2 LB IV)

transfusion id needed

endoscopic treatment, rarely surgery

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17
Q

What is the etiology for diverticulitis?

A

herniation of mucosa through the muscularis at points of artery entry

most common cause of major lower tract bleed

common in sigmoid colon

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18
Q

What is the H/P for diverticulosis?

A

acute, painless large volume maroon or bright red hematochezia in patients over age 50

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19
Q

What are the diagnostics for diverticulosis?

A

evaluation with colonoscopy in stable patients, once bleeding subsides

(panel of labs)

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20
Q

Treatment for diverticulosis?

A

high fiber diet, anticholinergics

supportive care

fluid/transfusion if needed

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21
Q

What is IBD?

A

chronic state of dys-inflammation

disruption of normal homeostasis by environment or genetics

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22
Q

What are some risks for developing IBD?

A

environment and genetics

bimodal distrubitions (20s+90s)

appendectomy before age 20 can be protective

Abx in first year of life increases IBD risk by 2.9%

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23
Q

What are the labs for IBD?

A

ANCA

ASCA

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24
Q

What will be seen on a barium enema with IBD?

A

string sign (narrowing from inflammation or stricture in CD)

Lead Pipe (loss of haistra in UC)

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25
Q

What is the H/P for Chron Disease?

A

RLQ pain

diarrhea with or without blood

Acute ileitis (looks like appy)

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26
Q

What are the diagnostics for Chron Disease?

A

ASCA

imaging (CT/MRI/Colonoscopy/Barium Enema)

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27
Q

What is the treatment for Chron Disease?

A

Corticosteroids

immunomodulating agents /biologics

Antibiotics

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28
Q

What are some complications of Chron Disease?

A

Fistula/Abscess

Bile salt malabsorption

gallstones/kidney stones

colon cancer

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29
Q

What is the H/P of ulcerative colitis?

A

Bloody Diarrhea

Tenesmus/fecal urgency

hx of recent smoking cessation

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30
Q

What are the diagnostics of Ulcerative colitis?

A

labs (pANCA, fecal calprotectin)

anoscopy

sigmoid/colonoscopy with bx

barium enema

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31
Q

What is the treatment for Ulcerative Colitis?

A

corticosteroids

immunomodulating/biologic agents

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32
Q

What are the complications of Ulcerative Colitis?

A

hemorrhage

perforation

cancer

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33
Q

What are some extraintestinal manifestations of IBD?

A

aphthous ulcer

toxic megacolon

uveitis/iritis

erythema nodosum

ankylosing spondylitis

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34
Q

What is the CD related gene for Chron disease?

A

card15/NOD2

ch. 16p

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35
Q

What type of cancer is increased in chrons and uclerative colitis?

A

Colon cancer

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36
Q

What are some specific features of ulcerative colitis that differentiates it from chron disease?

A

Colon only

continuous lesions

bloody diarrhea

smoking protective

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37
Q

What is the history of ischemic colitis?

What is seen on imaging?

Managment?

A

sudden cramping LLQ abd pain with urge to defecate

passage of blood or bloody diarrhea

“Thumb Printing” on imaging

stabilize and surgery

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38
Q

Up to ___ % of all cololorectal cancers are caused by what?

A

4%; germline genetic mutations

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39
Q

Due to genetic mutations causing colorectal cancers, who should be screened for colon cancer?

A

persons with:

Fmhx of colorectal cancer in more than one relative

personal or Fmhx of colorectal cancer under age 50

personal or fmhx of more than 20 polyps

personal or fmhx of multiple extracolonic cancers

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40
Q

What is the etiology of FAP?

A

100-1000s of adenomatous polyps and adenocarcinoma

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41
Q

What is the H/O for FAP?

A

polyps

congenital hypertrophy of the retinal pigment epithelium detected at birth

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42
Q

What are the diagnostics of FAP?

A

90% have AD mutation in APC gene

8% have AR mutation in MUTYH gene

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43
Q

What is the treatment for FAP?

A

proctocolectomy with ileoanal anastomosis before age 20

prophylactic colectomy to prevent inevitable colon cancer

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44
Q

What is the etiology of Lynch Syndrome(HNPCC)

A

polyps that undergo rapid transformation over 1-2 years to adenoma and then to cancer

Colorectal cancer risk (22-75%)

endometrial cancer (30-60%)

other cancers develop at a young age

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45
Q

What is the H/P for Lynch syndrome? (HNPCC)

A

based on fmhx, Bethesda Criteria

All colorectal cancers should undergo testing for Lynch syndrome with either immunohistochemistry or microsatellite instability

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46
Q

what are the diagnostics for Lynch sydndrome?

A

AD

DNA base-pair mismatch genetic testing for MLH1, MSH2

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47
Q

What is treatment for Lynch Syndrome? (HNPCC)

A

subtotal colectomy with ileorectal anastomosis with surveillance

prophylactic hysterectomy and oophorectomy is recommended to women at age 40 or once they have finished childbearing

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48
Q

What is the H/P for Peutz-Jeghers syndrome?

A

hamartomatous polyps

not malignant

pigmented macules on lips/buccal mucosa and skin

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49
Q

What is the H/P for familial juvenile polyposis?

A

several juvenile hamartomatous polyps located in colon

increased risk for adenocarcinoma

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50
Q

What is the H/P for PTEN (Cowden Disease)

A

hamartomatous polyps and lipomas in GI tract

increased risk for malignnacy is demonstrated in thyroid, breast and urogenital tract

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51
Q

What are the diagnostics of peutz-jeghers sydrome?

A

AD

serine threonine kinase 11 gene testing

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52
Q

What are the diagnostics of familial juvenile polyposis

A

AD

genetic defects ID’ed on loci 18q and 10q

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53
Q

What is the H/P for nonfamilial adenomatous and serrated polyps?

A

mostly completely asymptomatic

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54
Q

What are the treatments for nonfamilial adenomatous and serrated polyps?

A

colonoscopic polypectomy

post-polypectomy surveillance 3-10 years depending on type of polyp

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55
Q

What are the diagnostics for nonfamilial adenomatous and serrated polyps?

A

barium enema or CT or CT colonography that are diagnostic but not therapeutic

Colonoscopy remains the best test because it is diagnostic and therapeutic (polypectomy)

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56
Q

What are the guidelines for colon cancer screening?

A

start at age 45 and continue until age 75

75-85 screen based on preference, health, life expectancy

85 stop screening

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57
Q

What is the etiology for colon cancer?

A

over 45

S. bovis bacteremia

second most common internal cancer in humans

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58
Q

What is the H/p for colon cancer?

A

Left sided: presents with rectal bleeding, changes in bowel habits

Right sided: anemia, blood loss, weight loss

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59
Q

What are the diagnostics for colon cancer?

A

early diagnosis by screening asymptomatic persons with fecal blood testing

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60
Q

What is the treatment/prevention for colon cancer?

A

surgery/chemo/radiation for treatment

prevent with colonoscopies at age 45 and screening should start at 40 or ten years earlier than 1st degree relative if fmhx

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61
Q

What are AV malformations/angioectasias?

A

painless bleeding to occult blood loss

melena if proximal to ligament of trietz

common in those with chronic renal failure or aortic stenosis

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62
Q

What is the H/P for hemorrhoids?

A

bright red blood per rectum, usually only drops

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63
Q

What are the diagnostics for hemorrhoids?

treatment?

A

visualized externally or anoscopy

laxatives, stool softeners, band ligation

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64
Q

What is a complication of hemorrhoids?

A

thrombosed external hemorrhoid

onset after cough/sneeze, strain

acute pain, bluish perianal nodule

pain eases over 2-3 days

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65
Q

What is the etiology of anal fissures?

A

linear or rocket shapped ulcers from trauma to anal canal

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66
Q

What is the H/P for anal fissures?

treatment?

A

severe tearing pain with defecation followed by throbbing pain

hematochezia, blood on stool/paper

fiber, sitz baths, Botox of anal canal or Nitro ointment

67
Q

What are the DDx for RUQ abdominal pain?

A

Gallbladder

Duodenal ulcer

hepatitis

pancreatitis

budd chiari syndrome

68
Q

What are the DDx for epigastric abdominal pain?

A

Ruptured aortic aneurysm

PUD

Hiatal hernia

GERD

gastritis

esophagitis

pancreatitis

cholecystitis

69
Q

When do we worry about an aortic aneurysm rupturing?

A

risk of rupture increases with size

greater than 5cm is the most concerning

unruptured will commonly have no symptoms, may be found on routine exam

ruptures are usually spontaneous and always life-threatening

acute pain and hypotension occur with rupture and requires surgery

70
Q

What is a good screening tool for abdominal aortic anerysms?

A

US

esp. in men over 65 who have eber smoked

71
Q

What are the sx of aortic aneurysm dissection?

A

tear in intima of vessel

creates a false lumen

causes atypical chest pain, wide medistinum

72
Q

What are the DDx for LUQ pain?

A

gastric ulcer

gastritis

pancreatitis

perf. subdiaphragmatic viscus

73
Q

What are the DDx for RLQ pain?

A

appendicitis

ectopic pregnancy

ovarian torsion

IBD

Ogilvie syndrome

Meckel’s diverticulitis

74
Q

What is the etiology for appendicitis?

A

between ages 10-30 common

obstruction of appendix by fecolith, inflammation, etc

75
Q

What is the H/P for appendicitis?

A

vague colicky periumbilical pain that moves to RLQ within 12 hrs

+psoas sign

+obturator sign

+heel strike

+rebound tenderness

76
Q

What are the diagnostics for Appendicitis?

A

moderate leukocytosis, US or CT scan

77
Q

What is the treatment for appendicitis?

Complications?

A

surgery

abx

gangrene and perforation within 36hrs

78
Q

What is the etiology of ectopic pregnancy?

A

risks include hx of infertility, PID, ruptured appendix, prior tubal surgery

most common cause of maternal death in first trimester

79
Q

What is the H/P for ectopic pregnancy?

A

severe lower quadrant pain in almost every case 6-8 wks after LMP

80
Q

What are the diagnostics for ectopic pregnancy?

A

positive pregnancy test with serum bHCG greater than 2000 and NO intrauterine pregnancy on transvag US

81
Q

What is the etiology of ovarian torsion?

A

right sided 70% of the time due to increased length of utero ovarian ligament on right and sigmoid on left

82
Q

What is the H/P for ovarian torsion?

diagnostics?

A

sudden severe unilateral abdominal pain after exertion

transvag US with doppler

(typically ovary >4cm is most common finding in assx with torsion)

83
Q

What is the treatment for ovarian torsion?

A

surgery

84
Q

What is the etiology of acute colonic pseudo-obstruction? (ogilvie syndrome?)

A

spontaneous massive dilation of cecum or right colon without mechanical obstruction

85
Q

What is seen on xray due to which common H/P finding in acute colonic pseudo obstruction?

A

abdominal distension prompts xray which shows colonic dilation

86
Q

What are the diagnostics for acute colonic pseudo-obstruction?

A

xray or CT

upper limit of normal for cecal size is 9, so will see closer to 10-12 cm associated with an increased risk for colonic perforation

87
Q

What is the treatment for acute colonic pseudo obstruction?

A

conservative treatment if less than 12cm while treating underlying illness, NG tube

D/C drugs that reduce colon mobility

Cecal size reassessed every 12 hrs

if not improving, or over 12cm, consider neostigmine, colonoscopic decompression, surgery

88
Q

What are the rules of 2s for Meckel’s Diverticulum?

A

2ft from ileocecal valve

2% of pop. effected

2in long

2 types of ectopic tissue (Gastric and pancreatic)

2x more common in males

symptomatic by age 2

89
Q

What are the sx of meckel’s diverticulum?

A

rectal bleeding, intussuscption, perfoation

can’t be distinguised clincally from appendicitis

best to diagnose with technetium-99m scan

manage with surgery

90
Q

What are the DDx for LLQ?

A

diverticulitis

ischeimc colitis

ectopic pregnancy

ovarian torsion

ibd

colon cancer

91
Q

What is the etiology for diverticulitis?

A

inflammation of a diverticulum leading to microperforations and macroperforations with abscess or generalized peritonitis

92
Q

What is the H/p for diverticulitis?

A

acute LLQ pain

fever

constipation

mild LLQ tenderness with thick palpable sigmoid and descending colon (like a small mass)

93
Q

What is the treatment for diverticulitis

A

can diagnose with barium enema or colonoscopy 4-6 weeks after recovery

IV fluids, NPO, abx inpatient or abx and liquid diet outpatient

surgical resection if young, immunosuppressed

sigmoidectomy for abscesses

94
Q

What are the Ddx for periumbilical abd pain?

A

early appendicitis

mesenteric artery ischemia

ruptured aortic aneurysm

bowel obstruction

IBD

95
Q

What are the sx of acute mesenteric ischmia?

Imaging results?

Post-op anticoagulation?

A

periumbilical pain out of proportion to tenderness

N/V, GI bleed

Thumbprinting on xray and CT angio is test of choice to see vasculature

Yes if venous thombosis, controversial in arterial occlusion

96
Q

what are the symptoms in chronic mesenteric ischemia?

A

abdominal angina with crampy periumbilical pain 15-30 min after eating and lasting several hours

leads to “food fear”

evaluate with mesenteric arteriography

97
Q

What is the most common cause of intestinal obstruction?

What is the diagnosis?

treatment?

A

peritoneal adhesions

Xray or Ct with dilated bowel and air fluid levels

NG tube, fluids

urgent laparotomy for lysis of adhesions before ischemia sets in

98
Q

What is the H/P for SBO?

Diagnosis?

treatment?

A

N/V, feculent

KUB/abdominal series, CT scan

NG tube/surgery if NG isn’t enough

99
Q

What are the DDx for diffuse abdominal pain?

A

IBS

Mesenteric artery ischemia

peritonitis

intestinal obstruction

IBD

Toxic megacolon

constipation

100
Q

Primary bacterial peritonitis is most common among whom?

what is the pathogen?

A

pts with cirrhosis

enteric gram- bacilli like E. coli or gram+ like strep, enteroccoi, penumococci

typically a single organism is isolated

101
Q

How is primary bacterial peritonitis diagnosed?

A

peritoneal fluids contain >250 PMN cells

blood cultures done because bateremia is common

prophylaxis with fluoroquinolines or TMP-SMX or ceftriaxone or piperacillin

102
Q

what is secondary peritonitis?

What is the pathogen?

How will pt present?

A

bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus

mixed flora

pt lies still with knees up to avoid stretching/irritating nerves of peritoneal cavity

103
Q

What is the diagnosis of secondary peritonitis?

treatment?

A

radiographic studies to find source or immediate surgery

antibiotics and surgery

104
Q

What is toxic megacolon?

A

lethal comlication of IBD or C. diff

total or segmental nonobstructive colonic dilation plus systemic toxicity

clinical diagnosis in pts with abdominal distension and acute or chronic diarrhea and enlarged dialted colon on abd. imaging + severe systemic toxicity

105
Q

What are the DDx for fatigue?

A

occult GIB

cancer

IBD

chronic liver disease

malnutrition/malabsorption

106
Q

What are the DDx for unintentional weight loss?

A

cancer

malabsorption syndromes

IBD

poor dentition

107
Q

What is unintentional weight loss?

A

loss of 5-10% of body weight over 6 months should prompt further evaluation

rapid fluctuations of weight over days indicates loss/gain of fluid, while long term changes involve mass loss/gain

108
Q

What questions should you ask of a pt with unintentional weight loss?

What should the exam include?

A

ask about GI sx including eating/bowel changes

obtain pt’s weight

rectal exam for men, pelvic exam for women

stool occult blood exam

*50% of claims of weight loss cannot be substantiated*

109
Q

What should you make sure to check in a patient with unintential weight loss?

A

check their teeth during physical exam and ask about oral health

110
Q

What can stool appearance suggest about underlying conditions?

A

greasy/malodorous indicates malabsorption issue

blood/pus indicates inflammation

water indicates secretory process

111
Q

What does diarrhea plus abdominal pain indicate?

A

IBS

IBD

112
Q

What should the physical exam assess for in patients with diarrhea?

A

signs of malnutrition, dehydration, IBD

113
Q

What is diarrhea?

What nutrients are lost from diarrhea?

A

3+ loose or watery stools per day

OR

decrease in consistency and increase in frequency of BM daily

bicarb and potassium

114
Q

How long does acute diarrhea last?

A

2 weeks or less

115
Q

What are noninflammatory causes of acute diarrhea?

A

virus, bacteria

don’t need work up

(watery, mild)

116
Q

What are inflammatory causes of acute diarrhea?

A

invasive/toxic bacteria

(blood/pus, fever)

consider stool cultures in all patients and C.diff/ova+parasite panels as indicated

117
Q

How long does noninfectious diarrhea typically last?

A

>14 days

118
Q

What is the most common cause of noninfectious diarrhea?

A

medications, mainly Abx

also NSAIDs, antidepressents, chemo, antacids and laxatives

119
Q

What foods often cause diarrhea?

A

sweetners, sorbitol

found in Gum

120
Q

Is antibiotic associated diarrhea due to C. diff?

A

not typically

Abx associated diarrhea occurs during the period of abx exposure

121
Q

What is osmotic diarrhea?

A

stool volume decreases with fasting

increased stool osmotic gap over 50 (75 mosm/kg)

assx with intake of dairy, fruit, sweetners and ETOH

122
Q

What are the most common causes of osmotic diarrhea?

A

medications

disaccharidase def./carb malabsorption

laxative abuse

malabsorptive syndromes

123
Q

What are sx of secretory diarrhea?

A

stool volume doesn’t improve with fasting

nromal osmotic gap

high volume watery diarrhea over 1l per day

124
Q

What are the causes of secretory diarrhea?

A

endocrine tumors

bile salt malabsorption

factitious diarrhea (laxativeS)

villous adenoma

125
Q

How to approach diarrhea?

A

consider the most common causes of chronic diarrhea (meds, IBS, lactose intolerance) and then consider red flags like nocturnal diarrhea, weight loss, anemia, etc as those warrant more evaluation

126
Q

What are some initial labs for chronic diarrhea?

A

CBC/CMP

Vit. A+D

TSH

ESR/CRP

IgA TTG

127
Q

Stool studies for diarrhea?

A

stool electrolytes (osmotic gap)

sudan stain (fat malabsorption)

occult blood

lactoferrin, calprotectin, leukocytes (IBD)

ova/parasites, Giardia, E. histolytica fecal antigen (more senstivie and specific)

128
Q

A colonoscopy with mucosal biopsy will exclude?

A

IBD

microscopic colitis

colonic neoplasia

129
Q

EGD with SI bx is done to rule out?

A

celiac/whipple disease

protozoa in AIDS patients

130
Q

Pancreatic elastase less than ____ indicates?

calcifications seen on plain abd radiograph indicates ?

A

100; pancreatic insuffieciency

chronic pancreatitis

131
Q

breath tests for glucose or lactulose indicate what?

A

small bowel bacterial overgrowth

confirmed with aspirate

132
Q

carb malabsorption is diagnosed how?

A

elimination trial for 2-3 weeks or

hydrogen breath test

133
Q

Neuroendocrine tumors can be diagnosed how?

A

VIP

calcitonin

gastrin

5-HIAA

(serological test)

134
Q

If someone has nocturnal diarrhea, weight loss, anemia, or +FOBT is this consistent with meds, IBS, or lactose intolerance?

A

NO, needs further testing

135
Q

Common specific meds that cause diarrhea?

A

cholinesterase inhibitors

SSRIs

Angiotensin II receptor blockers

PPIs

NSAIDs

metformin

allopurinol

136
Q

What is the etiology of IBS?

A

altered motility (colonic or small bowel)

enhanced visceral sensation

increased psychiatric sx

137
Q

What are the three types of clinical presentation for IBS?

A

spastic colon

alternating constipation and diarrhea

chronic, painless diarrhea

138
Q

What are some alarm symptoms concerning the bowel

*these are NOT consistent with iBS and wararnt further testing

A

acute onset of sx

nocturnal diarrhea

severe constipation or diarrhea

hematochezia

weight loss

fever

fmhx of cancer

139
Q

What is the history of IBS?

A

altered bowel habits

abdominal pain, distension, mucus/loose stools, incomplete evacuation

no detectable organic pathology

pasty/ribbony or pencil tin stools

140
Q

how is IBS diagnosed?

A

chronic > 6 months of sx (must have sx at least 3 months before considering IBS in ddx)

Rome IV criteria

141
Q

treatment for IBS?

A

meds for diarrhea, constipation and pain

avoid stress, consider low FODMAPS diet

(fermentable, oligosaccharides, monosaccharides, disaccharides, and polyols)

142
Q

what pathogens are commonly associated with chronic diarrhea?

A

Protozoa: Giardia, E. histolytica, cyclospora

Nemotode: S. stercoralis

Bacteria: C. diff

AIDS: CMV, HIV, C. diff, M. Avium, Microsporida, Crypto, I. belli, Cyclospora

143
Q

What is the ost common cause of Abx associated colitis?

What is the microbiology?

A

C. Diff

aneaerobic Gram + spore forming bacillus

cytotoxin A and B

144
Q

Who is at high risk of C. diff?

A

hospitalized for more than three days

multiple abx for more than ten days

ampicillin

clindamycin

3rd gen cephalosporins

fluoroquinolines

PPIs

145
Q

HOw is C. diff diagnosed?

A

Stool assay for A and B toxins

PCR

Leukocytosis >15k

pseudomembranousis colitis with volcano exudate

146
Q

How to avoid spreading C diff?

What is a complication of c diff?

A

wash your hands you filthy animal

toxic megacolon and hemodynamic instability leading to death

147
Q

What are symptoms of malabsorption syndromes?

A

weight loss

osmotic diarrhea

steatorrhea

nutritional def.

148
Q

What can cause malabsorption syndromes?

A

small bowel mucosal disorders

pancreastic disease

bacterial overgrowth

lymphatic obstruction

149
Q

What is the etiology for celiac disease?

A

diffuse damage to proximal small intestinal muncosa with malabsorption of nutrients due to glut intolerance

most cases are undiagnosed or asymptomatic

150
Q

What is the haplotypes for celiac disease?

A

HLA DQ2 and DQ8

Antibodies to gluten, ttG

151
Q

What are the sx for celiac?

A

weight loss

chronic diarrhea

growth retardation

fatigue

dermatitis herpetifromis

IDA

osteoporosis

depression

amenorrhea

reduced fertility

152
Q

How is celiac dianosed?

A

abnormal serologic findings, small bowel bx

Iga tTG antibody (become undetectable after 3-12 months after gluten withdrawal)

atrophy or scalloping of duodenal folds on biopsy

complete loss of intestinal villi

153
Q

treatment for celiac?

A

lifelong removal of all gluten

154
Q

Significant steatorrhea can be due to?

A

chronic pancreatitis or pancreatic cacner

(malabsorption of triglycerides)

155
Q

What is bile salt malabsorption?

A

normally resorbed in terminal ileum but resection or chron’s disease can lead to a decrease

causes mild steatorrhea and imparied ADEK absorption

causes water diarrhea

156
Q

What is whipple disease?

A

rare multisystem disease due to infection with G+ T. Whipplei

source of infection unknown

157
Q

What is H/P for whipple disaese?

A

weight loss

malabsorption

chronic diarrhea

158
Q

how is whipple disease diagnosed?

treatment?

prognosis?

A

endoscopy with duodenal bx

PAS + with macrophages

abx

untreated, fatal, neuro signs can be permanent

159
Q

What is pseudo-diarrhea

what are the sx?

what is the cause?

A

small volume stool with frequent passage

rectal urgency, tenesmus, incomplete evacuation

IBS or proctitis

160
Q

What is overflow diarhea?

A

severe constipation and only liquid oozes out

commonly in elderly patients with fecal impactions

161
Q

What is the etiology of constipation/impaction?

A

opioids, bed rest, neurogenic disease or spinal cord injuries

162
Q

What is the H/P of fecal impaction?

A

paradoxical overflow diarrhea

DRE with palpable feces in rectal vault

DO NOT DO DRE if Leukopenia present

163
Q

What can caus malanosis coli?

A

a benign hyperpigmentation of the colon can be caused by chronic use of laxatives

Gastrointestinal II Exam 1 (16 decks)

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