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Question 1

Which type of celiac is harder to tx?

Answer 1

Type 2

Question 2

How to differentiate T1 v T2 celiac?

Answer 2

Flow cytometry of SI bx

Question 3

How to dx T2/T1 celiac?

Answer 3

T2 - >20% abnl T lymphs

Question 4

Whipples dz sxs

Answer 4

malabs, neuro, CV, pulm sxs

Question 5

MC group to get Whipples dz?

Answer 5

White male, 49-55 yo

Question 6

How to dx whipples?

Answer 6

SI bx - foamy macs with PAS+

Question 7

How to tx Whipples dz?

Answer 7

Bactrim x 1 yr, doxy if resistant

Question 8

Systemic mastocytosis has presentation similar to what?

Answer 8

Anaphylaxis, though intermittent episodes

Question 9

What sxs of systemic mastocytosis?

Answer 9

Rash beginning at ext and extending in, nausea, vomit, diarrhea

Question 10

How to dx systemic mastocytosis?

Answer 10

BM bx with tryptase staining - >15 mast cells on stain

Question 11

CVID presentation

Answer 11

Recurrent infxns (pulm, URI), diarrhea - similar to IBD or celiac

Question 12

Bx SI shows what in cvid?

Answer 12

Similar findings to celiac - IEL, villous atrophy

Question 13

What differentiates CVID from celiac on histo?

Answer 13

Celiac - high plasma cells

CVID - ABSENT plasma cells

Question 14

How to tx CVID?

Answer 14

CCS initially

Question 15

How does cirrhosis lead to PLE?

Answer 15

portal HTN gastropathy lead to inc interstitial pressures and impaired prot synthesis

Question 16

WHat is PLE?

Answer 16

Hypoalbuminemia leading to ascites and edema due to dec oncotic pressure, hypogammaglobulinemia, and fat malabs

Question 17

Best tx of PLE?

Answer 17

high prot, low long chain FA, high med chain FA and low fat overall

Question 18

Zinc def sxs

Answer 18

alopecia, poor taste, poor healing, scaly rash

Question 19

How much zinc to suppl in SBS?

Answer 19

50-100 mg daily

Question 20

How to tx Menetriers dz?

Answer 20

Tx H pylori or CMV if +; octreotide, antisecretory agents, cetuximab, or gastrectomy

Question 21

How to dx Meckels?

Answer 21

99mTC pertechnetate scan - only if HDS and between bleeds – after neg colon, EGD, capsule

Question 22

Folate and B12 in SIBO?

Answer 22

High folate (bact make it), low B12 (bact compete for it)

Question 23

T/F: AG DBE can lead to splenic rupture or AP

Answer 23

False - can cause AP but not splenic rupture

Question 24

What is potential celiac dz?

Answer 24

Elevated AB, normal bx +/- sxs

Question 25

Why is potential celiac dz important?

Answer 25

More likely to develop celiac dz if have thsi

Question 26

Prevalence of celiac in... 1. Gen pop 2. Whites 3. SDR w dz 4. FDR w dz

Answer 26

1. 1:141 2. 1:100 3. 1:39 4. 1:22

Question 27

Features of amyloidosis

Answer 27

Joint pain, carpal tunnel, periorbital edema, macroglossia, restrictive CM, GIB

Question 28

Sxs of beriberi

Answer 28

Thiamine def - peripheral neuropathy and sensory/motor probs, CHF, edema

Question 29

TPN dep malabs - criteria for SI TP

Answer 29

1. impending liver fx 2. 2+ line sepsis/yr 3. 1 fungemia 4. freq dehydration 5. thrombus of major CV

Question 30

Name the major CVs

Answer 30

subclavian, jugular, femoral

Question 31

How to screen for SI CA in Peutz Jeghers?

Answer 31

Capsule Q3yrs

Question 32

When polyps in SI seen in PJS, when to remove?

Answer 32

When > 1 cm

Question 33

Features of PJS?

Answer 33

hamartomas, panc, stomach/colon/SI CA

Question 34

If IgA def, how to test for celiac?

Answer 34

IgG Deaminated gliadin peptide (anti-DGP) AB

Question 35

What test to differentiate T1 & T2 celiac?

Answer 35

Flow cytometry - if > 20 % LCs abnl then type 2

Question 36

In newly dx celiac, which nutrition labs should be checked?

Answer 36

B12, folate, zinc, copper, vit D, Ca

Question 37

How to differentiate CD from AIE?

Answer 37

AIE - lack of LCs, absent goblet and paneth cells, can see + Anti-enterocyte & anti-goblet cell AB

Question 38

What are sxs of tropical sprue?

Answer 38

Diarrhea, wt loss, B12 & folate low, steatorrhea, macrocytic anemia - clinical like SIBO, endoscopic bx like celiac

Question 39

How to tx tropical sprue?

Answer 39

3-6 months of tetracycline

Question 40

Sxs of Whipples dz?

Answer 40

systemic sxs with GI involvement in White males around 50 yo

Question 41

What do bx of SI show in Whipples dz?

Answer 41

Foamy macs with +PAS stain

Question 42

How to tx Whipples dz?

Answer 42

Bactrim x 1 yr, alt doxy or hydroxychloroquine

Question 43

Sxs in systemic mastocytosis?

Answer 43

Similar to anaphylaxis with rash, syncope, lightheadedness

Question 44

How to dx systemic mastocytosis?

Answer 44

BM bx with tryptase staining

Question 45

How to differentiate CVID from celiac on bx?

Answer 45

CVID has absent plasma cells whereas celiac they are elevated

Question 46

T/F: Amyloidosis of the gut can PW protein losing diarrhea.

Answer 46

True

Question 47

What is tx of menetriers dz?

Answer 47

Octreotide, antisecretory agents, cetuximab, or total gastrectomy

Question 48

Which infxns can be AW menetriers?

Answer 48

H pylori and CMV

Question 49

Resection of what amt of TI can lead to B12 def?

Answer 49

60 cm or more

Question 50

Sxs of vit E def?

Answer 50

neuropathy (sensory and motor), ataxia, hemolytic anemia

Question 51

Sxs of vit A def?

Answer 51

Night blindness, inability to produce tears, follicular hyperkeratosis

Question 52

Sxs of niacin def?

Answer 52

sun rash, dementia, diarrhea, dysphagia, glossitis/angular chelitis

Question 53

Sxs of biotin def?

Answer 53

AMS, myalgias, dysthesias, anorexia, dermatitis

Question 54

Sxs of thiamine def?

Answer 54

beriberi - CHF, neuropathy, Wernickes, confusion/coma

Question 55

List names of Vits B1-12.

Answer 55

``` B1 - thiamine B2 - riboflavin B3 - niacin B6 - pyridoxine B7 - biotin B9 - folate B12 - cobalamin ```

Question 56

WHat is a Meckel scan?

Answer 56

99 TmC pertechnate scan

Question 57

How to tx giardiasis?

Answer 57

Flagyl, quinacrine

Question 58

How to tx Behcets?

Answer 58

Steroids first, then azathioprine or anti-TNF

Question 59

Once eosinophilic gastroenteritis affects this layer, pts can get ascites.

Answer 59

Subserosa

Question 60

Which subset of EG responds best to steroids - mucosal, muscularis, subserosal?

Answer 60

Subserosal

Question 61

AP is a complication of what scope besides ERCP?

Answer 61

DBE

Question 62

Splenic rupture can be seen after which scope?

Answer 62

Colonoscopy

Question 63

WHat is potential celiac dz? Why is it important?

Answer 63

+/-Sxs, increased AB, normal scope findings and bx - increased risk of developing celiac disease later in life

Question 64

Who gets tropical sprue?

Answer 64

People who have been in areas where you can get it over a month (Haiti, DR, PR, etc)

Question 65

What is seen with tropical sprue?

Answer 65

Diarrhea, bloating, wt loss, low B12/folate, steatorrhea, lymphocytes in duodenal bx

Question 66

How to tx tropical sprue?

Answer 66

Folic acid and tetra or doxy

Question 67

How to best dx Whipples dz?

Answer 67

EGD with duodenal biopsies with PAS staining - will have macrophages in duodenal lamina propria

Question 68

Sxs of Whipples dz?

Answer 68

Diarrhea, CNS, and joint sxs, weight loss

Question 69

At what SB length can SBS occur and at what length is TPN usually not able to be weaned?

Answer 69

SBS < 170 cm | TPN dependent < 60 cm

Question 70

Lab/bx findings in systemic mastocytosis?

Answer 70

Urinary histamine elevated Serum tryptase elevated Bowel bx with c-KIT + stain for mastocytes

Question 71

What is collagenous sprue?

Answer 71

Sxs similar to celiac with diarrhea, malodorous stool, weight loss, villous blunting but also see subepithelial collagen on bx

Question 72

How to tx collagenous sprue?

Answer 72

Steroids (pred or budesonide)

Question 73

Classic non-GI findings in amyloidosis?

Answer 73

Carpal tunnel, shoulder problems, periorbital petechiae, macroglossia

Question 74

MC VCE finding

Answer 74

Angioectasia

Question 75

Bowel CA screening strategy in PJS?

Answer 75

VCE every 3 years with enteroscopy to remove polyps > 1 cm

Question 76

If IgA def, what is best serologic celiac test?

Answer 76

Anti DGP

Question 77

If pt bleeds from SB AVMs and tx, what is risk of recurrent bleed over next 2 yrs?

Answer 77

40%

Question 78

How does a Meckel scan work?

Answer 78

Isotope injected that will stain gastric mucosa, so check for any ectopic mucosa. Only + if Meckel contains ectopic gastric mucosa.

Question 79

T/F: CHildren have higher chance of + Meckel scan than adult.

Answer 79

True - that is because if ectopic gastric mucosa, tend to get sxs sooner and thus get + dx

Question 80

T/F: Cimetidine can increase sensitivity of Meckel scan?

Answer 80

True - it increases affinity of binder to gastric mucosa

Question 81

T/F: Celiac can give false + Meckel scan.

Answer 81

False, but IBD can

Question 82

Biotin (B7) Def sxs

Answer 82

AADD-7 - AMS, anorexia, Dermatitis, Dysesthesias, Myalgias