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Gastro Review > SI@ > Flashcards

SI@ Flashcards

1
Q

Which type of celiac is harder to tx?

A

Type 2

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2
Q

How to differentiate T1 v T2 celiac?

A

Flow cytometry of SI bx

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3
Q

How to dx T2/T1 celiac?

A

T2 - >20% abnl T lymphs

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4
Q

Whipples dz sxs

A

malabs, neuro, CV, pulm sxs

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5
Q

MC group to get Whipples dz?

A

White male, 49-55 yo

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6
Q

How to dx whipples?

A

SI bx - foamy macs with PAS+

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7
Q

How to tx Whipples dz?

A

Bactrim x 1 yr, doxy if resistant

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8
Q

Systemic mastocytosis has presentation similar to what?

A

Anaphylaxis, though intermittent episodes

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9
Q

What sxs of systemic mastocytosis?

A

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

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10
Q

How to dx systemic mastocytosis?

A

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

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11
Q

CVID presentation

A

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

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12
Q

Bx SI shows what in cvid?

A

Similar findings to celiac - IEL, villous atrophy

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13
Q

What differentiates CVID from celiac on histo?

A

Celiac - high plasma cells

CVID - ABSENT plasma cells

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14
Q

How to tx CVID?

A

CCS initially

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15
Q

How does cirrhosis lead to PLE?

A

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

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16
Q

WHat is PLE?

A

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

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17
Q

Best tx of PLE?

A

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

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18
Q

Zinc def sxs

A

alopecia, poor taste, poor healing, scaly rash

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19
Q

How much zinc to suppl in SBS?

A

50-100 mg daily

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20
Q

How to tx Menetriers dz?

A

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

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21
Q

How to dx Meckels?

A

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

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22
Q

Folate and B12 in SIBO?

A

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

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23
Q

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

A

False - can cause AP but not splenic rupture

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24
Q

What is potential celiac dz?

A

Elevated AB, normal bx +/- sxs

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25
Q

Why is potential celiac dz important?

A

More likely to develop celiac dz if have thsi

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26
Q

Prevalence of celiac in…

  1. Gen pop
  2. Whites
  3. SDR w dz
  4. FDR w dz
A
  1. 1:141
  2. 1:100
  3. 1:39
  4. 1:22
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27
Q

Features of amyloidosis

A

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

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28
Q

Sxs of beriberi

A

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

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29
Q

TPN dep malabs - criteria for SI TP

A
  1. impending liver fx
  2. 2+ line sepsis/yr
  3. 1 fungemia
  4. freq dehydration
  5. thrombus of major CV
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30
Q

Name the major CVs

A

subclavian, jugular, femoral

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31
Q

How to screen for SI CA in Peutz Jeghers?

A

Capsule Q3yrs

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32
Q

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

A

When > 1 cm

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33
Q

Features of PJS?

A

hamartomas, panc, stomach/colon/SI CA

34
Q

If IgA def, how to test for celiac?

A

IgG Deaminated gliadin peptide (anti-DGP) AB

35
Q

What test to differentiate T1 & T2 celiac?

A

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

36
Q

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

A

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

37
Q

How to differentiate CD from AIE?

A

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

38
Q

What are sxs of tropical sprue?

A

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

39
Q

How to tx tropical sprue?

A

3-6 months of tetracycline

40
Q

Sxs of Whipples dz?

A

systemic sxs with GI involvement in White males around 50 yo

41
Q

What do bx of SI show in Whipples dz?

A

Foamy macs with +PAS stain

42
Q

How to tx Whipples dz?

A

Bactrim x 1 yr, alt doxy or hydroxychloroquine

43
Q

Sxs in systemic mastocytosis?

A

Similar to anaphylaxis with rash, syncope, lightheadedness

44
Q

How to dx systemic mastocytosis?

A

BM bx with tryptase staining

45
Q

How to differentiate CVID from celiac on bx?

A

CVID has absent plasma cells whereas celiac they are elevated

46
Q

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

A

True

47
Q

What is tx of menetriers dz?

A

Octreotide, antisecretory agents, cetuximab, or total gastrectomy

48
Q

Which infxns can be AW menetriers?

A

H pylori and CMV

49
Q

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

A

60 cm or more

50
Q

Sxs of vit E def?

A

neuropathy (sensory and motor), ataxia, hemolytic anemia

51
Q

Sxs of vit A def?

A

Night blindness, inability to produce tears, follicular hyperkeratosis

52
Q

Sxs of niacin def?

A

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

53
Q

Sxs of biotin def?

A

AMS, myalgias, dysthesias, anorexia, dermatitis

54
Q

Sxs of thiamine def?

A

beriberi - CHF, neuropathy, Wernickes, confusion/coma

55
Q

List names of Vits B1-12.

A 
B1 - thiamine
B2 - riboflavin
B3 - niacin
B6 - pyridoxine
B7 - biotin
B9 - folate
B12 - cobalamin
56
Q

WHat is a Meckel scan?

A

99 TmC pertechnate scan

57
Q

How to tx giardiasis?

A

Flagyl, quinacrine

58
Q

How to tx Behcets?

A

Steroids first, then azathioprine or anti-TNF

59
Q

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

A

Subserosa

60
Q

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

A

Subserosal

61
Q

AP is a complication of what scope besides ERCP?

A

DBE

62
Q

Splenic rupture can be seen after which scope?

A

Colonoscopy

63
Q

WHat is potential celiac dz? Why is it important?

A

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

64
Q

Who gets tropical sprue?

A

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

65
Q

What is seen with tropical sprue?

A

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

66
Q

How to tx tropical sprue?

A

Folic acid and tetra or doxy

67
Q

How to best dx Whipples dz?

A

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

68
Q

Sxs of Whipples dz?

A

Diarrhea, CNS, and joint sxs, weight loss

69
Q

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

A

SBS < 170 cm

TPN dependent < 60 cm

70
Q

Lab/bx findings in systemic mastocytosis?

A

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

71
Q

What is collagenous sprue?

A

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

72
Q

How to tx collagenous sprue?

A

Steroids (pred or budesonide)

73
Q

Classic non-GI findings in amyloidosis?

A

Carpal tunnel, shoulder problems, periorbital petechiae, macroglossia

74
Q

MC VCE finding

A

Angioectasia

75
Q

Bowel CA screening strategy in PJS?

A

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

76
Q

If IgA def, what is best serologic celiac test?

A

Anti DGP

77
Q

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

A

40%

78
Q

How does a Meckel scan work?

A

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

79
Q

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

A

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

80
Q

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

A

True - it increases affinity of binder to gastric mucosa

81
Q

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

A

False, but IBD can

82
Q

Biotin (B7) Def sxs

A

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

Gastro Review (15 decks)

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