Small bowel Flashcards
Classic symptoms of Whipples Disease?
Treatment?
arthralgia and diarrhea
Also neurological symptoms
CTX then Bactrim
Refractory Celiac disease?
lack of response to a strict gluten-free diet after 6-12 months
Treatment for small bowel amyloidosis?
Supportive
Stool test for protein-losing enteropathies ?
alpha-1-antitrypsin fecal concentrations over 100 mg/dL
rare condition characterized by dilatation of the intestinal lymphatics which blocks effective fluid drainage leading to a subsequent loss of lymph fluid into the GI tract?
Treatment?
primary intestinal lymphangiectasia
low-fat diet supplemented with medium chain triglycerides (medium chain triglycerides are directly absorbed, they do not cause further lymphatic dilation)
Vitamin deficiencies in SIBO?
This vitamin tends to be elevated in SIBO?
A,D,E,K,B12
Folate
short gut syndrome with increased output that is not controlled with conservative measures - try this drug? (Mechanism?)
teduglutide (glucagon-like peptide-2 agonist)
Refractory celiac disease (RCD) - type 1 vs type 2 (on pathology)?
type 1 with normal intraepithelial T lymphocytes
type 2 with aberrant intraepithelial T lymphocytes
Celiac vs CVID biopsies?
Both have villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis
Plasma cells are increased in celiac disease, they are absent in common variable immune deficiency.
Treatment for intestinal CVID? If fails?
corticosteroids (prednisone or budesonide)
infliximab or other anti-tumor necrosis factor agents
Patients with celiac disease, even when well-controlled, are at higher risk for this (non-intestinal) disease?
Ensure patients get?
pneumococcal pneumonia due to underlying hyposplenism
vaccination against Streptococcus pneumoniae
EGD biopsies with reduced surface intraepithelial lymphocytes, absent goblet and Paneth cells - Dx?
Autoimmune enteropathy
Endoscopic Appearance of tropical sprue?
Treatment?
similar to celiac disease, but the degree of villous atrophy is often less severe.
folic acid plus tetracycline 250 mg four times daily
Classic endoscopic findings in lymphangiectasia?
Lab finding?
creamy yellow-white jejunal villi indicating the dilated lymphatic vessels
Elevated A1AT
criteria for consideration of small bowel transplantation due to complications from TPN include:
Clots, infection, dehydration, liver failure
1) impending liver failure
2) two or more episodes of line-related sepsis in a year
3) one episode of line-related fungemia, frequent severe dehydration
4) thrombosis of a major central venous vein including the subclavian, jugular or femoral.
