Small Bowel 2

Question 1

Medication for celiac? Mechanism?

Answer 1

Larazotide acetate - Inhibits expression of zonulin (Tight junction proteins) leading to decreased paracellular permeability and decreased passage of gluten

Question 2

Positive celiac serology - next step?

Answer 2

EGD with biopsies

Question 3

Positive TTG antibody and negative biopsy - next step?

Answer 3

Repeat biopsy after gluten challenge

Test HLA DQ2/8

Question 4

Negative TTG antibody and positive biopsy - next step?

Answer 4

• check total IGA, or IgG TTG
• Check IgG deaminated gliadin peptides
• Test HLA DQ2/8

Question 5

Type 1 refractory celiac disease - histology? Five-year survival?

Answer 5

Normal intraepithelial lymphocytes

90%

Question 6

Type 2 refractory celiac disease - histology? Five-year survival?

Can progress to?

Answer 6

Abnormal clonal population of intraepithelial lymphocytes

Under 50%

Enteropathy-associated T cell lymphoma, ulcerative jejunoileitis, mesrnteruc lymph node cavitations

Question 7

oculomasticatory myorhythmia (?) and oculo-facial-skeletal myorhythmia(?) - Pathognomonic findings of?

Answer 7

Eye and jaw movement

Slow nystagmus with rhythmic jaw and skeletal movement

Whipples disease

Question 8

Non-pathognomonic neurologic findings Whipple disease? Cardiac manifestations?

Answer 8

Dementia, super nuclear ophthalmoplegia, seizures, ataxia, cranial nerve palsy

Endocarditis, myocarditis, pericarditis

Question 9

Endoscopic findings in Whipple’s disease?

Histologic findings?

Answer 9

Proximal intestinal edema, white patches (lipid collections)

Foamy macrophages in lamina propria and PAS positive

Question 10

Treatment for Whipples disease?

Do not use this (due to high relapse rate)

Answer 10

Ceftriaxone for two weeks then bactrim for one year

Tetracycline

Question 11

Most common tumor of the proximal small intestine? Distal ileum?

Answer 11

Adenocarcinoma

Carcinoid

Question 12

Disease predisposing to the development of multiple small intestinal GISTs?

Answer 12

Neurofibromatosis type one

Question 13

Most common type of GI lymphoma in the middle east? Other names? Arises from?

Associated with?

Answer 13

Immunoproliferative small intestinal disease

MALT

Mediterranean lymphoma, alpha-heavy chain disease

Campylobacter

Question 14

Mantle cell lymphoma is most common at this GI site?

Chromosomal Abnormality?

Answer 14

Ileocecum

T(11:14)

Question 15

Follicular lymphoma is most common at this G.I. site?

Chromosomal association?

Answer 15

Terminal ileum

T(14:18)

Question 16

Butkitt’s lymphoma most commonly arises from this part of the G.I. tract?

Answer 16

Terminal ileum and cecum

Question 17

Median survival of enteropathy associated t-cell lymphoma?

Answer 17

10 months

Question 18

Post transplant lymphoproliferative disease - induced by? Organ transplant with the highest risk? Lowest risk?

Answer 18

EBV Infection in the setting of immunosuppression

Small bowel transplant

Renal/liver transplant