Small Intestine Flashcards
DIARRHEA, CONSTIPATION, ABDOMINAL BLOATING & DISCOMFORT, DEFICIENCIES in IRON, VIT B12, FOLATE, VITAMIN D, ZINC, HLA DQ2 or DQ8 association?
CELIAC DISEASE (wheat, barley, rye)
When a patient has POSITIVE SEROLOGIC markers for CELIAC DISEASE (TTG and/or EMA) but NORMAL BIOPSIES, what does this mean?
LATENT CELIAC DISEASE - may or may not manifest disease
ANEMIA, OSTEOPOROSIS, PERIPHERAL NEUROPATHY, REDUCED FERTILITY, SKIN RASHES, elevated LFTs, DENTAL ENAMEL lesions and MOOD CHANGES are all extra-intestinal manifestations of what condition?
CELIAC DISEASE (associated with DERMATITIS HERPETIFORMIS, DM, DOWN SYNDROME, IgA defficiency, SJOGREN syndrome, PBC, autoimmune thyroid disease, IBD and microscopic colitis)
After what PERIOD of TIME will SEROLOGIC tests (anti gliadin IgA or IgG antibodies, anti-endomysial, anti-tissue transglutaminase antibody and anti-deamidted gliadin antibody) become negative once a patient with CELIAC DISEASE follow a strict GLUTEN-FREE diet?
WEEKS to MONTHS
Which SEROLOGIC TEST is the ONLY RECOMMENDED test for CELIAC DISEASE?
Anti-ENDOMYSIAL ANTIBODY (IgA) - HIGHEST DIAGNOSTIC ACCURACY (tissue transglutaminase Ab - IgA also)
In which patients with CELIAC DISEASE will anti-ENDOMYSIAL Ab and tTG-Ab be negative?
In those with IgA DEFICIENCY - USE IgG DGP (anti-DEAMIDATED giadin)
What TESTS can be used to TRACK CELIAC DISEASE ACTIVITY as a patient is follwing a GLUTEN-FREE DIET?
anti-ENDOMYSIAL Ab and tTG-Ab
What TESTING is helpful in EXLUDING CELIAC DISEASE in patients BEFORE performing a GLUTEN CHALLENGE or those NOT tested before starting a gluten free diet or in those with villous atrophy but negative tTG-Ab?
HLA DQ2 and DQ8 testing (small bowel BIOPSY is the GOLD STANDARD)
On EGD you find a REDUCED number of DUODENAL FOLDS, SCALLOPING, MUCOSAL NODULARITY and a MOSAIC pattern, where can this be found?
CELIAC DISEASE
DEEP HYPERPLASTIC CRYPTS on BIOPSY of SMALL BOWEL, CUBOIDAL EPITHELIUM infiltrated with LYMPHOCYTES and PLASMA CELLS with preservation of villous architecture?
CELIAC DISEASE
What can be used to TREAT REFRACTORY CELIAC DISEASE (no villous healing with gluten-free diet)?
Enteric-coated BUDESONIDE or 6MP - but can still be unresponsive (T-cell expansion CD4 and CD8) which can develop into LYMPHOMA with high-fatality rate
What is DERMATITIS HERPETIFORMIS associated with?
CELIAC DISEASE (so is DOWN SYNDROME)
Average AGE for diagnosis of CELIAC DISEASE in the US is?
45
In a patient with diagnosed CELIAC DISEASE who is NON-RESPONSIVE to a GLUTEN-FREE diet for over 1 YEAR, what MUST BE DONE?
RECONFIRM the DIAGNOSIS (HLA DQ2 and DQ8)
A STRONGLY POSITIVE IgA tTG or anti-Endomysial Ab WITH confirmatory HISTOLOGY is considered what?
HIGHLY-INDICATIVE of CELIAC DISEASE
What should be done if the DIAGNOSIS of CELIAC DISEASE is in QUESTION BEFORE considering INVASIVE REPEAT BIOPSY?
HLA (DQ2 and DQ8) TYPING and EXPERT PATHOLOGIST REVIEW of original biopsies obtained
How MANY people are POSITIVE for HLA DQ2 and DQ8 who do NOT HAVE CELIAC DISEASE?
40% (however, IF HLA testing is NEGATIVE, they DO NOT have CELIAC - high PPV)
In a patient WITHOUT CELIAC DISEASE (non-specific histology and negative serology) but who RESPONDS to GLUTEN-FREE DIET, what is the diagnosis?
NON-CELIAC GLUTEN SENSITIVITY
In a patient with CONFIRMED CELIAC DISEASE with confirmed and appropriate changes on RE-BIOPSY and on SEROLOGY but with PERSISTENT DIARRHEA, what should be done next?
COLONOSCOPY with BIOPSIES for possible MICROSCOPIC COLITIS
Where in the WORLD is the HIGHEST PREVALENCE of CELIAC DISEASE?
FINLAND
Is SYMPTOM response to GLUTEN-FREE DIET reliable for DIAGNOSIS of CELIAC DISEASE?
NO
CELIAC DISEASE is associated with a 6-FOLD increased RISK of what CANCER?
LYMPHOMA
ABERRANT INTRA-EPITHELIAL LYMPHOCYTES on histology of the SMALL BOWEL are adsociated with what?
REFRACTORY CELIAC DISEASE TYPE-II - POOR PROGNOSIS, 50% 5 year survival - LYMPHOMA
REFRACTORY CELIAC DISEASE TYPE-II (POOR PROGNOSIS, 50% 5-YEAR survival - LYMPHOMA) - responds best to what therapy?
NONE (no meds, no steroids, no gluten-free diet)
What other AUTOIMMUNE DISEASE is CELIAC DISEASE COMMONLY associated with?
DM-I
AUTOIMMUNE condition that results in SEVERE WEIGHT LOSS, SEVERE MALAPSORPTION, DEHYDRATION and ELECTROLYTE IMBALANCES?
AUTOIMMUNE ENTEROPATHY
What is the FIRST thing that must be checked for when treatment of CELIAC DISEASE is NON-RESPONSIVE?
If the DIAGNOSIS of CELIAC DISEASE is CORRECT in the first place
What MEDICATION can MIMIC CELIAC DISEASE DIARRHEA and thus MEDICATIONS must be evaluated in a patient who presents with CELIAC-DISEASE type diarrhea?
OLMESARTAN (antihypertensive) - olmesartan-induced enteropathy (with villous drop-out)
Does CELIAC DISEASE present with SEVERE DIARRHEA and MALABSORPTION?
NO
EQUIVOCAL HISTOLOGY (EGD biopsy with villous atrophy) and SEROLOGY (tTG NEGATIVE), what do youmdo NEXT to diagnose CELIAC DISEASE?
HLA DQ2 & DQ8 (99% NPV)
OLMESARTAN, CROHN’s, GIARDIASIS, BACTERIAL OVERGROWTH, COW’s MILK ALLERGY, AUTOIMMUNE ENTEROPATHY, POST-VIRAL GASTROENTERITIS, LYMPHOMA are all conditions that can result in the SAME HISTOLOGY AS?
CELIAC DISEASE (villous atrophy)
WHITE man 40-70 yo, BIOPSY of SMALL BOWEL (macrophages in lamina propria), PAS-ACID POSITIVE, ATROPHY, FEVER, LYMPHADENOPATHY, CNS disease (prolonged therapy to prevent relapse, CARDIOVASCULAR disease?
TROPHERYMA WHIPPELII (WHIPPLE’s Disease)
Vacuolated, lipid-laden enterocytes, acantocytosis with STEATORRHEA (infant); NYSTAGMUS, ATAXIA, MUSCLE WEAKNESS (childhood); CARDIOMYOPATHY, RETINITIS PIGMENTOSA (adult)?
ABETALIPOPROTEINEMIA
>50% of the Small Bowel removed (ischemia: SMA/SMV thrombosis, CHF) with SEVERE DIARRHEA and MALABSORPTION as well as after weight-loss surgery with JEJUNO-ILEAL BYPASS?
SHORT BOWEL SYNDROME
When REMOVING up to 40% of the SMALL BOWEL, the DUODENUM, DISTAL ILEUM and ILEOCECAL VALVE are IMPORTANT to preseve to avoid what condtion?
SHORT BOWEL SYNDROME
**After WHAT PERCENTAGE of SMALL BOWEL RESECTION is the SEVERE, INTRACTABLE DIARRHEA and MALABSORPTION LIFE THREATENING?
>75%
What is ESSENTIAL to PRESERVE in a patient with SHORT BOWEL SYNDROME?
COLON (absorb water and carbohydrate and slow small bowel motility)
What is the result of RESECTION of the ILEUM?
Vit B-12 and BILE SALT MALABSORPTION
What SURGICAL procedure can cause SMALL BOWEL BACTERIAL OVERGROWTH?
Removal of the ILEOCECAL VALVE
How is SHORT BOWEL SYNDROME treated?
FLUID & ELECTROLYTE SUPPLEMENTATION, TPN and ANTI-DIARRHEALS (opioids), then oral-intake to stimulate INTESTINAL ADAPTATION (low lactose, low fat with MEDIUM-CHAIN TRYGLICERIDES) - vitamins (B12) and mineral supplementation
Lethargy, Confusion, Ataxia after SHORT BOWEL SYNDROME treated with ANTIBIOTICS and REDUCED CARBOHYDRATE diet is caused by what?
D-lactic ACIDOSIS (changed bacterial flora)
BILE SALT DIARRHEA and FATTY ACID DIARRHEA can occur if this segment of the SMALL BOWEL is RESECTED?
TERMINAL ILEUM ( of the TI) - treat with CHOLESTYRAMINE
If >100 cm, treat with LOW-FAT DIET, Ca-SUPPLEMENTS, anti-DIARRHEALS and VITAMINS (kidney stones and gallstones)
BILLROTH II anastomosis (afferent limb stasis), multiple JEJUNAL DIVERTICULA, ENTEROENTERIC FISTULA, INTESTINAL STRICTURE or ANASTOMOSIS can all result in this condition that causes bloating, diarrhea and abdominal discomfort?
SIBO (or blind loops syndrome) - also SCLERODERMA, DM (abnormal motor activity of MMC)
What are the TWO MAJOR manifestations of SIBO?
MACROCYTIC ANEMIA (bacteria taking up B12 elevating serum folate) and DIARRHEA-STEATORRHEA (bacterial breakdown of bile salts used to digest fats)
Patient presents with DIARRHEA, MALABSORPTION, MALNUTRITION, elevated SERUM FOLATE, Vit B12 DEFICIENCY (macrocytic anemia and peripheral neuropahty) and bloating with gas?
SIBO
HOW is SIBO diagnosed?
JEJUNAL ASPIRATE (aerobes and anaerobes) or BREATH TESTS (glucose is BEST)
What confirms a POSITIVE glucose or lactulose HYDROGEN BREATH TEST for SIBO?
EARLY RISE in Hydrogen in 30-60 MINUTES from INGESTION of glucose or lactulose
In what cases can you NOT USE HYDROGEN BREATH TESTING for determination of SIBO?
SHORT BOWEL SYNDROME, ILEAL DISEASES, GASTRIC BYPASS
HOW is SIBO treated?
ANTIBIOTICS (CIPRO 500 mg PO BID x 10 DAYS and METRONIDAZOLE 500 mg PO BID x 10 DAYS) as well as LOW CARBOHYDRATE DIET, LOW FAT DIET (replacement of LONG-CHAIN fatty acids with MEDIUM-CHAIN FATTY ACIDS)
In WHAT THREE (3) DISEASES of the SMALL BOWEL are SB BIOPSIES RECOMENDED for DIANOSIS?
WHIPPLE’s DISEASE, AGAMMAGLOBULINEMIA, ABETALIPOPROTEINEMIA
What medication is HELPFUL in treating BILE-SALT induced DIARRHEA?
CHOLESTYRAMINE (worsens steatorrhea, so don’t use with this)
After SEVERAL ILEAL RESECTIONS and POSITIVE SUDAN STAIN of stool, what can be used as DIETARY TREATMENT?
LOW-FAT DIET supplemented with MEDIUM-CHAIN FATTY ACIDS
ILEAL resection including the ILEOCECALVALVE with MACROCYTIC ANEMIA and INCREASED SERUM FOLATE LEVELS with bloating and diarrhea are suggestive of what CONDITION?
SIBO (glucose hydrogen breath testm increased spike in first 30-60 min)
Which small bowel segment can be resected significantly and not have malabsorptive issues as compensation occurs (hyperplasia of remaining intestine) JEJUNUM or ILEUM?
JEJUNUM
What can be used to TREAT NEPHROLITHIASIS (calcium oxalate) that has been caused by MASSIVE SMALL BOWEL RESECTION?
LOW-OXALATE DIET (not low calcium)
DIARRHEA IMMEDIATELY FOLLOWING ILEAL RESECTION in CROHN’s disease is caused by WHAT and how is it TREATED?
BILE ACID MALABSORPTION - CHOLESTYRAMINE
In a patient with SHORT BOWEL SYNDROME as well as s/p COLECTOMY, what will be REQUIRED for THERAPY?
TPN
Villous atrophy, crypt hyperplasia and increased intraepithelial lympgocytes are non-specific manifestations of the intestinal mucosal response to immune mediated or infectious injury. What is DIFFERENT and DIAGNOSTIC about biopsies in AGAMMAGLOBULINEMIA?
ABSENCE of PLASMA CELLS
Post-MVA patient lost a LARGE portion of his SMALL BOWEL including the ILEUM. During the EARLY stages of recovery, he was placed on TPN. What ELSE will he need early on?
PPI and ANTI-DIARRHEAL AGENTS (stress ulcers and diarrhea)
In patients with apparent IBS-D who RESPOND to CHOLESTYRAMINE, reduced levels of** ILEAL HORMONE FIBROBLAST GROWTH FACTOR 19 (FGF19)** causes what type of DIARRHEA?
BILE ACID DIARRHEA (chenodeoxycholic acid in the feces)
PAS-POSITIVE MACROPHAGES in the LAMINA PROPRIA
WHIPPLE’s DISEASE
MIGRATORY POLYARTHRITIS, DIARRHEA, WEIGHT LOSS, ABDOINAL PAIN, FEVER of UNKNIOWN ORIGIN and DIFFUSE LYMPHADENOPATHY, CNS DISEASE may be FATAL if not diagnosed,** LONG-TERM ANTIBIOTICS** (1 year)?
WHIPPLE’s DISEASE
Site of CARBOHYDRATE SALVAGE, WATER and ELECTROLYTE ABSORPTION and the BRAKE to SMALL INTESTINAL MOTILITY?
The COLON
What are the** FACTORS** that influence SMALL INTESTINAL ADAPTATION for increased absoprtion and processing (hyperplasia, increased absoprtive surface, etc.) after partial resection?
NUTRIENTS, GLUTAMINE and GLP-2 (glucagon-like peptide 2 - teduglutide)
In a patient with SHORT BOWEL SYNDROME who still has a COLON, what are the dietary RECOMMENDATIONS?
LOW OXALATE FOODS, ISOTONIC (LOW Na), MULTIPLE SMALL MEALS, AVOID FIBER
HOW much of the small bowel needs to be RESECTED to develop BILE ACID DIARRHEA (no steatorrhea)?
Relatively SHORT segment (
HOW much of the small bowel needs to be RESECTED to develop FATTY ACID DIARRHEA (no steatorrhea)?
LONG SEGMENT (>100 cm) - RESPONDS to LOW-FAT DIET (cholestyramine will WORSEN)
What SUBSTANCE gets OVER-EXCRETED after an ILEAL RESECTION?
OXALATE (renal calcium-oxalate stones) diet LOW in oxalate and HIGH in Calcium, decrease FAT intake and substitute MEDIUM-chain FATTY ACIDS
What CONDITION can SMALL INTESTINAL DIVERTICULOSIS cause?
SIBO
HOW can the EFFECT of TREATMENT (antibiotics) of SIBO be tracked?
IMPROVED REPEAT HYDROGEN BREATH TESTS
Are PREBIOTICS, PROBIOTICS and ANTIBIOTICS helpful in IBS?
YES (becuse some have SIBO: IBS-D)
STEATORRHEA, CARBOHYDRATE MALABSORPTION, LOW Vit B12 (macrocytic anemia)and PROTEIN LOSS are all seen in this condition of the SMALL BOWEL?
SIBO
What is the GOLD STANDARD for diagnosis of SIBO but is seldom done?
SMALL BOWEL CULTURE (aerobes and anaerobes in JEJUNUM) - do HYDROGEN BREATH test instead with GLUCOSE (not good for distal SIBO, add methane test)
After a course of INFECTIOUS DIARRHEA in a YOUNG WOMAN, the symptoms of FEVER and VOMITING resolve after a few days, but ABDOMINAL DISCOMFORT, BLOATING and DIARRHEA persist?
POST-INFECTIOUS IBS
In a patient with STABLE CELIAC DISEASE on GFD, suddenly developing WATERY DIARRHEA, ABDOMINAL PAIN, WEIGHT LOSS and HEMATOCHEZIA is suggestive of what COMPLICATION?
(REFRACTORY CELIAC DISEASE TYPE-II): JEJUNO-ILEITIS (ulcration, stricture, hemorrhage, obstruction) or ENTEROPATHY-ASSOCIATED T-CELL LYMPHOMA
Can SMALL BOWEL DIVERTICULOSIS cause Vit B12 DEFICIENCY?
YES (because of SIBO in these patients - stasis) - ulcerative jejuno-ileitis does not
Disease of WHAT SEGMENT of SMALL BOWEL is associated with FOLATE DEFICIENCY?
DUODENUM (CELIAC DISEASE)
ELEVATED FOLATE levels are seen in what SMALL BOWEL condition?
SIBO
Which FAT-SOLUBLE VITAMIN is NOT DEFICIENT in SIBO?
Vit K
What CONDITION is seen to OVERLAP with IBS-D and can respond well to antibiotics for BLOATING, ABDOMINAL PAIN and LOOSE, WATERY STOOLS?
SIBO (rifaximin)
In ALL CASES of HEMATEMESIS or MELENA where the EGD was NORMAL, what should be done NEXT?
REPEAT the EGD (or push enteroscopy and if still negative, repeat the normal colonoscopy too before video capsule enteroscopy)
What is the LOCATION most likely for an LVAD patient to be bleeding from?
CECAL ANGIODYSPLASIA (followed by small bowel angiodysplasia)
In a patient with ABDOMINAL CRAMPS FOLLOWED by MAROON STOOLS, with a NEGATIVE EGD, COLONOSCOPY and VCE, what MUST be done next and why?
99mTc-pertechnetate scan (Meckel’s SCAN) - ILEUM outpouching - gastric ulcerated mucosa, male gender
A condition that occurs at the MESENTERY with a PALPABLE MASS, usually POST-SURGICAL or TRAUMA with FAT NECROSIS and evolves into a CHRONIC INFLAMMATORY STATE (lymphadenopathy) which then can result in FIBROSIS with may ENTRAP the SMALL BOWEL and MESENTERIC VESSELS?
SCLEROSING MESENTERITIS (panniculitis, lipodystrophy) - abdominal pain, nausea, vomiting, diarrhea, constipation, weight loss, fever - treat with STEROIDS + COLCHICINE (or axathioptine and tamoxifen)
JEWS/TURKS/ARABS/ARMENIANS, with RECURRENT episodes of PERITONITIS, PLEURITIS, SYNOVITIS, and ARTHRITIS accompanied by FEVER (which tapers off), SCROTAL PAIN, VASCULITIS (rashes). Symtoms develop by AGE 20 and can MIMIC APPENDICITIS, CHOLECYSTITIS and RENAL COLIC?
FAMILIAL MEDITERANEAN FEVER (treat with COLCHICINE, genetic testing)
How is FAMILIAL MEDITERANEAN FEVER treated and why?
LIFELONG with COLCHICINE (to prevent RENAL AMYLOIDOSIS)
What is the RECOMMENDED DIET for patients with IBS-D?
LOW-FODMAP
EPIGASTRIC abdominal pain (worsens AFTER MEALS and EXERCISE or LEANING FORWARD) with some NAUSEA with DEEP EXPIRATION (exercises) and occurs in YOUNG, THIN WOMEN, with abdominal BRUIT and is best seen on ANGIOGRAPHY or CT?
CELIAC ARTERY COMPRESSION SYNDROME (median arcuate ligament - diaphragm syndrome) - treatment is SURGICAL median arcuate ligament RELEASE
SYMPTOMS of INTESTINAL OBSTRUCTION s/p TRAUMA, SURGERY, MALIGNANCY or PROLONGED BED REST with EPIGASTRIC BRUIT that DOES NOT CHANGE with BREATHING (diaphragm movement), EPIGASTRIC PAIN, WEIGHT LOSS with N/V 15-30 MIN AFTER EATING?
SMA SYNDROME (compression of the DUODENUM between the SMA and the AORTA) - if the LEFT RENAL vein is also compresed - hematuria. TREATMENT is SURGERY
What does RADIATION ENTERITIS cause with symptoms of DIARRHEA, BLOATING, **WEIGHT LOSS **and LOW Vit B12 with resulting MACROCYTIC ANEMIA?
SIBO (treat with ANTIBIOTICS)
What is considered ESSENTIAL TREATMENT for SHORT BOWEL SYNDROME besides AGGRESSIVE ANTI-DIARRHEALS and TPN?
GASTRIC ACID SUPPRESSION with a PPI
What occurs EARLY POST-OP in SHORT BOWEL SYNDROME that CAUSES pancreatic lipase inactivation resulting in diarrhea and steatorrhea?
HYPERSECRETION of GASTRIC ACID requiring PPI THERAPY
What DEFFICIENCY is present when >100 cm of SMALL BOWEL is removed?
BILE SALT defficiency (not able to reabsorb) - therefore supplement with MEDIUM-CHAIN TRIGLYCERIDES
What happens when you use CHOLESTYRAMINE in a patient with SHORT-BOWEL SYNDROME?
You WORSEN the DIARRHEA
What AUTOIMMUNE CONDITION is CELIAC DISEASE associated with that affects the LIVER?
AUTOIMMUNE HEPATITIS (AIH), PSC and PBC - check ANA and anti-smooth muscle Ab
How does a LOW Vit D level affect LFTs?
ALP elevation
A patient with previous Hodkin Lymphoma received mantle field radiation and developed a protein-wasting enteropathy (diarrhea, LE swelling, abdominal distention, weight gain, ascites, low albumin, low total protein). What can be used to TEST for the PROTEIN-LOSING state?
Alpha-1-ntitrypsin CLEARANCE test
What is CONGO RED STAINING used for?
AMYLOIDOSIS (duodenum predilection, then colon, then esophagus)
Is it possible to have WHIPPLE DISEASE with a negative EGD biopsy?
NO
What is an Alpha-1-Antitrypsin CLEARANCE test used for?
Diagnose a PROTEIN-LOSING ENTEROPAHTY
HOW DOES MAI (MAC) affect the SMALL BOWEL in HIV patients with LOW CD COUNT?
Causes VILLOUS BLUNTING with PAS-positivity as well as ACID-FAST positivity (whipple disease also causes villous blunting with positive PAS)
What is seen on biopsy of CELAIC DISEASE besides villous blunting?
INTRAEPITHELIAL LYMPHOCYTOSIS and chronic inflammation
In which condition of the SMALL BOWEL are the villi SIGNIFICANTLY ATROPHIED?
AUTOIMMUNE ENTERITIS (anti-enterocyte antibodies)
What do ANTACIDS contain that can cause DIARRHEA in a patient with break-through REFLUX SYMPTOMS on a PPI?
MAGNESIUM (osmotic diarrhea)
Besides MICROSCOPIC COLITIS, what type of DIARRHEA can PPIs CAUSE?
SECRETORY DIARRHEA
How can you DISTINGUISH OSMOTIC diarrhea from SECRETORY diarrhea?
290 mOsm/kg - 2(stool sodium + stool potassium)
IF >100 mOsm/kg it is OSMOTIC DIARRHEA
Post GASTROJEJUNAL BYPASS surgery, pt develops a HYPOCHLOREMIC, MICROCYTIC ANEMIA, LEUKOPENIA, NEUTROPENIA, and NEUROLOGIC DISTURBANCES (ataxia), why?
LOW SERUM COPPER
What SMALL BOWEL ISSUES do patients with SCLERODERMA DEVELOP?
SIBO (LOW Vit B12, HIGH FOLATE, and HIGH METHYLMALONIC ACID)
LOOSE STOOLS, CRAMPY ABDOMINAL PAIN, CT shows an ILEAL MASS with possible LIVER METS?
CARCINOID SYNDROME
What CUTANEOUS MANIFESTATIONS can CARCINOID SYNROME have?
PELLAGRA (niacin defficiency) - scaly hyperpigmented rash involving arms, hands face and neck
In patients with WILSON DISEASE on D-PENICILLAMINE for COPPER CHELATION, what deficiency can occur causing a red, scaly rash around the mouth?
ZINC deficiency (caused by D-PENICILLAMINE)
What LAB ABNORMALITIES can TPN OVERFEEDING CAUSE?
ELEVATED AST and ALT
FATIGUE, LE DISCOMFORT, MYALGIAS, HEART MURMURS and ABNORMAL LFTs in a patient on CHRONIC TPN are caused by what DEFICIENCY?
SELENIUM
In CHRONIC TPN patients, what MINERAL DEFICIENCY causes DM?
CHROMIUM
What can be used to TREAT REFRACTORY CELIAC DISEASE (no villous healing even though on gluten-free diet)?
Enteric-coated BUDESONIDE or 6MP - but can still be unresponsive (T-cell expansion CD4 and CD8) which can develop intop LYMPHOMA with a HIGH-FATALITY rate
ABERRANT INTRA-EPITHELIAL LYMPHOCYTES on histology of the SMALL BOWEL are associated with what?
REFRACTORY CELIAC DISEASE TYPE-II - POOR PROGNOSIS (50% 5-YEAR SURVIVAL) - LYMPHOMA
