Celiac Disease & Inflammatory Bowel Disease

Question 1

what is the primary site of absorption?

Answer 1

small intestine

Question 2

permanent dietary disorder characterized by an inappropriate immunologic response to gluten that results in diffuse damage to proximal small intestines with malabsorption of nutrients and extra-GI symptoms

Answer 2

celiac disease

Question 3

when does celiac disease become symptomatic?

Answer 3

when gluten stimulates inappropriate response against the intestinal mucosa

Question 4

a 1 yo patient presents with diarrhea, steatorrhea, weight loss, abdominal distention, weakness, muscle wasting, or growth retardation. Dx?

Answer 4

celiac disease

Question 5

what 4 symptoms can a child >2 yo or adult present with if they have celiac disease?

Answer 5

chronic diarrhea
dyspepsia
flatulence
malabsorption

Question 6

what are 9 extra-intestinal symptoms that can present in celiac disease?

Answer 6

fatigue
rash
depression
iron deficiency anemia
osteoporosis
short stature
delayed puberty
amenorrhea
reduced fertility

Question 7

how does vit K deficiency caused by malabsorption of celiac disease present?

Answer 7

easy bruising

Question 8

how does calorie deficiency caused by malabsorption of celiac disease present?

Answer 8

loss of muscle and subcutaneous fat

Question 9

how does iron, folate, and vit B12 deficiencies caused by malabsorption of celiac disease present? (2)

Answer 9

pallor
anemia

Question 10

how does vit A deficiency caused by malabsorption of celiac disease present?

Answer 10

hyperkeratosis

Question 11

how does calcium deficiency caused by malabsorption of celiac disease present? (2)

Answer 11

bone pain + osteomalacia

Question 12

how does vit B1, B12 or vit E deficiencies caused by malabsorption of celiac disease present? (3)

Answer 12

peripheral neuropathy
ataxia
encephalopathy

Question 13

what is an atypical skin finding in celiac disease?

Answer 13

dermatitis herpetiformis

pruritic, erythematous maculopapular rash over extensor surfaces of extremities, trunk, scalp and neck

Question 14

what’s important to note about almost all patients with a rash?

Answer 14

have evidence of celiac disease on intestinal biopsy

Question 15

what is the preferred lab to diagnose celiac disease?

Answer 15

IgA tTG

Question 16

what is a second choice lab to diagnose celiac disease?

Answer 16

EMA-IgA

Question 17

levels of IgA tTG and EMA-IgA become undetectable how long after removal of gluten from diet?

Answer 17

3-12 months

Question 18

what is the confirmatory test for celiac disease in patients with a + serological test?

Answer 18

endoscopic mucosal biopsy of proximal duodenum

Question 19

when can an endoscopic mucosal biopsy of the proximal duodenum give a false negative?

Answer 19

if the patient has been on gluten-free diet for 3-12 months

Question 20

what are the treatment options for celiac disease? (2)

Answer 20

removal of all gluten from diet
steroids + immunomodulator meds if refractory

Question 21

which patients with celiac disease have an increase in intestinal lymphoma and cancers of the mouth, pharynx, and esophagus? (3)

Answer 21

maintain a normal diet
only adhere to reduced gluten diet
have refractory disease

Question 22

what are the 2 major disorders of inflammatory bowel disease (IBD)?

Answer 22

ulcerative colitis
crohn disease

Question 23

what are 2 risk factors for IBD?

Answer 23

genetics
NSAID use

Question 24

cigarette smoking has an increased association with __________

Answer 24

crohn disease

Question 25

cigarette smoking has a decreased association with __________

Answer 25

ulcerative colitis

Question 26

diet high in processed, fried, and sugary foods increases the risk for _____

Answer 26

crohn disease

Question 27

obesity increases _______ severity

Answer 27

crohn disease

Question 28

insidious, chronic inflammatory condition with transmural inflammation and skip lesions most commonly throughout the ileum and proximal large intestine

Answer 28

crohn disease

Question 29

a patient presents with fatigue, weight loss, rash, eye problems, SOB, diarrhea +/- blood, abdominal pain, mouth, joint, and anal pain. Dx?

Answer 29

crohn disease

Question 30

where is abdominal tenderness felt in a patient with crohn disease? why?

Answer 30

RLQ involves the proximal small bowel

Question 31

what will labs show in a patient with crohn disease? (3)

Answer 31

electrolyte/nutritional deficiency elevated CRP/ESR + fecal leukocytes

Question 32

what is the 1st line diagnostic for crohn disease?

Answer 32

colonoscopy

Question 33

what will a colonoscopy show in a patient with crohn disease?

Answer 33

patchy, skip lesions of inflammation in large and distal small intestine

Question 34

in which case should a colonoscopy be avoided in a patient with crohn disease and ulcerative colitis?

Answer 34

in severe acute cases d/t possible perforation

Question 35

what is the 2nd line diagnostic for crohn disease?

Answer 35

CT / MR enterography

Question 36

what is the diet treatment for crohn disease? (4)

Answer 36

small, frequent meals refer to nutritionist avoid fatty foods maintain hydration

Question 37

what is the 1st line induction medication for mild-moderate crohn disease of the ileum/proximal colon? alternative?

Answer 37

PO budesonide (steroid) PO mesalamine (5-ASA)

Question 38

what is the 1st line induction medication for mild-moderate crohn disease of the left colon or diffuse colitis? alternative?

Answer 38

PO prednisone PO sulfasalazine (pro-5-ASA)

Question 39

what are the 1st line induction medications for moderate-severe crohn disease? (3)

Answer 39

infliximab + methotrexate +/- PO prednisone

Question 40

what is the 1st line maintenance medication for mild-moderate crohn disease?

Answer 40

PO mesalamine (5-ASA)

Question 41

what is the 1st line maintenance medication for mild-moderate crohn disease of the left colon or diffuse colitis?

Answer 41

PO sulfasalazine (pro-5-ASA)

Question 42

what is the 1st line maintenance medication for moderate-severe crohn disease?

Answer 42

infliximab

Question 43

what are 5 indications for surgery in crohn disease?

Answer 43

no response to therapy abscess formation massive bleeding fistula obstructions

Question 44

what is the recurrence of crohn disease of patients within 1 year post surgery?

Answer 44

60%

Question 45

chronic inflammatory condition with relapsing and remitting inflammation limited to the mucosal layer of the colon; involves the rectum and extends proximally to involve other parts of the colon

Answer 45

ulcerative colitis

Question 46

a patient presents with bloody diarrhea, abdominal pain/cramping, fecal urgency and tenesmus, +/- weakness and fatigue from blood loss. Dx?

Answer 46

ulcerative colitis

Question 47

where would abdominal tenderness be present in a patient with ulcerative colitis?

Answer 47

LLQ

Question 48

what will labs show in a patient with ulcerative colitis? (4)

Answer 48

anemia increased CRP + ESR decreased albumin + fecal leukocytes

Question 49

what is the 1st line diagnostic for ulcerative colitis? what will it show?

Answer 49

colonoscopy diffuse mucosal inflammation involving the colon

Question 50

what is a 2nd diagnostic to diagnose ulcerative colitis?

Answer 50

sigmoidoscopy

Question 51

what is the 1st line induction treatment for mild-moderate ulcerative colitis of the distal colon?

Answer 51

topical mesalamine (5ASA)

Question 52

what is the 1st line induction treatment for mild-moderate ulcerative colitis of the extensive colon? (2)

Answer 52

topical + PO mesalamine (5-ASA)

Question 53

what is the treatment for ulcerative colitis that is refractory to 5-ASA?

Answer 53

steroids

Question 54

what is the treatment for ulcerative colitis that is refractory to steroids?

Answer 54

infliximab

Question 55

what is the maintenance treatment for ulcerative colitis?

Answer 55

topical mesalamine (5-ASA)

Question 56

what are 4 complications of ulcerative colitis?

Answer 56

perforation colon infection toxic megacolon colon cancer

Question 57

what provides complete cure of ulcerative colitis but requires ileostomy?

Answer 57

total proctocolectomy