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Gastroenterology > Disorders Of The Intestines > Flashcards

Disorders Of The Intestines Flashcards

1
Q

What are the complications of celiac disease (5)?

A
  • Nutritional deficiency and anemia
  • Osteopenia/osteoporosis
  • Elevated liver enzymes
  • dermatitis herpetiformis
  • enteropathy-associated T-cell lymphoma (EATL)
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2
Q

What nutritional deficiencies would you expect in celiac disease?

A

Vitamin B12
Vitamin D
Iron
Calcium

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3
Q

What are the risk factors for celiac disease (7)?

A 
Northern European descent
Family history
T1DM
Autoimmune thyroid disease
Down & Turner’s syndrome
1st degree relative
IgA deficiency
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4
Q

Which foods contain gluten?

A

Barley
Rye
Oats (contaminated)
Wheat

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5
Q

What investigation should be done in follow up for patients with celiac disease?

A

Follow up serology in 6-12 months post diagnosis, then annually.

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6
Q

What are the biological used in therapy for Crohn’s disease (4)?

A

Anti-TNF: Infliximab, adalimumab
Anti-Integrin: Vedolizumab
Anti-IL12/23: Ustekinumab

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7
Q

Which treatment should be used upfront for fistulizing Crohn’s?

A

Anti-TNF

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8
Q

Which treatment should be used upfront in perinatal Crohn’s disease (after antimicrobial therapy if infection is present)?

A

Anti-TNF

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9
Q

What is the definition of proctitis?

A

Inflammation within 18 cm of the anal verge.

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10
Q

Which biologic agents can be used in ulcerative colitis therapy?

A

Anti-TNF: infliximab, adalimumab, golimumab
Anti-Integrin: Vedolizumab
Anti-IL-12/23: Ustekinumab
JAK-Inhibitor: Tofacitnib

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11
Q

What are the criteria for toxic mega colon?

A 
Radiographic mega colon (>6 cm)
PLUS at least 3 of:
- fever (>38C)
- HR > 120 bpm
- neutrophils > 10.5
- anemia
PLUS at least 1 of:
- dehydration
- altered sensorium
- electrolyte disturbances
- hypotenstion
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12
Q

What are the indications for colectomy in fulminant ulcerative colitis?

A
  • Toxic Megacolon
  • Colonic Perforation
  • Severe Refractory Hemorrhage
  • Refractoriness to medial therapy after 3-5 days
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13
Q

When does bile-salt diarrhea occur?

A

Occurs with ileitis in Crohn’s or after ideal resection. Always treat active IBD before treating for bile salt diarrhea with cholestyramine, a bile acid sequestrant.

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14
Q

What is Type I IBD arthropathy?

A

Pauciarticular arthritis, usually self limiting attacks in large joints (ankles, knees, elbows, wrists, shoulders) that parallels disease activity.

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15
Q

What is Type 2 IBD arthropathy?

A

Polyarticular arthropathy of small joints and axial disease, typically independent of activity.

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16
Q

How long do high-risk lesions resulting in UGIB require PPI therapy for?

A

72 hours post-endoscopy

17
Q

When is indefinite PPI therapy recommended post-UGIB?

A

For patients requiring ongoing anti-platelet therapy for secondary prophylaxis or if unclear cause of PUD.

18
Q

Which patients should you test for H. Pylori?

A 
PUD
MALT Lymphoma
Gastric Cancer
Long term NSAID/ASA use
Otherwise unexplained iron deficiency
ITP

DO NOT test GERD patients

19
Q

What are the options for H. Pylori diagnosis?

A 
Stool Antigen
Histology (Best)
Biopsy Culture
Urea Breath Test (2nd Best)
IgG Serology (sensitive but not specific for acute infection)
20
Q

What are the recommended treatment options for H. Pylori?

A 
First Line - 14 days of:
- PPI/Bismuth/Metronidazole/Tetracycline
- PPI/Amoxicillin/Metronidazole/Clarithromycin
Treatment Failure of above options:
PPI/amoxicillin/levofloxacin
21
Q

When should you do a test of eradication in patients treated for H. Pylori?

A

Confirm eradication in all patients:
- Wait at least 4 weeks after completing antibiotic therapy and at least 1-2 weeks after PPI therapy before testing for H. Pylori to ensure the test is accurate.

22
Q

What are the classic features of a somatostatinoma?

A

Classic triad of:

  1. Diabetes/Glucose Intolerance
  2. Cholelithiasis
  3. Diarrhea/Steatorrhea
23
Q

How do you calculate a stool osmotic gap?

A

290 (expected stool osmolality) - 2 x (stool Na + stool K)

A normal gap = 50 to 100

24
Q

What are the causes of a low stool osmotic gap?

A

Secretory diarrhea:
Infection - Cholera, ETEC
VIP, Gastrinoma
Non-osmotic Laxative Abuse

25
Q

What are the causes of a high stool osmotic gap?

A 
Suggestive of osmotic diarrhea:
Celiac, lactulose intolerance, lactase deficiency
Chronic pancreatitis
Whipple’s 
Osmotic Laxative Abuse
26
Q

What is the treatment for microscopic colitis?

A

Imodium
Stop NSAIDs and offending medications
Budesonide PO

Gastroenterology (4 decks)

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