GI misc

Question 1

Food allergy v. food intolerance?

Answer 1

IgE-mediated

difficulty digesting or metabolizing a food

Question 2

MC food allergies?

Answer 2

fish/seafood & peanuts/tree nuts

Question 3

Presentation of food intolerance?

Answer 3

Gas
Bloating
Abdominal pain
Diarrhea

Question 4

Presentation of food allergy?

Answer 4

usually immediate

Pruritis, urticarial, flushing, swelling of lips/face/throat,

N/V/D, abd cramping

wheezing, lightheadedness, syncope, hypotension

Question 5

PE findings seen in pt w/ food allergy?

Answer 5

Urticaria
Angioedema
Resp, CV, GI, ENT, derm

Question 6

Dx of food allergies?

Answer 6

H&P

trial of elimination of food x 2 wk +/- food challenge

labs-test for IgE mediated food allergy

• skin testing
• IgE immunoassays

Question 7

Tx for food allergies?

Answer 7

Epinephrine autoinjector

Food avoidance

Allergist referral

Question 8

What is lactose intolerance? Epidemiology?

Answer 8

Intolerance to lactose containing food

Lowest: European and European American

Highest: African American, Hispanic, Asian, Asian American, Native American

prevalence increases w/ age

Question 9

Normal lactose physio??

Answer 9

lactase breaks down lactose –> glucose & galactose, absorbed by small intestine, passes into colon, converted to fatty acid & hydrogen gas in the colon

Question 10

Pathophys of lactose malabsorption?

Answer 10

lactose malabsorption

-lactase deficiency

Question 11

Clinical presentation of lactose intolerance?

Answer 11

Abdominal pain
Bloating
Flatulence
Diarrhea 
Borborygmi 

sxs affected by diet, varies

Question 12

Dx of lactose intolerance?

Answer 12

Sxs after lactose ingestion

Sxs resolve with avoidance of lactose

Lactose hydrogen breath test

Question 13

Tx for lactose intolerance?

Answer 13

Lactose-free diet or lactose restrictions

Enzyme replacement – lactase (Lactaid)

Monitor calcium, vit D

Question 14

What is Glucose-6-phosphate dehydrogenase deficiency?

Answer 14

Genetic defect in G6PD, a RBC enzyme that generates NADPH and protects RBCs from oxidative injury

X-linked disorder

lots of varying degrees of enzyme deficiency

Question 15

G6PD deficiency is assoc. with?

Answer 15

hemolytic anemia

Question 16

Presentation of G6PD deficiency?

Answer 16

Usually asxs until a trigger causes acute hemolysis

Jaundice, pallor, dark urine, abdominal pain, back pain

Question 17

What triggers G6PD deficiency?

Answer 17

meds, food, acute illness/infx

Question 18

Labs seen in pt w/ G6PD deficiency?

Answer 18

Normochromic, normocytic anemia

Peripheral smear: “bite cells”, Heinz bodies (denatured globin chains attached to the RBC membrane)

Question 19

Tx of G6PD deficiency?

Answer 19

spontaneous resolution and reversal of anemia

Avoidance of oxidative stress to RBCs

Removal of offending agent

Hydration

Transfusion for severe anemia

Question 20

What is Paget disease of bone
(Osteitis deformans)?

Answer 20

Localized area of increased bone turnover causing overgrowth of bone

Question 21

Patho of paget disease of bone?

Answer 21

Increased osteoclast activity lytic lesions in the bone > increased osteoblast activity > disorganized bone formation > abn. bones with enlarged skeletal deformity

Question 22

What are the MC locations of paget disease of bone?

Answer 22

pelvis, vertebrae, femur, humerus, skull

Can be polyostotic or monostotic

Question 23

Presentation of paget disease of bone?

Answer 23

Usually asxs & discovered incidentally

Elevated serum alk phos (then isoenzyme to dif. bone v. liver)

x-ray: Osteolytic lesions

Question 24

Paget disease of the bone is usually discovered incidentally, however, how might a pt present if they were sxs?

Answer 24

Pain – aching, deep, worse at night and with weight bearing

Bone changes: bowed tibias, kyphosis, “chalkstick” fxs with minimal trauma, increased hat size, HA

Question 25

Dx studies for paget's disease of the bone?

Answer 25

Bone turnover markers Serum calcium Serum 25-OH vitamin D Bone scintigraphy

Question 26

Tx of paget disease of bone?

Answer 26

Asxs: monitor ``` Bisphosphonates: IV zoledronate (preferred but can use any) ```

Question 27

recurrence rate of paget disease of bone?

Answer 27

12-60%

Question 28

comps of paget disease of bone?

Answer 28

``` Hypercalcemia Renal calculi High output HF Arthritis CN palsies Vascular steal syndrome Radiculopathy or paralysis Bone tumors (sarcoma, giant cell tumors) -rare ```

Question 29

What is rickets?

Answer 29

Deficiency in calcium or phosphate leading to altered bone growth and mineralization

Question 30

Typical locations affected by rickets?

Answer 30

distal forearm, knee, and costochondral junctions

Question 31

Etiology of rickets?

Answer 31

Decreased intake, malabsorption, or increased excretion of calcium, phosphate, or vitamin D

Question 32

Clinical presentation of rickets?

Answer 32

Bowing of weight-bearing extremities Skeletal fxs Proximal myopathy

Question 33

Labs seen in rickets?

Answer 33

Alk phos – elevated Serum phosphorus – low Serum Ca – low or normal PTH – elevated in calcipenic rickets 25-hydroxyvitamin D

Question 34

Radiology findings seen in rickets?

Answer 34

Widened growth plate at long bones and costochondral junction Decreased radiopacity of long bones If occurs after growth plate closure – decreased cortical thickness, relative radiolucency of skeleton

Question 35

Tx of rickets?

Answer 35

Treat underlying disorder Vitamin D replacement Calcium supplementation