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Intestines Flashcards

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1
Q

3 potential complications of Celiac Disease?

A
  • Refractory Sprue
    (persisting symptoms and histological injury despite being on diet for 12 months)
  • Intestinal Adenocarcinoma
  • T cell lymphoma
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2
Q

Gliadin is deaminated by ___a___ in the __b__ of the small intestine which facilitates gliadin’s ability to interact w/ __b__ & __b__ located on the surface of Antigen Presenting Cells

A

a) Tissue Transglutaminase (TTG)

b) HLA-DQ2 & HLA-DQ8

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3
Q

Celiac Disease: Clinical Presentation?

A
  • Diarrhea
  • Weight loss
  • Failure to thrive
  • Short stature
  • Anemia (Iron, Folate, B12 deficiencies)
  • Bone disease (vit. D deficiency)

(many patients remain asymptomatic

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4
Q

Celiac Disease: Treatment?

A
  • Gluten-free diet (70-90% respond)
  • Vitamins & Minerals (iron, folate, Vitamins D, B12)
  • Screen for Bone Injury: densiometry
  • Screen Family for Celiac Disease (DQ2, DQ8)
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5
Q

Celiac Disease: Diagnosis

Endoscopy findings?

A
  • Scalloping of duodenal folds
  • Flattened/absent villi
  • Mosaic appearing surface of mucosa
  • May be normal appearing (always take 4-6 biopsies when suspicious)
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6
Q

Celiac Disease: Diagnosis Histopathologic findings?

A
  • Increased intraepithelial lymphocytes
  • Increased lymphocytes and plasma cells in the lamina propria
  • Absent or blunted villi
  • Elongated Intestinal crypts
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7
Q

Celiac Disease: Diagnosis

Serology findings?

A
  • Anti-endomyoseal IgA antibody *
  • TTG IgA antibody**
  • Anti-gliadin IgA &/or IgG antibody
  • Deaminated gliadin peptide
  • HLA-DQ2, DQ8
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8
Q

Define the following:
1. Gluten
2. Gliadin
3. Alfa fraction

A
  1. Gluten: the protein component of wheat, barley and rye.
  2. Gliadin: the alcohol soluble portion of digested gluten.
  3. Alfa fraction: the portion of gliadin able to pass the mucosal barrier of the intestine.
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9
Q

Folic acid deficiency results in _____ anemia.

A

macrocytic

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10
Q

A gluten free diet results in the resolution of which of the following?
a. patient’s symptoms b. positive serology
c. abnormal histology

A

All of them

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11
Q

T or F? Iron deficiency may be the only sign of Celiac disease.

A

True

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12
Q

Vitamin A deficiency results in..?

A

Night blindness, conjunctival dryness, and keratomalacia

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13
Q

Vitamin D deficiency results in..?

A

Osteomalacia: Clinically manifests as muscle weakness and musculoskeletal pain
- Osteopenia and osteoporosis

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14
Q

Vitamin E deficiency results in..?

A

Hemolytic anemia, gait disturbance, and neuropathy

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15
Q

Vitamin K deficiency results in..?

A

Prolonged prothrombin time, resulting in decreased synthesis of clotting factors II, VII, IX, and X

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16
Q

Sucrose = ____ & ____

A

Glucose & Fructose

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17
Q

Lactose = ____ & ____

A

Glucose & gaLACTOSE

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18
Q

Absorbed products of lipolysis, once in the enterocytes, are synthesized into __(a)__ and exit as __(b)__ into lymph lacteals.

A

a) Triglycerides
b) Chylomicrons

(Chylomicron = Triglyceride + Apolipoproteins)

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19
Q

Once chyme reaches the cecum, _____ is released & this stops the process of CCK release.
What are some effects of this further inhibition of CCK release?

A

Peptide YY

Decreased:

  • Gastric acid secretion & Gastric emptying
  • Pancreatic secretion
  • Colonic motility
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20
Q

3 functions of intestine in between meals?

A
  1. Propulsion- Motilin stimulates migrating motor complexes to move stuff out of SI
  2. Retention- Luminal distention triggers stretch receptors to initiate the anorectal inhibitory reflex to preserve continence
  3. Defecation- Involuntary (internal anal sphincter is relaxed) & Voluntary (external relaxed)
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21
Q

D-xylose test is most helpful in distinguishing..?

A

Maldigestion (pancreatic insufficiency) from Malabsorption (celiac sprue)

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22
Q

How do you interpret a d-Xylose test?

A

d-Xylose Excretion:

  • Normal in Maldigestion
  • Dec’d in Malabsorption

Fecal Fat:
- Inc’d in Maldigestion & Malabsorption

Jejunal Biopsy:

  • Normal in Maldigestion
  • Abnormal/”flat” in Malabsorption
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23
Q

Schilling Test evaluates..?

Study These Flashcards
A

possible B12 deficiency

24
Q

Schilling Test, for each step:
What is done?
If B12 corrects @ this step, Dx is..?

Study These Flashcards
A
  1. Give parenteral B12 for loading, then radio-labeled B12
    Dx = Dietary deficiency
  2. Radio-labeled B12 given w/ Intrinsic Factor
    Dx = Pernicious Anemia
  3. Repeat w/ enzymes
    Dx = Pancreas problem
  4. Repeat w/ antibiotics
    Dx = Bacterial overgrowth
  5. Ileum problem
25
Diarrhea definition by stool weight or stool water is an increase in how much?
Increase in stool weight or water > 150-200 gm/24hr WHO definition: "Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual."
26
Lower GI bleed- dDx?
- Neoplasm (Polyps, Colorectal adenocarcinoma) - Colitis - Infectious Diarrhea (E.coli, Shigella, Salmonella, C. jejuni) - Diverticular Disease - Hemorrhoids
27
Diarrhea: | Classification/Types?
- Secretory - Osmotic - Exudative - Malabsorptive - Abnormal motility
28
Water absorption occurs due to the osmotic gradient established by __(a)__ - which itself is dependent on absorption of __(b)__ & __(c)__.
a) Sodium b) Glucose c) Amino Acids (primary mechanism of Na+ absorption is cotransport w/ glucose & AAs)
29
Simplified diarrhea classifications involved in: - Watery diarrhea - Bloody diarrhea - Fatty diarrhea
Watery: - Osmotic - Secretory - Motility Disorders - Infectious Bloody: - Exudative/inflammatory - Infectious Fatty: - Malabsorptive - Motility disorders
30
Secretory Diarrhea - Features?
- Stool isotonic w/ plasma - Large volume diarrhea (>1L/day) - Diarrhea persists when fasting - Electrolytes account for most of stool osmolality (which is small, <50)
31
_______ is the classic secretory diarrhea (etiology)
Vibrio Cholera
32
Vibrio Cholera - does organism colonize intestinal cells?
No, it sticks to the surface of small bowel cells, w/out ever penetrating the mucosal surface, & produces its enterotoxin
33
How does Vibrio Cholera cause diarrhea?
- Produces an enterotoxin (protein) that enters enterocytes in the SI - Irreversibly activates Adenylate Cyclase - Na/Cl absorption is inhibited & anions are secreted, causing Secretory diarrhea
34
Does Vibrio Cholera cause intestinal damage?
No, it does not invade cells -- its toxin does but does not destroy them
35
Diagnosis? | Severe "rice water" stool output (>1L/day)
Vibrio Cholera
36
Tx for Vibrio Cholera that dramatically improves mortality?
Oral solution w/ glucose (& pinch of sodium) | - enhances sodium absorption via sodium-glucose cotransport
37
Hormone producing tumors that cause secretory diarrhea?
1. Carcinoid (5HT, Prostaglandins, Bradykinin) 2. VIPoma (VIP) 3. Gastrinoma (Gastrin) 4. Medullary Carcinoma of Thyroid (Calcitonin, Prostaglandins) 5. Ganglioneuroma (probably VIP)
38
Carcinoid Syndrome- what type of diarrhea can this cause & how?
Secretory diarrhea, caused by increased production & metabolism of Tryptophan, leading to increased 5HT - 5HT causes secretory diarrhea via anion secretion & Na/Cl inhibition
39
Osmotic diarrhea- pathophysiology?
Poorly absorbed solutes creates osmotic gradient that draws water into intestinal lumen - Failure to transport osmotically active solute
40
Osmotic diarrhea- Causes?
- Magnesium (in laxatives) | - Lactose ingestion w/ lactase deficiency
41
Osmotic diarrhea- Features?
- Stool volume typically 125 - Acidic stool pH from carbohydrate malabsorption - Unmeasured non-electrolytes account for most of stool osmolality (which is large, >125)
42
3 Diagnostic methods of Lactase deficiency?
1. Trial of milk produce ingestion w/ & w/out lactase enzyme supplement 2. Hydrogen breath test: Lactose hydrogen (H2) absorbed into portal circulation & excreted in breath (rise in exhaled hydrogen >20ppm) 3. Lactose Tolerance Test: Ingest 50 mg lactose, blood glucose rises <20 mg/dL
43
Examples of Motility disorders causing diarrhea?
- IBS - Scleroderma - Intestinal surgery predisposing to bacterial overgrowth syndrome
44
Examples of Edudative diarrhea?
IBD: - Crohn's Disease - Ulcerative Colitis Infectious: - Shigella - Clostridium dificile - Entamoeba Histolytica
45
Classic malabsorptive diarrhea symptoms?
Steatorrhea & weight loss - Large volume stools - Malodorous & fat droplets
46
Complications of malabsorptive diarrhea?
- Fat soluble vitamin deficiencies | - Edema &/or ascites
47
Giardia causes a ______ diarrhea
malabsorptive
48
Giardia diarrhea- Features?
Trophozoites - attach via adhesive disk on ventral surface - reside in proximal small bowel - no cellular invasion or necrosis - Inflammatory response causes changes to villous & crypt architecture - Disruption of microvilli & brush border enzymes - No cleare enterotoxin
49
Whipple's Disease- etiology?
Chronic systemic infection - Tropheryma whippelii - PAS-positive, bacteria-laden macrophages in lamina propria of small intestine - Macrophage infiltration of mucosa & obstruction of mesenteric lymph nodes leads to malabsorption - SI most commonly affected - -- Joints, CV system, CNS
50
3 types of diarrhea-causing E. coli?
Bloody diarrhea: - Enterohemorrhagic E. coli (EHEC) - -- O157:H7 strain in US, usually affects children - -- Shiga-like toxin, can cause HUS - Enteroinvasive E. coli (EIEC) - -- invades colonic mucosa Watery diarrhea: - Enterotoxigenic E. coli - -- Traveler's diarrhea & Infantile diarrhea - -- Produces ST & LT Toxins - -- Cramps, occasional vomiting, low-grade fever
51
Causative Organism? - Bloody diarrhea - Comma or S-shaped organisms, growth @ 42F
Campylobacter
52
Causative Organism? | - Bloody diarrhea caused by Protozoan
Entamoeba Histolytica
53
``` Causative Organism(s)? - Watery diarrhea caused by Protozoa ```
- Giardia (cysts in stool, Tx = Metronidazole or Nitazoxanide) - Cryptosporidium (immunocompromised -- must order specific exam for Dx; Tx = Nitazoxanide)
54
Causative organism? - Bloody diarrhea - Day-care outbreaks, psuedoappendicitis
Yersinia enterocolitica
55
It is appropriate to obtain endoscopic biopsies looking for celiac disease in patients w/ what 4 symptoms/conditions?
1. Positive Serologic test 2. Iron deficiency Anemia 3. Chronic diarrhea 4. Weight loss
56
Villous atrophy is found in a number of GI diseases. | Name 5 of them.
1. Celiac Disease 2. Whipple's Disease 3. Tropical Sprue 4. Intestinal Lymphoma 5. Crohn's Disease

OSD_GI (13 decks)

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