Small Intestine Flashcards
(116 cards)
1
Q
DIARRHEA, CONSTIPATION, ABDOMINAL BLOATING & DISCOMFORT, DEFICIENCIES in IRON, VIT B12, FOLATE, VITAMIN D, ZINC, HLA DQ2 or DQ8 association?
A
CELIAC DISEASE (wheat, barley, rye)
2
Q
When a patient has POSITIVE SEROLOGIC markers for CELIAC DISEASE (TTG and/or EMA) but NORMAL BIOPSIES, what does this mean?
A
LATENT CELIAC DISEASE - may or may not manifest disease
3
Q
ANEMIA, OSTEOPOROSIS, PERIPHERAL NEUROPATHY, REDUCED FERTILITY, SKIN RASHES, elevated LFTs, DENTAL ENAMEL lesions and MOOD CHANGES are all extra-intestinal manifestations of what condition?
A
CELIAC DISEASE (associated with DERMATITIS HERPETIFORMIS, DM, DOWN SYNDROME, IgA defficiency, SJOGREN syndrome, PBC, autoimmune thyroid disease, IBD and microscopic colitis)
4
Q
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?
A
WEEKS to MONTHS
5
Q
Which SEROLOGIC TEST is the ONLY RECOMMENDED test for CELIAC DISEASE?
A
Anti-ENDOMYSIAL ANTIBODY (IgA) - HIGHEST DIAGNOSTIC ACCURACY (tissue transglutaminase Ab - IgA also)
6
Q
In which patients with CELIAC DISEASE will anti-ENDOMYSIAL Ab and tTG-Ab be negative?
A
In those with IgA DEFICIENCY - USE IgG DGP (anti-DEAMIDATED giadin)
7
Q
What TESTS can be used to TRACK CELIAC DISEASE ACTIVITY as a patient is follwing a GLUTEN-FREE DIET?
A
anti-ENDOMYSIAL Ab and tTG-Ab
8
Q
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?
A
HLA DQ2 and DQ8 testing (small bowel BIOPSY is the GOLD STANDARD)
9
Q
On EGD you find a REDUCED number of DUODENAL FOLDS, SCALLOPING, MUCOSAL NODULARITY and a MOSAIC pattern, where can this be found?
A
CELIAC DISEASE
10
Q
DEEP HYPERPLASTIC CRYPTS on BIOPSY of SMALL BOWEL, CUBOIDAL EPITHELIUM infiltrated with LYMPHOCYTES and PLASMA CELLS with preservation of villous architecture?
A
CELIAC DISEASE
11
Q
What can be used to TREAT REFRACTORY CELIAC DISEASE (no villous healing with gluten-free diet)?
A
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
12
Q
What is DERMATITIS HERPETIFORMIS associated with?
A
CELIAC DISEASE (so is DOWN SYNDROME)
13
Q
Average AGE for diagnosis of CELIAC DISEASE in the US is?
A
45
14
Q
In a patient with diagnosed CELIAC DISEASE who is NON-RESPONSIVE to a GLUTEN-FREE diet for over 1 YEAR, what MUST BE DONE?
A
RECONFIRM the DIAGNOSIS (HLA DQ2 and DQ8)
15
Q
A STRONGLY POSITIVE IgA tTG or anti-Endomysial Ab WITH confirmatory HISTOLOGY is considered what?
A
HIGHLY-INDICATIVE of CELIAC DISEASE
16
Q
What should be done if the DIAGNOSIS of CELIAC DISEASE is in QUESTION BEFORE considering INVASIVE REPEAT BIOPSY?
A
HLA (DQ2 and DQ8) TYPING and EXPERT PATHOLOGIST REVIEW of original biopsies obtained
17
Q
How MANY people are POSITIVE for HLA DQ2 and DQ8 who do NOT HAVE CELIAC DISEASE?
A
40% (however, IF HLA testing is NEGATIVE, they DO NOT have CELIAC - high PPV)
18
Q
In a patient WITHOUT CELIAC DISEASE (non-specific histology and negative serology) but who RESPONDS to GLUTEN-FREE DIET, what is the diagnosis?
A
NON-CELIAC GLUTEN SENSITIVITY
19
Q
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?
A
COLONOSCOPY with BIOPSIES for possible MICROSCOPIC COLITIS
20
Q
Where in the WORLD is the HIGHEST PREVALENCE of CELIAC DISEASE?
A
FINLAND
21
Q
Is SYMPTOM response to GLUTEN-FREE DIET reliable for DIAGNOSIS of CELIAC DISEASE?
A
NO
22
Q
CELIAC DISEASE is associated with a 6-FOLD increased RISK of what CANCER?
A
LYMPHOMA
23
Q
ABERRANT INTRA-EPITHELIAL LYMPHOCYTES on histology of the SMALL BOWEL are adsociated with what?
A
REFRACTORY CELIAC DISEASE TYPE-II - POOR PROGNOSIS, 50% 5 year survival - LYMPHOMA
24
Q
REFRACTORY CELIAC DISEASE TYPE-II (POOR PROGNOSIS, 50% 5-YEAR survival - LYMPHOMA) - responds best to what therapy?
A
NONE (no meds, no steroids, no gluten-free diet)
25
What other **AUTOIMMUNE DISEASE** is **CELIAC DISEASE COMMONLY** associated with?
**DM-I**
26
**AUTOIMMUNE** condition that results in **SEVERE WEIGHT LOSS**, **SEVERE MALAPSORPTION**, **DEHYDRATION** and **ELECTROLYTE IMBALANCES**?
**AUTOIMMUNE ENTEROPATHY**
27
What is the **FIRST** thing that must be checked for when treatment of **CELIAC DISEASE is NON-RESPONSIVE**?
If the **DIAGNOSI**S of **CELIAC DISEASE** is **CORRECT** in the first place
28
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)
29
Does **CELIAC DISEASE** present with **SEVERE DIARRHEA** and **MALABSORPTION**?
**NO**
30
EQUIVOCAL HISTOLOGY (EGD biopsy with villous atrophy) and **SEROLOGY** (tTG NEGATIVE), what do youmdo **NEXT** to diagnose **CELIAC DISEASE**?
**HLA DQ2 & DQ8** (99% NPV)
31
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)
32
**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)
33
Vacuolated, lipid-laden enterocytes, acantocytosis with STEATORRHEA (infant); NYSTAGMUS, ATAXIA, MUSCLE WEAKNESS (childhood); **CARDIOMYOPATHY, RETINITIS PIGMENTOSA** (adult)?
**ABETALIPOPROTEINEMIA**
34
**>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**
35
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**
36
****After WHAT PERCENTAGE of **SMALL BOWEL RESECTION** is the **SEVERE, INTRACTABLE DIARRHEA** and **MALABSORPTION LIFE THREATENING**?
**>75%**
37
What is **ESSENTIAL** to **PRESERVE** in a patient with **SHORT BOWEL SYNDROME**?
**COLON** (absorb water and carbohydrate and slow small bowel motility)
38
What is the result of **RESECTION** of the **ILEUM**?
**Vit B-12** and **BILE SALT MALABSORPTION**
39
What **SURGICAL** procedure can cause **SMALL BOWEL BACTERIAL OVERGROWTH**?
Removal of the **ILEOCECAL VALVE**
40
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
41
**Lethargy**, **Confusion**, **Ataxia** after **SHORT BOWEL SYNDROME** treated with **ANTIBIOTICS** and **REDUCED CARBOHYDRATE** diet is caused by what?
**D-lactic ACIDOSIS** (changed bacterial flora)
42
**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)
43
**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)
44
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)
45
Patient presents with **DIARRHEA, MALABSORPTION, MALNUTRITION**, elevated **SERUM FOLATE, Vit B12 DEFICIENCY** (macrocytic anemia and peripheral neuropahty) and bloating with gas?
**SIBO**
46
**HOW** is **SIBO** diagnosed?
**JEJUNAL ASPIRATE** (aerobes and anaerobes) or **BREATH TESTS** (**glucose** is BEST)
47
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
48
In what cases can you **NOT USE HYDROGEN BREATH TESTING** for determination of **SIBO**?
**SHORT BOWEL SYNDROME, ILEAL DISEASES, GASTRIC BYPASS**
49
**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**)
50
In **WHAT THREE** (**3**) **DISEASES** of the **SMALL BOWEL** are SB **BIOPSIES RECOMENDED** for **DIANOSIS**?
**WHIPPLE's DISEASE, AGAMMAGLOBULINEMIA, ABETALIPOPROTEINEMIA**
51
What medication is **HELPFUL** in treating **BILE-SALT** induced **DIARRHEA**?
**CHOLESTYRAMINE** (worsens steatorrhea, so don't use with this)
52
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**
53
**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)
54
Which small bowel segment can be resected significantly and not have malabsorptive issues as compensation occurs (hyperplasia of remaining intestine) **JEJUNUM** or **ILEUM**?
**JEJUNUM**
55
What can be used to **TREAT NEPHROLITHIASIS** (calcium oxalate) that has been caused by **MASSIVE SMALL BOWEL RESECTION**?
**LOW-OXALATE DIET** (not low calcium)
56
**DIARRHEA IMMEDIATELY FOLLOWING ILEAL RESECTION** in **CROHN's** disease is caused by **WHAT** and how is it **TREATED**?
**BILE ACID MALABSORPTION - CHOLESTYRAMINE**
57
In a patient with **SHORT BOWEL SYNDROME** as well as s/p **COLECTOMY**, what will be **REQUIRE**D for **THERAPY**?
**TPN**
58
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**
59
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)
60
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)
61
**PAS-POSITIVE MACROPHAGES** in the **LAMINA PROPRIA**
**WHIPPLE's DISEASE**
62
**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**
63
Site of **CARBOHYDRATE SALVAGE, WATER** and **ELECTROLYTE ABSORPTION** and the **BRAKE** to **SMALL INTESTINAL MOTILITY**?
The **COLON**
64
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)
65
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**
66
**HOW** much of the small bowel needs to be **RESECTED** to develop **BILE ACID DIARRHEA** (no steatorrhea)?
Relatively **SHORT** segment (
67
**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)
68
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**
69
What **CONDITION** can **SMALL INTESTINAL DIVERTICULOSIS** cause?
**SIBO**
70
**HOW** can the **EFFECT** of **TREATMENT** (antibiotics) of **SIBO** be tracked?
**IMPROVED REPEAT HYDROGEN BREATH TESTS**
71
Are **PREBIOTICS**, **PROBIOTICS** and **ANTIBIOTICS** helpful in **IBS**?
**YES** (becuse some have SIBO: IBS-D)
72
**STEATORRHEA**, **CARBOHYDRATE MALABSORPTION**, **LOW Vit B12** (macrocytic anemia)and **PROTEIN LOSS** are all seen in this condition of the **SMALL BOWEL**?
**SIBO**
73
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)
74
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**
75
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**
76
Can **SMALL BOWEL DIVERTICULOSIS** cause **Vit B12 DEFICIENCY**?
**YES** (because of **SIBO** in these patients - stasis) - ulcerative jejuno-ileitis does not
77
Disease of **WHAT SEGMENT** of **SMALL BOWEL** is associated with **FOLATE DEFICIENCY**?
**DUODENUM** (CELIAC DISEASE)
78
**ELEVATED FOLATE** levels are seen in what **SMALL BOWEL** condition?
**SIBO**
79
Which **FAT-SOLUBLE** VITAMIN is **NOT DEFICIENT** in **SIBO**?
**Vit K**
80
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)
81
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)
82
What is the **LOCATION** most likely for an **LVAD** patient to be bleeding from?
**CECAL ANGIODYSPLASIA** (followed by small bowel angiodysplasia)
83
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
84
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)
85
**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)
86
How is **FAMILIAL MEDITERANEAN FEVER** treated and why?
**LIFELONG** with **COLCHICINE** (to prevent **RENAL AMYLOIDOSIS**)
87
What is the **RECOMMENDED DIET** for patients with **IBS-D**?
**LOW-FODMAP**
88
**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**
89
**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**
90
What does **RADIATION ENTERITIS** cause with symptoms of **DIARRHEA**, **BLOATING**, **WEIGHT LOSS **and **LOW Vit B12** with resulting **MACROCYTIC ANEMIA**?
**SIBO** (treat with **ANTIBIOTICS**)
91
What is considered **ESSENTIAL TREATMENT** for **SHORT BOWEL SYNDROME** besides **AGGRESSIVE ANTI-DIARRHEALS** and **TPN**?
**GASTRIC ACID SUPPRESSION** with a **PPI**
92
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**
93
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**
94
What happens when you use **CHOLESTYRAMINE** in a patient with **SHORT-BOWEL SYNDROME**?
You **WORSEN** the **DIARRHEA**
95
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**
96
How does a **LOW Vit D** level affect **LFTs**?
**ALP** elevation
97
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
98
What is **CONGO RED STAINING** used for?
**AMYLOIDOSIS** (duodenum predilection, then colon, then esophagus)
99
Is it possible to have **WHIPPLE DISEASE** with a negative **EGD** biopsy?
**NO**
100
What is an **Alpha-1-Antitrypsin CLEARANCE** test used for?
Diagnose a **PROTEIN-LOSING ENTEROPAHTY**
101
**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)
102
What is seen on biopsy of **CELAIC DISEASE** besides villous blunting?
**INTRAEPITHELIAL LYMPHOCYTOSIS** and chronic inflammation
103
In which condition of the **SMALL BOWEL** are the villi **SIGNIFICANTLY ATROPHIED**?
**AUTOIMMUNE ENTERITIS** (anti-enterocyte antibodies)
104
What do **ANTACIDS** contain that can cause **DIARRHEA** in a patient with break-through **REFLUX SYMPTOMS** on a PPI?
**MAGNESIUM** (osmotic diarrhea)
105
Besides **MICROSCOPIC COLITIS**, what type of **DIARRHEA** can **PPIs CAUSE**?
**SECRETORY DIARRHEA**
106
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
107
Post **GASTROJEJUNAL BYPASS** surgery, pt develops a **HYPOCHLOREMIC**, **MICROCYTIC ANEMIA**, **LEUKOPENIA**, **NEUTROPENIA**, and **NEUROLOGIC DISTURBANCES** (ataxia), why?
**LOW** SERUM **COPPER**
108
What **SMALL BOWEL ISSUES** do patients with **SCLERODERMA** **DEVELOP**?
**SIBO** (**LOW Vit B12**, **HIGH FOLATE**, and **HIGH METHYLMALONIC ACID**)
109
**LOOSE STOOLS**, **CRAMPY ABDOMINAL PAIN**, **CT** shows an **ILEAL MASS** with possible **LIVER METS**?
**CARCINOID SYNDROME**
110
What **CUTANEOUS MANIFESTATIONS** can **CARCINOID SYNROME** have?
**PELLAGRA** (niacin defficiency) - scaly hyperpigmented rash involving arms, hands face and neck
111
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)
112
What **LAB ABNORMALITIES** can **TPN OVERFEEDING CAUSE**?
**ELEVATED AST** and **ALT**
113
**FATIGUE**, LE DISCOMFORT, **MYALGIAS**, **HEART** MURMURS and **ABNORMAL LFTs** in a patient on **CHRONIC TPN** are caused by what **DEFICIENCY**?
**SELENIUM**
114
In **CHRONIC TPN** patients, what **MINERAL DEFICIENCY** causes **DM**?
**CHROMIUM**
115
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
116
**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**
