The Intestines

Question 1

What is the role of cholestyramine in Crohns disease?

Answer 1

It helps bind to bile acids that reach the colon because they were not reabsorbed in the ileum.

When they are not reabsorbed this leads to colonic malabsorption of water. The colon cannot reabsorb water due to the blockage of the bile acids so it all gets loss in the feces and causes diarrhea.

Question 2

What type of scope does each person need:

< 50 yrs old + Rectal bleeding?

> 50 yrs old
+ Rectal bleeding?

Answer 2

1. Flex Sig
2. Colonoscopy

Question 3

Treatment of Toxic Megacolon? Why IV Metonidazole?

What if ileus is present?

Answer 3

Oral vancomycin
IV Metronidazole
(oral flagyl cannot get to the GI tract with Toxic Megacolon)
and Urgent surgical evaluation for possible Colectomy

PO Vanc + IV Metor + Surgical Consult

NG if patient is lethargic
If ileus than give rectally (enema)

Question 4

Why does Aortic Stenosis make AVM malformations bleed?

What other types of conditions can cause this bleeding?

Answer 4

The turbulent flow through the aortic valve CHOPS Up the von willibrand multimers (Aquired Von Willibrand Dz) causing the patient to be more susceptible to bleeding

ESRD, the Uremia inhibits Platelet Aggregation

Question 5

Test for Mesenteric Ischemia ?
What test should be monitored?

Answer 5

1. CT or MR Angiongraphy
2. Lactate

Question 6

How does having Celiac Dz worsen hypothyroisdism?

Answer 6

It can cause Malabsorption of Synthroid.

All autoimmune diseases run together ……..Celiac Dz ppl with have Hypothyroidism as well and can struggle to have TSH and T4 levels respond.

Question 7

1. Why is pneumoccacal vaccination important in celiac disease?
2. What nutritinoal deficiencies is associated with celiac disease ?
3. How can Celiac Dz worsen hypothyroidism?
4. What screening test should be done at the time of diagnosis of celiac disease ?

Answer 7

1. Celiac Disease is associated with HYPOsplenism
2. Vitamin D, Iron because of malabsorption
3. Due to decrease malabsorption of synthroid
4. DEXA scan due to malabsorption
5. It should be done Regardless of age and menopausal status.

Question 8

Whats the next best imaging study if a Perforation is suspected but not seen on Xray?

Answer 8

Ct Scan of the abdomen with water soluble contrast.