Gi 15

Front 1

What are 2 macroscopic findings of celiac disease?

Back 1

1. Scalloped appearance along duodenal folds

2. Mucosal Nodularity

Front 2

What are the classic sx's of celiacs?

Back 2

All usual GI symptoms: nausea, diarrhea, distention, pain, vomiting, etc

Front 3

What is the most common age of presentation of non GI manifestations of celiacs?

Back 3

Older child to adult

Front 4

What are the 3 categories of the "celiac iceberg"?

Back 4

1. Symptomatic celiac disease (manifest mucosal lesions)

2. Silent Celiac Disease (manifest mucosal lesion)

3. Latent Celiac Disease (normal mucosa)

Front 5

What are the 2 broad components of the pathogenesis of celiacs?

Back 5

1. Genetic Predisposition

2. Environmental Triggers (Dietary/Non-Dietary)

Front 6

WRT to genetics, there is a strong association of what to celiacs?

Back 6

HLA assoication

Front 7

90-95% of patients with celiacs have what HLA?

Back 7

HLA-DQ2

(BUT also found in 20-30% of controls)

Remainder have DQ8

Front 8

What is the 33 AA peptide that contains critical epitopes that is important in the pathogenesis of celiacs?

Back 8

Gliadin - high in glutamine and proline

Front 9

What is the role of gliadin peptide in celiacs?

Back 9

Resistant to digestion and penetrates epithelial barrier

Modified by enzyme transglutaminase

Binds to HLA-DQ2 on the surface of APCs

Activates CD4+ T cells

Front 10

Gliadin specific T cells have what phenotype with a high secretion of what?

Back 10

Th1 functional phenotype with high secretion of IFN-gamma

Front 11

What are the 2 main pathophysiology sequelae of celiacs?

Back 11

1. Malabsorption of nutrients, iron, folate, calcium, etc

2. Increased intestinal permeability may permit entry of other toxins which might induce autoimmune disease

Front 12

What are the 2 best serologic tests for celiacs?

Back 12

1. EMA (IgA)

2. TTG (IgA)

Front 13

What are 2 new ESPGAN criteria for celiacs?

Back 13

1 Biopsy with:

Characteristic morphologic abnormalities in SI in pt ingesting gluten +/- presence of serum gliadin or endomysial antibodies

Front 14

What are 3 main histologic characteristics seen in celiac's?

Back 14

1. Increased IEL's (intra-epithelial lymphocytes)

2. Villus Atrophy

3. Crypt Hyperplasia

Front 15

Will celiac's be seen in every segment of the SI?

Back 15

NO, will be patchy

More common in proximal SI than distal

Front 16

After removal of a gluten in a diet (gluten free diet), will histological changes in celiacs reverse themselves?

Back 16

YES

Front 17

What is eosinophilic esophagitis?

Back 17

An allergic inflammatory condition of the esophagus

Food hypersensitiy

Front 18

What epidemiologic changes are being seen wrt to allergies?

Back 18

3x increase in prevalence of allergies over past 20 years

Front 19

What describes Eosinophilic Esophagitis and Gastroenteritis wrt to IgE?

Back 19

They are BOTH IgE and NON-IgE

Front 20

Eosinophilic esophagitis presents with symptoms similar to what disease?

Back 20

Gastroesophageal reflux disease (GERD)

Front 21

Eosinophilic Esophagitis is responsive to what 3 items?

Back 21

1. Cortiocosteroids

2. Amino Acid Based Formula

3. Restriction Diet

Front 22

What are the endoscopic findings in eosinophilic esophagitis?

Back 22

White plaques

Front 23

Does eosinophlia = allergy

Does allergy = eosinophilia?

Back 23

NO - ex: parasites

NO - ex: celiac

Front 24

What is the "normal" number of eosinophils in the esophagus, stomach, SI, right colon, and left colon?

Back 24

Esophagus = none

Stomach = rare

SI = More numerous

Right Colon = Very numerous

Left colon = less numerous

Front 25

What is allergic proctocolitis?

Back 25

Common cause of rectal bleeding in infants

Eeosinophilia of colon

Front 26

Do infants with allergic proctocoliti s usually have weight loss, look malnourished?

Back 26

NO, look normal

Front 27

What are the 3 main provacative antigens in allergic proctocolitis?

Back 27

1. Cow's milk protein

2. Soy milk

3. Breast milk

Front 28

Is allergic proctocolitis is chronic condition?

Back 28

NO, usually temporary

Symptoms resolve themselves after removal of antigens

Front 29

In allergic proctocolitis usually continuous in the colon?

Back 29

NO, frequently patchy and rather variable in severity

Front 30

What are the 3 main eosinophilic GI disorders?

Back 30

1. Eosinophilic Esophagitis

2. Allergic Proctocolitis

3. Eosinophilic Gastroenteritis

Front 31

What are the 3 criteria for eosinophilic gastroenteritis?

Back 31

1. Eosinophilic infiltrate in various sites of GI tract

2. Exclusion of known causes of GI eosinophilia

3. GI symptoms

Front 32

What is the etiology of eosinophilic gastroenteritis?

Back 32

Unknown

Front 33

What is important wrt to the treatment of eosinophilic gastroenteritis?

Back 33

It is the MOST difficult to treat eosinophilic disorder of the GI tract

Front 34

What section of the stomach is involved in >95% of all cases of eosinophilic gastroenteritis?

Back 34

Gastric Antrum

Front 35

What are the 3 factors in the development of IBD?

Back 35

1. Genetic Predisposition

2. Mucosal Immune System

3. Environmental Triggers

Front 36

What are the 2 types of IBD?

Back 36

1. Crohn's

2. Ulcerative Colitis

Front 37

Review chart on 2H-55

Back 37

see notes

Front 38

What are the 2 primary symptoms seen in UC that are NOT seen in Crohn's?

Back 38

1. Rectal Bleeding

2. Diarrhea

Front 39

What are the 2 primary symptoms seen in Crohn's that are NOT seen in UC?

Back 39

1. Weight loss

2. Growth failure

Front 40

Crohn's ileitis will demonstrate what?

Back 40

Stenosis, linear ulceration, and mucopurulent exudate

Front 41

The colon in UC demonstrates what?

Back 41

1. Erythema

2. Granularity

3. Friability

4. Mucupurulent exudates

5. Loss of vascular pattern

Front 42

Is there generally ileal involvement in UC?

Back 42

NO

Front 43

Patients with Crohn's Colitis have what 2 findings?

Back 43

1. Deep linear ulceration

2. Segmental disease in the colon ("skip" lesions)

Front 44

In CD, what is often spared from inflammation?

Back 44

The rectum

Front 45

In ACUTE colitis, what is NOT seen?

Back 45

No structural or architectural changes seen

Front 46

What type of infilitrate is seen in colitis?

Back 46

Neutrophilic infiltrate

Front 47

What are the 2 key findings in CHRONIC colitis?

Back 47

1. Abnormal glandular architecture (crypt atrophy / crypt branching)

2. Inflammatory cell infiltrate

Front 48

What is the geographic pattern of UC?

Back 48

1. Distal --> Proximal (cecum)

2. More superficial (limited to mucosa)

Front 49

How many layers are involved in CD?

Back 49

ALL layers involved

Front 50

The presence of what is a histologic marker of CD?

Back 50

Granulomas

Front 51

Two woman were talking about the new hunk in the neighborhood. "But he acts so stupid," said one to the other. "I think he must have his brains between his legs." "Yeah," her friend sighed, "but I'd sure love to blow his mind."

Back 51

Haha