Im Gi Malabsorption Usmle 2

Front 1

Definition:
Gluten-induced enteropathy in susceptible persons affecting the small bowel

Back 1

Celiac Sprue

Front 2

What HLA is Celiac sprue?
(2)

Back 2

HLA DR3

HLA DQw2

Front 3

Dx:
Malabsorption (diarrhea, bloating, abd pain, steatorrhea, weight loss), vitamin deficiency (high PT/INR, low iron and calcium), Rash

Back 3

Celiac sprue

Front 4

Pathology Bx of small bowel:
flattened intestinal villi, infiltration of lymphocytes, hyperplasia and lengthing of the intestinal crypts

Back 4

Celiac sprue

Front 5

what does Antiendomysial Ab test?
What other test accompanies this one?

When is it performed?

What is the most accurate test for this Dx?

Back 5

Confirms Dx of Celiac Sprue

(also Antigliadin Ab test)

Performed:
After a Sudan Black stain confirms Malabsorption

Most Accurate: Small Bowel Bx
(must be done to Dx the disease and to R/O Lymphoma)

Hint 5

Sprue Always Tests Bowel

Front 6

Definition:
A pruitic rash associated w/ Celiac sprue, responds to Tx of topical Sulfone, resolves w/ regression of disease

Back 6

Dermatitis Herpetiformis

Front 7

Tx for Celiac sprue

Back 7

All grains are eliminated from diet except Rice and Corn
(no wheat rye or barley)

Front 8

*Patient has chronic pale, greasy, malodorous diarrhea and no evidence of infection.

Initial test?

Back 8

Sudan Black stain

Front 9

Pathology Bx:
mildly flattened intestinal villi w/ jejunal infiltration of monocytes

Back 9

Tropical sprue

Front 10

Dx:
malabsorption signs, megaloblastic anemia, decreased calcium, B-12, iron, folic acid, cholesterol, albumin and magnesium

Back 10

Tropical sprue

Front 11

Tx for Tropical sprue
(2)

Back 11

Vitamin B-12 and Folate supplements

Tetracycline (for a few months)

Front 12

Difference b/t Whipple's disease and Sprue

Back 12

Whipple's has CNS involvement

Front 13

If there is the presence of a normal jejunal Bx, what malabsorption disease is ruled-out?

Back 13

Tropical sprue

Front 14

Dx:
54-yo farmer who has been suffering w/ diarrhea, weight loss, and arthralgias for the past few months is brought in by his wife for memory deficits that have been occurring for the past 3 weeks.

Back 14

Whipple's dz

Front 15

Definition:
devastatingly profound malabsorption syndrome due to destruction of the intestinal lamina due to a gram-negative rod of the Actinomyces genus

Back 15

Whipple's Dz

Front 16

Dx:
arthralgia, abdominal pain, malabsorption, fever, inc skin pigment, uveitis, confusion, CNS palsies, nystagmus, heart failure

Back 16

Whipple's Dz

Front 17

*Most accurate test for Whipple's Dz

Other test?

Back 17

Most accurate:
PAS positive macrophages in the lamina propria;

other:
PCR of peripheral blood for T. whippelii (Actinomyces strain)

Front 18

Abx Tx of Whipple's Dz
(2 steps)

Back 18

1. initial course of Ceftriaxone
2. TMP-SMZ and Tetracycline for 1 year

Front 19

Definition:
Albumin lost to the GI lumen in excess

Back 19

Protein-losing Enteropathy

Front 20

Dx:
Diarrhea, edema, steatorrhea, low albumin

Back 20

Protein-losing Enteropathy

Front 21

Dx test for Protein-losing Enteropathy

Back 21

Alpha-1-Antitrypsin comparison in serum vs stool

Front 22

Similar look to gastric cancer on barium study

Back 22

Menetrier's Dz

Front 23

Definition:
Protein-losing enteropathy that causes mucosal thickening due to hyperplasia of glandular cells replacing chief and parietal cells leading to enlarged, tortuous rugae

Back 23

Menetrier's Dz

Front 24

Dx:
epigastric pain, diarrhea, edema, steatorrhea, decreased gastric acid secretion, low albumin

Back 24

Menetrier's Dz

Front 25

Dx Tests for Menetrier's Dz
(2)

Back 25

Endoscopy w/ deep mucosal Bx

Barium swallow will reveal large gastric folds

Front 26

Rx Tx for Menetrier's Dz
(2 plus MOA of each specific to this)

Back 26

Anticholinergics
(reduce width of tight junctions b/t gastric mucosal cells)

H-2 Blockers
(reduce protein loss)

Front 27

Definition:
Stool frequency < 3 times per week

Back 27

Constipation

Front 28

Etiology of Constipation
(6)*

Back 28

OLD MD Farts:
Obstruction;
Low thyroid(hypothyroidism);
Disturbed colonic motility;
Medications;
DM;
Fluid and fiber intake is low

Front 29

what amount should you increase your fiber to, if your are constipated?

Back 29

30 g/day