GI

Question 1

Celiac Disease

• Symptoms
• Diagnosis
• Treatment

Answer 1

Symptoms:
- fatigue, bloody stools, weight loss

Diagnosis

• Anemia (IDA)
• LFTs abnormal
• Anti-TTG, anti-endomysial
• Definitive=biopsy (crypt hyperplasia, intraepithelial lymphocytes, villous blunting)

*anti-ttg may be negative in IgA deficient

Treatment:

• Gluten Free Diet
• If not compliant at risk for T-cell Lymphoma (abd pain, b-symptoms, intestinal obstruction or perforation)
• no indication for repeat biopsies if sx resolve

Question 2

Screening in Celiac Disease

Answer 2

DXA (perform at time of diagnosis)

Treat with Vit D/Calcium

Question 3

Microscopic Colitis

Answer 3

Symptoms: watery diarrhea without weight loss or abd pain
Diagnosed by biopsy:
- Normal looking mucosa however biopsy may show:
—– intraepithelial lymphocytes, cryptitis
—– Collagen band thickening of the subepithelium

Treatment:

1. remove offending agent (PPI, NSAID)
2. Bismuth, loperamide
3. Budesonide (Oral)

Question 4

VIPoma

Answer 4

Diarrhea and Flushing

Electrolyte abnormalities related to diarrhea

Question 5

Carcinoid Syndrome

• Symptoms
• Diagnosis
• Treatment

Answer 5

Symptoms:

• Skin: flushing, telangiectasias
• Pulm: bronchospasm
• Heart: right sided>left sided valve disease
• GI: diarrhea
• Niacin deficiency

Diagnosis:

• Elevated 24 hour urine 5H1AA
• CT/Ab pelvis to identify tumor
• Octreotide scans

Treatment:

• Octreotide
• Surgical resection of tumor
• Surgical resection/platinum based chemo if liver mets

Question 6

Indications for treatment of hepatitis B

Answer 6

• Chronic infection (IgG) with Continue ALT elevation with HBV DNA >10k
• immunosuppressive therapy
• acute liver failure (IgM)
• test chronic hepatitis B for hepatitis D