Friday Lectures -> MC, Gold Standard, TOC, DOC

Wernicke Encephalopathy

What is this triad associated with?

• Ataxia

• Confusion

• Opthalmoplegia

Vitamin B1 (thiamine)

What deficiency is most common in alcoholics?

Vitamin B2 deficiency (riboflavin)

What symptoms are these associated with?

• Angular cheilitis

• Stomatitis

• Magenta colored tongue

Vitamin B3 (niacin)

What deficiency is associated with this triad?

• Pellagra

  • Triad → diarrhea, dementia, dermatitis

Vitamin B12 (cobalamin)

Which deficiency is associated with the following symptoms?

• Megaloblastic anemia

• Peripheral neuropathy

• Glossitis

• Memory disturbances

• Fatigue

Vitamin A

What deficiency can cause syptoms of

• Night blindness

• Xerosis (xerophthalmia)

• Corneal ulceration

• Bitot’s spots

Vitamin C (scurvy)

Which deficiency is associated with

• Hyperkeratosis

• Corkscrew hairs

• Hemorrhage

Vitamin D

Which deficiency is associated with

• Rickets

• Osteomalacia

• Muscle cramps/weakness

• Bone pain

• Bowing of long bones

Vitamin E

Which deficiency is associated with

• Gait disturbances

• Ophthalmoplegia

• Hyperreflexia

Vitamin K

Which deficiency is associated with

• Bleeding 

• Bruising

• low bone density

HLA-DQ2, HLA-DQ8

Which genes are strongly associated with celiac disease?

Dermatitis herpetiformis

What condition is associated with celiac disease that is

• intensely pruritic, papulovesicular rash

• Symmetrically distributed over extensor surfaces mostly

Celiac Disease

What has an increased association of small bowel adenocarcinoma and lymphoma?

Endoscopic biopsy

What is the gold standard diagnostic for celiac disease?

Anti-tissue transglutaminase-IgA antibody (serologic testing)

What is the first line diagnostic for Celiac disease?

duodenal resection

What kind of small bowel resection is associated with

• Folate, iron, and/or calcium malabsorption

Jejunal Resection

What kind of small bowel resection is associated with

• Primary digestive and absorptive site for most macro and micronutrients

• Almost always require parenteral nutrition

Ileal resection

What kind of small bowel resection is associated with

• Bile salts and vitamin B12 malabsorption

Whipple Disease

What condition shows the following on duodenal biopsy with histologic exam

• Periodic acid-Schiff (PAS) positive macrophages containing gram positive bacilli and dilation of lacteals

ceftriaxone or meropenem (x 2 weeks then bactrim x 12 months)

What is the initial treatment for Whipple Disease?

intestinal ischemia

What condition requires a rapid dx because it can lead to sepsis, bowel infarction, bowel death, and death?

CTA (CT angiography)

What is the study of choice when diagnosing acute mesenteric ischemia (arterial - occlusive)?

surgical embolectomy

What is the first line treatment for Acute mesenteric ischemia (arterial - occlusive) embolism?

Mesenteric bypass

What is the first line treatment for acute mesenteric ischemia (arterial - occlusive) thrombus?

Mesenteric arteriography (and/or CT/MR angiography)

What is the diagnostic for acute mesenteric ischemia (arterial - nonocclusive)?

CT w/ contrast

What is the best initial screening for acute mesenteric ischemia (venous thrombosis)?

CT or MR venography

What is the best (but typically second line) diagnostic for acute mesenteric ischemia (venous thrombosis)?

anticoagulation

What is the mainstay treatment for acute mesenteric ischemia (venous thrombosis)?

CT angiography (CTA)

What is the first line diagnostic for Chronic Mesenteric Ischemia (intestinal angina)?

Revascularization

What is the treatment for SYMPTOMATIC chronic mesenteric ischemia (intestinal ischemia)?

Colonic ischemia (ischemic colitis)

What is the most frequent form of intestinal ischemia?

CT with contrast

What is the first line diagnostic for colonic ischemia?

Colonic ischemia

What condition can show segmental wall edema or “thumbprinting” on CT with contrast?

ROME III

What criteria is used to assess for functional constipation?

normal transit (functional)

What is the most common type of primary constipation?

• Normal rate of stool passage but difficulty with evacuation

• Sedentary lifestyle, low residue diet, low fluid intake, withholding stool

hemorrhoids

What is the most common complication of constipation?

colonoscopy

What is the most important work up for a person that has red flags coming in for new onset of constipation?

manual disimpaction (manual fragmentation)

What is the treatment of choice for fecal impaction?

S. aureus

What is the MC pathogen in anorectal abscesses?

I&D

What is the treatment you should do promptly for an anorectal abscess?

amoxicillin-clavulanate (or ciprofloxacin + metronidazole)

What empiric antibiotics should you prescribe for an anorectal abscess?

external hemorrhoids

What kind of hemorrhoids come from the inferior hemorrhoidal plexus?

internal hemorrhoids

What kind of hemorrhoids come from the superior hemorrhoidal plexus?

internal hemorrhoids

What kind of hemorrhoid is not sensitive to pain, touch, or temperature?

external hemorrhoids

What kind of hemorrhoid is sensitive to pain?