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Gastro > Malaborption and Coeliac > Flashcards

Malaborption and Coeliac Flashcards

1
Q

What is coeliac disease? [3]

Ep

A 
Autoimmune disease involving abnormal reaction to Gliadin 
- present in gluten 
Inflammation via tissue transglutaminae
- Villus atrophy and malabsorption
Ep: F>M, infancy or 50-60y/o
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2
Q

Presentation of coeliac disease [6]

A 
Diarrhoea, steatorrhea
Weight loss 
Anaemia - iron, b12, folate (normochromic)
Abdo pain and bloating
Dermatitis herpetiformis
Aphthous ulcers
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3
Q

What should you do if someone has these symptoms

A

Coeliac serology

Must be on gluten to do this

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4
Q

What are RF for coeliac [8]

A 
HLA DQ2 / DQ8
Autoimmune thyroid / gastritis / hepatitis
Type 1 DM
IgA deficiency 
IBS
PBC
Down's
FH
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5
Q

Coeliac screening [2]

A

Patients with type I DM or autoimmune thyroid disease should be screened for coeliac at diagnosis

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6
Q

What tests are part of coeliac serology? [3]

A
  1. IgA and TTG IgA
  2. But IgA def can cause false neg so if IgA is low, do endomysial Ab IgG
    * need to be on gluten for 6w before testing*
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7
Q

What is the definitive test for coeliac?
What are features of coeliac [3]
What are the ESPGHAN guidelines?

A

OGD duodenal biopsy:
Villous atrophy
Crypt hyperplasia
Lymphocyte infiltration

ESPGHAN guidelines: NO biopsy required if anti-TTG x10 upper limit of normal, anti-endomysial IgG positive and HLA-DQ2 or DQ8 positive

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8
Q

What will blood investigations show? [6]

A

• FBC + film and haematinics:
reduced ferritin and folate, increased or decreased MCV, hyposplenism (Howell-Jolly bodies, target cells)
• Other bloods:
LFT (reduced albumin), INR, bone profile, B12

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9
Q

How do you Dx in children [2]

A

Serology

HLA status

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10
Q

Management of coeliac [4]

A

• Diet:
- lifelong gluten free diet (DO NOT remove before serological or histological dx as features will resolve)
- AVOID barley, rye, oats, wheat; CAN have maize, soya, rice
• Functional hyposplenism: pneumococcal vaccination

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11
Q

What are complications [7]

A 
Hyposplenism
Subfertility
Neuropathy
Enteropathy associated T cell lymphoma of small bowel
small bowel adenocarcinoma
breast cancer
bladder cancer
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12
Q

What are the most common causes of malabsorption [6]

A 
Coeliac
IBD
Chronic pancreatitis
Amyloid
PBS
Biliary obstruction
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13
Q

What are infectious causes of malbasorption [6]

A 
Tropical sprue 
HIV
Giardia lambila
Cryptospordium
Traveller's
Whipples
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14
Q

What is tropical spure

A

Folate or b12 deficiency causing inflammation

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15
Q

Whipple’s disease features [6]

A

It is more common in those who are HLA-B27 positive and in middle-aged men.

Features

  • malabsorption: diarrhoea, weight loss
  • large-joint arthralgia
  • lymphadenopathy
  • skin: hyperpigmentation and photosensitivity
  • pleurisy, pericarditis
  • neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus
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16
Q

How do you Dx [2]

A

Jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Trepheryma Whipelli

17
Q

How do you Rx [2]

A

Co-trimoxaole for 1y

Tetracycline

18
Q

How do you treat tropical sprue [2]

A

Tetracycline

Folic acid

19
Q

How do you treat Giardia lambila

A

Metronidazole

20
Q

What are motility causes of malabsorption [5]

A 
Systemic sclerosis
Scleroderma
DM = stasis
Pseudoobstruction
Lymphoma
21
Q

What are iatrogenic causes [5]

A 
Gastric surgery
Short gut
Radiation
Drugs
Alcohol
22
Q

Pancreatic causes [3]

A

CF
Pancreaitits
Cancer

23
Q

What are symptoms of malabsorption [8]

A 
Weight loss
Diarrhoea
Steathorrhea
Bloating
Fatigue
Abdo pain
Anaemia
Muscle wasting
24
Q

How do you Dx malabsorption [6]

A 
FBC, Ca, B12, folate, lipids
INR as risk of clotting defieincy
Coeliac
Stool microscopy
Biopsy + endoscopy
Test for infection
25
Q

What does vit A deficiency cause [4]

A

dry conjunctivae with Bitots spots, cloudy corneas with ulceration, night blindness then total blindness; TERATOGENIC in high doses

26
Q

What does vitamin B deficiency (thiamine = B1) cause [3]

Ax [2]

A
  1. Beri Beri: wet = heart failure and oedema
  2. dry = polyneuropathy
  3. Wernicke’s = ophthalmoplegia, ataxia, confusion
    o Ax: profuse vomiting, alcohol
27
Q

What does vitamin C deficiency cause? [7]

A 
Scurvy 
Bleeding gums / epistaxis, Bruises
Dental, Gingivitis
Malaise
Poor wound healing
Weakness
Arthralgia
28
Q

What does vitamin D deficiency features [2]

Common causes

A

Osteomalacia, Metabolic bone disease
Bone pain, #

  1. Dietary
  2. Lack of sunlight
29
Q

What does vitamin K cause

A

bruising, petechiae and platelet type bleeding

30
Q

What does hypo calcium cause [3]

A

Spasms
Tetany
Neuropathy
Check vit D and PTH

31
Q

What are the fat soluble vitamins

A

ADEK

32
Q

What is folic acid and B12 needed for

A

DNA Synthesis

Always replace B12 first to avoid degernation of spinal cord

33
Q

When are you at increased risk of b12 deficiency / folic [4]

A

Pregnanc
Alcohol
Phenytoin
Methotrexate

34
Q

What is phosphate important for [2]

A

ATP

Respiration

35
Q

B6 deficiency

Ax

A

AKA Pyroxidine
Peripheral sensory neuropathy
Ax: isoniazid

36
Q

B3 deficiency

A

AKA niacin
Pellagra
4D’s
= diarrhoea, dermatitis, depression, dementia (neuropathy and ataxia)

Gastro (17 decks)

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