gastric: coeliac, malapsorption, bariatric surgery

Question 1

what autoimmune disorders is coeliac associated with

Answer 1

T1dm, hepatitis, thyroid

Question 2

what genes is coliac assoc with

Answer 2

HLA DQ2/8

Question 3

what skin condition is coaliac assoc with

Answer 3

dermatitis herpetiformis (purple, itchy(

Question 4

symptoms coeliac

Answer 4

diarrhoea/ persistant GI symptoms / abdo pain and cramp

Question 5

what anaemia is most common in coeliac

Answer 5

folate > B12

Question 6

what complications are seen in coeliac (6)

Answer 6

anaemia // hypospleen // osteoporosis // lactose // T cell lymphoma // subfertile

Question 7

what cancer can be assoc with coeliac

Answer 7

T cell lymphoma

Question 8

when should a gluten diet be recommenced when testing coeliac

Answer 8

for 6 weeks prior

Question 9

what serology tests can be done for coeliac and what is first line

Answer 9

TTG antibodies are first line WITH IgA // antigialidin can also be done

Question 10

what is gold standard for coeliac

Answer 10

biopsy

Question 11

what is seen of biopsy on coeliac

Answer 11

villous atrophy / crypt hyperplasia

Question 12

what vaccine should coeliac patients get and why

Answer 12

pneumococcal with booster every 5 years // hyposplenism

Question 13

what are secondary causes of bile acid malabsorptions (3)

Answer 13

cholecystectomy // coeliac // small intestine bacteria overhrowth

Question 14

what is the main symptom of ile acid malabsorptions and wat deficiencies does it cause

Answer 14

steathorrhea // ADEK vitamins

Question 15

invx for bile acid malabsorptions

Answer 15

SeHCAT

Question 16

mx bile acid malabsorptions

Answer 16

bile acid sequestrate eg cholestryamine

Question 17

what is pernicious anaemia

Answer 17

autoimmune damage of gastric mucosa –> vit B12 deficiency

Question 18

what antibodies are produced in pernicious anaemia

Answer 18

antibodies to IF which blocks vit B12 binding sites

Question 19

who is pernicious anaemia most common in

Answer 19

middle aged/ elderly females/ group A

Question 20

what are symptoms of pernicious anaemia

Answer 20

anaemia features // neurological: pins and needles, weakness, ataxia, memory // glossitis

Question 21

what bloods are seen with pernicious anaemia

Answer 21

macrocytic anaemia // low WCC and platelets // hypersegmented on blood film

Question 22

what antibodies can be screened for in pernicious anaemia

Answer 22

intrinsic factor antibodies

Question 23

mx pernicious anaemia

Answer 23

B12 injection 3x for 2 weeks –> every 3 months // +/- folic acid

Question 24

what cancer does pernicious anaemia increase risk of

Answer 24

gastric

Question 25

what BMI tends to be referred for bariatric surgery

Answer 25

40-50

Question 26

at what stage of obesity is bariatric surgery reccommended

Answer 26

early - to prevent disease progression

Question 27

what are 3 restrictive bariatric surgeries

Answer 27

lap gastric band (LAGB) // sleeve gastrectomy // intragastric balloon

Question 28

what is a primary malabsorpative bariatric surgery

Answer 28

bilopancreativ diversion with duodenal switch

Question 29

what is a mixed bariatric surgery

Answer 29

rout en Y bypass

Question 30

what bariatric surgery is first line for 30-39 BMI

Answer 30

LABG

Question 31

what bariatric surgery is first line for BMI >60

Answer 31

bilopancreatic diversion

Question 32

what bariatric surgery gives best functional outcomes

Answer 32

rout en Y

Question 33

when would a duodenal or jejunal tube be favoured over gastric feeding

Answer 33

if there is upper GI dysfunction

Question 34

what defines a malnourished patient (3)

Answer 34

BMI <18,5 // weight loss of >10% // BMI <20 and weight loss >5%

Question 35

what are common complications of enteral feeding (4)

Answer 35

diarrhoea, aspiration, hyperglycaemia, refeeding

Question 36

when can a PEG be used / removed

Answer 36

use 4 hours after // must be in for 2 weeks

Question 37

when is parenternal feeding used

Answer 37

nutritionally compromised surgical patients

Question 38

how is parental food given

Answer 38

IV - usually through a central vein eg (PICC)