General Flashcards
Causes of gastro-intestinal malabsorption
Decrease in bile Pancreatic insufficiency Small bowel mucosa Bacterial overgrowth Infection Intestinal hurry
Examples of diseases of intestinal malabsorption common in UK
Crohns
Coeliac
Chronic pancreatitis
GI malabsorption: Causes of decreased bile
Primary Biliary cholangitis
Ileal resection
Biliary obstruction
Colestyramine
GI malabsorption: Causes of pancreatic insufficiency causing GI malabsorption
Pancreatic cancer
Cystic fibrosis
GI malabsorption: Causes of Bacterial overgrowth causing malabsorption
Spontaneous in elderly
Jejunal diverticula
Post-op blind loops
Diabetes M and PPI are risk factors
Treat Bacterial overgrowth causing GI malabsorption
Metronidazole
GI malabsorption: Causes of Infection causing malabsorption
Giardiasis
Cryptosporidium
Diphyllobothriasis (B12 malabsorption)
Strongyloidiasis
GI malabsorption: Causes of Small bowel mucosa causing malabsorption
Whipple's disease Radiation enteritis Tropical sprue Brush border enzyme deficiencies e.g. lactase insufficiencies Drugs (Metformin, alcohol)
GI malabsorption: Causes of intestinal hurry causing malabsorption
Post-gastrectomy dumping
Post-vagotomy
Gastrojejunostomy
Symptoms of GI malabsorption
Diarrhoea Decreased weight Lethargy Steatorrhoea Bloating
Deficiency signs (of GI malabsorption)
Anaemia (low iron, B12, folate) Bleeding disorders (decreased Vitamin K) Oedema (decreased protein) Metabolic bone disease (decreased vitamin D) Neurological features e.g. neuropathy
Tests of GI malabsorption
(FBC)
Stools
Breath hydrogen analysis (for bacterial overgrowth)
Endoscopy + small bowel biopsy
GI malabsorption expected FBC results
low Ca2+
low Fe
low B12 + folate
increased INR
Describe stool test of GI malabsorption
Sudan stain for fat globules Stool microscopy (infection)
How does tropical sprue cause infectious malabsorption
Villous atrophy
What could you give for infection causing GI malabsorption
Tetracycline
Causes of splenomegaly
- Liver disease (cirrhosis, hepatitis)
- Acute or chronic infection (bacterial endocarditis, infectious mononucleosis, HIV, malaria, tuberculosis, histiocytosis)
- Hematologic malignancy (lymphomas, leukemias, myeloproliferative disorders)
- Congestion (splenic vein thrombosis, portal hypertension, congestive heart failure)
- Inflammation (sarcoidosis, lupus, rheumatoid arthritis, systemic lupus)
- Splenic sequestration (pediatric sickle cell, hemolytic anemias, thalassemias)
What is dyspepsia
One or more of following:
- Postprandial (after eating) fullness
- Early satiation
- Epigastric pain or burning for more than 4 weeks
Red alarm flag symptoms for cancer
- Unexplained weight loss
- Anaemia
- Evidence of GI bleeding e.g. melaena (dark tar like black stools) or haematemesis
- Dysphagia
- Upper abdominal mass - Persistent vomiting
Management of dyspepsia
- Reassurance
- Dietary review
- Antidepressants e.g. selective serotonin reuptake inhibitors e.g. CITALOPRAM (low doses are use to reduce the sensitivity of the gullet)
- Look for Helicobacter pylori using faecal antigen testing or breath test (less common now)
- Endoscopy to find clear picture of whats going on
How many layers does the smooth muscle wall of the stomach have
3
What are 3 layers of smooth muscle of the stomach called
(Outer) Longitudinal
Inner Circular
(Innermost) Oblique
What are 2 sphincters of stomach called
Gastro-oesophageal sphincter
Pyloric sphincter
Which smooth muscle layer of the stomach makes up most of the pyloric sphincter
Circular muscle layer thickening makes up most of pyloric sphincter
Controls exit of gastric contents into the duodenum
