Iron Deficiency Anaemia and GI Investigations

Question 1

awhat percentage of iron deficient anaemia will have underlying GI malignancy

Answer 1

10%

Question 2

causes of IDA

Answer 2

poor intake of dietary intake
reduced absorption (e.g. coeliac or post surgery)
increased iron/blood loss (e.g. menstruation or cancer)
increased demand (e.g. pregnancy or adolescence)

Question 3

symptoms of IDA

Answer 3

often asymptomatic
tiredness
dyspnoea
headache

Question 4

common signs of IDA

Answer 4

pallor
atrophic glossitis

Question 5

foods containing iron

Answer 5

green veg
liver, kidney, pork, shellfish, chicken, eggs
lentils, chickpeas, dates, apricots
enriched breads and cereals

Question 6

what are the two types of iron

Answer 6

ferrous (haem)
ferric (non-haem)

Question 7

what type of iron is found in meat and fish

Answer 7

haem/ferrous

Question 8

what type of iron is found in plants

Answer 8

non-haem/ferric

Question 9

which iron is more absorbable

Answer 9

found in meat and fish (haem/ferrous)

Question 10

what things enhance absorption of iron

Answer 10

vitamin C
fructose
alcohol

Question 11

what things inhibit absorption of iron

Answer 11

tea (tannins)
eggs
pulses
dairy (calcium)

Question 12

what disease is a result of too much iron absorption

Answer 12

haemochromatosis

Question 13

where is iron stored in the body

Answer 13

liver
spleen
bone marrow
muscle

Question 14

what form is iron stored in in the body

Answer 14

ferratin

Question 15

what should you measure as a marker of how much iron is in the body

Answer 15

ferratin
free iron is not helpful as it is transient

Question 16

what type of anaemia can look similar to IDA

Answer 16

anaemia of chronic disease

Question 17

how can IDA and ACD be differentiated

Answer 17

by looking at ferratin and transferrin levels

in IDA:
- ferratin will be low
- transferrin will be high

in ACD:
- ferratin will be high
- transferrin will be low or normal

Question 18

what are ferratin and transferrin levels in IDA and ACD combined

Answer 18

transferrin - low
ferratin - low or normal

Question 19

definition of iron deficiency anaemia

Answer 19

low ferratin
or
low serum iron and high transferrin (>3)

Question 20

what is worth doing in someone with iron deficient anaemia

Answer 20

coeliac disease test (TTG)

Question 21

what type of sedation is aimed for in a standard endoscopy

Answer 21

conscious sedation where the patient can respond but doesn’t remember

Question 22

which is better tolerated transnasal or through the mouth endoscopy

Answer 22

transnasal

Question 23

disadvantage of transnasal endoscopy

Answer 23

can’t perform most procedures

Question 24

why are right side lesions more likely to be missed on a colonoscopy

Answer 24

prep tends to be poorer on that side

Question 25

what is the preparation for colonoscopy

Answer 25

liquid only diet and purgative medication

Question 26

advantgaes of CT colonoscpy

Answer 26

less invasive quicker option for minimal prep for frail patients as effective at standard colonoscopy for >5mm polyps

Question 27

disadvantages of CT colonoscopy

Answer 27

radiation still need standard colonoscopy is lesion found usually still need to take prep can result in incidentalomas (findings which would not cause disease)

Question 28

what is done after endoscopy and colonoscopy are done

Answer 28

usually nothing check no blood loss from urinary tract investigate small bowel if recurrent IDA

Question 29

first line treatment of IDA

Answer 29

optimise diet oral iron supplements for 3 months after iron deficiency corrected

Question 30

side effects of iron supplements

Answer 30

constipation GI upset dark stools

Question 31

what can be done if oral iron isn't tolerated

Answer 31

once daily/alternate day dosing IV iron