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Medicine Year 3 (Bear) > Week 300 > Flashcards

Week 300 Flashcards

1
Q

Week 300

What form of malabsoption (IE “what is not absorbed properly/at all) causes glossitis, stomatitis and cheilosis?

A

Deficiency in:

Iron

Riboflavin

Niacin

(you would be forgiven for saying B12!)

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2
Q

Week 300

What form of malabsoption

(IE “what is not absorbed properly/at all) causes: Microcytic anaemia?

A

iron/pyridoxine deficiency

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3
Q

Week 300

What form of malabsoption

(IE “what is not absorbed properly/at all) causes: Macrocytic anaemia?

A

Folate

B12 deficiency

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4
Q

Week 300

What form of malabsoption

(IE “what is not absorbed properly/at all) causes: bleeding

A

Vitamin K deficiency

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5
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Osteopenic bone disease?

A

Calcium

Vitamin D

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6
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Tetany?

A

Calcium

Magnesium

Vit D

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7
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Amenorrhea, impotence, and infertility?

A

Generalised malabsorbtion and malnutrition. Remmber that you get amenorrhea below BMI 17.5

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8
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Secondary Hyperparathyroidism?

A

protracted calcium and Vit D deficiency

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9
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Purpura?

A

Vitamin K Deficiency

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10
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Follicular Hyperkeratosis and dermatitis?

A

Vit A

Zinc

Essential fatty acids

Niacin

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11
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Oedema?

A

Protein losing enteropathy is a cause.

malabsorbtion of dietary protein

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12
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Hyperpigmentation?

A

Secondary hypopituitarism and adrenal insufficiency (Addisons disease)

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13
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Vesicular eruption?

A

Dermatitis herpetiformis

I know, I know - it’s not a very well written card - sorry!

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14
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Xeropthalmia (no tears) and night blindness?

A

Vitamin A Deficiency

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15
Q

Week 300

What form of malabsorption

(IE “what is not absorbed properly/at all) causes: Peripheral Neuropathy?

A

Vit B12

Thiamine

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16
Q

Week 300

Malabsorbtion of Calories results in which clinical features and laboratory findings?

A

Weight loss with normal apetite.

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17
Q

Week 300

Malabsorbtion of Fat results in which clinical features and laboratory findings?

A
  • Pale and voluinous stool
  • Diarrhoea
  • Steatorrhea
  • Stool Fat>6g/day
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18
Q

Week 300

Malabsorbtion of Protein results in which clinical features and laboratory findings?

A
  • Oedema
  • Muscle Atrophy
  • Amenorrhea
  • Hypoalbuminaemia
  • Hypoproteinemia
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19
Q

Week 300

Malabsorbtion of Carbs results in which clinical features and laboratory findings?

A
  • Watery Diarrhoea
  • Flatulence
  • Acidic stool pH
  • Milk intolerance
  • Stool osmotic gap

Increased breath hydrogen also.

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20
Q

Week 300

Malabsorbtion of Vit B12 results in which clinical features and laboratory findings?

A
  • Anaemia (usually macrocytic)
  • subacute combined degeneration of the spinal cord (early signs are paraesthesia and ataxia)
  • Abnormal Schilling test (test for pernicious anaemia)
  • Serum methylmalonic acid and homocysteine increased
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21
Q

Week 300

Malabsorbtion of Folate results in which clinical features and laboratory findings?

A
  • Anaemia (macrocytic)
  • Seum and RBC folate decreased
  • Serum homocysteine increased
22
Q

Week 300

https://www.brainscape.com/decks/4141496/cards/157432251/edit

Malabsorbtion of Vitamin B results in which clinical features and laboratory findings?

A
  • Cheilosis (sores in corner of mouth)
  • Painless Glossitis
  • Acrodermatitis
  • Angular stomatitis
23
Q

Week 300

Malabsorbtion of Calcium and vitamin D results in which clinical features and laboratory findings?

A
  • Paresthesia
  • Tetany (muscle spasms)
  • Pathological fracture(s)
  • Osteomalacia (Rickets)
  • Positive Chvostek (think “slap cheek”)and Trousseau signs (signs of hypocalcaemia and nerve excitability)
24
Q

Week 300

Malabsorbtion of Vit D and Calcium results in which laboratory findings?

A
  • Hypocalcaemia
  • Serum alkaline phosphatase increase
  • Abnormal bone density (DEXA scan)
25
Q

Week 300

Malabsorbtion of Vitamin A results in which clinical features and laboratory findings?

A
  • Follilcular hyperkaratosis
  • Night blindness
  • Serum carotene is decreased
26
Q

Week 300

Malabsorbtion of Vitamin K results in which clinical features and laboratory findings?

A
  • Haematoma
  • Bleeding disorders
  • Prolonged PTT
  • Decrease in Vit K dependent coagulation factors
27
Q

Week 300

Measurement of Faecal elastase is conducted to exclude WHAT?

A

Pancreatic exocrine insufficiency, which can be caused by chronic pancreatitis, cystic fibrosis, pancreatic tumour, cholelithiasis or diabetes mellitus

28
Q

Week 300

In malabsorption, lab tests will show that many things are decreased (i.e. iron, ca2+ etc). But what things are INCREASED?

A

Oxalate in urine

Prothrombin time

Serum total iron binding capacity

29
Q

Week 300

  • 22 yo female with abdo pain in R iliac fossa, loose stools and weight loss
  • Blood tests: Anaemia IDA and B12 deficiency
  • Raised CRP and platelets
  • Ileo-Colonoscopy shows apthous ulceration of the small bowel.

What is the most likely diagnosis for this patient?

A

Chron’s Disease

30
Q

Week 300

23 Yo female presents with diarrhoea, bloating and abdo cramps.

Blood tests show FE, B12 and folate deficiency and low calcium.

Mother diagnosed with sim. problem.

Mother has coeliac disease.

What is the likely diagnosis for this patient? What test would you do first?

A

This is most likely coeliac too.

You would first check for Immunoglobulin A Anti Transglutaminase antibodies - if raised, do osophageogastroduodenoscopy and D2 biopsies to confirm.

31
Q

Week 300

28 yo Female presents with abdo pain, distension, diarrhoea, borborygmi and flatus. Examination is normal. Blood rests all nornal, including haematinics and CRP/ESR. Breath test with lactose shows peak rise in breath hydrogen to 45ppm.

What is the most likely diagnosis in this case?

A

This is most likely lactose intolerence. Trial without lactose products to confirm.

32
Q

Week 300

28 YO female presents with abso pain, distension, diarrhoes, borborygmi and flatus. History of surgery for Chron’s disease repair of strictures in ileum. Normal examination. Blood tests all normal including CRP/ESR. Ileo-colonoscopy and barium follow through were normal. B12 deficiency, but normal ferritin and folate. Lactulose breath test show peak hydrogen of 45 ppm.

What is the most likely diagnosis in this case?

A

Bacterial overgrowth.

Treat with course of antibiotic (typicall ciprofloxacin 11 weeks) for resolution of symptoms.

33
Q

Week 300

A 32 YO male with well controlled Crohn’s presented with diarrhoea. He has a history of terminal ileal resection. Normal examination. Blood tests show low plasa B12. Faecal elastase is normal. SeHCAT (23-seleno-25-homo-tauro-cholic acid)- 5 (>15%).

What is the most likely diagnosis?

A

Remember. an SeHCAT test is used to test for Bile acid malabsorbtion. A result of larger than 15 is normal. Anything less suggests that bile acid is being malabsorbed.

With that in mind, and considering the previous history (and knowing your relevent physiology appreciating that bile acid is reabsorbed through the portal system via the distal ileum) - it is likely that this gentlemans condition is:

Bile acid malabsorbtion

34
Q

Week 300

A 50 YO male presents with abdo pain, easy bruising, weight loss and loose stools.

Stools difficult to flush as they are slimy and pale. Px gives history of alcohol abuse above normal levels.

A

This gentleman has presenting acute steatorrhoea, and signs of clotting insufficiency. It is likely that he is deficienct in Vitamin K as a result of liver cirrhosis and chronic pancreatitis.

Further tests would be an AXR to assess for pancreatic calcification and a faecal elastase test (for pancreatitis).

These happen to both show positive.

CHRONIC PANCRERATITIS

35
Q

Week 300

56 YO man presents with hx of recurrent duodenal ulceration and multiple stomach ulcers that has not responded to treatment. Patient complains of pain, weight loss and diarrhoea which was watery at times. Serum gastrin levels were assesed and were shown to be above the normal range.

What is the likely condition in this case?

A

This man is likely to have Zollinger -Ellison syndrome, a type of pancreatic gastrinoma which results in the production of excess gastrin, perpetuating high levels of HCL release from parietal cells, and subsequent ulceration. Becasue this is from the pancreas, it also results in acid damage to the duodenal mucosa and denaturation of pancreatic enzymes and bile acids.

36
Q

Week 300

What is the first line treatment for Microcytic hypochromic anaemia (iron deficiency anaemia)?

A
  • Correct problems causing any bleeds - stop NSAIDS if possible
  • Strart with oral Ferrous sulphate 22mg bd or tds.
  • If Ferrous sulphate is not tolerated, consider oral ferrous fumarate or ferrous gluconate tablets.
37
Q

Week 300

Name some iron containing foods!

A
  • MEAT (think Uplands MegaBEast)
  • Fortified breads and cereals
  • beans and lentils
  • Tofu
  • Dried fruits
  • Spinach and other dark greens
  • Prune juice
38
Q

Week 300

Name some side effects of iron supplementation.

A
  • Abdo/epigastric pain
  • Constipation and black stools
  • Diarrhoea
  • Heartburn
  • N and V
39
Q

Week 300

Which anaemic patients should have blood transfusions?

A
  • Patients with symptomatic anaemia despite iron therapy AND at risk of cardiovascular instability because of their degree of anaemia

REMEMBER!!!!

Aim to restore HB to safe, but not necessarily normal levels.

It is only a SHORT TERM treatment.

40
Q

Week 300

How ong after starting iron supplementation should HB levels be checked?

A

2-4 weeks.

If there is a response, check again after 2-4 months to see that levels have returned to normal.

41
Q

Week 300

What are the parenteral preparations of iron?

A
  1. Iron sucrose (Venofer) - IV only
  2. Carboxymaltose (Ferinject) - IV only
  3. Iron Isomaltoside 1000 (monofer) - IV only
  4. Iron (III) hydroxide dextran (Cosmofer) can be given either IV or by deep gluteal IM injection.

NB: IM are painful - and require several injections!

42
Q

Week 300

How commonly are adverse effects to parenteral iron preparations observed - and what are they?

A
  • Iron Dextran - 50%
  • Iron Sucrose - 36%
  • Ferric carboxymaltose - 35%

Most common adverse effects include:

  • Hypotension
  • Hypertension
  • Bradycardia
  • Chest pain
  • N and V
  • Abdo pain
  • Diarrhoea
  • Headache
  • fever
  • Myalgias/Arthralgias etc.
43
Q

Week 300

23 YO female with Crohn’s for 4 years - no response to medical treatment. She undergoes surgery (right hemicolectomy).

Post-surg px develops loose stool BO 6/day loose, with no blood.

Physical examination, blood tests and radiology/endoscopy all show normal.

What could this be?

A

This is a possible bile salt malabsorbtion. It would explain the symptoms occuring after removal of ileojejunal region of small bowel.

44
Q

Week 300

What are the causes of Bile salt malabsorption?

A
  • Ileal disease
  • Ileal resection
  • Bypass
  • Cholecystectomy
    • Idiopathic
45
Q

Week 300

An abnormal SeHCAT test (less than 15) indicated which pathology?

A

Bile acid malabsorption.

46
Q

Week 300

What is the treatment for bile acid malabsoprtion?

A

Bile acid sequestrants.

  • Cholestyramine/Colestipol
  • Used in: Bile acid disarrhoea, Pruritis (itching skin) and hypercholesterolaemia

Side effects:

Constipation/Bloating/Tastes GROSS/reduce absorption of other drugs

47
Q

Week 300

45 YO Male with recurrent abdo pains described as “deep, sometimes severe” and dull in epigastric region. May radiate through to the back, which is often precipitated by eating. Seems to be associated with N and V. Patient describes a history of chronic alcohol abuse.

On examination:

  • Bloating/abdo cramps/flatus
  • Weight loss
  • Stetorrhoea
  • Diagnosis: Chronic pancreatitis
  • Steatorrhoea: Loose, greasy, foul smelling stools that will not flush.

What is the most likely diagnosis in this case?

A

This is most likely Chronic pancreatitis, preceded by chronic alcohol abuse.

Chronic, irreversible inflammation and/or fibrosis of the pancreas, often characterised by disabling pain and progressive pancreatic endocrine and exocrine insufficiency.

48
Q

Week 300

What does Exocrine pancreatic insufficiency, secondary to chronic pancreatitis result from?

A

Damage to Acinar cells, with subsequent failure of production of digestive enzymes, causing maldigestion and malabsorption.

49
Q

Week 300

What does endocrine pancreatic insufficiency, secondary to chronic pancreatitis result from?

A

Damage to the endocrine tissue of the pancreatic gland (islets of langerhans), with failure to produce insulin, causing glucose intolerance and diabetes mellitus. Usually requires insulin. Glucagon production is also affected, increasing the risk of hypoglycaemia.

50
Q

Week 300

What is the treatment of Chronic pancreatitis?

A

Provision of adequate pain relief is KEY.

If this is not adequate, consider therapy for removal of pancreatic stones or stricture dilatation.

Coeliac axis block, or splanchnicectomy are also sometimes employed.

51
Q
A

Medicine Year 3 (Bear) (6 decks)

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