Week 8 - GI Disease 1 Flashcards
What complications can arise from GORD?
Can cause reflux oesophagitis
This can cause dysphagia itself or can cause a stricture also causing dysphagia
What is another name for a stricture of the oesophagus?
Schatski ring
What are the risk factors for GORD?
Hiatus hernia
Obesity
A new diagnosis of Coeliac Disease is made in a 35-year old woman. What in her diet might she be allergic to? Select multiple answers.
- Gluten
- Barley
- Rye
- Contaminated oats
- Rice grain
- Semolina
Correct answers
- Gluten, Barley, Rye, Contaminated oats and semolina
What tests can confirm GORD?
OGD or pH studies
What Rx can be used for GORD?
Lifestyle changes
PPIs
Surgery - fundoplication
What is the name of the disorder which causes peristalsis of the oesophagus due to failure of the distal sphincter to relax?
Achalasia
What are the S&S of achalasia?
Dysphagia to liquids AND solids
Food regurgitation
Retrosternal chest pain
How is achalasia diagnosed?
OGD, barium swallow and manometry
What is Rx for achalasia?
Oesophageal dilatation
POEMs (Pereoral endoscopic myotomy)
Which things do we look at when calculating risk of malnutrition?
Protein
Energy intake
What percentage of hospital patients lose weight whilst in hospital?
70%
What is the cost of malnutrition in terms of the NHS burden?
Increased dependency, GP visits, prescriptions, referrals, readmissions etc.
What is the malnutrition carousel?
That Ps come into hospital, get malnourished, have longer stays with more complications, need more support on discharge and more care etc, and are more likely to need readmission to hospital again - where they lose even more weight
What are the consequences of malnutrition?
Lack of protein can result in loss of muscle mass & strength
Weak abdominal muscles - cant cough effectively
Heart is a muscle - if you are losing muscle mass you can catabolise heart muscle.
Ps are really cold - hypothermia.
Not enough energy leads to loss of appetite & depression.
Who is most at risk of malnutrition?
Losing weight is not a natural part of ageing.
What is the difference in definition between short term and prolonged starvation in terms of duration?
Short term starvation = <72 hours
Prolonged starvation = >72 hours
What are the differences of catabolism between short term and prolonged starvation?
What is stress starvation?
Occurs when the body is subject to a metabolic stress - the normal adaptive responses are overridden and metabolic rate rises massively.
E,g, when there is burns, trauma, sepsis etc.
What happens to salt and water in stress starvation?
Increased retention of salt and water
This causes oedema and hypoalbuminaemia.
How does stress starvation differ from simple starvation?
What can cause malnutrition?
Altered nutritional requirements - e.g. infection, cancer, wind, burn, trauma, tremor
Inadequate intake - e.g. depression, loss of appetite, pain, inability to cook/shop, poverty, drink/drugs etc.
Malabsorption - dysfunction of stomach, intestines etc.
Excess losses - D&V, drains, fistulae, stomas, ulcers etc.
Which tool is used for screening for malnutrition?
MUST
What is a MUAC used for?
Mid Upper Arm Circumference
Used to measure someone’s BMI
<23.5cm - BMI likely to be <20
> 32cm - BMI is likely to be >30
What score on MUST indicates a high risk of malnutrition
2 or more
What Qs can you ask a P regarding whether they are eating enough?
What dietary advice can you give to someone who isn’t eating well?
What are the cut offs for obesity using BMI or waist circumference?
What is the difference between central and general obesity?
What is the health impact of obesity?
Changes at cellular and metabolic levels
Inc wear and tear of joints
Asthma and sleep apnoea
Altered insulin response
Cancer
Reproductive and urological problems
Liver disease
Reflux, gallstones, pancreatitis
Psychological and social issues - low self esteem, stress, social disadvantage, depression, reduced libido
What is the health impact of obesity in children?
What factors can cause obesity?
Genetic, psychological, physical, metabolic, neurological and hormonal impairment
How do you determine what Rx to give for obesity?
Who qualifies for bariatric surgery?
Those with a BMI above 40 or 35-40 + comorbs
Where are
- the majority of Vitamins absorbed
- water absorbed
What is absorbed by the large intestine?
Maj of Vits = small intestine
- Water = stomach & large intestine
Large intestine absorbs water, Na, Cl, K, FAs and Vit K
What are S&S of malabsorption?
How does fat malabsorption present?
Steatorrhoea - pale, malodorous, greasy, unformed floating stools - can leave greasy residue in toilet.
How does carbohydrate malabsorption present?
Watery & frothy diarrhoea - due to presence of fermented sugars
