Week 8 - GI Disease 1 Flashcards
(115 cards)
1
Q
What complications can arise from GORD?
A
Can cause reflux oesophagitis
This can cause dysphagia itself or can cause a stricture also causing dysphagia
2
Q
What is another name for a stricture of the oesophagus?
A
Schatski ring
3
Q
What are the risk factors for GORD?
A
Hiatus hernia
Obesity
4
Q
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
A
Correct answers
- Gluten, Barley, Rye, Contaminated oats and semolina
5
Q
What tests can confirm GORD?
A
OGD or pH studies
6
Q
What Rx can be used for GORD?
A
Lifestyle changes
PPIs
Surgery - fundoplication
7
Q
What is the name of the disorder which causes peristalsis of the oesophagus due to failure of the distal sphincter to relax?
A
Achalasia
8
Q
What are the S&S of achalasia?
A
Dysphagia to liquids AND solids
Food regurgitation
Retrosternal chest pain
9
Q
How is achalasia diagnosed?
A
OGD, barium swallow and manometry
10
Q
What is Rx for achalasia?
A
Oesophageal dilatation
POEMs (Pereoral endoscopic myotomy)
11
Q
Which things do we look at when calculating risk of malnutrition?
A
Protein
Energy intake
12
Q
What percentage of hospital patients lose weight whilst in hospital?
A
70%
13
Q
What is the cost of malnutrition in terms of the NHS burden?
A
Increased dependency, GP visits, prescriptions, referrals, readmissions etc.
14
Q
What is the malnutrition carousel?
A
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
15
Q
What are the consequences of malnutrition?
A
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.
16
Q
Who is most at risk of malnutrition?
A
Losing weight is not a natural part of ageing.
17
Q
What is the difference in definition between short term and prolonged starvation in terms of duration?
A
Short term starvation = <72 hours
Prolonged starvation = >72 hours
18
Q
What are the differences of catabolism between short term and prolonged starvation?
A
19
Q
What is stress starvation?
A
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.
20
Q
What happens to salt and water in stress starvation?
A
Increased retention of salt and water
This causes oedema and hypoalbuminaemia.
21
Q
How does stress starvation differ from simple starvation?
A
22
Q
What can cause malnutrition?
A
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.
23
Q
What can B12 deficiency cause?
A
Pernicious anaemia
Nerve problems
24
Q
Where is B12 absorbed?
A
Terminal ileum
25
What does Vit D deficiency cause?
Rickets in children
Osteomalacia in adults
26
What does Thiamine deficiency cause?
Wet or dry Beriberi
Wernicke Korsakoff syndrome
27
What does Vit C deficiency cause?
Scurvy
28
What does Vit A deficiency cause?
Night blindness
Dry mouth
29
What can niacin deficiency cause?
Pellagra
30
What can iodine deficiency cause?
Goitre
31
Which tool is used for screening for malnutrition?
MUST
32
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
33
What score on MUST indicates a high risk of malnutrition
2 or more
34
What Qs can you ask a P regarding whether they are eating enough?
35
What dietary advice can you give to someone who isn't eating well?
36
What are the cut offs for obesity using BMI or waist circumference?
37
What is the difference between central and general obesity?
38
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
39
What is the health impact of obesity in children?
40
What factors can cause obesity?
Genetic, psychological, physical, metabolic, neurological and hormonal impairment
41
How do you determine what Rx to give for obesity?
42
Who qualifies for bariatric surgery?
Those with a BMI above 40 or 35-40 + comorbs
43
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
44
What are S&S of malabsorption?
45
How does fat malabsorption present?
Steatorrhoea - pale, malodorous, greasy, unformed floating stools - can leave greasy residue in toilet.
46
How does carbohydrate malabsorption present?
Watery & frothy diarrhoea - due to presence of fermented sugars
47
What investigations should you do for Upper GI bleeding?
Plus do DRE - rule out rectal bleeding or malena
48
What can cause bleeding from the oesophagus?
Ulcers
Mallory Weiss tera
Varices
Cancer
Oesophagitis
49
What is a violent tear to the lower oesophagus (by vomiting or coughing) called?
Mallory-Weiss tear
49
What is a perforation to the lower oesophagus (by vomiting or coughing) called?
Boerhaave's syndrome
50
What can cause bleeding from the stomach?
Ulcer
Tumour
Varices
Gastritis
Dieulafoy's lesions
Portal hypertensive gastropathy
Ectasia
51
What can cause bleeding from the duodenum?
Ulcer
Vascular malformation
Bleeding from ampulla due to heptobiliary pathology
52
What is:- a large tortuous artery most commonly in the stomach wall (submucosal) that erodes and bleeds. It can present in any part of the gastrointestinal tract. It can cause gastric hemorrhage but is relatively uncommon. Is an AVM. High mortality.
How is treated?
Dieulafoy's lesion
Treated by clipping
53
How can you differentiate between duodenal and gastric ulcers?
Gastric ulcer pain worsens with eating
Duodenal ulcer pain worsens when empty
54
What are the main causes of PUD (peptic ulcer disease)?
H Pylori
NSAIDs
Smoking
Cancer
Crohn's
55
What investigations can you do for PUD?
OGD
CLO test (Campylobacter-like organism and is also known as the Rapid Urease Test)
H Pylori stool antigen
56
Which Rx is given for PUD?
PPI
2 Abx for 14 days
If bleeding - endoscopy
Perforation - surgery
Repeat OGD after 8w to confirm healing and ensure its not a cancer
57
Which score is used to prognosticate the severity of Upper GI bleeds?
Blatchford score
58
What are the common causes of microcytic anaemia?
TAILS
T = Thalassaemia
A = Anaemia of chronic disease
I = Iron deficiency
L = Lead poisoning
S = Sideroblastic anaemia
59
What are the common causes of normocytic anaemia?
3 As & 2Hs
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
60
What investigations can you do for microcytic anaemia?
Iron levels
Ferritin
Transferrin sats
Haemoglobinopathy screen (if appropriate)
Blood film
61
How does iron deficiency anaemia appear in blood results?
Low iron
Low ferritin
Low transferrin
62
What is ferritin?
Stores of iron in the body
63
What is transferrin?
Transferrin is a glycoprotein that transports iron around the body to the tissues.
64
What does (a) low and (b) high transferrin indicate?
Low = Low levels of transferrin saturation (the percentage of transferrin that is bound with iron) can indicate iron deficiency anemia. Since it is made by the liver - low levels can also indicate liver problems.
High = High levels of transferrin can also be a marker of iron deficiency, as the body produces more transferrin to try to capture more iron from the blood.
High levels of transferrin saturation can also indicate iron overload conditions, such as hemochromatosis, where the body absorbs too much iron from the diet
65
What does low ferritin indicate?
Low ferritin levels indicate depleted iron stores and are a primary indicator of iron deficiency anemia or chronic blood loss.
66
What can high ferritin indicate?
Iron overload - e.g. haemochromomatosis
May also be seen in conditions like chronic liver disease, inflammation, and certain infections.
Ferritin is an acute-phase reactant, meaning its levels can increase in response to inflammation, infection, or malignancy.
Elevated ferritin in the context of normal or high iron stores might indicate underlying inflammation or chronic disease rather than iron overload.
67
What is TIBC?
Total Iron Binding Capacity
It measures the maximum amount of iron that can be bound by proteins in the blood, primarily transferrin. It is an indirect measure of transferrin levels, as transferrin is the main protein responsible for binding and transporting iron in the bloodstream.
TIBC is useful in diagnosing various conditions related to iron deficiency or overload:
In iron deficiency anemia, TIBC is usually elevated because the body produces more transferrin in an attempt to capture and utilize the limited available iron.
High TIBC indicates that there is a greater capacity to bind iron, but actual iron levels in the blood are low.
Iron Overload:
In conditions like hemochromatosis, TIBC is often low to normal because there is already a sufficient amount of iron in the body, and the transferrin saturation is high.
Low TIBC indicates that most of the transferrin is already saturated with iron.
Chronic Diseases and Inflammation:
TIBC can be low in chronic inflammatory conditions, malignancies, and liver diseases. In these conditions, the production of transferrin decreases, leading to lower TIBC.
68
What can cause iron deficiency anaemia?
Lack of absorption or loss or iron
Stomach = ulcers, cancer, GAVE, gastritis
SI = Ulcers, duodenitis, cancers (rare)
LI = polyps, cancer, IBD
69
What investigations can you consider for IDA?
Urine dipstick for blood
GI cause? OGD, Colonoscopy, Capsule Endoscopy
70
What is GAVE?
Gastric Antral Vascular Ectasia
Rare condition affecting the stomach, in which abnormal tiny blood vessels become prone to bleeding. It may also be called ‘watermelon stomach’ due to the striped appearance of the stomach lining.
People may not notice symptoms, but they can lose blood over a long period of time. This results in iron deficiency anaemia (a shortage of iron and a low blood count). It can occasionally result in significant bleeding within the gut, in the form of vomiting blood, or passing black or bloody stools.
71
Which protein are coeliacs intolerant to?
Gliadin (from gluten) - wheat, barley, rye, oats
72
Which other conditions have a high prevalence of coeliac disease?
Downs
T1DM
AI hepatitis
Thyroid gland abnormalities
73
Which genes are associated with Coeliac disease?
HLA DQ2
HLA DQ8
74
How can coeliac disease present?
Diarrhoea
Steatorrhoea
Weight loss
Anaemia
Vague abdo pains
Glossitis, mouth ulcers, dermatitis herpetiformis
Pallow
Angular stomatitis
75
Where is dermatitis herpetiformis usually found?
On extensor surfaces
76
What causes glossitis and angular stomatitis?
Both = B12 and Iron deficiency
77
How does the small bowel appear on endoscopy with coeliac disease?
Get scalloping of the linear folds of the duodenum
Decreased folds
Villous atrophy = shiny and smooth
78
What is the pathophysiology of coeliac disease?
tTG binds to HLA-DQ2 on T-cells => immune response => anti-tTG IA, antiendomysial and antigliadin ABs.
Cross-reacts with epidermal TG as well = causes dermatitis herpetiformis.
79
What serology can confirm coeliac disease?
Anti-endomysial
IgA anti-tTG
Anti-gliadin
However - up to 22% of Ps with coeliac disease will be serology negative CD
80
What Rx should coeliac Ps be given?
Dietary advice
Give pneumococcus vaccination - as Ps can get hyposplenism
Osteoporosis screening
Give Iron, B12 and folate supplementation
Screen for other AI diseases
Annual bloods
81
How is MUST calculated?
82
What is refeeding syndrome?
Sudden rise in insulin following refeeding activates transport receptors on CSM - this transports P and K into the cell along with glucose. K is also transported into the cell in exchange for Na. Because the Na leaves the cell, water follows.
Thiamine follows glucose (cofactor) so goes into the cell with glucose.
Therefore get
- Hypokalaemia
- Hypophosphatemia
- Fluid shifts
- Thiamine depletion
83
How can refeeding syndrome affect the heart?
Can cause arrhythmia and HF
84
How can refeeding syndrome affect the lungs?
Can cause respiratory failure to due oedema
85
How can refeeding syndrome affect the neuromuscular system?
Can cause weakness, seizures, coma, rhabdo, paralysis, ataxia, tremors, Wernicke-Korsakoff
86
Who is at risk of refeeding syndrome?
87
How can you manage refeeding syndrome?
Vitamin supplementation + Thiamine oral or Pabrinex IV
Slow introduction of nutrition
88
What is the difference between enteral and parenteral feeding?
Enteral = via the gut (OG, NG, NJ, PEG, RIG, etc)
Paraenteral = IV feeding
89
90
What are the short term enteral access routes?
91
What are the long term enteral access routes?
92
Where does a non-tunnelled catheter go for parenteral feeding?
Internal jugular
Subclavian
Femoral veins
93
Where does a peripherally inserted central catheter go? (PICC)
SVC via basilic or cephalic veins
94
Where does a Hickman line go?
Into the SVC via the subclavian or internal jugular vein
95
How can you tell the difference between small bowel and large bowel on AXR?
Small bowel = valvular conniventes go all the way across.
In large bowel - haustra - dont go all the way across
96
What is the colour of small bowel contents?
Green
97
What are the key factors involved in refeeding syndrome?
Glucose
Mg, P, K
Thiamine
Fluids, Na
98
What do neurones & RBCs use for energy?
Glucose - glycolysis only - no mitochondria!
99
What are possible signs of malabsorption?
100
Where is Vit B12 absorbed?
Terminal ileum
101
IBD can make you deficient in which nutrients?
Iron
B12
Vit D
Vit K
Folic acid
Selenium
Zinc
B6
B1
102
What can cause dumping syndrome?
Accelerated gastric emptying = means everything is dumped undigested into the SI = malabsorption of fluids and nutrients -> diarrhoea
103
What is early dumping and what is its cause?
Occurs soon after eating = get sweating, dizziness, faintness, rapid weak pulse and hypotension.
Cause = rapid & early deliver of hyperosmolar load into jejunum.
104
What is late dumping syndrome and what is its cause?
Occurs approx 2 hours after a meal.
Sx = weakness, cold, faintness and sweating
Cause = over production of insulin in response to rapid absorption of glucose.
105
What are the Sx of lactose malabsorption?
Explosive watery diarrhoea
Abdominal distension
Flatulence
106
What is intestinal failure defined as?
Reduction of gut function below the minimum necessary for the absorption of macronutrients +/- water +/- electrolytes - to the extent that IV supplementation is required
107
At what length of remaining bowel is the small bowel deemed to be short?
<200cm
108
Which part of the pancreas is responsible for insulin & glucagon, and which is responsible for digestive enzymes and HCO3 secretion?
Head = digestive enzymes (lipase, proteolytic enzymes) and bicarb
Tail = endocrine function
109
How can CF affect nutrition?
Blocks pancreatic ducts = obstruction and damage = reduced secretion of enzymes ->
- Poor energy intake + inc energy expenditure
- Impaired absorption of protein, fat & fat soluble vitamins
110
What can malabsorption of the following cause:
- Vit A
- Vit D
- Vit K
Vitamin A = night blindness
Vitamin D = rickets / osteomalacia
Vitamin K = prolonged bleeding time
111
Resection of the large intestine causes fluid losses of how much?
Initially - 1.2 - 2L per day
8w+ adapts and reduces to 400-600mls per day
112
Where does carbohydrate metabolism occur?
Initially in mouth - amylase (inactive in stomach by pH)
Then in small intestine - amylase, maltase and sucrase.
Glucose is absorbed into the blood via GLUT2 transporters.
113
Where does fat digestion occur?
Mouth - mechanical + lipase
Stomach - lingual & gastric lipase (chief cells) + churning
Duodenum - bile - absorbed in enterocytes in SI as chylomicrons
114
Where does protein digestion occur?
Gastric & pancreatic proteases break down
Pepsinogen (chief cells - stomach)
Trypsinogen & Chymotrypsinogen = pancreas
Enterocytes of SI then absorb AAs
