Clinical Topic 3: Malnutrition Flashcards
What features may be seen on Biopsy in a patient’s duodenum with active Coeliac’s Disease?
- Villous atrophy
- Crypt hyperplasia
- Increased epithelial lymphocytes
What features may be seen on Endoscopy in a patient’s duodenum with active Coeliac’s Disease?
- Scalloping of bowel folds
- Mosaic pattern of mucosa
What are the alleles associated with Coeliac’s Disease?
HLA-DQ8
HLA-DQ2
What is the significance of the Marsh classification?
Determines severity of Coeliac’s Disease on histology
State 5 complications of Coeliac’s Disease
- Risk of adenocarcinoma
- Risk of EATL (Enteropathy Associated T-cell Lymphoma)
- Dermatitis Hepatiformis
- Osteopenia and Osteomalacia
- Hyposplenism
What three serology tests can be used to test for Coeliac’s disease? What is first-line?
IgA-tTG (first-line)
EMA
IgG-DGP
Why can patients get false negatives on IgA-tTG serology testing? Two reasons
Some patients may have adopted a gluten-free diet, which would show normal IgA-tTG. Some patients may also have an IgA deficiency
What region of the GI tract is commonly affected in Coeliac’s Disease?
Duodenum
What is the significance of Feacal Elastase?
Used to test for Pancreatic Insufficiency
Angular Stomatitis is a sign of what deficiency?
Iron deficiency anaemia
Coeliac’s disease patients are at risk of some infections. Why is this? What is offered to prevent this?
These patients have hyposplenism and hence are at risk of infections from encapsulated bacteria. They thus are offered vaccinations for pneumococcus, meningitis C and HiB
What are the 5 different types of Nutritional Support Regimes offered to patients?
Enteral Nutrition (A tube into the functioning GI tract)
- Nasogastric, NG (From nose to stomach)
- Percutaneous Endoscopic Gastrostromy, PEG (From abdominal muscle/skin to stomach)
- Radiologically Inserted Gastrostomy, RIG (From abdominal muscle/skin to stomach)
- Percutaneous Endoscopic Jejunostomy, PEJ (From abdominal muscle/skin to stomach)
Parental Nutritional (A tube into the bloodstream)
Lactase breaks down what?
Lactose into Glucose and Galactose
Sucrase breaks down what?
Sucrose into Glucose and Fructose
Maltase breaks down what?
Maltose into two Glucose
State five causes of Microcytic Anaemia
TAILS
Thallasemias Anaemia of Chronic Disease Iron Deficiency Anaemia Lead Poisoning Sideroblastic Anaemia
State three causes of Normocytic Anaemia
Acute Blood Loss
Hypersplenism
Anaemia of Chronic Disease
Two causes Macrocytic, Megaloblastic Anaemia is B12 and Folate Deficiency. What are four specific causes of B12 Deficiency?
- Pernicious Anaemia
- Post gastrectomy / ileal resection
- Dietary deficiency i.e. veganism
- HIV / Bacterial / Parasitic infection
Two causes Macrocytic, Megaloblastic Anaemia is B12 and Folate Deficiency. What are four specific causes of Folate Deficiency?
- Dietary deficiency
- Malabsorption
- Increased demands i.e. haemolysis / leukaemia
- Drugs i.e. MTX, SSZ, Trimethoprim, Alcohol, Anti-epileptics
What is FODMAP? What is the FODMAP diet?
FODMAP: Fermentable oligosaccharides, disaccharides, monosaccharides and polyols
FODMAPS are poorly absorbed by the small intestine and pass through to the large intestine whereby they are fermented by bacteria and produce excess flatus and bloating
A diet for patients with IBS, whereby they restrict all foods containing significant amounts of FODMAP for 2 months and FODMAP foods are slowly introduced one by one to determine the culprit
What are the electrolyte disturbances visualised in patients with refeeding syndrome?
Hypophostaemia, Hypokalaemia, Hypomagnesemia
What is Refeeding syndrome?
Patients who have had nutrition reinstated too quickly post-starvation, triggering insulin release and driving electrocytes into cells away from the blood
