Clinical Topic 3: Malnutrition

Question 1

What features may be seen on Biopsy in a patient’s duodenum with active Coeliac’s Disease?

Answer 1

• Villous atrophy
• Crypt hyperplasia
• Increased epithelial lymphocytes

Question 2

What features may be seen on Endoscopy in a patient’s duodenum with active Coeliac’s Disease?

Answer 2

• Scalloping of bowel folds

- Mosaic pattern of mucosa

Question 3

What are the alleles associated with Coeliac’s Disease?

Answer 3

HLA-DQ8

HLA-DQ2

Question 4

What is the significance of the Marsh classification?

Answer 4

Determines severity of Coeliac’s Disease on histology

Question 5

State 5 complications of Coeliac’s Disease

Answer 5

• Risk of adenocarcinoma
• Risk of EATL (Enteropathy Associated T-cell Lymphoma)
• Dermatitis Hepatiformis
• Osteopenia and Osteomalacia
• Hyposplenism

Question 6

What three serology tests can be used to test for Coeliac’s disease? What is first-line?

Answer 6

IgA-tTG (first-line)
EMA
IgG-DGP

Question 7

Why can patients get false negatives on IgA-tTG serology testing? Two reasons

Answer 7

Some patients may have adopted a gluten-free diet, which would show normal IgA-tTG. Some patients may also have an IgA deficiency

Question 8

What region of the GI tract is commonly affected in Coeliac’s Disease?

Answer 8

Duodenum

Question 9

What is the significance of Feacal Elastase?

Answer 9

Used to test for Pancreatic Insufficiency

Question 10

Angular Stomatitis is a sign of what deficiency?

Answer 10

Iron deficiency anaemia

Question 11

Coeliac’s disease patients are at risk of some infections. Why is this? What is offered to prevent this?

Answer 11

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

Question 12

What are the 5 different types of Nutritional Support Regimes offered to patients?

Answer 12

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)

Question 13

Lactase breaks down what?

Answer 13

Lactose into Glucose and Galactose

Question 14

Sucrase breaks down what?

Answer 14

Sucrose into Glucose and Fructose

Question 15

Maltase breaks down what?

Answer 15

Maltose into two Glucose

Question 16

State five causes of Microcytic Anaemia

Answer 16

TAILS

Thallasemias
Anaemia of Chronic Disease
Iron Deficiency Anaemia
Lead Poisoning
Sideroblastic Anaemia

Question 17

State three causes of Normocytic Anaemia

Answer 17

Acute Blood Loss
Hypersplenism
Anaemia of Chronic Disease

Question 18

Two causes Macrocytic, Megaloblastic Anaemia is B12 and Folate Deficiency. What are four specific causes of B12 Deficiency?

Answer 18

• Pernicious Anaemia
• Post gastrectomy / ileal resection
• Dietary deficiency i.e. veganism
• HIV / Bacterial / Parasitic infection

Question 19

Two causes Macrocytic, Megaloblastic Anaemia is B12 and Folate Deficiency. What are four specific causes of Folate Deficiency?

Answer 19

• Dietary deficiency
• Malabsorption
• Increased demands i.e. haemolysis / leukaemia
• Drugs i.e. MTX, SSZ, Trimethoprim, Alcohol, Anti-epileptics

Question 20

What is FODMAP? What is the FODMAP diet?

Answer 20

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

Question 21

What are the electrolyte disturbances visualised in patients with refeeding syndrome?

Answer 21

Hypophostaemia, Hypokalaemia, Hypomagnesemia

Question 22

What is Refeeding syndrome?

Answer 22

Patients who have had nutrition reinstated too quickly post-starvation, triggering insulin release and driving electrocytes into cells away from the blood