Coeliac and nutrition Flashcards
What’s a S+S of coeliac disease?
Dermatitis herpetiformis
How does dermatitis herpetiformis present?
Cutaneously Blistering Intensely itchy Scalp, shoulders, elbows, knees IgA deposit in skin
Which antibody test is most reliable and why?
IgG as some people just don’t make IgA so an IgA serology wouldn’t work for them
What’s the gold standard Ix for coeliac?
Distal duodenal biopsy Looks for villus atrophy -partial -subtotal -total
Tx for coeliac?
Withdraw gluten
Must refer to dietician
Where is gliadin found?
Absent from rice and maize
Not found in oats but most oats in contaminated with wheat
Conditions associated with coeliac
Dermatitis herpetiformis IDDM -insulin dependent diabetes mellitus Autoimmune thyroid disease Autoimmune hepatitis Primary biliary cholangitis
Complications arising from coeliac disease
Refractory coeliac disease -symptoms despite gluten free diet Small bowel lymphoma Oesophageal carcinoma Colon carcinoma Small bowel adenocarcinoma
Other small bowel disease which may cause malabsorption
Can be due to inflammation or infection
Inflammation:
- coeliac
- crohns
Infection:
- tropical spruce
- -folate deficiency
- HIV
- giardia lamblia
- whipple’s disease
What’s giardia lamblia, where is it found, and what’s the Tx?
Unicellular parasite
Contaminated water is where its found
Metronidazole
RF for whipple’s disease
Middle aged men
S+S for whipple’s disease
Skin, brain, joint and cardiac effects
Weight loss
Malabsorption
Abdominal pain
What is the causative organism in whipple’s disease?
Tropheryma whippelli
Tx for small bowel bacterial overgrowth
each for 2 weeks
Metronizadole
Tetracycline
Amoxicillin
Vitamin and nutrition supplements
Ix for small bowel bacterial overgrowth
H2 breath test
Can be unreliable
Consequences of antibiotic treatment?
Decreased diversity
Opportunity for pathogen colonisation
Results in a pathogen dominated colonisation
Recurring C. difficile infections
What’re probiotics?
Live microorganisms which can have health benefits
In what ways do probiotics improve gut function?
Stool bulking, faster transit
Management of IBD
Reduces the risk of colon cancer
Why do probiotics reduce the risk of colon cancer?
Reduce DNA damage and cell proliferation
Calcium absorption and bone health
Mechanisms of probiotic actions
Competition Bioconversions Production of vitamins Direct antagonisms Barrier function Reduce inflammation Immune stimulation
In which % of cases and in which type of infection is FMT effective?
90
C. Difficile
How is the basal metabolic rate measured?
Direct calorimetery
What does the basal metabolic rate depend on?
Lean body mass
Activity
Illness
What is the term for undernourishment which causes a child’s weight to be much lower than it should be for its age?
Marasmus
What’s stage one of MUST and its method of scoring?
BMI
Score <20=1
Score <18=2
What’s step 2 of MUST?
Unintentional weight loss in the last 30% months
Yes-10%=2
Yes-5%=1
Step 3 of MUST
Has the patient eaten in the last 5 days?
Yes=2
What score on MUST must you achieve to be at a suggested risk of undernutrition?
2
What is the Tx for a MUST score of 1?
Supplements and watch
What odes a MUST score of 0 mean?
Subject patient to monitoring
What is malnutrition associated with?
Illness
Social isolation
Age
Socially vulnerable groups
Clinical consequences of malnutrition?
Impaired immune response Reduced muscle strength Impaired wound healing Impaired psycho-social function Impaired recovery from illness and surgery Poorer outcomes
What’re the 3 classifications of aetiologies for malnutrition?
Appetite failure
Access failure
Intestinal failure
2 examples of appetite failure?
Anorexia nervosa
Disease related
4 examples of access failure
Teeth
Stroke
Cancer of the head and neck
Head injury
What causes intestinal failure malnutrition?
Reduction in functioning gut mass below minimal amount necessary for adequate absorption of nutrients
