gastric: coeliac, malapsorption, bariatric surgery Flashcards
what autoimmune disorders is coeliac associated with
T1dm, hepatitis, thyroid
what genes is coliac assoc with
HLA DQ2/8
what skin condition is coaliac assoc with
dermatitis herpetiformis (purple, itchy(
symptoms coeliac
diarrhoea/ persistant GI symptoms / abdo pain and cramp
what anaemia is most common in coeliac
folate > B12
what complications are seen in coeliac (6)
anaemia // hypospleen // osteoporosis // lactose // T cell lymphoma // subfertile
what cancer can be assoc with coeliac
T cell lymphoma
when should a gluten diet be recommenced when testing coeliac
for 6 weeks prior
what serology tests can be done for coeliac and what is first line
TTG antibodies are first line WITH IgA // antigialidin can also be done
what is gold standard for coeliac
biopsy
what is seen of biopsy on coeliac
villous atrophy / crypt hyperplasia
what vaccine should coeliac patients get and why
pneumococcal with booster every 5 years // hyposplenism
what are secondary causes of bile acid malabsorptions (3)
cholecystectomy // coeliac // small intestine bacteria overhrowth
what is the main symptom of ile acid malabsorptions and wat deficiencies does it cause
steathorrhea // ADEK vitamins
invx for bile acid malabsorptions
SeHCAT
mx bile acid malabsorptions
bile acid sequestrate eg cholestryamine
what is pernicious anaemia
autoimmune damage of gastric mucosa –> vit B12 deficiency
what antibodies are produced in pernicious anaemia
antibodies to IF which blocks vit B12 binding sites
who is pernicious anaemia most common in
middle aged/ elderly females/ group A
what are symptoms of pernicious anaemia
anaemia features // neurological: pins and needles, weakness, ataxia, memory // glossitis
what bloods are seen with pernicious anaemia
macrocytic anaemia // low WCC and platelets // hypersegmented on blood film
what antibodies can be screened for in pernicious anaemia
intrinsic factor antibodies
mx pernicious anaemia
B12 injection 3x for 2 weeks –> every 3 months // +/- folic acid
what cancer does pernicious anaemia increase risk of
gastric
what BMI tends to be referred for bariatric surgery
40-50
at what stage of obesity is bariatric surgery reccommended
early - to prevent disease progression
what are 3 restrictive bariatric surgeries
lap gastric band (LAGB) // sleeve gastrectomy // intragastric balloon
what is a primary malabsorpative bariatric surgery
bilopancreativ diversion with duodenal switch
what is a mixed bariatric surgery
rout en Y bypass
what bariatric surgery is first line for 30-39 BMI
LABG
what bariatric surgery is first line for BMI >60
bilopancreatic diversion
what bariatric surgery gives best functional outcomes
rout en Y
when would a duodenal or jejunal tube be favoured over gastric feeding
if there is upper GI dysfunction
what defines a malnourished patient (3)
BMI <18,5 // weight loss of >10% // BMI <20 and weight loss >5%
what are common complications of enteral feeding (4)
diarrhoea, aspiration, hyperglycaemia, refeeding
when can a PEG be used / removed
use 4 hours after // must be in for 2 weeks
when is parenternal feeding used
nutritionally compromised surgical patients
how is parental food given
IV - usually through a central vein eg (PICC)
