Gastroenterology Flashcards by Blessita Sabu

When there is bloating, what do you have to consider?

Women

where

when

central/lower/upper abdomen

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What is the pathway you should be thinking when a patient presents with upper abdominal bloating?

THAT VARIES

HP- h polyri

you may also look at faecal antigen test

serology test for antibody of hp

Breath test if they havent experiences before

SIBO- small intestinal bacterial overgrowth- only consider this if IBS is ruled out too

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How does SIBO occur?

it occurs when there is fermentation of food within the small bowel because there is abnormal amount of bacteria.

Could occur due to small bowel anomaly, diverticulosis, after surgery, in response to radiotherapy

Tx: Abx

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What is the pathway you should be thinking when a patient presents with upper abdominal bloating?

THAT DOES NOT VARY

Vomitting and weightloss are red flags. These could indicate obstruction, malignancy, scarring to peptic ulceration

If endoscopy is negative then this could indicate gastric residue, gastroparesis,

Examination- looking for masses/ascities

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What is the pathway you should be thinking when a patient presents with central/lower abdominal bloating?

THAT VARIES

Neg ttg test (coeliac

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What is the pathway you should be thinking when a patient presents with central/lower abdominal bloating?

THATS PERSISTENT

Ultrasound

Colonscopy

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What does thyroid do?

The thyroid gland regulates tissue metabolism and development

It is controlled by thyroid stimulating hormones (TSH) from the pituitary gland and it produces triiodothyronine T3 and thyroxine T4 hormones

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What is hypothyroidism

Causes?

A condition in which the thyroid gland produces insufficient thyroid hormone for the bodys requirements.

Causes include auimmune thyroid disease (hashimoto’s), radioactive iodine or surgery and drugs such as lithium carbonate and sulfonamides

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Signs and symptoms of hypothyroidism?

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What is hyperthyroidism?

Causes

This is a condition where the body produces too much T3 and T4 hormones.

Causes include autimmune and thyroid disease (graves disease) thyroiditis and thyroid nodules

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Signs and symptoms of hyperthyroidism

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Tx Hypothyroidism vs Hyperthyroidism

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Epidemiology of Coeliac Disease?

Who are the high risk population?

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What is gluten?

A composite of storage proteins termed prolamiens and glutelins.

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What is an extra intestinal manifestation of Coeliac Disease?

Dermatitis Herpetiformis- itchy skin rash. These are most commonly located on the elbows, knees, buttocks, lower back and scalp.

Tiredness

Neuropathy

Osteoporosis

Ix for Coeliac?

After taking a biopsy for coeliac Ix, what are histoligists looking out for?

What is the classification called?

Some people might refuse to do a gastroscopy when investigating for coeliac. What would you do then?

Check for HLA genes

Also check for bloods- calcium, vit D, TSH, HbA1c, FBC, LFT

Dexa- look at NICE guidance (i.e we do not need to test everyone we see)

Tx for coeliac disease?

Also think about relatives

What is the classification for hyponatraemia?

Units?

Causes of Hyponatraemia?

Medication-

Reduced blood volume

EABV states (liver/heart/renal failure)

SIADH

Renal salt wasting

Primary polydipsia

Pseudohyponatraemia

Symtoms of hyponatraemia?

Nausea

Vomiting

Confusion

Reduced GCS

Headache

Seizures

Case 1

68 yo lady

HTN, CKD3b, DM2 (diet controlled)

Meds: amloipine, BFZ, atorvastatin, omeprazole

Admitted with pneumonia (CAP CURB 2 nedding O2)

Treated with abx as per hospital formulary

Day 2 developls hyponatraemia

Na 131 (135-145) k 4,5 Bic 21 Ur 8.9 Cr 189

Inflammatory markers and clinical status improving

What is important to look for on a clinical examination?

Look for severe symptoms like reduced GCS etc

Fluid status - oedema, fluid overload, ascities

Signs of hypoaldosteronsim

Signs of thyroid dysfunction

Urine Output

Case 1 68 yo lady HTN, CKD3b, DM2 (diet controlled) Meds: amloipine, BFZ, atorvastatin, omeprazole Admitted with pneumonia (CAP CURB 2 nedding O2) Treated with abx as per hospital formulary Day 2 developls hyponatraemia Na 131 (135-145) k 4,5 Bic 21 Ur 8.9 Cr 189 Inflammatory markers and clinical status improving **What Ix would you want to order to help with diagnosis?**

Urine and serum osmolality Urine U + E - sodium Cortisol TFTs - hyperthyroidism Blood glucose

**SIADH** **Medication** **Hypovolaemia** Failure (heart/ renal/liver) Addison's Severe hypothyroidism Renal salt wasting Pseudohyponatraemia

What medications would you stop with a patient with hyponatraemia?

Diuretics Hyperglycaemia Raised Lipids

Case 2 81 yo man Admitted due to hypoxia CXR shows alveolar oedema, Kerly B lines, Pleural effusions Anasarca (global body oedema) On high doses of furosemide in the community but not effective Places on high dose of IV furosemide regime nasal oxygen Fluid and salt resticted Na 133 mmol/L on admission and falling on day 2 and 3 Good urine output Weight static- you want to see weightloss as it signifys fluid loss **What is important to look for on clinical examination?**

Need to check if they fluid overload in extracellular compartment look at sacrum, jvp, heart sounds, capillary refill time CHeck urine output.

BNP- suggestive of heart failure

Case 2 81 yo man Admitted due to hypoxia CXR shows alveolar oedema, Kerly B lines, Pleural effusions Anasarca (global body oedema) On high doses of furosemide in the community but not effective Places on high dose of IV furosemide regime nasal oxygen Fluid and salt resticted Na 133 mmol/L on admission and falling on day 2 and 3 Good urine output Weight static- you want to see weightloss as it signifys fluid loss **What would you do with the diuretic dose in this gentleman and what may help you decide?**

Very difficult but needs careful review of volume status, if felt to be EABV may need redcution of diuretics. however if felt to be truly overloaded, may benefit from ongoing cautious diuresis. Needs senior doctor management

Case 3 24 yo male Normally fit and well D+V for several days Likely food poisoning Not improving at home so admitted for IV fluids and antiemetics **Clinical Examination?**

Most likely will be lethargic Cappilary refill time Raised JVP Thirsty Skin turgor is not a marker of dehydration U+ E Ix

Case 3 24 yo male Normally fit and well D+V for several days Likely food poisoning Not improving at home so admitted for IV fluids and antiemetics **Possible causes?**

hypovolemia

Pathway for hyponatraemia?

If the patient is hypovolaemic and hyponatraemic how do you calculate the **amount of sodium replacement?** ## Footnote **Infusion rate:**

0.6 x weight (kg) x 0.5 Infusion rate: amount of sodium replacement X (1000/154)

Management for mild/moderate cases of **hypervolaemic hyponatraemia?**

FLuid and salt restriction, consider diuretics. Treat underlying cause

Management for mild/moderate cases of **euvolaemic hyponatraemia?**

Treat the cause (eg chest infection, malignancy or hormal insufficency) If treatinf SIADH- Commence fluid retriction (500-750ml/day) with close follow up