GI 2 Flashcards
what is a coeliac disease
it is an autoimmune disorder due to the ingestion of gluten (formed from glaidin and glutenin)
give examples of gluten products
wheat
barely
rye
what happens when a coeliac eats gluten product
Immune response activated attacking small intestine- Autoimmune response
Villi are finger like projections in GIT (especially attacked)
which Reduces ability to absorb nutrients
Reason why coeliacs often have comorbidities such as anaemia
what are the symptoms of coeliac disease
Possible symptoms may include: Occasional or excessive Diarrhoea, wind or even constipation Persistent or unexplained GI symptoms such as nausea vomiting Recurrent stomach pain/bloating/cramps Headaches and/or tiredness Sudden weight loss Mouth ulcers Tooth enamel problems Skin rashes Depression Iron deficient anaemia
how to diagnose coeliac disease
Doctor will initially recommend serological testing
Tissue Transglutaminase-IgA test
Should be offered to those with diagnosis of IBS
If test is positive or symptoms severe may be referred to Gastroenterologist for full diagnosis
Likely to be biopsy and endoscopy
Throughout diagnosis process must not exclude gluten form diet may make diagnosis harder
what is the treatment for coeliac disease?
Only treatment is life-long adherence to a strictly gluten free diet
Avoid foods containing wheat, barley rye
E.g. Beer, Bread, pasta
Look for cross grain symbol or read labels to check
Even small amounts of gluten can cause GI damage
what is the difference between a syndrome and disease?
A disease: characterized by an identifiable group of signs, symptoms, or both. Underlying causes normally identified including infection, inflammation, external factors, genetic defects
A syndrome: group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition
What is IBS - functional disorder
no apparent damage but function affected
what is the the cause of iBS
Suggested include, Drugs (antibiotics),Foods (food intolerances), GI surgery, Ovarian hormones, fat, lack of fibre, GI infections
Excessive fat releases cholecystokinin (CCK)
Excessive intake of caffeinated drinks can stimulate bowel
what are symptoms of IBS
Typical Symptoms Include: abdominal pain/cramps or discomfort Often relieved by going to toilet bloating and constipation urgency to get to the toilet alternate constipation and diarrhea Non GI symptoms e.g. headaches, dizziness, tiredness, pains, anxiety, SOB, depression and many more
What is the diagnosis of IBS?
Any of ABC for at least 6 months
Abdominal pain or Discomfort
Bloating
Change in bowel habit
Rule out red flags signs + symptoms of cancer
check symptoms for IBD
Diagnosis only considered if pain relived by defecation or associated with stool form or frequency AND 2 from these symptoms
there is no tests so we need to eliminate other conditons and do full blood counts etc
what is the management of IBS - lifestyle
Lifestyle ,Physical activity, diet and symptom targeted medications
Diet and nutrition
8 cups of fluid (water, herbals tea) per day
Review fibre intake (normally reduce)
Many need to decrease or increase, reduce insoluble fibre.
Limit fresh fruit (3 portions per day)
Limit caffeinated, alcoholic and fizzy drinks
Probiotics - must try for at least 4 weeks to assess impact
Food diaries
what is the management of IBS - pharmacological
Antispasmodics – as required
E.g. cholinergic drugs like hyoscine (Buscopan)
Laxatives (not lactulose) for constipation
Loperamide for diarrhoea
For both should learn to titrate according to stool
Aiming for 4 on the Bristol stool scale
Second line:
Tricyclic antidepressants (TCAs) amitriptyline
SSRIs (only if TCA ineffective)
Psychological interventions
Only if pharmacological fail after 12 months and still have symptoms (refractory IBS)
what is dyspepsia
Dyspepsia is a general term for pain/discomfort in the upper gastrointestinal tract (normally oesophagus, stomach and duodenum)
E.g. heartburn, “trapped wind”
best described as a SYMPTOM of other GI conditions
what is GORD?
Gastro-Oesophageal Reflux Disease
“ The symptoms and/or mucosal injury due to abnormal reflux of gastric contents in the oesophagus”
