Iron Deficiency Anaemia and GI Investigations Flashcards
awhat percentage of iron deficient anaemia will have underlying GI malignancy
10%
causes of IDA
poor intake of dietary intake
reduced absorption (e.g. coeliac or post surgery)
increased iron/blood loss (e.g. menstruation or cancer)
increased demand (e.g. pregnancy or adolescence)
symptoms of IDA
often asymptomatic
tiredness
dyspnoea
headache
common signs of IDA
pallor
atrophic glossitis
foods containing iron
green veg
liver, kidney, pork, shellfish, chicken, eggs
lentils, chickpeas, dates, apricots
enriched breads and cereals
what are the two types of iron
ferrous (haem)
ferric (non-haem)
what type of iron is found in meat and fish
haem/ferrous
what type of iron is found in plants
non-haem/ferric
which iron is more absorbable
found in meat and fish (haem/ferrous)
what things enhance absorption of iron
vitamin C
fructose
alcohol
what things inhibit absorption of iron
tea (tannins)
eggs
pulses
dairy (calcium)
what disease is a result of too much iron absorption
haemochromatosis
where is iron stored in the body
liver
spleen
bone marrow
muscle
what form is iron stored in in the body
ferratin
what should you measure as a marker of how much iron is in the body
ferratin
free iron is not helpful as it is transient
what type of anaemia can look similar to IDA
anaemia of chronic disease
how can IDA and ACD be differentiated
by looking at ferratin and transferrin levels
in IDA:
- ferratin will be low
- transferrin will be high
in ACD:
- ferratin will be high
- transferrin will be low or normal
what are ferratin and transferrin levels in IDA and ACD combined
transferrin - low
ferratin - low or normal
definition of iron deficiency anaemia
low ferratin
or
low serum iron and high transferrin (>3)
what is worth doing in someone with iron deficient anaemia
coeliac disease test (TTG)
what type of sedation is aimed for in a standard endoscopy
conscious sedation where the patient can respond but doesn’t remember
which is better tolerated transnasal or through the mouth endoscopy
transnasal
disadvantage of transnasal endoscopy
can’t perform most procedures
why are right side lesions more likely to be missed on a colonoscopy
prep tends to be poorer on that side
what is the preparation for colonoscopy
liquid only diet
and purgative medication
advantgaes of CT colonoscpy
less invasive
quicker
option for minimal prep for frail patients
as effective at standard colonoscopy for >5mm polyps
disadvantages of CT colonoscopy
radiation
still need standard colonoscopy is lesion found
usually still need to take prep
can result in incidentalomas (findings which would not cause disease)
what is done after endoscopy and colonoscopy are done
usually nothing
check no blood loss from urinary tract
investigate small bowel if recurrent IDA
first line treatment of IDA
optimise diet
oral iron supplements for 3 months after iron deficiency corrected
side effects of iron supplements
constipation
GI upset
dark stools
what can be done if oral iron isn’t tolerated
once daily/alternate day dosing
IV iron
