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GI > Malaborption and Coeliac > Flashcards

Malaborption and Coeliac Flashcards

1
Q

What is coeliac

A

Autoimmune
Abnormal reaction to Gliadin present in gluten
Inflammation via tissue transglutaminae
Villus atrophy and malabsorption

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2
Q

What should raise high suspicion of coeliac

A 
Diarrhoea
Weight loss 
Anaemia - iron, b12, folate (normochromic)
- Always think 
Abdo pain
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3
Q

What should you do if someone has these symptoms

A

Coeliac serology

Must be on gluten to do this

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4
Q

What are other features

A 
FTT in young children 
Steatorrhoea
Fatigue / low energy 
Lethargy 
Dyspepsia
Bloating
Indigestion
Constipation
N+V
Features of malabsorption
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5
Q

What are associated symptoms

A 
Anaemia due to malabsorption 
Dermatitis herpetiforms
Clubbing
Ataxia
Peripheral neuropathy - can present with this in adults so always think 
Apthous ulceration
Angular stomatitis
Osteomalacia
FTT
Hyposplenism
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6
Q

What are RF for coeliac

A 
HLA DQ2 / DQ8
Autoimmune thyroid - always test if Dx 
Autoimmune gastritis hepatitis
Type 1 DM - always test if Dx 
IgA deficinet
IBS
PBC
Down's syndrome 
FH
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7
Q

What do you do if patient Dx with type 1 DM / thyroid

A

Coeliac serology

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8
Q

How do you Dx coeliac

A

Serology

  • TTG IgA
  • IgG if IgA deficient as not accurate
  • Endomysial Ab

Distal duodenal biopsy

Must be on gluten for 6 weeks to do test

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9
Q

What does biopsy show

A

Villous atrophy
Crypt hyperplasia
Lymphocyte
Do in endoscopy if looks normal but symptoms / iron anaemia

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10
Q

What other tests

A 
HLA status
FBC - decreased Hb, B12, ferritin
U+E, LFT, CRP
Vit D / Ca 
Stool culture
Thyroid
Calprotectin
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11
Q

How do you Dx in children

A

Genetics + Sx can be enough
Serology
HLA status

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12
Q

How do you Rx

A 
Withdraw gluten
Dietician
Rechallenge if Dx <2 
Pneumococcal vaccine due to hyposplenism
Fix B12 before folate
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13
Q

What are complications

A 
Refractory disease = steroid
Iron deficiency / B12 so typically normocytic 
Vitamin deficiency 
Hypospleism
Ulceration / apathos stomatitis 
Osteporosis
Subfertility
Delayed puberty
Neuropathy
Small bowel lymphoma / NHL
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14
Q

What are the most common causes of malabsorption / Ddx

A 
Coeliac
IBD
Chronic pancreatitis
Amyloid
PBS
Biliary obstruction
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15
Q

What are infectious causes of malbasorption

A 
Tropical spure 
HIV
Giardia lambila
Cryptospordium
Traveller's
Whipples
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16
Q

What is tropical spure

A

Folate or b12 deficiency causing inflammation

17
Q

What is Whipple’s

A 
Middle age men
Malabsorption - diarrhoea / weight loss
Arthralgia
Abdominal pain
LN
CNS - seizure / dementia / ataxia / opthalmoplegia
Skin brain joints heart
18
Q

How do you Dx

A

Biopsy

Trepheryma Whipelli

19
Q

How do you Rx

A

Co-trimoxaole

Tetracycline

20
Q

How do you treat tropical supra

A

Tetracycline

FOlic acid

21
Q

How do you treat Giardia lambila

A

Metronidazole

22
Q

What are motility causes of malabsorption

A

Systemic sclerosis
Scleroderma
DM = stasis
Pseudo-obstruction

23
Q

What are iatrogenic causes

A 
Gastric surgery
Short gut
Radiation
Drugs
Alcohol
24
Q

Pancreatic causes

A

CF
Pancreaitits
Cancer

25
Q

What are symptoms of malabsorption

A 
Weight loss
Diarrhoea
Steathorrhea
Bloating
Fatigue
Abdo pain
ANaemia
Muscle wasting
26
Q

How do you Dx malabsorption

A 
FBC, Ca, B12, folate, lipids
INR as risk of clotting defieincy
Coeliac
Stool microscopy
Biopsy + endoscopy
Test for infection
27
Q

What does vit A deficiency cause

A

Night blindess

Teratogenic

28
Q

What does vitamin B deficiency (thiamine = B1) cause

A

Memory loss
Dementia
Korsokoff / Weirnecke

29
Q

What does vitamin C defineicy cause

A 
Scurvy 
Bleeding gums / epistaxis
Dental
Malaise
Poor wound healing
Gingivitis
Bruises
Weakness
Arthralgia
30
Q

What does vitamin D deficiency cause

A

Osteomalacia

Metabolic bone disease

31
Q

What does vitamin K cause

A

Clotting issues

32
Q

What does hypo calcium cause

A 
Spasms
Tetany
Trosseuks - spasm of hand when BP cuff cuts of blood
Chovstek - touching face = spasm  
Neuropathy
Check vit D and PTH
33
Q

What are the fat soluble vitamins

34
Q

What is folic acid and B12 needed for

A

DNA Synthesis

Always replace B12 first to avoid degernation of spinal cord

35
Q

When are you at increased risk of b12 deficiency / folic

A

Pregnanc
Alcohol
Phenytoin
Methotrexate

36
Q

What is phosphate important for

A

ATP

Respiration

37
Q

When do you test for coeliac

A 
DM at diagnosis 
Autoimmune thyroid at Dx
1st degree with coeliac
IBS Sx in adults
Unexplained iron, b12 or folate deficiency 
Weight loss
Fatigue
Faltering growht
Abdo / GI Sx
38
Q

What does niacin (B3) deficiency cause

A 
Pellagra syndrome 
Dermatitis
Diarrhoea
Dementia
Death

GI (29 decks)

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