Malaborption and Coeliac Flashcards
What is coeliac
Autoimmune
Abnormal reaction to Gliadin present in gluten
Inflammation via tissue transglutaminae
Villus atrophy and malabsorption
What should raise high suspicion of coeliac
Diarrhoea Weight loss Anaemia - iron, b12, folate (normochromic) - Always think Abdo pain
What should you do if someone has these symptoms
Coeliac serology
Must be on gluten to do this
What are other features
FTT in young children Steatorrhoea Fatigue / low energy Lethargy Dyspepsia Bloating Indigestion Constipation N+V Features of malabsorption
What are associated symptoms
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
What are RF for coeliac
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
What do you do if patient Dx with type 1 DM / thyroid
Coeliac serology
How do you Dx coeliac
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
What does biopsy show
Villous atrophy
Crypt hyperplasia
Lymphocyte
Do in endoscopy if looks normal but symptoms / iron anaemia
What other tests
HLA status FBC - decreased Hb, B12, ferritin U+E, LFT, CRP Vit D / Ca Stool culture Thyroid Calprotectin
How do you Dx in children
Genetics + Sx can be enough
Serology
HLA status
How do you Rx
Withdraw gluten Dietician Rechallenge if Dx <2 Pneumococcal vaccine due to hyposplenism Fix B12 before folate
What are complications
Refractory disease = steroid Iron deficiency / B12 so typically normocytic Vitamin deficiency Hypospleism Ulceration / apathos stomatitis Osteporosis Subfertility Delayed puberty Neuropathy Small bowel lymphoma / NHL
What are the most common causes of malabsorption / Ddx
Coeliac IBD Chronic pancreatitis Amyloid PBS Biliary obstruction
What are infectious causes of malbasorption
Tropical spure HIV Giardia lambila Cryptospordium Traveller's Whipples
What is tropical spure
Folate or b12 deficiency causing inflammation
What is Whipple’s
Middle age men Malabsorption - diarrhoea / weight loss Arthralgia Abdominal pain LN CNS - seizure / dementia / ataxia / opthalmoplegia Skin brain joints heart
How do you Dx
Biopsy
Trepheryma Whipelli
How do you Rx
Co-trimoxaole
Tetracycline
How do you treat tropical supra
Tetracycline
FOlic acid
How do you treat Giardia lambila
Metronidazole
What are motility causes of malabsorption
Systemic sclerosis
Scleroderma
DM = stasis
Pseudo-obstruction
What are iatrogenic causes
Gastric surgery Short gut Radiation Drugs Alcohol
Pancreatic causes
CF
Pancreaitits
Cancer
What are symptoms of malabsorption
Weight loss Diarrhoea Steathorrhea Bloating Fatigue Abdo pain ANaemia Muscle wasting
How do you Dx malabsorption
FBC, Ca, B12, folate, lipids INR as risk of clotting defieincy Coeliac Stool microscopy Biopsy + endoscopy Test for infection
What does vit A deficiency cause
Night blindess
Teratogenic
What does vitamin B deficiency (thiamine = B1) cause
Memory loss
Dementia
Korsokoff / Weirnecke
What does vitamin C defineicy cause
Scurvy Bleeding gums / epistaxis Dental Malaise Poor wound healing Gingivitis Bruises Weakness Arthralgia
What does vitamin D deficiency cause
Osteomalacia
Metabolic bone disease
What does vitamin K cause
Clotting issues
What does hypo calcium cause
Spasms Tetany Trosseuks - spasm of hand when BP cuff cuts of blood Chovstek - touching face = spasm Neuropathy Check vit D and PTH
What are the fat soluble vitamins
ADEK
What is folic acid and B12 needed for
DNA Synthesis
Always replace B12 first to avoid degernation of spinal cord
When are you at increased risk of b12 deficiency / folic
Pregnanc
Alcohol
Phenytoin
Methotrexate
What is phosphate important for
ATP
Respiration
When do you test for coeliac
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
What does niacin (B3) deficiency cause
Pellagra syndrome Dermatitis Diarrhoea Dementia Death
