Specific GI disorders

Question 1

Key clinical features of coeliac disease: classic tetrad

+ other less important features

Answer 1

Diarrhoea, weight loss, iron/folate deficiency, abdo bloating

Lethargy/malaise
Flatulence
Mouth ulceration
Alternating diarrhoea/constipation
Pale, thin patient
Low subcutaneous fat

Question 2

Diagnosing coeliac disease?

Answer 2

Positive coeliac antibodies on blood test

Elevated fecal fat content

Duodenal biopsy: villous atrophy

Question 3

Coeliac disease: Associated conditions

Answer 3

Iron-deficiency anemia
DMT1
Subfertility
Pernicious anaemia
Dermatitis Herpetiforms
Autoimmune thyroid disease
Psteoporosis
Neurological conditions
Down Syndrome
Primary biliary cirrhosis
IgA deficiency
Malignancy - esp lymphoma

Question 4

Key points for coeliac disease management and diet

Answer 4

Diet: high complex carbohydrates, low fat, gluten free: no wheat, barley, rye or oats

Treat specific vit and mineral deficiencies

Pneumococcal vaccination - at higher risk of pneumococcus sepsis

Question 5

Main conditions to be considered in elderly patients

Answer 5

Colorectal Cancer (or other malignancy - ovarian, peritoneal)
Fecal Impaction with spurious diarrhoea (especially in bedridden)
Drug interactions (including digoxin)
Ischaemic Colitis

Question 6

Ischaemic Colitis: cause and key features

Answer 6

Atheromatous occlusion of mesenteric vessels –> ischemia

Clin features:
Usually elderly patient
Sharp abdo pain + bloody diarrhoea

OR

Periumbilical pain and diarrhoea ~15-30 mins post-prandial

Question 7

Findings and investigations to diagnose ischaemic colitis

Answer 7

Evidence of atherosclerosis

Definitive diagnosis: aortograaphy and selective angiography of mesenteric vessels

Barium enima showing ‘thumb print sign’ of submucosal odema

Question 8

Typical ischemic colitis prognosis

Answer 8

Most cases resolve, stricture may follow

Question 9

When may gastritis/enteritis patients be treated at home?

Answer 9

When severe dehydration not involved
If family can cope
Vomiting not a problem

Question 10

When do gastritis/enteritis patients need to be admitted

Answer 10

If severely dehydrated
Persisting vomiting
Family can't cope
Infants <6 months
High-risk patients

Question 11

How to assess for dehydration?

Answer 11

Symptoms and general observations of patient (e.g. alertness, irritability, thirst)

Signs: mucous membranes, pulse rate and strength, sunken eyes or fontanelles

Pinched skin test: Normal / 1-2 seconds / >2 seconds

Urine output

Question 12

Mild dehydration:

and treatment

Answer 12

Thirsty, alert, restless

Normal vitals and other signs

Normal skin pinch test

Treat: oral rehydration salts with solids after 24 hours, maintain replacement of lost fluids

Question 13

Moderate dehydration is:

and treatment

Answer 13

Thirsty, restless, lethargic, irritable

Dry mucous membranes, absent tears

Skin pinch test retracts slowly 1-2 seconds

Decreased urine output

Treatment:
Oral rehydration
Consider nasogastric tune for steady fluid infusion
Possible IV infusion

Question 14

Severe dehydration is:

+ treatment

Answer 14

Infants: drowsy, limp, cold, sweaty, cyanotic limbs, comatose
Adults: apprehensive, sweaty, cold, cyanotic limbs

Signs:
Rapid feeble pulse
Hypotensive
Sunken eyes and fontanelles
Very dry mucous membranes

Skin pinch test retracts very slowly: >2 secs

Nil urine output

Treatment:
Urgent IV infusion w/ isotonic fluid

Question 15

Rule of thumb for fluid replacement in infants and children

Answer 15

Infants: 100ml/kg in first 6 hours, then maintain

Older children: 50ml/kg in first 6 hours, then maintain