Gastroenterology Notes

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GASTROENTEROLOGY Contents: GI • Coeliac disease • Diverticular disease • Gastro-oesophageal reflux disease • Inflammatory bowel disease • Irritable bowel syndrome

Hepatobiliary
• Autoimmune hepatitis
• Cirrhosis

Pancreas
• Acute pancreatitis

To view pictures, just hit the link! 
GI COELIAC DISEASE

Summary Points
• Coeliac disease is a genetically determined chronically inflammatory small bowel disorder of gluten intolerance.
• Patients typically feel bloated, have an altered bowel habit and lose weight
• It is diagnosed by a positive transglutaminase test and a jejunal or duodenal biopsy for confirmation
• It is managed by a gluten free diet

Aetiology and Pathophysiology T-cell mediated autoimmune disease of small bowel causing a prolamin (alcohol- soluble proteins in wheat, barley, rye, and sometimes oats) intolerance. This leads to villous atrophy and malabsorption which can have a number of secondary complications.

Associated with HLA DQ2 in 95% and DQ8 for 5%, so often see a familial link. Gluten intolerance varies person to person (i.e. some can tolerate oats). Epidemiology and Associated Risk Factors Affects between 1/100 and 1/500 in the UK though a large number are undiagnosed. Occurs at any age - peak incidences are during infancy and 50-60yrs, mostly an adult presentation.

Risk factors: • Males • Family history • Dermatitis herpetiformis (a bumpy, itchy, blistered eruption) • Diabetes mellitus • Hashimoto's thyroiditis • IBS • Down's Syndrome • Osteoporosis • Subfertility • Irish, Punjabi and South Asian descent

Presentation 50% are asymptomatic. Presentation can vary by age:

Babies and young children:
• Failure to thrive - weight loss and malabsorption
• GI - diarrhoea, vomiting, pale stools (steatorrhoea), constipation
• Irritability, anorexia/off feeds
• Abdo may protrude w/ everted umbilicus.

Older children and adults: • GI - nausea, vomiting, steatorrhoea, abdo pain/discomfort, bloating, weight loss • Fatigue, weakness and arthralgia • Mouth and peri-oral: aphthous ulcers and angular stomatitis (irritation and inflammation around sides of mouth) • Secondary to malabsorption - Vit D deficiency - osteomalacia; Vit K deficiency - bleeding problems

Assessment
- O/E - • In infants and young children, their abdomen may protrude w/ an everted umbilicus • In older children and adults: o Dermatitis herpetiformis - picture: http://www.mybwmc.org/library/2/2791

- Ix - Blood: • Serum IgA anti-tissue transglutaminase antibodies preferred - false negs in 0.4% population due to IgA deficiency

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