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Gastroenterology Notes

This is a sample of our (approximately) 28 page long Gastroenterology notes, which we sell as part of the Medicine and Surgery Notes collection, a === Other === package written at Peninsula Medical School in 2011 that contains (approximately) 121 pages of notes across 6 different documents.

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Coeliac disease

Diverticular disease

Gastro-oesophageal reflux disease

Inflammatory bowel disease

Irritable bowel syndrome Hepatobiliary

Autoimmune hepatitis

Cirrhosis Pancreas

Acute pancreatitis

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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 (alcoholsoluble 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:
- Ix - Blood:

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

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