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Gastroenterology Notes

Medicine Notes > Medicine and Surgery Notes

This is an extract of our Gastroenterology document, which we sell as part of our Medicine and Surgery Notes collection written by the top tier of Peninsula Medical School students.

The following is a more accessble plain text extract of the PDF sample above, taken from our Medicine and Surgery Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

GASTROENTEROLOGY Contents: GI

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Coeliac disease

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Diverticular disease

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Gastro-oesophageal reflux disease

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Inflammatory bowel disease

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Irritable bowel syndrome Hepatobiliary

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Autoimmune hepatitis

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Cirrhosis Pancreas

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Acute pancreatitis

To view pictures, just hit the link! ?
GI COELIAC DISEASE Summary Points

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Coeliac disease is a genetically determined chronically inflammatory small bowel disorder of gluten intolerance.

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Patients typically feel bloated, have an altered bowel habit and lose weight

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It is diagnosed by a positive transglutaminase test and a jejunal or duodenal biopsy for confirmation

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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:

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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:

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Failure to thrive - weight loss and malabsorption

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GI - diarrhoea, vomiting, pale stools (steatorrhoea), constipation

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Irritability, anorexia/off feeds

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Abdo may protrude w/ everted umbilicus. Older children and adults:

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GI - nausea, vomiting, steatorrhoea, abdo pain/discomfort, bloating, weight loss

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Fatigue, weakness and arthralgia

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Mouth and peri-oral: aphthous ulcers and angular stomatitis (irritation and inflammation around sides of mouth)

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Secondary to malabsorption - Vit D deficiency - osteomalacia; Vit K deficiency - bleeding problems Assessment
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In infants and young children, their abdomen may protrude w/ an everted umbilicus

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In older children and adults: o Dermatitis herpetiformis - picture: http://www.mybwmc.org/library/2/2791
- Ix - Blood:

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

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