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home - Miscellaneous - Other - Endocrine and GI Disease Written by Dr Sebastian Zeki

Defines the pathophysiology of fluid and nutrient malabsorption,
including causes, e.g. anatomical and functional short bowel
syndrome, high output stomas, enterocutaneous fistulae and
pancreatic insufficiency

Knows how to investigate patients with malabsorption
Describes the clinical consequences of malabsorption, including
malnutrition, fluid and electrolyte disturbance and micronutrient
deficiency and anaemia and how to manage these

Describes all other causes of anaemia, including bone marrow
disorders and haemolysis

Describes the metabolism, absorption and bioavailability of iron, B12
and folate and clinical conditions and diets associated with their

Identifies and appropriately investigates clinical features suggestive of

Manages fluid, electrolyte and micronutrient disturbances associated
with short bowel syndrome or high output stomas

Uses the appropriate investigations for the different types of anaemia
Takes a careful clinical approach to managing patients with
malabsorption and anaemia. Explains plan of management clearly to
patients and their relatives.



Knows the different causes of enteric dysmotility (myopathy and
neuropathy) and their presenting features

Have a knowledge of scleroderma amyloid and congenital motor
abnormalities of the gut that affect absorption

Knows the principles of investigation pain relief and prokinetic drug

Understands bacterial overgrowth and its treatment
Understands how emotional status can affect gut function
Knows how diabetic complications can affect the gut
Can determine when organic obstruction is occurring TO
Can understand the principles and interpret the results of
gastrointestinal motility investigations (including manometry transit
studies etc) and autonomic function tests
Advises on appropriate prokinetic drugs and analgesics
Can detect and treat bacterial overgrowth
Advises on appropriate surgery including bypass procedures
Can relieve symptoms while not causing/risking harm with other
medications (e g opiates)

Works with the multidisciplinary NST psychiatrists/psychologists
surgeons and the pain management team

Can give careful explanation of the problems to the patient carers
friends and family

Endocrine and GI Disease

Acromegaly Autoimmune thyroiditis Causes in DM: Pylorospasm Decrease frequency and amplitude Fundic and antral contractions Diarrhoea Hypoglycaemia Endocrine and The Gut HypertriglyceridesHypercalcaemia Autoimmune nephropathy (Correlates with glycaemic control) Weight loss and vomiting Weight loss and diarrhoea Hypercalcaemia Thyrotoxicosis Diarrhoea can be severe N+V+abdominal pain Diarrhoea Relative hepatic ischaemia - ALT bilirubin increase Associations PA PCB CAH Vomiting and anorexia. Constipation. Pancreatitis. Screening - CBSG polyp guidelines - Metformin - Bacterial overgrowth - Coeliac disease - Dietetic foods (sorbitol) - Pancreatic exocrine deficiency - Bile acid malabsorption - Abnormal colonic motility - Altered intestinal secretions - Anorectal dysfunction Whipple's triad A) Get symptoms when glucose is low B) Symptoms resolve with increase in glucose C) Glucose definitely low Causes Exogenous Pancreas Liver Addison's Insulinoma Neoplasms Diabetes Gastroparesis Addison's Phaeochromocytoma Acute pancreatitis Medullary Cancer Written by Dr Sebastian Zeki