Gastroenterology

Gastroenterology

Rawya BadreldinDyspepsia
Rawya Badreldin (Consultant Gastroenterologist)

Rawya Badreldin is a Consultant Gastroenterologist and Endoscopy Clinical Lead who has tackled this topic from the point of view of looking at the NICE guidelines and producing a lecture that will assist us in our management of dyspeptic patients.
If you are interested in the evidence for some of the common therapies, there are some surpises in store.
PPIs are dealt with in detail, their usages and foibles are exellently laid out.
The rationale for referal is discussed and a series of case histories are given that demonstrate the issues raised.
This lecture will be reassuring for many GPs and is an excellent resource and update on the tricky subject that is "dyspepsia".

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Ian FellowsAnaemia and the Gut
Ian Fellows (Consultant Gastroenterologist)

Ian Fellows is a Consultant Gastroenterologist at the Norfolk and Norwich University Hospital NHS Trust and Honorary Senior Lecturer at the University of East Anglia.
He has led the Multidisciplinary Clinical Nutrition Support Team in Norwich since 1995, providing hospital and community-based artificial enteral and parenteral nutrition. He introduced PEG and HPN in the 1990s and provides an HPN service to patients in Norfolk and East Suffolk.
He has served as Chairman of the Education and Training Committee of BAPEN and as a member of its Council. He has served as a member of the Small Bowel and Nutrition Committee of the BSG.
He has a major interest in medical education and is currently Chairman of the East of England Deanery Core Medical Training Committee. He promoted the inclusion of Clinical Nutrition in postgraduate medical curricula.

The 3 types of anaemia covered in this lecture, ( iron , B12 and folate), are very common and knowledge of them is an essential part of a GPs workload. Ian reminds us also that they form a large part of a gastroenterologists workload too, iron deficiency accounting for 10% by all accounts.

His expert knowledge comes across to reassure us about referral of anaemic patients and his insights are interesting, for instance he makes it clear why lower GI investigation is performed before upper GI investigation in patients where localising symptoms can not be made.

As GPs we are constantly finding these anaemias and deficiencies in patients. As a result this lecture will become a frequently returned to staple in any portfolio. It is also a lecture that would be well shown collectively to a group of GPs in a practice setting, as it will generate discussion about how the practice manages its patients blood test results.

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Simon GreenfieldThe Secret to Managing LFTs in General Practice
Simon Greenfield (Consultant Gastroenterologist)

Simon Greenfield is a Consultant Gastroenterologist who works at the QE2 Hospital in Welwyn Garden City and the Lister Hospital in Stevenage. His talk is about managing abnormal LFT results, something that affects all GPs on a daily basis.

In Part 1 Simon looks at a series of cases demonstrating important points about LFTs. He looks at the main liver enzymes and the significance of isolated raised readings, and the significance of commonly found combinations of raised readings.

In Part 2 Simon discusses Non-alcoholic fatty liver disease and the subject of statins in liver disease. He comes to a very interesting statement about the way in which we think about (most) abnormal LFTs, that they can be thought of as a metabolic disorder similar to diabetes. Interesting...

Liver Function Test (LFT) is a bit of a misnomer given that most do not directly assess liver function per se. LFT is a panel of tests which is used to screen for liver disease, to aid in deciding on further liver related investigations and also to monitor liver disease.

Measuring protein and albumin can help in looking at the synthetic role of the liver (although changes in them may occur through many non-liver causes!).
Bilirubin looks at an excretory role of the liver and in particular the functioning of the biliary tree.
ALT is a marker of damage to liver cells. It is relatively specific for liver as compared to another enzyme called AST which is much more widely distributed in the body.
Alkaline phosphatase is a marker of cholestasis as levels rise if there is back pressure within the biliary tree.
GGT is also a marker of cholestasis, but high levels can be seen due to drugs and ethanol.
Remember to look at the LFT results in the light of the clinical scenario and other investigations. The pattern of changes in the LFTs is often the key to their interpretation.

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