Gastroenterology Masterclass

June is a lady of 48 who presents with tiredness and lack of energy.

She has no specific GI symptoms and her weight is steady.

She still has periods, but they are now irregular with gaps of two or three months and not very heavy. She is getting some menopausal flushing.

She has had no serious illnesses in the past though had a cholecystectomy age 40 for gallstones.

She is not on medication. She used to donate blood regularly but stopped about 4 years ago.

She is sleeping OK and is not tearful, and though her children have now left home she works happily in a clothing shop.

Examination is unremarkable but you decide to do some baseline blood tests and review.

These show normal U+E, LFTs, TFTs and random blood sugar. Her Hb is 10.1 with an MCV of 68. Further tests show a ferritin of less than 5, normal B12 and folate. Her TTG is 5 and 3 FOBs are negative.

Questions

a) List the possible causes for her anaemia.

b) How useful are FOBs in investigating anaemia? Why do misleading positives and negatives occur and what might cause them?

c) How would you manage her?

d) What methods for investigating the large bowel are there, and what are the risks? Would you have a colonoscopy?