MP322 - MANAGEMENT OF GI AND ENDOCRINE DISEASES

Question 1

Malabsorption

Answer 1

inadequate absorption of nutrients from the GI tract - most absorption through small intestine

Question 2

Macronutrients

Answer 2

carbohydrate
fat
protein

Question 3

micronutrients

Answer 3

vitamins
minerals

Question 4

Crohn’s disease

Answer 4

mucosal
malabsorption linked to inflammation (+/- surgical resection)
- iron deficiency anaemia
- B12/folate deficiency
- vitamin D and calcium deficiency (osteoporosis/osteomalacia)

Question 5

Coeliac disease

Answer 5

mucosal
autoimmune condition
glutens activate an abnormal mucosal response
chronic inflammation and villous atrophy

• fatigue, GI symptoms, weight loss
• diagnosed via serological testing
• common complications include anaemia and osteoporosis

treatment - cut gluten out of diet

Question 6

Short bowel syndrome

Answer 6

mucosal
secondary to surgery, but can be congenital
- may require parenteral nutrition
- less surface area available for absorption
- osteoporosis and vitamin deficiencies are potential risks

levothyroxine, warfarin, oral contraceptives, digoxin - higher doses required

Question 7

chronic pancreatitis

Answer 7

pre-mucosal
chronic inflammation leads to impaired function
- affects M>F, decreases pancreatic enzymes
- strong association with long-term alcohol use
- tests include faecal elastase
- also tests for fat-soluble vitamin deficiencies

Question 8

cystic fibrosis

Answer 8

pre-mucosal
inherited
decreased chloride secretion, increased sodium absorption = thick mucus
- pancreatic insufficiency
- steatorrhoea
- osteoporosis
- malnutrition, weight loss

pancreatic enzyme supplementation, fat soluble vitamin supplementation, calorie replacement

Question 9

Lactase deficiency

Answer 9

pre-mucosal
- primarily, secondary, congenital or developmental
- reduce or eliminate dietary lactose intake
- alternative calcium source may be required

Question 10

bacterial overgrowth

Answer 10

mucosal and pre-mucosal
- chances increase with age
- reduced gastric acid (atrophic gastritis, drugs?)
- impaired motility

causes - chronic pancreatitis and motility disorders

Question 11

fat malabsorption

Answer 11

problem with digestion (insufficient enzymes, bile) or absorption
- deficiencies of fat-soluble vitamins (A,D,E,K)

Question 12

steatorrhoea

Answer 12

excess fat is lost in the stools, making them float, appear pale and bulky, smell offensive

Question 13

vitamin malabsorption

Answer 13

poor fat absorption will impact vitamin absorption

Question 14

carbohydrate, protein, fat malabsorption - treatment

Answer 14

supplementation of pancreatic enzymes - lipase, amylase, protease (Creon)

Question 15

iron malabsorption

Answer 15

iron deficiency anaemia common with impaired absorption
oral iron replacement