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Malabsorption Flashcards

1
Q

what is malabsorption

A

defective mucosal absorption

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2
Q

what leads to malabsorption

A

defective luminal digestion,
mucosal disease,
structural disorders

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3
Q

what are the common causes of malabsorption

A

coeliac disease, crohns disease, post infectious, biliary obstruction, cirrhosis

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4
Q

what are the uncommon causes of malabsorption

A

pancreatic cancer, parasites, bacteria overgrowth, drugs, short bowel

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5
Q

what are the two types of protein malabsorption

A

digestive and absorptive

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6
Q

what are the digestive causes of protein malabsorption

A

partial/total gastrectomy (poor mixing),

exocrine pancreatic insufficiency

trypsinogen deficiency

congenital deficiency of intestinal enterokinase

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7
Q

what are the absorptive cause of protein malabsorption

A

celiac disease and tropical sprue

methionine malabsorptive syndrome & blue diaper syndrome

SBS

jejunoileal bypass

defects in neutral amino acid transporters

cystinuria I-III

occulocerebral syndrome of lowe

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8
Q

where does the digestive process of fat digestion occur

A

pancreas and liver

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9
Q

where does the absorptive process of fat digestion occur

A

jejunal mucosa

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10
Q

where does the post absorptive process (delivery) of fat digestion occur

A

in the lymphatics

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11
Q

what can cause digestive fat malabsorption

A

(less time mixing)
gastric resection, autonomic neuropathy, amyloidosis

decreased bile secretion- cirrhosis, biliary obstruction, CCK deficiency

(decreased lipolysis)
CF, chronic pancreatitis, tumours, low pH

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12
Q

what can cause absorptive fat malabsorption

A

descreased chlyomicron formation/ absorption, coeliac disease, chylomicron retention disease

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13
Q

what can cause post absorptive fat malabsorbtion

A

defective lymphatic transport- lymphoma, trauma, retroperitoneal fibrosis

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14
Q

what can cause digestive carb malabsorbtion

A

severe pancreatic insufficiency (alpha- amylase deficiency)

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15
Q

what can cause absorptive carb malabsorption

A

primary or acquired lactase deficiency

  • post infectious lactase deficiency
  • celiac disease
  • crohns
  • sucrase-isomaltase deficiency
  • trehalase deficiency
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16
Q

what vitamins are commonly malabsorbed

A

B12, folic acid, fat soluble vitamins (ADEK) - anything that disrupts fat absorption

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17
Q

what minerals are common malabsorbed

A

calcium, magnesium, iron (most common), zinc, copper

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18
Q

describe coeliac disease and the pathology behind it

A

exposure to wheat, barley or rye induces a characteristic mucosal lesion

intestinal antigen-presenting cells in people expressing HLA-DQ2, or HLA-DG8, bind with dietary gluten peptides in their antigen-binding grooves activate specific mucosal T lymphocytes, producing cytokine mucosal damage

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19
Q

what are the symptoms of coeliac disease

A

weight loss, diarrhoea, excess flatus and abdominal discomfort

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20
Q

how is coeliac disease diagnosed

A

IgA anti tissue transglutaminase test (tTGA), biopsy confirmative

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21
Q

what causes lactose malabsorption

A

deficiency of lactase

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22
Q

what are the clinical features of lactose malabsorption

A

history of the induction of diarrhoea, abdominal discomfort, flatulence following the ingestion of dairy products

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23
Q

how is lactose malabsorption diagnosed

A

lactose breath hydrogen test, oral lactose intolerance test

24
Q

how is lactose intolerance treated

A

lactose free diet

25
Q

what is tropical sprue

A

colonisation of the intestine by an infectious agent or alterations in the intestinal bacterial flora induced by the exposure to another environmental agent

26
Q

what are the clinical features of tropical sprue

A

diarrhoea, steatorrhea, weight loss, nausea, anorexia, anaemia, biopsy

27
Q

how is tropical sprue treated

A

tetracycline + folic acid

28
Q

what is whipples disease

A

commonly in white males, absorption in intestine reduced. caused by tropheryma whipplei, multi system involvement

29
Q

what are the clinical features of whipples disease

A

weight loss, diarrhoea, steatorrhea, abdominal distention, arthritis, fever, nutritional deficiency syndromes

30
Q

how is whipples disease diagnosed

A

demonstration of T. whipplei in involved tissues by microscopy

31
Q

how is whipples disease treated

A

antimicroial

32
Q

crohns disease patients with what other co-morbidities can develop severe malabsorption

A

extensive ileal involvement, extensive intestinal resections, enterocolic fistulas, strictures leading to small intestine bacterial overgrowth

33
Q

what are the clinical features of crohns disease

A

abdominal pain and diarrhoea, fever, weight loss, abdominal tenderness - most classically in the right lower quandrant

34
Q

how is crohns disease diagnosed

A

endoscopy, barium imaging of small bowel mucosal disease, CT, MRI, colonoscopy

35
Q

how is crohns disease treated

A

steroids, immunosuppresants, azathioprine 6-MP, biological therapy (anti TNF)

36
Q

what are the risk factors for the parasitic infection giardia Iamblia

A

travel to areas where the water supply may be contaminated/ swimming in ponds

37
Q

what are the clinical features of giardia Iamblia

A

diarrhoea, flatulence, abdominal cramps, epigastric pain, nausea

steatorrhea and weight loss may develop

38
Q

how is giardia Iamblia diagnosed

A

stool examination for ova and parasites

39
Q

how is giardia iamblia treated

A

metronidazole 1 week

40
Q

what other parasites can cause malabsorption

A

coccidial, stronglyoides

41
Q

what are the symptoms of small bowel bacterial overgrowth

A

diarrhoea, steatorrhoea, macrocytic anemia (B12)

42
Q

what bacteria commonly cause a small bowel overgrowth

A

E.Coli or bacteroides

43
Q

what can predispose someone to a small bowl overgrowth

A

diverticula, fistulas and strictures relating to crohns,

bypass surgeries, functional stasis

44
Q

what is a small bowl overgrowth

A

the presence of excess bacteria in the intestine

45
Q

how is a small bowel overgrowth diagnosed

A

low cobalamin and high folate levels, schillling test

46
Q

how is small bowel bacterial overgrowth breated

A

surgical correction of an anatomical loop, tetracyclines 2-3 weeks

47
Q

what past medical history would make you think malabsorption

A

gastric or small bowel resection, gastrointestinal diversion (bariatric), radiation exposure, travel

48
Q

what are the gastrointestinal symptoms of malabsorption

A

diarrhoea, weight loss, flatulence, abdominal bleeding, abdominal cramps, pain, oedema

49
Q

what signs could be found on examination in malabsorption

A

easy bruising, acrodermatits enteropathica, dermatitis herpetiformis, glossitis and angular stomatitis, spooning of the nails,

50
Q

what can cause easy bruising

A

vitamin C def ‘scurvy’, vit k def

51
Q

what causes acrodermatits enteropathica

A

autosomal recessive, impaired zinc uptake

52
Q

what causes dermatitis herpetiformis

A

may indicate coeliac disease

53
Q

what cause glossitis and angular stomatitis

A

B vit and iron def

54
Q

what causes spooning of the nails

A

iron def (thyroid)

55
Q

what are the base line investigations in malabsorption

A 
full blood count (anaemic, vit def)
coagulation (vit k test)
liver function test,
albulmin,
calcium/ magnesium,
stool culture
56
Q

what anatomic investigations can be done in malabsorption

A

endoscopy, imaging

57
Q

how is malabsorption treated

A

treat underlying cause, replace the deficiency, support nutritionally,

GI (64 decks)

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