Digestion and Absorption Disorders Flashcards
1
Q
Malabsorption Syndromes
A
- Pancreatic Insufficiency
- Bile Salt Deficiency
2
Q
Pancreatic Insufficiency
A
- lack of pancreatic digestive enzymes
- lipase
- amylase
- trypsin
- chymotrypsin
3
Q
Causes of Pancreatic Insufficiency
A
- Pancreatitis
- Pancreatic Carcinoma
- Pancreatic Resection
- Cystic Fibrosis
4
Q
Primary Problem of Pancreatic Insufficiency
A
- Fat maldigestion
5
Q
Most common signs of Pancreatic Insufficiency?
A
- Fatty Stools (steatorrhea)
- weight loss
6
Q
Treatment of Pancreatic Insufficiency
A
- Lipase supplements
7
Q
Bile Salt Deficiency
A
- Poor intestinal absorption of lipids
8
Q
Bile salt deficiency caused by
A
- liver disease
- bile obstructions
9
Q
Most common signs of bile deficiency
A
- fatty stools
- diarrhea
- loss of fat-soluble vitamins (A,D,E,K)
10
Q
Bile Salt Deficiency treatment
A
- increase medium-chain triglyercides (MCFA-MCT-oil) in diet
- Parenterally administer fat soluble vitamines A,D,E,K
11
Q
General Symptoms of Fat Malabsorption
A
- steatorrhea
- foul stools
- flatulence
- abdominal distension
- abdominal cramping
- Diarrhea: irritating products of colonic bacteria
- SCFA (small chain fatty acids) stimulate colonic crypt Cl- secretion
- Diarrhea: >100/250mL of water/liquid per day in stool
- Fat malnutrition:
- weight loss
- fatigue
- neuropathy
- nervous tissue composed of fat
12
Q
Fat soluble Vitamin Deficiency Symptoms:
A
- A
- night blindness
- D
- osteopenia
- osteoporosis
- rickets
- E
- capillary fragility
- bruising
- bleeding
- stress
- K
- clotting disorders
- bleeding
- anemia
13
Q
Diagnosis of Fat Malabsorption:
A
- Confirmation test:
- fecal fat test
- normal: <7g/day
- fecal fat test
- Determine cause: includes general malabsorption
- imaging:
- endoscopy of upper GI
- barium contrast may detect disease
- endoscopy of upper GI
- Blood tests
- Vitamins A, D, E, & K
- Iron/Hct/RBCs
- Vitamin B12
- Folate
- Fectal tests
- fecal elastase
- for pancreatic insufficiency
- Fecal osmotic gap:Osmolarity
- >100=osmotic diarrhea
- malabsorption
- <50=secretory Diarrhea
- solutes are ions
- due to colonic secretions
- >100=osmotic diarrhea
- fecal elastase
- Provacative/Functional Tests
- imaging:
14
Q
Diagnosis of Fat Malabsorption: Provacative Malabsorption Tests
A
- Bile salt absoprtion
- measure absorption of radiolabeled bile salts
- low absorption=damage to terminal ileum or chemical interference (ex: lipid lowering drugs)
- Schilling Test
- measure radiolabelled B12 absorption
- If low repeat with intrinsic factor
- if absorption low in both, cause=terminal ileum
- absorption is low w/o IF=gastric
- D-xylose
- Transported by SGLT1 but not metabolized
- measure in urine over several hours
- low=intestinal disease
- celiac, Crohn’s
15
Q
Fat Malabsorption: Gastric Causes
Etiology
A
- Gastric Insufficiency from disease process
- gastritis
- Reduced and delayed emulsification
16
Q
Fat Malabsorption: Gastric Causes
Severity and Symptoms
A
- Severity:
- Moderate fat malabsorption
- Symptoms:
- Odorous stools
- flatulence
- abdominal cramps
- fecal incontenence
- Deficiencies in B12 or iron
- not A, D, E, K
17
Q
Fat Malabsorption: Gastric Causes
Diagnosis
A
- Schilling test
- Anemia Tests
18
Q
Fat Malabsorption: Gastric Causes
Treatment
A
- Treat underlining causes/condtions
- Decrease dietary fat intake
- increase small meal frequency
19
Q
Fat Malabsorption: Liver/Gallbladder
etiology
A
- Reduced bile salts and phospholipids
20
Q
Fat Malabsorption: Liver/Gallbladder
Severity and Symptoms
A
- Severity:
- moderate
- Symptoms:
- Odorous stools
- flatulence
- abdominal cramps
- fecal intolerance
- fat souble vitamin deficiency syndromes
21
Q
Fat Malabsorption: Liver/Gallbladder
Treatment
A
- Treat underlying causes
- decrease fat intake
- increase small meal frequency
- Dietary Ursodeoxycholic acid (non-detergent bile salt)
22
Q
Fat Malabsorption: Intestinal
Etiology
A
- Reduced absorption
- usually intestinal disease or short bowel syndrome
- other genetic or acquired casues
23
Q
Fat Malabsorption: Intestinal
Severity and Symptoms
A
- Severity:
- variable depending on disease
- Symptoms:
- Fat, carbohydrate, protein or vitamin deficiency
24
Q
Fat Malabsorption: Intestinal
Treatment
A
- Treat undelrying causes/condition
- parenteral nutrition
25
Fat Malabsorption: Other causes
* Lymph Obstruction (Lymphangiectasia)
* Cellular Processing
* Other
* MCFA enter by gap juncitons
26
Lymph Obstruction
* Aka lymphangiectasia
* tumor or other growth
* wilson/parasite disease
* typically presents **w/fat malabsorption**
* Biopsy
* **chylomicrons in lamina propria**
27
Cellular Processing
* Genetic Lesions to:
* golgi
* ER
* chaperone proteins
* cytoskeleton
* transport proteins
* apoproteins
* B lipoprotein (most common)
* exocytosis
* Biposy:
* **fat in organelles or accumulated chylomcrons**
28
Fat Malabsorption: Other causes
Treatment
* Treat underlying condition
* MCFA
* **parenteral nutrietion or diet**
29
Carbohydrate Intolerance
etiology
* Enzyme deficiencies
* Congenital
* rare
* lactase or sucrase
* Acquired
* primary adult hypolactasia
* **use it or loose it phenomenom**
* Secondary
* mucosal damage
* celiac
* crohns
30
Disaccharidase Deficiencies
* Lactose Intolerance
* lactase=inducible enzyme
* neonatal and adults forms
* 37% of US population is lactase deficient
* Tx: Abstinence
* Sucrose Intolerance
* 1 in 10,000
* tx: avoid sucrose (cane or beet sugar)
31
Carbohydrate: Transport Deficiencies
* Fructose intolerance
* Deficient GLUT5
* most common monosaccharide malabsorption syndrome
* Symptoms:
* Like lactose intolerance
* Tx:
* reducing fructose or adding glucose or sucrose
* Other:
* Lack of Na-glucose cotransporter-1 (SGLT1)
* tx: substitute fructose for glucose
32
Protein Digestion Disorders
* Pancreatic Insufficiency
* Gastric Disorder
* Amino Acid transport disorder
33
