Digestion and Absorption Disorders Flashcards Preview

week 46 > Digestion and Absorption Disorders > Flashcards

Flashcards in Digestion and Absorption Disorders Deck (33)
Loading flashcards...
1

Malabsorption Syndromes

  • Pancreatic Insufficiency
  • Bile Salt Deficiency 

2

Pancreatic Insufficiency

  • lack of pancreatic digestive enzymes
    • lipase
    • amylase
    • trypsin
    • chymotrypsin

3

Causes of Pancreatic Insufficiency

  • Pancreatitis
  • Pancreatic Carcinoma
  • Pancreatic Resection
  • Cystic Fibrosis

4

Primary Problem of Pancreatic Insufficiency

  • Fat maldigestion

5

Most common signs of Pancreatic Insufficiency?

  • Fatty Stools (steatorrhea)
  • weight loss

6

Treatment of Pancreatic Insufficiency

  • Lipase supplements

7

Bile Salt Deficiency

  • Poor intestinal absorption of lipids

8

Bile salt deficiency caused by

  • liver disease
  • bile obstructions

9

Most common signs of bile deficiency

  • fatty stools
  • diarrhea
  • loss of fat-soluble vitamins (A,D,E,K)

10

Bile Salt Deficiency treatment

  • increase medium-chain triglyercides (MCFA-MCT-oil)  in diet
  • Parenterally administer fat soluble vitamines A,D,E,K

11

General Symptoms of Fat Malabsorption

  • 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

Fat soluble Vitamin Deficiency Symptoms:

  • A
    • night blindness
  • D
    • osteopenia
    • osteoporosis
    • rickets
  • E
    • capillary fragility
    • bruising
    • bleeding 
    • stress 
  • K
    • clotting disorders
    • bleeding 
    • anemia

13

Diagnosis of Fat Malabsorption:

  • Confirmation test:
    • fecal fat test
      • normal: <7g/day
  • Determine cause: includes general malabsorption
    • imaging:
      • endoscopy of upper GI
        • barium contrast may detect disease
    • 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
    • Provacative/Functional Tests

14

Diagnosis of Fat Malabsorption: Provacative Malabsorption Tests

  • 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

Fat Malabsorption: Gastric Causes

Etiology

  • Gastric Insufficiency from disease process
    • gastritis
  • Reduced and delayed emulsification

16

Fat Malabsorption: Gastric Causes

Severity and Symptoms

  • Severity:
    • Moderate fat malabsorption
  • Symptoms:
    • Odorous stools
    • flatulence
    • abdominal cramps
    • fecal incontenence
    • Deficiencies in B12 or iron
      • not A, D, E, K

17

Fat Malabsorption: Gastric Causes 

Diagnosis

  • Schilling test
  • Anemia Tests

18

Fat Malabsorption: Gastric Causes

Treatment

  • Treat underlining causes/condtions
  • Decrease dietary fat intake 
  • increase small meal frequency

19

Fat Malabsorption: Liver/Gallbladder

etiology

  • Reduced bile salts and phospholipids

20

Fat Malabsorption: Liver/Gallbladder

Severity and Symptoms

  • Severity:
    • moderate
  • Symptoms:
    • Odorous stools
    • flatulence
    • abdominal cramps
    • fecal intolerance
    • fat souble vitamin deficiency syndromes

21

Fat Malabsorption: Liver/Gallbladder

Treatment

  • Treat underlying causes
  • decrease fat intake
  • increase small meal frequency
  • Dietary Ursodeoxycholic acid (non-detergent bile salt)

22

Fat Malabsorption: Intestinal

Etiology

  • Reduced absorption
  • usually intestinal disease or short bowel syndrome
  • other genetic or acquired casues

23

Fat Malabsorption: Intestinal

Severity and Symptoms

  • Severity:
    • variable depending on disease
  • Symptoms:
    • Fat, carbohydrate, protein or vitamin deficiency

24

Fat Malabsorption: Intestinal

Treatment

  • 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