Malabsorbtion

Question 1

What is the definition of malabsorption?

Answer 1

Defective mucosal absorption which is caused by defective luminal digestion, mucosal disease or structural abnormalities

Question 2

What are the common causes of malabsorbtion?

Answer 2

Coeliac disease 
Crohn's disease 
Post infectious 
Biliary obstruction 
Cirrhosis

Question 3

What are the uncommon causes of malabsorbtion?

Answer 3

Pancreatic cancer 
Parasites 
Bacterial overgrowth 
Drugs 
Short bowel sundrome

Question 4

What is the most common mineral to be malabsorbed in the world?

Answer 4

Iron (anaemia)

Question 5

What are the diseases that drive malabsorbtion?

Answer 5

Coeliac disease 
Whipple's disease 
Crohn's disease 
Parasitic infections 
Small bowel bacterial overgrowth

Question 6

What is lactose malabsorbtion?

Answer 6

Evidence of deficiency of lactose

Question 7

What are the clinical presentations of lactose malabsorbtion?

Answer 7

Induction of diarrhoea, abdominal discomfort and flactulence following the ingestion of dairy products

Question 8

How is lactose malabsorbtion diagnosed?

Answer 8

Confirmed by the lactose breath hydrogen test, or an oral lactose intolerance test

Question 9

What is the management of lactose malabsorbtion?

Answer 9

Lactose free diet

Question 10

What is trocial sprue?

Answer 10

Evidence of colonisation of the intestine by an infectious agent or alteration in the intestinal bacterial flora induced by the exposure to antoerh envorinmental agen

Question 11

What does tropical sprue present with?

Answer 11

Diarrhoea, steatohhrea, weight loss, nausea, anorexia and anaemia

Question 12

How is tropica sprue diagnosed?

Answer 12

Biopsy

Question 13

How is tropical sprue treated?

Answer 13

Tetracycline and folic acid

Question 14

What is whipple’s disease?

Answer 14

Evidence of tropheryma whipplei, multi-system involvement with an increase int he frequency of HLA-B27

Question 15

How does whipple’s disease present?

Answer 15

Weight loss, diarrhoea, steatorrhea, abdominal distension, arthritis, fever and nutritional deficiency symptoms

Question 16

How is whipple’s disease treated?

Answer 16

Antimicrobials

Question 17

How is whipple’s disease diagnosed?

Answer 17

Demonstration of T.whipplei in involved tissue by microscopy

Question 18

What is crohn’s disease?

Answer 18

Evidence of extensive ileal involvement, extensive intestinal resections, enterocolic fistulas and stricutres leading to small intestine bacterial overgrowth that may develop significant and occasionally devestating malabsorbtion

Question 19

What does crohn’s disease present with?

Answer 19

Abdominal pain and diarrhoea, fever and weight loss, abdominal tenderness most clasically in the RLQ

Question 20

How is crohn’s disease diagnosed?

Answer 20

Endocscopy, barium imaging of the small bowel mucosal disease including strictures, ulcerations and fistulae. CT and MRI

Question 21

How is crohn’s disease treated?

Answer 21

Steroids, immunosuppresants, axathioprine 6-MP, biological therapy (anti-TNF)

Question 22

What is an example of a parisitic infection that can lead to malabsorbtion?

Answer 22

Giardia lamblia

Question 23

What do parasitic infections present with?

Answer 23

Diarrhoea, flactulence, abdominal cramps, epigastric pain and nausea. Can experience vomiting, significant malabsorbtion with steatorrhea and weight loss

Question 24

How are parasitic infections diagnosed?

Answer 24

Stool examination for ova and parasites

Question 25

How are parasitic infections treated?

Answer 25

Metrondiazole

Question 26

What bugs can cause small bowel bacterial overgrowth?

Answer 26

E.coli or bacteroides

Question 27

How is small bowel bacterial overgrowth diagnosed?

Answer 27

Evidence of diverticula, fistulas and strictures related to crohn's disease, bypass surgeries with a functional status

Question 28

How can small bowel bacterial overgrowth be diagnosed?

Answer 28

Low coalbamin levels adn high folate levels

Question 29

What is the treatment for small bowel bacterial overgrowth?

Answer 29

Surgical correction of an anatomical blind loop, tetracyclines for 2/3 weeks

Question 30

What are common GI symptoms?

Answer 30

Diarrhoea Abdominal swelling Oedema Low mood

Question 31

What is important to check in PMH for malabsorbtion?

Answer 31

Gastric or small bowel resection GI diverstion Radiation exposure Travel

Question 32

What are important features to a malabsobtion examination?

Answer 32

Easy bruising Vitamin C deficiency (scurvy), vitamin K deficiency Skin - acrodermatitis enteropathica, dermatitis herptetiforms Glossitis and angular stomatitis Spooning of nails

Question 33

What baseline investigations should be done to determine malabsorbtion?

Answer 33

``` FBC Coagulation LFTs Albumin Calcium/Mg Stool culture ```

Question 34

What anatomic investigations can be done?

Answer 34

Endoscopy | Imaging