Malabsorption Flashcards
What is steatorrhea?
greater than 5% of dietary fat intake excreted in stool
Who do we expect to ahve steatorrhea?
unexplained weight loss greasy stools development of osteomalacia easy bruising iron defic anemia not due to blood loss adult development of lactos insufficiency gastric surgery, especially billroth ii
What are stool characteristics of someone with steattorhea?
floats, hard to flush, greasy, especially at top fo water, stinks, oil droplets with minimal stools
what are mechanisms causing diarrhea in steatorrhea?
xs amts of osmotically active particles fro mmalabsorbed dietary constituents
hydroxylation of 10-hydroxy oleate which acts as a cathartic
fatty acids themselves impair fluid and electrolyte absorption
What is the most sensitive test for steatorrhea?
secretin
what does the hydrogen breath test test for?
carb malabsorption
what is the most common cause of steatorrhea?
pancreatic insufficiency
In the intraluminal stage, with lipase insufficiency, what are potential causes?
chronic pancreatitis
zes - acid disrupts needed pH for lipase
post-gastrectomy
cystic fibrosis (too thick of secretions)
in the intraluminal stage, with solubilization problems, what are potential causes?
bile acid insufficiency (from cholestatic liver dz, terminal ileectomy, small bowel overgrowth, reduced cck release)
what are the effects of impaired bile salts circulation
diarrhea or steatorrhea
increased proportion of bile acid pool conjugated with glycine vs taurine
increase proportino of deoxycholate in bile
a reduced bil salt pool size
In the intestinal stage, with epithelial cell surface digestion problems, potential causes?
disaccharidase insufficiency
stasis syndrome
In intestinal stage, with intestinal cell dysfunction, what are potential cuases?
gluten-sensitive enteropathy stasis syndrome whipples disease intestinal ischemia radiation enteritis tropical sprue genetic disorders like cysteinuria anderon's dz abetalipoproteinemia
What test is very high sensitivity and specificity for gluten-sensitive enteropathy?
IgA Ab
in GES, which area is most severly affected, which absorption is most afffected?
proximal intestine, affecting abso of fat, protein, water and vitamins
What are other conditions associated with steatorrhea besides GES?
giardiasis adrenal insufficiency amyloid diabetes hyperthyroidism combined variable immunodeficiency
