Malabsorption

Question 1

What is malabsorption?

Answer 1

Malabsorption is a condition where the intestine fails to absorb nutrients properly from the food you eat. This can include macronutrients (like fats, proteins, carbs), micronutrients (like vitamins and minerals), or fluids and electrolytes.

Question 2

What three categories can malabsorption be categorised into?

Answer 2

1. Intraluminal phase - Digestion issue
2. Mucosal Phase - Absorption issue
3. Post-mucosal phase - Transport issue

Question 3

Give 2 examples of intraluminal malabsorption:

Answer 3

1. Pancreatic insufficiency (e.g., chronic pancreatitis, CF)
2. Bile salt deficiency (e.g., cholestasis, ileal resection)

Question 4

Give 4 examples of mucosal malabsorption:

Answer 4

1. Celiac disease
2. Tropical sprue
3. Crohn’s disease
4. Lactose intolerance (disaccharidase deficiency)

Question 5

Give an example of post-mucosal malabsorption:

Answer 5

Lymphatic obstruction (e.g., lymphoma, Whipple’s disease)

Question 6

Name 3 symptoms of malabsorption:

Answer 6

1. Chronic diarrhoea (often bulky, pale, foul-smelling → steatorrhea = fat in stool)
2. Weight loss
3. Bloating, flatulence

Question 7

How is malabsorption diagnosed?

Answer 7

Fecal fat test (72-hour stool collection)

Blood tests: CBC, iron studies, B12, vitamin D, albumin

D-xylose test: checks for mucosal absorption

Endoscopy with biopsy (e.g., for celiac disease)

Imaging: CT/MRI, small bowel series, capsule endoscopy

Question 8

What is the treatment for malabsorption?

Answer 8

Treat the underlying cause

Nutritional support (dietary modifications, vitamin/mineral supplementation)

Enzyme replacement (e.g., pancreatic enzymes)

Gluten-free diet (for celiac disease)

Antibiotics (for bacterial overgrowth)

Question 9

What does the pneumonic MALABSORB stand for to remember common causes of malabsorption?

Answer 9

M: Mucosal (Celiac, Crohn’s)

A: AIDS-related enteropathy

L: Lymphatic obstruction (Whipple’s, lymphoma)

A: Autoimmune

B: Bile salt deficiency

S: Small bowel overgrowth

O: Oat (gluten sensitivity)

R: Resection of bowel

B: Bacterial/parasitic infection