Malabsorption

Question 1

What is global malnutrition?

Answer 1

Failure to absorb all nutrients

Question 2

What is partial malnutrition?

Answer 2

Failure to absorb selected nutrients

Question 3

How might global malnutrition present?

Answer 3

Pale, greasy stools (failure of fat absorption)
Foul smelling stools
Weight Loss

Question 4

What is seen with fat malabsorption?

Answer 4

Steatorrhea
Deficiency of fat soluble vitamins- A,D,E, K and symptoms due to this e.g. clotting deficiency, hyperparathyroidism, poor vision

Question 5

How can fat malabsorption be investigated for?

Answer 5

72 hour stool collection to check fat levels

Question 6

What does vitamin A deficiency cause?

Answer 6

Vision problems

Night blindness

Question 7

What does vitamin D deficiency cause?

Answer 7

Hyperparathyroidism

Osteomalacia

Question 8

What does vitamin E deficiency cause?

Answer 8

Muscle weakenss

Question 9

What does vitamin K deficiency cause?

Answer 9

Clotting abnormalities and bleeding

Question 10

What symptoms might be seen with protein malabsorption?

Answer 10

Muscle atrophy
Oedema
Immune deficiency

Question 11

What doe carbohydrate malabsorption cause?

Answer 11

Bloating
Diarrhea
Weight loss
Fatigue

Think celiac signs

Question 12

What malabsorption could cause anaemia?

Answer 12

IDA- Microcytic

B12/Folate deficiency- Macrocytic (Also get degeneration of dorsal columns, cerebellar dysfunction)

Question 13

What disease cause global malabsorption?

Answer 13

IBD
Coeliac disease
Exocrine pancreatic deficiency

Question 14

What are some symptoms fo coeliac?

Answer 14

Diarrhoea
Bloating
Flatulence
Weight loss
IDA
B12 and Folate deficiency

Dermatitis herpetiformis

Question 15

What skin manifestation is seen in Coeliac patients?

Answer 15

Dermatitis herpetiformis

Question 16

What are the investigations for coeliac?

Answer 16

Anti TTG
Anti- endomysial proteins
Biopsy to investigate for histological changes seen in coeliac (obtained via OGD)

Question 17

What are the features of coeliac disease on a biopsy?

Answer 17

Inflammation
Villous atrophy
Crypt hyperplasia
Raised white cells

Question 18

What type of Ab is Anti- TTG?

Answer 18

IgA

It is a mucosal Ab, also check total IgA in case overall is low

Question 19

What HLA association is seen in coeliac?

Answer 19

HLA-DQ2

Question 20

What is the management for coeliac?

Answer 20

Gluten free diet- get dietician input

Rice, Maize, soya and potatoes

Question 21

What investigations can be done to investigate for coeliac?

Answer 21

Bloods- FBC, Iron studies, B12, Folate
Coeliac Screen- Anti TTG, Anti Endomysial, Total IgA
OGD with biopsy- crypt hyperplasia, inflammation and villous atrophy

Question 22

What changes are seen on microscopy for coeliac disease?

Answer 22

Villous atrophy
Crypt hyperplasia
White cell infiltration

Question 23

Why does exocrine pancreatic insufficiency cause malabsorption?

Answer 23

Reduced release of pancreatic enzymes required for the breakdown of foodstuffs.

Question 24

What can cause exocrine pancreatic insufficiency?

Answer 24

Pancreatitis
Pancreatic cancer
Autoimmune attack

Question 25

What test can check pancreatic exocrine function?

Answer 25

Faecal elastase 1 level Serum trypsinogen If both are reduced it suggest pancreatic insufficiency

Question 26

What are the symptoms of lactose intolerance?

Answer 26

Diarrhoea Bloating Abdominal pain Flatulence After eating dairy products

Question 27

What can be done to diagnose lactose intolerance?

Answer 27

Lactose hydrogen breath test Increases in hydrogen occur if the lactose is broken down by bacteria instead.

Question 28

What test can be done to investigate for carbohydrate malabsorption?

Answer 28

D-Xylose in the serum