Malabsorption (pie) Flashcards
(23 cards)
What is malabsorption ?
Defective mucosal absoption caused by defective luminal digestion, mucosal disease, structural disorders
What are the common causes of malabsorption ?
- Coeliacs disease
- Crohns disease
- Post-infectious
- Biliary obstruction
- Cirrhosis
- Short bowel syndrome
What are the uncommon causes of malabsorption ?
- Pancreatic cancer
- Parasites
- Bacterial overgrowth
- Drugs
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What are the general signs/symptoms of GI malabsorption ?
Symptoms:
- Diarrhoea
- Steatorrhoea (increased fat in stool which is hard to flush away/floats)
- Weight loss (anorexia)
- Lethary
- Bloating
Signs:
- Anaemia due to - low iron, B12 or folate
- Bleeding disorders - due to low vit K
- Oedema - due to low protein
- Metabolic bone disease osteomalacia/osteoporosis - due to low Vit D
- Nuerological features e.g. neuropathy
What is needed for fat absorption ?
Pancreatic juices (lipases) and bile salts
What are the fat soluble vitamins ?
ADEK - anything that affects fat absorption will results in one or more deficiencies of these vitamins
What are the signs/symptoms of lactose intolerance ?
Diarrhoea, abdo discomfort & flatulence following ingestion of diary products
How is a diagnosis of lactose intolerance diagnosed ?
- Using the lactose breath hydrogen test
- OR the oral lactose intolerance test
How is lactose intolerance treated?
Lactose free diet
What is tropical sprue?
- A malabsorption disease commonly found in tropical regions - far east, middle east & caribbean
- It is characterised by flattening of the villi and inflammation of the lining of the small intestine.
- Caused by an infectious agent or alterations in the intestinal bacterial flora
What are the signs/symptoms of tropical sprue ?
- Diarrhoea
- Steatorrhoea
- Weight loss
- Nausea
- Anorexia
- Anaemia
How is tropical sprue diagnosed ?
What is the treatment of tropical sprue?
Tetracycline + folic acid
What is whipples disease ?
A rare multi-system disorder caused by Tropheryma whippelii infection.
Who is whipples disease more common in ?
Those who are HLA-B27 positive and in middle-aged men.
What are the clinical features of whipples disease ?
- Malabsorption: diarrhoea, steatorrhoea, weight loss, abdo distension
- Fever
- Large-joint arthralgia
- Lymphadenopathy
- Skin: hyperpigmentation and photosensitivity
- pleurisy, pericarditis
How is whipples disease diagnosed ?
By demonstrating T.whippeli in involved tissues by microscopy
What is the treatment of whipples disease ?
Oral co-trimoxazole for a year is thought to have the lowest relapse rate +/- preceded by a course of IV penicillin
What is small bowel overgrowth syndrome ?
A disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.
What are the clinical features of small bowel overgrowth syndrome ?
- chronic diarrhoea, steatorrhoea
- Macrocytic anaemia (low B12)
- bloating, flatulence
- abdominal pain
- High cobalbamin and folate levels
How is small bowel bacterial overgrowth syndrome diagnosed ?
- Hydrogen breath test or schilling test
- Small bowel aspiration & culture via intubation
What are the causes of small bowel bacterial overgrowth syndrome ?
Risk factors for SBBOS
- neonates with congenital gastrointestinal abnormalities
- scleroderma
- diabetes mellitus
- Diverticula, fistulas, strictures related to crohns disease
- Byspass surgeries
What is the treatment of small bowel bactieral overgrowth syndrome ?
- correction of underlying disorder
- antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance.
