142. Malabsorption Clinical Features

Question 1

What key vitamins/minerals/nutrients are absorbed in the duodenum, jejunum, ileum, terminal ileum, colon?

Answer 1

Duodenum: heavy metals (Fe, Cu, Mg, Ca)
Jejunum: more heavy metals, monosaccharides, small AA/peptides, some fat soluble vitamins/lipids
Ileum: lipids, fat soluble vitamins (ADEK), Folate
Terminal Ileum: B12, bile salts, fat
Colon: SCFAs, water

Question 2

What is a malnutritional sx of celiac disease?

Answer 2

inappropriate immune reaction to gluten = small bowel enteropathy (typically proximal = duodenal)
Leads to Fe DEFICIENCY - CHECK IRON LEVELS!
Sx: Fe-Deficient Anemia
Tx: gluten avoidence

Question 3

What are key tests and sx of exocrine pancreatic insufficiency?

Answer 3

Tests: high fecal fat, low fecal elastase (exocrine enzyme), fat soluble vitamin deficiencies (ADEK)

Sx: steatorrhea, weight loss, trouble seeing at night (vitA)

Tx: fix obstruction, pancreatic enzyme replacement, replete vitamin deficiencies

Question 4

What is Iatrogenic Small Bowel Syndrome? When does it occur? How is it treated?

Answer 4

Post-bariatric Surgery (RYGB, Gastric Sleeve)
Malabsorption due to inadequate exposure of food to bile salts/pancreatic enzymes
Needs LIFELONG vitamin/mineral supplementation needed
Consider parenteral nutrition