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Lucy Knox - Year 2.5 > 237 - Malabsorption > Flashcards

237 - Malabsorption Flashcards

1
Q

Diarrhoea can result after a change in absorption or secretion of just what %?

A

1% increase

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2
Q

Describe osmotic diarrhoea

A

Caused by ingestion of poorly absorbed osmotically active substance (non-electrolyte) that retains fluid in the lumen.

eg. ions - Mg, sulphate, phosphate
Sugars - mannitol, sorbitol
Lactose deficiency
Lactulose

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3
Q

What are signs of osmotic diarrhoea?

A

Moderatly increases stool volume
Stops when feeding stops
Osmolality normal or increased
Ion gap>100

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4
Q

How do you calculate ion gap?

A

Ion gap = Osmolality - (2x (Na + K))

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5
Q

Describe secretory diarrhoea

A

Disordered electrolyte transportation causes

  • net secretion of anions (chloride + bicarb)
  • net inhibition of Na absoption
  • Water can’t be absorbed (as it follows Na)

-> diarrhoea

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6
Q

What can cause secretory diarrhoea?

A 
Cholera (exogenous)
NE tumour (endogenous)
Absence of Ion transporter (congenital chlorideorrhoea)
Loss of GI surface area
Intestinal ischaemia
Rapid gut transit
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7
Q

What are the signs of secretory diarrhoea?

A

V large stool volume
Continues with no food
Normal osmolality
Ion gap

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8
Q

Name 5 diseases that cause malabsorption

A 
Coeliac
Pernicious anaemia
Intestinal lymphangiectasia
Glucose-galactose malabsorption
Lactase deficiency
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9
Q

What mediates coeliac disease?

A

Autoantigen transglutimase

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10
Q

What are the symptoms and signs of coeliac?

A 
Chronic diarrhoea
Poor weight gain 
Distended abdomen
Reduced s/c fat
Muscle wasting (see on buttocks)
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11
Q

What blood results may you find in coeliac?

A

Microcytic hypochromic anaemia (Fe deficiency)
Low serum ferritin
High ALT (a mild transaminitis is assoc with coeliac)
High Alk Phos (?low vit D - osteromalacia)
Low selective IgA (anti tTG) - associated with autoimmune diseases
- IgG anti-tTG more specific to coeliac

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12
Q

If you take a SI biopsy in coeliac what will you see?

A

Villous atrophy - flat mucosa
Crypt hyperplasia - elongated
Dense inflammatory infiltrates

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13
Q

What other conditions are associated with coeliac?

A

Diabetes type I
Autoimmune thyroiditis
Selective IgA deficiency
Syndromes - downs, williams, turners

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14
Q

Describe glucose-galactose malabsorption

A

Autosomal recessive disease, where the SGLT1 transported is inactive.
SGLT1 absorbs glucose and galactose (and so lactose can’t be either as it breaks down into them)

Get osmotic diarrhoea

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15
Q

What is a test for glucose-galactose malabsorption?

A

H2 breath test (sometimes called lactose breath test)

Feed glucose - increased H2 exhaled
feed Fructose (dif transporter) - normal H2 exhaled
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16
Q

What causes primary lactase deficiency?

A

congenital deficiency - very rare, osmotic diarrhoea from birth

Late onset - around 5 years old, mostly in asians

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17
Q

What is a secondary lactase deficiency?

A

Acquired deficiency - uncommon

May get transient deficiency after an infection or mucosal damage

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18
Q

What symptoms may you get with pernicious anaemia?

A

Tiredness
Light headed
Pins + needles
Sore mouth

19
Q

What signs may you see in pernicious anaemia?

A

Glossitis (B12 deficiency)
Vitiligo (autoimmune - assoc)
Goitre (autoimmune thyroid disease - assoc)

20
Q

What tests can you do for pernicious anaemia?

A

FBC - see macrocystic normochromic anaemia
Reduced selective IgA (autoimmune)
If thyroid disease TSH raised?

anti-parietal cell antibodies
anti-intrinsic factor antibodies

21
Q

What is the management of pernicious anaemia?

A

B12 injections
Thyroid hormone replacement
Surveillance endoscopies - as gastric carcinoma increased risk with atrophic gastritis

22
Q

What is intestinal lymphangietasia?

A

Dilation of the intestinal lymphatics and loss of lymph fluid/drainage in the GI tract

Causes:

  • hypotroteineamia
  • Oedema
  • Lymohocytopoenia
  • Malabsorption - of fat, fat soluble vitamins (ADEK) and iron
23
Q

What vitamins are fat soluble?

A

ADEK

24
Q

How can you manage intestinal lymphangietasia?

A

Restrict dietary long chain triglycerides that block the lymph flow
Supplement medium chain - that can be absorbed via mucosa into blood
Supplement ADEK

25
Q

What + where are cells in the stomach?

A

In body/corpus - Cheif cells (pepsinogen) and Parietal cells (HCL and intrinsic factor)

In Antrum - Cheif cells (pepsinogen), endocrine cells - G cells (gastrin) and D cells (somatostatin) and cells producing HCO3-

26
Q

What cells int he pancreas are involved in digestion?

A 
Duct cells (bicarb)
Acinar cells (produce pancreatic juices: proteiolytic enzymes, amylases, lipases)
27
Q

What is given as a substitute to pancreatic secretions for digestion?

A

Creon

28
Q

What happens in the duodenum?

A

Chyme mixes with bile -> chylomicrons
Lipase, protease and CHO digestion

Absorbs: Iron, ca, mg, zn

29
Q

Which clotting factors need Vit K?

A

Factors 2, 7, 9 and 10

30
Q

What is absorbed from the jejunum?

A 
Proteins
Monosaccharides
some fat + vit ADEK
Water + water soluble vitamins
Folate
Ca
Minerals + trace elements
31
Q

What is absorbed from the proximal ileum?

A

Fats + vit ADEK
Water
Water soluble vitamins

32
Q

What is absorbed from the distal ileum?

A

B12 + intrinsic factor

Bile salts

33
Q

What is absorbed from the colon?

A

Water + electrolytes

Short chain FA (once they’ve been fermented by colonic bacteria from dietary fibre)

34
Q

CCK - What? Where from?

A

Cholecystokinin
From: duodenum, jejenum, ileum, colon

Action: Pancreas secretes enzymes + call bladder constriction

35
Q

Gastrin - What? Where from?

A

From G cells in antrum

Action: Cause parietal cells in gastric body to produce HCL

36
Q

Gastrin releasing hormone - what? Where from?

A

From Vagal nerves

Action: Cause G cells in antrum to release Gastrin

37
Q

Glucagon - What? Where from?

A

From islets of langerhans in pancreas

Action: Cause liver to increase glucose production and breakdown glycogen

38
Q

Guanylin - What? Where from?

A

From ileum and colon

Action: Cause SI and colon to increase fluid absorption

39
Q

Somatostatin - What? Where from?

A

From D cells in stomach and duodenum + Delta cells in pancreas islets

Action:

  • Stomach - reduce gastrin
  • Intestine - increase fluid absorption + reduce secretion
  • Pancreas - reduce endo+exocrine secretion
  • Liver - reduce bile flow
40
Q

VIP: Vasoactive intestinal peptide - What? Where from?

A

From Enteric NS neurones

Action: Cause SI and Pancreas to increase secretions + SI to relax smooth muscles

41
Q

A deficiency in Vit A causes what?

A

Compromised mucosas
Night blindness
Benign intracranial hypertension

42
Q

A deficiency in Vit D causes what?

A

Ricketts / osteomalacia

43
Q

A deficiency in Vit E causes what?

A

Increase in oxidative stress
Heamolysis
Neuological issues

44
Q

A deficiency in Vit K causes what?

A

Increase in PT
Coagulopathies
Need Vit K for Factors 2, 7, 9, 10

Lucy Knox - Year 2.5 (15 decks)

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