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GI 1 > ClinMed- common disorders of intestinal malabsorption > Flashcards

ClinMed- common disorders of intestinal malabsorption Flashcards

1
Q

Common disorders of malabsorption (6)

A
  1. Small intestinal bacterial overgrowth (SIBO)
  2. Exocrine pancreatic insufficiency
  3. Impaired bile acid synthesis or secretion
  4. Lactose intolerance
  5. leaky gut syndrome
  6. celiac dz
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2
Q

What 4 components are required for normal small bowel absorption

A
  1. digestion of nutrients in lumen
  2. appropriate absorptive surface of small intestine
  3. functioning membrane transport systems
  4. available epithelial absorptive enzymes
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3
Q

SIBO

- def

A

abnormal colonization of the small bowel with colonic bacteria

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4
Q

SIBO

- pathophysiology

A
  • anatomic alterations of foregut promotes stasis of intestinal contents leads to overgrowth (small-bowel diverticulosis, surgical blind loops, postgastrectomy states, strictures)
  • intestinal motility disorders (DM neuropathy, impaired bacterial clearance)
  • Achlorhydria may cause bacterial overgrowth in elderly people (ex. PPI overuse)
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5
Q

What 6 things do bacteria do in SIBO

A
  1. Deconjugate bile salts = fat malabsorption = diarrhea
  2. metabolize B12, preventing absorption in the ileum
  3. bacterial proteases, glycosides, toxins damage the epithelium
  4. bacteria inflame the mucosa = diarrhea
  5. Consume nutrients = malabsorption
  6. exert inhibitory effects on upper GI functions
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6
Q

SIBO

- clinical presentation

A
  • weight loss or nutrient deficiencies
  • abd discomfort
  • diarrhea, steatorrhea
  • bloating, excess flatulence
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7
Q

SIBO

- dx

A
  • breath H+ test: easiest

- quantitative culture of intestinal fluid aspirate via endoscopy: no need to do this, just breath test…

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8
Q

SIBO

- tx

A
  • 10-14 days abx, tetracycline, metronidazole best
  • can be cyclic if sx recur
  • low carb, high fat diet (bacteria metabolize carbs)
  • correct nutritional deficiencies (esp B12)
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9
Q

Exocrine pancreatic insufficiency (EPI)

- clinical sx

A
  • steatorrhea
  • diarrhea
  • gas, flatulence
  • weight loss
  • bloating
  • abd pain
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10
Q

What percentage loss pancreatic secretory capacity must be loss to result in sx of EPI?

A

once capacity is <10% of normal

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11
Q

Conditions associated with EPI

A
  • CF
  • chronic pancreatitis
  • DM type I
  • prior pancreatic sx
  • pancreatic ca or blockage of pancreatic duct
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12
Q

EPI

- dx

A
  • qualitative fecal fat (easiest, always include in diarrhea wo)
  • quantitative fecal fat (collect and keep stool for 72 hours)
  • fecal elastase stool test (Roark never used)
  • direct pancreatic stimulation test (not going to use in the real world)
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13
Q

EPI

- Tx

A
  • pancreatic enzyme supplementation - Creon & Zenpep (porcine-derived lipases, proteases, amylases)
  • expensive
  • Vitamin replacement ADEK
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14
Q

Impaired Bile Acid Synthesis / Malabsorption

- common co-morbidity

A

IBS-D

  • 10% of pts with IBS-D have severe bile acid malabsorption
  • historically underestimated in IBS-D
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15
Q

Impaired Bile Acid Synthesis / Malabsorption

- sx

A
  • sudden onset, high volume, nocturnal diarrhea

- yellow discoloration of stool

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16
Q

Impaired Bile Acid Synthesis / Malabsorption

- pathophysiology

A
  • inadequate ileal reabsorption of bile acid

- excess bile acid reach colon leads to secretory diarrhea

17
Q

What percentage decrease of bile acid reabsorption must occur in the ileum to produce sx of Impaired Bile Acid Synthesis / Malabsorption??

A

5% decrease or less than 95% normal absorption

18
Q

Impaired Bile Acid Synthesis / Malabsorption

- what happens when bile acids reach colon

A
  • increases gut permeability
  • activates adenylate cyclase
  • stimulates colonic secretion
  • increases stool water and colonic motility
19
Q

Impaired Bile Acid Synthesis / Malabsorption

- feedback loop

A
  • decreased circulating fibroblast growth factor 19 (FGF19) leads to excessive bile acid synthesis
  • loss of feedback inhibition
  • last thing pt needs is MORE bile acids
20
Q

Impaired Bile Acid Synthesis / Malabsorption

- what condition can precede

A
  • acute ileitis
  • Salmonella spp. or C. jejuni gastroenteritis
  • “an insult” to the ileum
21
Q

Impaired Bile Acid Synthesis / Malabsorption

- what sx does it commonly follow

A
  • cholecystectomy
  • liver dumps bile acids into digestive tract, can send more than ileum is able to reabsorb
  • body will often adjust over time and sx will stop
22
Q

Impaired Bile Acid Synthesis / Malabsorption

- treatment

A
  • Bile salt-binding sequestrants (cholestyramine, colestipol, colesevelam)
23
Q

Impaired Bile Acid Synthesis / Malabsorption

- bile salt-binding sequestrant effects on sx

A

Decrease diarrhea caused by excess fecal bile acids

24
Q

Impaired Bile Acid Synthesis / Malabsorption

- how to take bile salt-binding sequestrant

A
  • 1-3 times before meals

- do not take cholestyramine and colestipol with other drugs, take at least 2 hours before/after

25
Q

Impaired Bile Acid Synthesis / Malabsorption

- bile salt-binding sequestrant ADR

A
  • bloating
  • flatulence
  • constipation
  • fecal impaction
26
Q

Lactose intolerance

- list three types

A
  1. Primary Lactase deficiency
  2. secondary lactase deficiency
  3. Acquired lactase deficiency
27
Q

Primary lactase deficiency

A
  • very rare
  • inherited deficiency/absence of lactase
  • autosomal recessive
  • babies require special formula with diff sugar such as sucrose
28
Q

Secondary lactase deficiency

A
  • temporary, often caused by infection
  • ex. Rotavirus and Giardia, Celiac and Crohn’s
  • damage to small intestine lining
  • Tx of infection heals lining
  • LTI resolves within 3-4 weeks
29
Q

Acquired lactase deficiency

A
  • very common
  • 50% US adults
  • normal decline in lactase as age
30
Q

Lactose intolerance

- etiology

A
  • lactose is not digested in SI and passes whole into colon
  • colon bacteria digest lactose
  • bacteria produce CO2, H+ gases
31
Q

Lactose intolerance

- sx

A
  • abd distention and pain
  • excess burping
  • loud bowel sounds
  • gas and diarrhea following ingestion lactose
  • watery, explosive BM
  • stool urgency
32
Q

Lactose Intolerance

- dx

A
  • H+ breath test (if need to prove, most pts know they have it… and don’t want to ingest equivalent of a quart of milk!!)
  • pt can’t tolerate breath test, treat for 2-4 weeks and reassess
33
Q

Leaky gut syndrome

A
  • limited EBM
  • intestinal inflammation = disruption gut barrier
  • major determinant of rate of permeability is opening/closure of tight junctions between enterocytes
34
Q

Leaky gut syndrome

- causes of inflammation

A
  • parasites
  • candida overgrowth
  • other pathogens
  • NSAIDS
  • alcohol
  • aspirin
  • foods containing lectins punch holes in cell membranes
35
Q

Leaky gut syndrome

  • common co-morbidity
  • genetics
A
  • increased permeability in most Crohn’s dz pts (worse if also take ASA)
  • also seen in 10-20% of Crohn’s dz patients healthy relatives
36
Q

Leaky gut syndrome

- two other (not Crohn’s) co-morbidities

A
  • celiac
  • NSAIDs

*not sure if it is people who have celiac and take NSAIDS or if it is celiac dz and NSAID use…

37
Q

Celiac Dz

- overview

A
  • gluten-sensitive enteropathy
  • aka Celiac Sprue
  • intolerance to gluten (wheat, rye, barley, other grain)
  • injures/inflames mucosa

GI 1 (16 decks)

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