Gastro - malabsorption Flashcards
What is malabsorption?
Disorders leading to abnormal digestion or absorption of nutrients or fluids in the intestines
NICE symptoms suggestive of possible coeliac disease? Who else should be offered serological testing?
Persistent, unexplained GI/abdo symptoms Faltering growth Prolonged fatigue Unexpected weight loss Severe/persistent mouth ulcers Unexplained Iron, Vit B12, or folate deficiency
Relatives of patients with these should get tested for coeliac:
T1DM, autoimmune thyroiditis, IBS, Down’s, Turner syndrome and relatives of patients with coeliac disease.
Infants who are not eating gluten yet should not be tested!
Which serological tests are used for diagnosing coeliac disease?
Total IgA and IgA tissue Transglumatinase (tTG) is first choice.
IgA endomysial antibodies if IgA tTG weakly positive.
Only a biopsy is diagnostic, however. (flat mucosa on jejunal biopsy)
Resolution of symptoms and catch-up growth upon gluten withdrawwal
Which factors are measured during the recommended annual coeliac review?
Weight and height
Symptoms
Consider diet and adherence to gluten free and specialist dietetic advise
What is the general diet advise in coeliac disease?
Gluten free diet
Possible supplements, especially Vit D and Calcium for bones
What is the next step, if symptoms such as diarrhoea, stomach pain, weight loss, fatigue and anaemia do not resolve 1 year after starting gluten-free diet?
May be referred for a small intestinal biopsy
Classic and atypical presentation of Coeliac disease
Classic:
8-24 months with abnormal stools, FTT, abdominal distension, muscle wasting and irritability
Other:
Short stature Anaemia
Screening
(eg children with DM)
Who should receive testing for coeliac disease
First-degree relative has coeliac
Unexplained abdo symptoms Flatering growth Prolonged fatigue Severe or persistent mouth ulcers Unexplained iron, vit B12 or folate deficiency T1DM (offer test at diagnosis) Autoimmune thyroiditis (offer testing at diagnosis) IBS (adults ONLY)
Symptoms of food allergy/intolerance
IgE mediated:
History of allergic symptoms (urticarial to facial swelling to anaphylaxis). Usually 10-15 minutes after food ingestion.
Non-IgE mediated (food INTOLERANCE techniqually):
Usually hours after ingestion.
diarrhoea, vomiting, abdo pain, sometimes FTT
Colic or eczema
Blood in stool may be present if first few weeks
Risk factors for food allergy
FH (asthma, eczema, hives, hay fever and allergies)
Past food allergy
Other allergies to food or hayfever, asthma, eczema
Age (toddlers and infants most common). Severe allergies and allergise to nuts and shellfish are more likely to be lifelong
Type 1 hypersensitivity reactions in food intolerance: presentation and management
IgE mediated
Urticaria and itchy skin Facial swelling Wheeze Stridor Abdo pain D/V Shock/collapse
Written self-management plan.
Mild - anti-histamines
Severe - adrenaline iv (Epipen)
Type 2 hypersensitivity reactions in food intolerance: presentation and management
Non-IgE mediated
Neutrophils bind to innocuous substances and release lytic enzyme that cause tissue damage… LONGER TERM
D +V
Abdo pain
Colic
FTT
Avoid relevant food
Advice of paeds dietician is essential
Intraluminal digestive tract causes of malabsorption
Carbohydrate intolerance (eg. lactose) Protein-energy malnutrition CF Chronic pancreatitis Pernicious anaemia Specific digestive enzyme deficieny (eg. lipase)
Mucosal abnormality causes of malabsorption
Coeliac disease
Dietary protein intolerance (eg. cows milk)
Parasites (giardia)
IBD
First line investigations for malabsorption
FBC U and E Creatinine Albumin Total protein Ca Phosphate LFTs Iron status Coeliac antibody Coagulation screen Stool MC
Further tests, if unclear: Sweat test Faecal fat measurement Faecal alpha1antitrypsin Exocrine pancreatic function tests Upper GI endoscopy with biopsy for enteropathy
