Intestinal Malabsorption Flashcards
def. of maldigestion
impaired breakdown
example of maldigestion
pancreatic insufficiency
def. of malabsorption
defective mucosal uptake and transport of adequately digested nutrients
malabsorption and maldigestion =
malassimilation
presentation of malabsorption/maldigestion
weight loss
bloating
diarrhoea
cramps
lethargy
malaise
distention
borborygymi
what is borborygmi
excessive noise in abdomen
what is the presentation of malabsorption syndrome
steatorrhoea
distension
weight loss
oedema
a rare presentation
whta is steatorrhoea and features of it
fatty stool
floats in toilet
malodourous and pale
past medical history clues linked to malabsorption
metabolic bone disease
GI surgery
pancreatitis
cystic fibrosis
alcohol
coeliac in family
what skin condition is linked to coeliac
dermatitis herpetiformis
deficiency of what vitamin causes neurological symptoms
B12
most common causes of malabsorption
coeliac
small intestinal bacterial overgrowth (SIBO)
pancreatic insufficiency
lab signs of malabsorption
macrocytosis
microcytosis
hypoalbuminaemia
vitamin deficiencies
high ALP
low Ca2+
investigation of malabsorption - first step
investigation coeliac, pancreatic insuffiency and SIBO first
what test is used to find coeliac
TTG
what test is used to find pancreatic insufficiency
faecal elastase
what test is used for SIBO
glucose H2 breath test
general malabsorption tests
stool microbiology
biopsy
CT
breath tests
MRI
definiton of coeliac
small bowel disorder characterised by
1. mucosal inflammation
2. vilious atrophy
3. crypt hyperplasia
which occur upon exposure to dietary gluten and which demonstrate imporvement after withdrawal of gluten from the diet
coeliac disease signs on investigation
anaemia
iron deficiency
low Ca
hypoalbuminaemia
diseases associated with coeliac
infertility
dermatitis herpetiformis
colitis
jejeunitis
osteoporosis
autoimmune diseases
diagnosis of coeliac
TTG
small intestine biopsy
digestion of what tends to suffer first in pancreatic insufficiency
fat
what extent of pancreatic insufficiency is needed before symptoms are apparent
90% loss
symptoms of PEI
steatorrhoea (because fat not broken down)
weight loss
vitamin deficiecny
gene mutation in cystic fibrosis
autosomal recessive
CFTR gene
what dysfunctions in cystic fibrosis
impaired bicarbonate and chloride secretion so mucus is too thick
risk factors of PEI
alcohol
cystic fibrosis
diagnosis of PEI
symptoms
CT or MRI of pancreas
faecal elastase
secretin stimulation tests (rarely used but more sensitive)
PEI treatment
pancreatic enzyme replacement
gastric acid suppresion
vitamin supplements
causes of bacterial overgrowth in SIBO
crohn’s
TB
old age
opiates
diabetes
systemic sclerosis
operations causing blind loops (e.g. old form of bariatric surgery)
immunosuppression
consequences of bacterial overgrowth
B12 malabsorption
bile acid deconjugation
ulceration
damage to epithelium
protein use by bacteria
diagnois of SIBO
quantitative culture of jejunal fluid (good but cumbersome)
glucose hydrogen breath test
small bowel radiology to check for abnormalities
how does the glucose hydrogen breath test work
human cells don’t usually make hydrogen
but colon bacteria do
so when given glucose bacteria will metabolise it and form H+ which can be detected on breath
SIBO treatment
2 weeks of antibiotics
may need repeated
where are bile acids reabsorbed
ileum
if bile isn’t resorbed what is caused
secretory diarrhoea
cause of bile acid malabsorption
ileal disease
ileal resection
rapid transit
other malabsorption problems
post-cholecystectomy
bile acid malabsorption not due to lack of reabsorption could be due to
overproduction
what is type 1 BAM
ileal disease or resection
what is type 2 BAM
idiopathic
what is type 3 BAM
associated with cholecystectomy
rapid transit
coeliac
SIBO
chronic pancreatitis
BAM investigation
serum 7-alpha cholestenone
SeHCAT retention
BAM treatment
cholestyramine
colesevelam
what is the most common pathogen cause of malabsorption
giardia lamblia
what is whipple’s disease
uncommon bacterial infection in older men
presentation of whipple’s
diarrhoea
arthritis
fever
cough
headache
muscle weakness
treatment of whipples
month to years of antibiotics
