Intestinal Malabsorption

Question 1

def. of maldigestion

Answer 1

impaired breakdown

Question 2

example of maldigestion

Answer 2

pancreatic insufficiency

Question 3

def. of malabsorption

Answer 3

defective mucosal uptake and transport of adequately digested nutrients

Question 4

malabsorption and maldigestion =

Answer 4

malassimilation

Question 5

presentation of malabsorption/maldigestion

Answer 5

weight loss
bloating
diarrhoea
cramps
lethargy
malaise
distention
borborygymi

Question 6

what is borborygmi

Answer 6

excessive noise in abdomen

Question 7

what is the presentation of malabsorption syndrome

Answer 7

steatorrhoea
distension
weight loss
oedema

a rare presentation

Question 8

whta is steatorrhoea and features of it

Answer 8

fatty stool
floats in toilet
malodourous and pale

Question 9

past medical history clues linked to malabsorption

Answer 9

metabolic bone disease
GI surgery
pancreatitis
cystic fibrosis
alcohol
coeliac in family

Question 10

what skin condition is linked to coeliac

Answer 10

dermatitis herpetiformis

Question 11

deficiency of what vitamin causes neurological symptoms

Answer 11

B12

Question 12

most common causes of malabsorption

Answer 12

coeliac
small intestinal bacterial overgrowth (SIBO)
pancreatic insufficiency

Question 13

lab signs of malabsorption

Answer 13

macrocytosis
microcytosis
hypoalbuminaemia
vitamin deficiencies
high ALP
low Ca2+

Question 14

investigation of malabsorption - first step

Answer 14

investigation coeliac, pancreatic insuffiency and SIBO first

Question 15

what test is used to find coeliac

Answer 15

TTG

Question 16

what test is used to find pancreatic insufficiency

Answer 16

faecal elastase

Question 17

what test is used for SIBO

Answer 17

glucose H2 breath test

Question 18

general malabsorption tests

Answer 18

stool microbiology
biopsy
CT
breath tests
MRI

Question 19

definiton of coeliac

Answer 19

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

Question 20

coeliac disease signs on investigation

Answer 20

anaemia
iron deficiency
low Ca
hypoalbuminaemia

Question 21

diseases associated with coeliac

Answer 21

infertility
dermatitis herpetiformis
colitis
jejeunitis
osteoporosis
autoimmune diseases

Question 22

diagnosis of coeliac

Answer 22

TTG
small intestine biopsy

Question 23

digestion of what tends to suffer first in pancreatic insufficiency

Answer 23

fat

Question 24

what extent of pancreatic insufficiency is needed before symptoms are apparent

Answer 24

90% loss

Question 25

symptoms of PEI

Answer 25

steatorrhoea (because fat not broken down)
weight loss
vitamin deficiecny

Question 26

gene mutation in cystic fibrosis

Answer 26

autosomal recessive
CFTR gene

Question 27

what dysfunctions in cystic fibrosis

Answer 27

impaired bicarbonate and chloride secretion so mucus is too thick

Question 28

risk factors of PEI

Answer 28

alcohol
cystic fibrosis

Question 29

diagnosis of PEI

Answer 29

symptoms
CT or MRI of pancreas
faecal elastase

secretin stimulation tests (rarely used but more sensitive)

Question 30

PEI treatment

Answer 30

pancreatic enzyme replacement
gastric acid suppresion
vitamin supplements

Question 31

causes of bacterial overgrowth in SIBO

Answer 31

crohn’s
TB
old age
opiates
diabetes
systemic sclerosis
operations causing blind loops (e.g. old form of bariatric surgery)
immunosuppression

Question 32

consequences of bacterial overgrowth

Answer 32

B12 malabsorption
bile acid deconjugation
ulceration
damage to epithelium
protein use by bacteria

Question 33

diagnois of SIBO

Answer 33

quantitative culture of jejunal fluid (good but cumbersome)
glucose hydrogen breath test
small bowel radiology to check for abnormalities

Question 34

how does the glucose hydrogen breath test work

Answer 34

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

Question 35

SIBO treatment

Answer 35

2 weeks of antibiotics
may need repeated

Question 36

where are bile acids reabsorbed

Answer 36

ileum

Question 37

if bile isn’t resorbed what is caused

Answer 37

secretory diarrhoea

Question 38

cause of bile acid malabsorption

Answer 38

ileal disease
ileal resection
rapid transit
other malabsorption problems
post-cholecystectomy

Question 39

bile acid malabsorption not due to lack of reabsorption could be due to

Answer 39

overproduction

Question 40

what is type 1 BAM

Answer 40

ileal disease or resection

Question 41

what is type 2 BAM

Answer 41

idiopathic

Question 42

what is type 3 BAM

Answer 42

associated with cholecystectomy
rapid transit
coeliac
SIBO
chronic pancreatitis

Question 43

BAM investigation

Answer 43

serum 7-alpha cholestenone
SeHCAT retention

Question 44

BAM treatment

Answer 44

cholestyramine
colesevelam

Question 45

what is the most common pathogen cause of malabsorption

Answer 45

giardia lamblia

Question 46

what is whipple’s disease

Answer 46

uncommon bacterial infection in older men

Question 47

presentation of whipple’s

Answer 47

diarrhoea
arthritis
fever
cough
headache
muscle weakness

Question 48

treatment of whipples

Answer 48

month to years of antibiotics