Intestinal Malabsorption Flashcards

1
Q

def. of maldigestion

A

impaired breakdown

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2
Q

example of maldigestion

A

pancreatic insufficiency

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3
Q

def. of malabsorption

A

defective mucosal uptake and transport of adequately digested nutrients

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4
Q

malabsorption and maldigestion =

A

malassimilation

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5
Q

presentation of malabsorption/maldigestion

A

weight loss
bloating
diarrhoea
cramps
lethargy
malaise
distention
borborygymi

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6
Q

what is borborygmi

A

excessive noise in abdomen

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7
Q

what is the presentation of malabsorption syndrome

A

steatorrhoea
distension
weight loss
oedema

a rare presentation

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8
Q

whta is steatorrhoea and features of it

A

fatty stool
floats in toilet
malodourous and pale

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9
Q

past medical history clues linked to malabsorption

A

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

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10
Q

what skin condition is linked to coeliac

A

dermatitis herpetiformis

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11
Q

deficiency of what vitamin causes neurological symptoms

A

B12

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12
Q

most common causes of malabsorption

A

coeliac
small intestinal bacterial overgrowth (SIBO)
pancreatic insufficiency

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13
Q

lab signs of malabsorption

A

macrocytosis
microcytosis
hypoalbuminaemia
vitamin deficiencies
high ALP
low Ca2+

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14
Q

investigation of malabsorption - first step

A

investigation coeliac, pancreatic insuffiency and SIBO first

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15
Q

what test is used to find coeliac

A

TTG

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16
Q

what test is used to find pancreatic insufficiency

A

faecal elastase

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17
Q

what test is used for SIBO

A

glucose H2 breath test

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18
Q

general malabsorption tests

A

stool microbiology
biopsy
CT
breath tests
MRI

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19
Q

definiton of coeliac

A

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

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20
Q

coeliac disease signs on investigation

A

anaemia
iron deficiency
low Ca
hypoalbuminaemia

21
Q

diseases associated with coeliac

A

infertility
dermatitis herpetiformis
colitis
jejeunitis
osteoporosis
autoimmune diseases

22
Q

diagnosis of coeliac

A

TTG
small intestine biopsy

23
Q

digestion of what tends to suffer first in pancreatic insufficiency

24
Q

what extent of pancreatic insufficiency is needed before symptoms are apparent

25
symptoms of PEI
steatorrhoea (because fat not broken down) weight loss vitamin deficiecny
26
gene mutation in cystic fibrosis
autosomal recessive CFTR gene
27
what dysfunctions in cystic fibrosis
impaired bicarbonate and chloride secretion so mucus is too thick
28
risk factors of PEI
alcohol cystic fibrosis
29
diagnosis of PEI
symptoms CT or MRI of pancreas faecal elastase secretin stimulation tests (rarely used but more sensitive)
30
PEI treatment
pancreatic enzyme replacement gastric acid suppresion vitamin supplements
31
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
32
consequences of bacterial overgrowth
B12 malabsorption bile acid deconjugation ulceration damage to epithelium protein use by bacteria
33
diagnois of SIBO
quantitative culture of jejunal fluid (good but cumbersome) glucose hydrogen breath test small bowel radiology to check for abnormalities
34
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
35
SIBO treatment
2 weeks of antibiotics may need repeated
36
where are bile acids reabsorbed
ileum
37
if bile isn't resorbed what is caused
secretory diarrhoea
38
cause of bile acid malabsorption
ileal disease ileal resection rapid transit other malabsorption problems post-cholecystectomy
39
bile acid malabsorption not due to lack of reabsorption could be due to
overproduction
40
what is type 1 BAM
ileal disease or resection
41
what is type 2 BAM
idiopathic
42
what is type 3 BAM
associated with cholecystectomy rapid transit coeliac SIBO chronic pancreatitis
43
BAM investigation
serum 7-alpha cholestenone SeHCAT retention
44
BAM treatment
cholestyramine colesevelam
45
what is the most common pathogen cause of malabsorption
giardia lamblia
46
what is whipple's disease
uncommon bacterial infection in older men
47
presentation of whipple's
diarrhoea arthritis fever cough headache muscle weakness
48
treatment of whipples
month to years of antibiotics