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Management of GI and Endocrine Conditions > Lecture 13 - Malabsorption Conditions > Flashcards

Lecture 13 - Malabsorption Conditions Flashcards

1
Q

What is malabsorption?

A

Inadequate absorption of nutrients from the GI tract

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2
Q

Where does most absorption happen?

A

through the small intestine

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3
Q

What happens when food gets to the stomach?

A

it is mixed and digestive processes start

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4
Q

What happens once food reaches the duodenum?

A

more digestive enzymes are added, the food is broken down and absorbed into the body in the small intestine

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5
Q

What are macronutrients?

A

main food groups

carbohydrate, fat, protein

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6
Q

What are micronutrients?

A

key to our general health and wellbeing

vitamins and minerals

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7
Q

What are the types of malabsorption?

A

acute vs chronic

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8
Q

What are examples of mucosal (absorption) problems?

A

Crohn’s disease

coeliac

surgery

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9
Q

What is mucosal absorption deficiencies?

A

where the mucosa within the small intestine isn’t working properly

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10
Q

What are pre-mucosal issues related to?

A

digestion and digestive tissues

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11
Q

What are examples of pre-mucosal (digestion) problems?

A

pancreatitis

cystic fibrosis

lactase deficiency

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12
Q

What is pancreatitis?

A

the pancreas is not producing enough pancreatic enzymes added in the duodenum

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13
Q

What does lactase deficiency effect?

A

the ability to break down lactose and other carbohydrates

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14
Q

What effect do Crohn’s and coeliac have?

A

Mucosal

abnormal epithelium (epithelial cells do not develop properly) = deficient absorption

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15
Q

What effect do surgical resection, bypass and congenital abnormality have?

A

Mucosal

shorter bowel means less surface area for absorption, can be temporary or permanent

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16
Q

What effect do cystic fibrosis and pancreatitis have?

A

Pre-mucosal

insufficient digestive agents, so food is not broken down allowing it to be absorbed

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17
Q

What is small intestinal bacteria overgrowth?

A

Both

damage to mucosa +/- bile salts metabolised by bacteria

affects mucosal ability to absorb food

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18
Q

What does crohn’s disease cause?

A

malabsorption linked to inflammation (+/- surgical resection)

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19
Q

Consequences of Crohn’s disease?

A

iron deficiency anaemia

B12/folate deficiency

vitamin D and calcium deficiency (osteoporosis/osteomalacia)

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20
Q

What does steroid use in IBD effect?

A

bones

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21
Q

What can vitamin D and calcium deficiency affect?

A

bone development and lead to osteoporosis or rickets in children

can be treated with supplementation

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22
Q

What is coeliac disease?

A

mucosal

an autoimmune condition, gluten activates an abnormal mucosal response which causes chronic inflammation and damage - villous atrophy

this causes poor absorption of food

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23
Q

Symptoms of coeliac?

A

fatigue, GI symptoms, weight loss

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24
Q

how is coeliac diagnosed?

A

via serological testing

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25
Q

Common complications of coeliac?

A

anaemia, osteoporosis (vit D&calcium)

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26
Q

Treatment of coeliac?

A

elimination of gluten from the diet

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27
Q

What is short bowel syndome?

A

MUCOSAL

usually secondary to surgery. can be congenital

removing a chunk of the small intestine, affects the ability to absorb food

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28
Q

What might short bowel syndrome require?

A

parenteral nutrition, depending on how much has been removed

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29
Q

Complications of short bowel syndrome?

A

osteoporosis and vitamin deficiencies

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30
Q

How can the vitamin deficiencies and osteoporosis be treated?

A

supplementation of calcium +/- vitamins and minerals

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31
Q

What do we need to be aware of in short bowel syndrome?

A

medications absorbed in the small intestine e.g. levothyroxine, warfarin, oral contraceptives, digoxin

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32
Q

What may be required with medications absorbed in the small intestine?

A

higher doses

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33
Q

How is parenteral nutrition administered in patients with short bowel syndrome?

A

through a tube via their blood vessels

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34
Q

What is chronic pancreatitis?

A

PRE-MUCOSAL

chronic inflammation leads to impaired function, lack of pancreatic digestive enzymes so food is not broken down properly

35
Q

Who does chronic pancreatitis affect more?

A

men more than women

36
Q

What is chronic pancreatitis associated with?

A

long term alcohol consumption

37
Q

How is chronic pancreatitis diagnosed?

A

tests include faecal elastase (available tests only confirm severe pancreatic insufficiency)

also test for fat soluble vitamin deficiencies

38
Q

What is cystic fibrosis?

A

it is inherited

decreased chloride secretion so increased sodium absorption = thick mucus in the lining

39
Q

What does cystic fibrosis affect?

A

pancreatic function and causes pancreatic insufficiency in ~85% of patients

40
Q

What does cystic fibrosis cause?

A

steatorrhoea (faeces and yellow and floaty)

osteoporosis - multi factorial

malnutrition (from poor absorption of nutrients)

weight loss

41
Q

What is the treatment for cystic fibrosis?

A

pancreatic enzyme supplementation, fat soluble vitamin supplementation, calorie replacement

42
Q

What else do we check for in cystic fibrosis?

A

intestinal obstruction

43
Q

What is lactase deficiency?

A

PRE-MUCOSAL

primary, secondary or congenital or developmental

44
Q

Treatment for lactase deficiency?

A

reduce or eliminate dietary lactose intake

45
Q

What may be required in patients with lactase deficiency?

A

alternative calcium source due to reduced intake of dairy

46
Q

Why is lactase deficiency tested for in babies?

A

it is frequently missed and can cause severe repercussions e.g. brain and development issues

47
Q

What does bacterial overgrowth affect?

A

both mucosal and digestive processes

48
Q

When does bacterial overgrowth incidence increaase?

A

with age

49
Q

What is bacterial overgrowth affected by?

A

chronic pancreatitis and motility disorders

50
Q

What can impaired motility be caused by?

A

diabetes, radiation enteritis, drugs, post surgery (loops)

51
Q

What else can affect bacterial overgrowth?

A

reduced gastric acid - atrophic gastritis, drugs

52
Q

What is fat malabsorption?

A

problem with digestion (insufficient enzymes, bile) or absorption

53
Q

When is malabsorption more common?

A

in coeliac, crohn’s disease

54
Q

What does fat malabsorption cause?

A

deficiencies of fat soluble vitamins (A,D,E,K)

55
Q

What are fat soluble vitamins necessary for?

A

a variety of bodily functions and need to be absorbed in the fats we take in

56
Q

What is a symptom of fat malabsorption?

A

steatorrhoea - excess fat is lost in the stools, making them float and appear pale and bulky and smell offensive

57
Q

What does poor fat absorption affect?

A

the absorption of vitamins A,D,E,K

58
Q

What can vitamin malabsorption cause?

A

vitamin D deficiences such as osteomalacia (rickets), osteoporosis

59
Q

What does a lack of vitamin D cause?

A

bone matrix does not form properly, bones are thinner, brittle and more likely to break

60
Q

What does a lack of vitamin K cause?

A

clotting problems, makes you more prone to bleeding

61
Q

Treatment options for carb, protein and fat malabsorption?

A

supplementation of pancreatic enzymes - lipase, amylase and protease (Creon)

in pancreatitis, CF where there are deficiencies of pancreatic enzymes

62
Q

What does supplementation of pancreatic enzymes cause?

A

reduces steatorrhoea, boosts nutritional status by allowing food to be broken down and absorbed

63
Q

What does creon capsules cause?

A

local irritation

64
Q

When should creon capsules be taken?

A

during or just after a meal

65
Q

Strengths of creon capsules?

A

10,000 units and 25,000 units

66
Q

What is important about creon capsules?

A

they are derived from pork - religious issues and allergies

67
Q

What causes iron malabsorption?

A

impaired absorption - mucosal absorption is not working properly and iron isn’t absorbed

68
Q

When is iron deficiency anaemia commonly seen?

A

in patients with coeliac, crohn’s, small bowel resection

69
Q

When is there a potential blood loss?

A

in crohn’s and ulcerative colitis

70
Q

Treatment of iron malabsorption?

A

oral iron replacement

71
Q

Why is oral iron replacement problematic?

A

absorbing iron can be difficult, it reaches a plateau and it doesnt matter how much you take over and above this but can get complications from too much iron

72
Q

When was the gluten free foods service introduced?

A

in scotland in 2014/15

73
Q

who gets the gluten free food service?

A

patients with a diagnosis of coeliac or dermatitis herpetiformis

74
Q

How many units per months of gluten free food can a patient get?

A

~14

it is providing basic food without providing luxuries

75
Q

What else needs to be considered with intolerances?

A

lactose and gluten in medicines

76
Q

What is an issue with malabsorption?

A

need to consider where drug will be absorbed

77
Q

How is gluten found in medicines?

A

as wheat starch used as a bulking agent

78
Q

sign of fat malabsorption?

A

steatorrhoea

79
Q

sign of protein malabsorption?

A

muscle wasting, malnutrition, oedema

80
Q

sign of carb malabsorption?

A

bloating, flatulence, diarrhoea

81
Q

sign of vit D/calcium malabsorption?

A

bone problems

82
Q

Vit E malabsorption?

A

neurological problems

83
Q

Vit K malabsorption?

A

coagulation (bleeding) problems

84
Q

Vit A malabsorption?

A

night blindness

Management of GI and Endocrine Conditions (24 decks)

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