Lecture 13 - Malabsorption Conditions

Question 1

What is malabsorption?

Answer 1

Inadequate absorption of nutrients from the GI tract

Question 2

Where does most absorption happen?

Answer 2

through the small intestine

Question 3

What happens when food gets to the stomach?

Answer 3

it is mixed and digestive processes start

Question 4

What happens once food reaches the duodenum?

Answer 4

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

Question 5

What are macronutrients?

Answer 5

main food groups

carbohydrate, fat, protein

Question 6

What are micronutrients?

Answer 6

key to our general health and wellbeing

vitamins and minerals

Question 7

What are the types of malabsorption?

Answer 7

acute vs chronic

Question 8

What are examples of mucosal (absorption) problems?

Answer 8

Crohn’s disease

coeliac

surgery

Question 9

What is mucosal absorption deficiencies?

Answer 9

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

Question 10

What are pre-mucosal issues related to?

Answer 10

digestion and digestive tissues

Question 11

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

Answer 11

pancreatitis

cystic fibrosis

lactase deficiency

Question 12

What is pancreatitis?

Answer 12

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

Question 13

What does lactase deficiency effect?

Answer 13

the ability to break down lactose and other carbohydrates

Question 14

What effect do Crohn’s and coeliac have?

Answer 14

Mucosal

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

Question 15

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

Answer 15

Mucosal

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

Question 16

What effect do cystic fibrosis and pancreatitis have?

Answer 16

Pre-mucosal

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

Question 17

What is small intestinal bacteria overgrowth?

Answer 17

Both

damage to mucosa +/- bile salts metabolised by bacteria

affects mucosal ability to absorb food

Question 18

What does crohn’s disease cause?

Answer 18

malabsorption linked to inflammation (+/- surgical resection)

Question 19

Consequences of Crohn’s disease?

Answer 19

iron deficiency anaemia

B12/folate deficiency

vitamin D and calcium deficiency (osteoporosis/osteomalacia)

Question 20

What does steroid use in IBD effect?

Answer 20

bones

Question 21

What can vitamin D and calcium deficiency affect?

Answer 21

bone development and lead to osteoporosis or rickets in children

can be treated with supplementation

Question 22

What is coeliac disease?

Answer 22

mucosal

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

this causes poor absorption of food

Question 23

Symptoms of coeliac?

Answer 23

fatigue, GI symptoms, weight loss

Question 24

how is coeliac diagnosed?

Answer 24

via serological testing

Question 25

Common complications of coeliac?

Answer 25

anaemia, osteoporosis (vit D&calcium)

Question 26

Treatment of coeliac?

Answer 26

elimination of gluten from the diet

Question 27

What is short bowel syndome?

Answer 27

MUCOSAL usually secondary to surgery. can be congenital removing a chunk of the small intestine, affects the ability to absorb food

Question 28

What might short bowel syndrome require?

Answer 28

parenteral nutrition, depending on how much has been removed

Question 29

Complications of short bowel syndrome?

Answer 29

osteoporosis and vitamin deficiencies

Question 30

How can the vitamin deficiencies and osteoporosis be treated?

Answer 30

supplementation of calcium +/- vitamins and minerals

Question 31

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

Answer 31

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

Question 32

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

Answer 32

higher doses

Question 33

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

Answer 33

through a tube via their blood vessels

Question 34

What is chronic pancreatitis?

Answer 34

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

Question 35

Who does chronic pancreatitis affect more?

Answer 35

men more than women

Question 36

What is chronic pancreatitis associated with?

Answer 36

long term alcohol consumption

Question 37

How is chronic pancreatitis diagnosed?

Answer 37

tests include faecal elastase (available tests only confirm severe pancreatic insufficiency) also test for fat soluble vitamin deficiencies

Question 38

What is cystic fibrosis?

Answer 38

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

Question 39

What does cystic fibrosis affect?

Answer 39

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

Question 40

What does cystic fibrosis cause?

Answer 40

steatorrhoea (faeces and yellow and floaty) osteoporosis - multi factorial malnutrition (from poor absorption of nutrients) weight loss

Question 41

What is the treatment for cystic fibrosis?

Answer 41

pancreatic enzyme supplementation, fat soluble vitamin supplementation, calorie replacement

Question 42

What else do we check for in cystic fibrosis?

Answer 42

intestinal obstruction

Question 43

What is lactase deficiency?

Answer 43

PRE-MUCOSAL primary, secondary or congenital or developmental

Question 44

Treatment for lactase deficiency?

Answer 44

reduce or eliminate dietary lactose intake

Question 45

What may be required in patients with lactase deficiency?

Answer 45

alternative calcium source due to reduced intake of dairy

Question 46

Why is lactase deficiency tested for in babies?

Answer 46

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

Question 47

What does bacterial overgrowth affect?

Answer 47

both mucosal and digestive processes

Question 48

When does bacterial overgrowth incidence increaase?

Answer 48

with age

Question 49

What is bacterial overgrowth affected by?

Answer 49

chronic pancreatitis and motility disorders

Question 50

What can impaired motility be caused by?

Answer 50

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

Question 51

What else can affect bacterial overgrowth?

Answer 51

reduced gastric acid - atrophic gastritis, drugs

Question 52

What is fat malabsorption?

Answer 52

problem with digestion (insufficient enzymes, bile) or absorption

Question 53

When is malabsorption more common?

Answer 53

in coeliac, crohn's disease

Question 54

What does fat malabsorption cause?

Answer 54

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

Question 55

What are fat soluble vitamins necessary for?

Answer 55

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

Question 56

What is a symptom of fat malabsorption?

Answer 56

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

Question 57

What does poor fat absorption affect?

Answer 57

the absorption of vitamins A,D,E,K

Question 58

What can vitamin malabsorption cause?

Answer 58

vitamin D deficiences such as osteomalacia (rickets), osteoporosis

Question 59

What does a lack of vitamin D cause?

Answer 59

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

Question 60

What does a lack of vitamin K cause?

Answer 60

clotting problems, makes you more prone to bleeding

Question 61

Treatment options for carb, protein and fat malabsorption?

Answer 61

supplementation of pancreatic enzymes - lipase, amylase and protease (Creon) in pancreatitis, CF where there are deficiencies of pancreatic enzymes

Question 62

What does supplementation of pancreatic enzymes cause?

Answer 62

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

Question 63

What does creon capsules cause?

Answer 63

local irritation

Question 64

When should creon capsules be taken?

Answer 64

during or just after a meal

Question 65

Strengths of creon capsules?

Answer 65

10,000 units and 25,000 units

Question 66

What is important about creon capsules?

Answer 66

they are derived from pork - religious issues and allergies

Question 67

What causes iron malabsorption?

Answer 67

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

Question 68

When is iron deficiency anaemia commonly seen?

Answer 68

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

Question 69

When is there a potential blood loss?

Answer 69

in crohn's and ulcerative colitis

Question 70

Treatment of iron malabsorption?

Answer 70

oral iron replacement

Question 71

Why is oral iron replacement problematic?

Answer 71

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

Question 72

When was the gluten free foods service introduced?

Answer 72

in scotland in 2014/15

Question 73

who gets the gluten free food service?

Answer 73

patients with a diagnosis of coeliac or dermatitis herpetiformis

Question 74

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

Answer 74

~14 it is providing basic food without providing luxuries

Question 75

What else needs to be considered with intolerances?

Answer 75

lactose and gluten in medicines

Question 76

What is an issue with malabsorption?

Answer 76

need to consider where drug will be absorbed

Question 77

How is gluten found in medicines?

Answer 77

as wheat starch used as a bulking agent

Question 78

sign of fat malabsorption?

Answer 78

steatorrhoea

Question 79

sign of protein malabsorption?

Answer 79

muscle wasting, malnutrition, oedema

Question 80

sign of carb malabsorption?

Answer 80

bloating, flatulence, diarrhoea

Question 81

sign of vit D/calcium malabsorption?

Answer 81

bone problems

Question 82

Vit E malabsorption?

Answer 82

neurological problems

Question 83

Vit K malabsorption?

Answer 83

coagulation (bleeding) problems

Question 84

Vit A malabsorption?

Answer 84

night blindness