Malabsoprtion

Question 1

What are some hematopoietic signs of malabsorption?

Answer 1

Anemia, bleeding

Question 2

What are some endocrine signs of malabsorpion?

Answer 2

Amenorrhea, impotence, secondary hyperthyroidism

Question 3

What are some derm sings of malabsorption?

Answer 3

Purpura, edema, hyperpigmentation

Question 4

How is Fat malabsorption diagnosed?

Answer 4

1. During a 72 hour fecal fat collection, an average greater of 6 grams of fat per 24 is abnormal
2. Abdominal xray or CT scan to see Pancreatic calcifications.
3. An EGD with small bowel biopsy (celiac sprue)

Question 5

What suggests Carbohydrate malabsorption?

Answer 5

Stool with pH

Question 6

Discuss Secretory Diiarrhea

Answer 6

Derangements in fluid and electrolyte transport across enterocolic mucosa leads to increased intestinal secretion or decreased absorption.
Typically PAINLESS w/ large amounts of stool.

Question 7

What can lead to secretory diarrhea?

Answer 7

Chronic ethanol ingestion, Bowel resection, disease or fistula. Drugs and toxins (senna, castor oil, arsenic)

Question 8

Discuss Osmotic Diarrhea

Answer 8

Poorly absorbable, osmotically active solutes draw fluid into colon to exceed absorptive capacity.

Question 9

Name some agents that will cause osmotic diarrhea

Answer 9

Laxatives, Non-absorbable carbs (sorbitol, lactulose)

Question 10

What is the Osmotic Gap?

Answer 10

290-2(Na + K)

Normal is less than 50. Pure Osmotic Diarrhea is greater than 125

Question 11

What can help you rule out malabsorption in ddx?

Answer 11

Tests like: Carotene, B12, Folate, Iron, Calcium, Phosphorus, Albumin, Protein

Question 12

What are the details regarding antibody tests in celiac disease?

Answer 12

IgG has good sensitivity. IgA has good specificity.
False negatives for antiendomysial Ab are common in patients w/ IgA deficiency.
Anti-tissue transglutaminase Ab is highly sensitive and specific.

Question 13

Discuss Tropical Sprue

Answer 13

Malabsorptive syndrome characterized by megaloblastic anemia, B12 deficiency and/or folic acid deficiency in patients from tropical countries

Question 14

How is Tropical sprue diagnosed?

Answer 14

Endoscopy and biopsy mimic celiac sprue but serologies are NEGATIVE.

Question 15

How is tropical sprue treated?

Answer 15

Tetracycline

Question 16

How do you diagnose lactose intolerance?

Answer 16

lactose breath test

Question 17

How do you treat lactose intolerance?

Answer 17

1. Complete elimination initially.

2. Reintroduce yogurt and modified diary products gradually as tolerated.

Question 18

What are some non-dairy sources of calcium?

Answer 18

Calcium fortified juices, Leafy greens, Fortified soy milk, Brussel sprouts, tofu, fish.

Question 19

What are 3 causes of bacterial overgrowth?

Answer 19

Impaired GI motility, Mechanical obstruction, Lack of intestinal continuity

Question 20

What is the manifestation of bacterial overgrowth?

Answer 20

Malabsorption of fat (steatorrhea), protein (edema), and carbohydrates (acidic stool)

Question 21

How is Bacterial Overgrowth diagnosed?

Answer 21

Culture of small bowel, Breath test or Schilling Test (Nuclear medicine)

Question 22

How do you treat Bacterial Overgrowth?

Answer 22

Treat underlying cause. If unresponsive, use antibiotics.