Malabsorbtion Flashcards
What is the definition of malabsorption?
Defective mucosal absorption which is caused by defective luminal digestion, mucosal disease or structural abnormalities
What are the common causes of malabsorbtion?
Coeliac disease Crohn's disease Post infectious Biliary obstruction Cirrhosis
What are the uncommon causes of malabsorbtion?
Pancreatic cancer Parasites Bacterial overgrowth Drugs Short bowel sundrome
What is the most common mineral to be malabsorbed in the world?
Iron (anaemia)
What are the diseases that drive malabsorbtion?
Coeliac disease Whipple's disease Crohn's disease Parasitic infections Small bowel bacterial overgrowth
What is lactose malabsorbtion?
Evidence of deficiency of lactose
What are the clinical presentations of lactose malabsorbtion?
Induction of diarrhoea, abdominal discomfort and flactulence following the ingestion of dairy products
How is lactose malabsorbtion diagnosed?
Confirmed by the lactose breath hydrogen test, or an oral lactose intolerance test
What is the management of lactose malabsorbtion?
Lactose free diet
What is trocial sprue?
Evidence of colonisation of the intestine by an infectious agent or alteration in the intestinal bacterial flora induced by the exposure to antoerh envorinmental agen
What does tropical sprue present with?
Diarrhoea, steatohhrea, weight loss, nausea, anorexia and anaemia
How is tropica sprue diagnosed?
Biopsy
How is tropical sprue treated?
Tetracycline and folic acid
What is whipple’s disease?
Evidence of tropheryma whipplei, multi-system involvement with an increase int he frequency of HLA-B27
How does whipple’s disease present?
Weight loss, diarrhoea, steatorrhea, abdominal distension, arthritis, fever and nutritional deficiency symptoms
How is whipple’s disease treated?
Antimicrobials
How is whipple’s disease diagnosed?
Demonstration of T.whipplei in involved tissue by microscopy
What is crohn’s disease?
Evidence of extensive ileal involvement, extensive intestinal resections, enterocolic fistulas and stricutres leading to small intestine bacterial overgrowth that may develop significant and occasionally devestating malabsorbtion
What does crohn’s disease present with?
Abdominal pain and diarrhoea, fever and weight loss, abdominal tenderness most clasically in the RLQ
How is crohn’s disease diagnosed?
Endocscopy, barium imaging of the small bowel mucosal disease including strictures, ulcerations and fistulae. CT and MRI
How is crohn’s disease treated?
Steroids, immunosuppresants, axathioprine 6-MP, biological therapy (anti-TNF)
What is an example of a parisitic infection that can lead to malabsorbtion?
Giardia lamblia
What do parasitic infections present with?
Diarrhoea, flactulence, abdominal cramps, epigastric pain and nausea. Can experience vomiting, significant malabsorbtion with steatorrhea and weight loss
How are parasitic infections diagnosed?
Stool examination for ova and parasites
How are parasitic infections treated?
Metrondiazole
What bugs can cause small bowel bacterial overgrowth?
E.coli or bacteroides
How is small bowel bacterial overgrowth diagnosed?
Evidence of diverticula, fistulas and strictures related to crohn’s disease, bypass surgeries with a functional status
How can small bowel bacterial overgrowth be diagnosed?
Low coalbamin levels adn high folate levels
What is the treatment for small bowel bacterial overgrowth?
Surgical correction of an anatomical blind loop, tetracyclines for 2/3 weeks
What are common GI symptoms?
Diarrhoea
Abdominal swelling
Oedema
Low mood
What is important to check in PMH for malabsorbtion?
Gastric or small bowel resection
GI diverstion
Radiation exposure
Travel
What are important features to a malabsobtion examination?
Easy bruising
Vitamin C deficiency (scurvy), vitamin K deficiency
Skin - acrodermatitis enteropathica, dermatitis herptetiforms
Glossitis and angular stomatitis
Spooning of nails
What baseline investigations should be done to determine malabsorbtion?
FBC Coagulation LFTs Albumin Calcium/Mg Stool culture
What anatomic investigations can be done?
Endoscopy
Imaging
