Malabsorbtion

Question 1

Name symptoms of malabsorption and symptoms of associated vitamin deficiencies

Answer 1

• Diarrhoea, steatorrhoea, WL, lethargy

- Anaemia, bleeding disorders, oedema, osteomalacia, neuropathy

Question 2

Name some causes of malabsorption and their appropriate tests?

Answer 2

• Crohn’s (Calprotectin, colonoscopy + biopsy/CT)
• Coeliac (anti TTG,EMA or endoscopy + biopsy)
• Chronic pancreatitis (ERCP, faecal elastase)
• Pancreatic insufficiency from CF or cancer
• Infection (MCS)
• Bacterial overgrowth in bowel (breath hydrogen analysis)
• Reduced bile e.g. biliary obstruction, cholestyramine (LFTs, ERCP)
• Lactate insufficiency

Question 3

Describe the histology of coeliac disease

Answer 3

TTG enzymes modify alpha-gliandin. This then mounts and AI response against the mucosa.

• Loss of vili
• Hyperplasia of the crypts
• Increased inter-epithelial lymphocytes

Question 4

What are the symptoms of coeliac disease

Answer 4

Diarrhoea, steathorea, WL, anaemia (IDA/B12), abdo cramps, fatigue, bloating, N+V, failure to thrive (children), apthous ulcers, atrophic glossitis, dermatitis hepatiformis

Question 5

Long term risks of coeliac disease

Answer 5

Osteoporosis, small risk of lymphoma, neuropathy, hyposplenism

Question 6

What are the symptoms of chronic pancreatitis

Answer 6

Weight loss, DM, steatorrhoea, chronic pain, obstructive jaundice

Question 7

Describe the diagnostic work up of chronic pancreatitis

Answer 7

Bloods: Faecal elastase, trypsinogen, USS, MRCP

+/- signs of alcohol abuse e.g. GGT or macrocytic anaemia

Question 8

What is the management of chronic pancreatitis

Answer 8

Analgesia, creon, multivite (fat soluble vitamins), blood sugar monitoring, low fat diet

Partial pancreatectomy last line