Malabsorption

Question 1

What are the potential causes of malabsorption?

Answer 1

Decreased bile - biliary tract obstruction, PBC, ileal resection
Pancreatic insufficiency - CF, chronic pancreatitis
Small bowel mucosa - Whipple’s disease, tropical sprue, burst border enzyme deficiency, IBD, radiation, amyloid, drugs (metformin, neomycin, alcohol), small bowel resection, coeliac disease
Intestinal hurry - post-gastrectomy, post-vagotomy
Bacterial overgrowth
Infection - giardiasis

Question 2

Describe the presentation (including secondary effects) of malabsorption

Answer 2

Steatorrhoea
Abdominal bloating
Diarrhoea
Lethargy / fatigue
Weight loss
Macrocytic anaemia (Vitamin B12/folate deficiency)
Osteopenia (Vit D and calcium deficiency)
Bleeding / bruising (Vit k deficiency)
Oedema (hypoalbuminaemia)
Neurological disease (Vitamin B12/folate deficiency)

Question 3

What investigations should be done for a patient presenting with malabsorption?

Answer 3

FBC
Haematinincs
LFTs
U+Es
CRP / ESR
Stool cultures
Coag
Bone profile / vit D
Breath hydrogen test
Endoscopy +/- biopsy
Test for coeliac