malabsorption Flashcards
malabsorption
- inadequate absorption of nutrients from the GI tract
macronutrients
carbohydrate, fat, protein
micronutrients
vitamins and minerals
mucosal (absorption)
- issues relating directly to small intestine wall
- crohn’s, coeliac, surgery
crohn’s disease / coeliac
- mucosal
- abnormal epithelium
- deficient absorption
surgical resection / bypass / congenital abnormality
- mucosal
- short bowel
- less surface area for absorption
cystic fibrosis / pancreatitis
- pre-mucosal
- lactase deficiency
- insufficient digestive agents
- macronutrients not broken down
small intestinal bacterial overgrowth
- mucosal/pre-mucosal
- damage to mucosa
- bile salts metabolised by bacteria
crohn’s disease
- malabsorption linked to inflammation
deficiencies include: - iron deficiency (anaemia)
- B12/folate deficiency
- vitamin D/calcium deficiency
coeliac disease
- autoimmune condition
- gluten activates an abnormal mucosal response
- chronic inflammation and damage to small intestine mucosa leading to villous atrophy (villi becoming inflamed)
- fatigue, gastrointestinal symptoms, weight loss
- common complications: anaemia, osteoporosis
- treatment = elimination of gluten from diet
short bowel syndrome
- usually secondary to surgery but can be congenital
- may require parental nutrition
- less surface area available for absorption
- osteoporosis and vitamin deficiencies are potential risks
- levothyroxine/warfarin/oral contraceptives/digoxin may need higher doses as small intestine site of absorption and less surface area means less absorption in bloodstream
chronic pancreatitis
- chronic inflammation of pancreas leads to impaired function
- affects more males than females
- decrease in pancreatic enzymes
- strong association with long term alcohol consumption
cystic fibrosis
- inherited
- decreased chloride secretion, increased sodium absorption = thick mucus
- inhibits absorption
- steatorrhea (too much fat in stools)
- osteoporosis (weak bones)
- malnutrition/weight loss
- treated with pancreatic enzyme supplementation, fat soluble vitamin supplementation, calorie replacement
- intestinal obstruction
lactase deficiency
- primary, secondary, congenital or development
- reduce or eliminate dietary lactose intake
- alternative calcium source may be required
bacterial overgrowth
- incidence increases with age
- chronic pancreatitis and motility disorders most common causes
- reduced gastric acid- restricts digestion/atrophic gastritis/ drugs
- impaired motility - diabetes/ radiation enteritis, (post surgery loops)
fat malabsorption
- problem with digestion (insufficient enzymes/bile) or absorption
- malabsorption more common in coeliac, crohns
- deficiencies of fat-soluble vitamins (A/D/E/K)
- steatorrhea
vitamin malabsorption
- poor fat absorption will impact the absorption of vitamins A/D/E/K
- vitamin D - osteoporosis
- vitamin K - clotting problems
treatment options for fat malabsorption
- supplement of pancreatic enzymes: lipase, amylase, protease (creon)
- treatment of cystic fibrosis/pancreatitis
- cautions: local irritation, take during or just after a meal (timing is important)
- derived from pork
iron malabsorption
- iron deficiency anaemia commonly seen with coeliac, crohn’s, small bowel resection
- potential blood loss with crohn’s ulcerative colitis
- oral iron replacement
symptoms of fat malabsorption
steatorrhea - excess fat is lost in stools making them float appear pale and bulky and smell offensive
symptoms of protein malabsorption
- muscle wasting
- malnutrition
- oedema
symptoms of carbohydrate malabsorption
- bloating
- flatulence
- diarrhoea
symptoms of vitamin e malabsorption
neurological problems
symptoms of vitamin K malabsorption
coagulation (bleeding) problems
symptoms of vitamin A malabsorption
night blindness
