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year 5 - GIT Internal medicine > Malabsorption > Flashcards

Malabsorption Flashcards

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1
Q

what are the classifications of malabsorption ?

A

either generalized ( all major nutrient classes ) or specific ( single nutrient )

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2
Q

what is the normal range for fecal fat testing ?

A

2 to 7 grams over a 24 hour period

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3
Q

what is the minimum time for collection of faecal fat ?

A

3 days

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4
Q

what is a rapid way for testing absorption of fat in the small bowel ?

A

14 C triolein breath test

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5
Q

what are the contraindications to using the 14C triolein breath test ?

A

pregnancy
children
COAD ( chronic obstructive airway disease )

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6
Q

how can jejunal absorptive capacity be tested (intestinal permeability )?

A

xylose absorption test

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7
Q

what additional test to xylose absorption test must be used for children ?

A

blood levels of xylose

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8
Q

what can cause problems when interpreting xylose absorption test ?

A

inaccurate urine collection
low GFR
delayed gastric emptying
oedema

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9
Q

how is the detection of bacterial overgrowth achieved ?

A

14C glycocholate breath test ( bile acid breath test)

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10
Q

what are the contraindications to 14C glycocholate breath test ?

A

pregnancy
children
chronic airway disease

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11
Q

what specific test is used for cystic fibrosis ?

A

sweat electrolytes

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12
Q

what can be used to diagnose a disaccharide deficiency ?

A

brush border biopsy

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13
Q

example of a disaccharidase deficiency ?

A

lactase deficiency

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14
Q

how can a diagnosis of impaired B12 absorption ?

A

Schilling test

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15
Q

what is the malabsorbed nutrient in a patient with easy bruising ?

A

vitamin K
vitamin C

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16
Q

what are the expected lab findings in a patient with easy bruising ?

A

increased prothrombin time

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17
Q

what is thee malabsorbed nutrient in a patient with oedema and what is the expected lab findings ?

A

deficiency in protein
low albumin

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18
Q

if a patient presents with abdominal pain/distention/flatulence/ diarrhea what is the malbsorbed nutrient ?

A

lactose
bacterial overgrowth

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19
Q

what are the expected lab findings in a patient with steatorrhea ?

A

low fat soluble vitamins ( ADEK )

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20
Q

what is the initial investigation for lactose intolerance?

A

hydrogen breath test

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21
Q

what is the initial investigation for bacterial overgrowth ?

A

14C Glycocholate breath test

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22
Q

what is the initial investigation for diarrhea associated with hyperthyroidism ?

A

TFT from serum

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23
Q

what is the initial investigation for a patient with malabsorption due to EPI ?

A

faecal elastase

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24
Q

what diseases cause pancreatic insufficiency ?

A

chronic pancreatitis
cystic fibrosis
IBD
zollinger ellison syndrome

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25
Q

if the cause of malabsorption is Coeliac what is the initial investigation ?

A

IgA and anti-tTG antibodies

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26
Q

if the cause of malabsorption is due to IBD what is the initial investigation ?

A

faecal calprotectin

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27
Q

what are the differentials of megaloblastic anemia ?

A

cobalamin deficiency (B12 deficiency )
folate deficiency
liver disease
hypothyroidism
hemolytic anemia

28
Q

what are the causes of b12 deficiency ?

A

inadequate intake
pernicious anemia
gastrectomy
pancreatic insufficiency
bacterial overgrowth
fish tapeworm
abnormal intrinsic factor

29
Q

what are the causes of pernicious anemia ?

A

autoimmune disorder - atrophic gastritis, loss of parietal cellss

30
Q

where does b12 absorption occur ?

A

the terminal ileum

31
Q

what is the serology for pernicious anemia ?

A

parietal cell antibodies but intrinsic factor antibodies are more specific

32
Q

what other autoimmune diseases are associated with pernicious anemia ?

A

addison’s disease
vitiligo
thyroid disease

33
Q

what is the classic triad of pernicious anemia ?

A

weakness
sore tongue - glossitis
symmetrical paraesthesia inn thee finger and the toes

34
Q

if a patient with neurological complications associated with b12 deficiency , what is the most app management ?

A

higher doses of b12

35
Q

why must periodic evaluation of patients with pernicious anemia be done ?

A

in fear of gastric carcinoma

36
Q

what is the criteria for the diagnosis of IBS ?

A

1- recurrent abdominal pain at least once a week for the last 3 months, associated with 2 or more of the following :
- pain associated with defecation
- associated with a change in stool frequency
- associated with a change in stool form

should be fulfilled for the last 3 months with onset over 6 months prior to diagnosis

37
Q

what is the most sensitive and specific antibodies for the confirmation of celiac disease ?

A

tIgA and endomysial IgA
IgA TTG

38
Q

what is the pathology in celiac disease ?

A

villous atrophy

39
Q

what are the dietary requirements for tesstiing in ccelliac disease ?

A

must be done on gluten containing diet ( 1 gluten containing meal every day for at least 6 weeks)

40
Q

what dermatological disease is associated with celiac disease ?

A

dermatitis herpetiformis

41
Q

what does a gluten free diet consist of ?

A

strict avoidance of any products containing wheat, barley and rye

42
Q

what should diabetic patients with digestive issues be tested for ?

A

celiac disease

43
Q

if there is found to be elevated ALT levels with no other explanation what should be sought after ?

A

celiac disease

44
Q

what is the gold standard for the stimulation off pancreatic function ?

A

CCK and Secretin

45
Q

where are bile salts and B12 reabsorbed ?

A

in the ileum

46
Q

what does the presence of steatorrhea indicate ?

A

small bowel involvement / terminal ileum

47
Q

what structure prevents the retrograde translocation of bacteria from the colon to the small intestine ?

A

ileocecal valve

48
Q

how is a hydrogen breath test carried out ?

A

it is indicated in patients with diarrhea and/or abdominal discomfort

given glucose for bacterial overgrowth
lactose for lactose intolerance
fructose for fructose malabsorption

a baseline breath test is taken then one every 30 minutes

49
Q

intestinal failure vs intestinal insufficiency ?

A

failure : reduction in the gut function that requires IV supplementation

deficiency : reduction in the gut function but does not require IV supplementation

50
Q

what are the pathological classifications of intestinal failure ?

A

short bowel
intestinal fistula
intestinal dysmotility
mechanical obstruction
extensive small bowel mucosal disease

51
Q

what are the types of intestinal failure ?

A

Type I : acute, short term and self limiting

Type II : prolonged acute condition, in metabolically unstable patients, require IV supplementation

Type III : chronic condition, metabolically stable patient, requiring IV supplementation, may be reversible or irreversible

52
Q

what are the main causes of short bowel syndrome ?

A

surgical resection
mesenteric vessel occlusion
radiation enteritis

53
Q

what is better tolerated when it comes to the resection of the small bowel ?

A

resection of the jejunum is better tolerated than thee resection of the ileum

54
Q

what are the consequences of ileal resection ?

A

b12 deficiency
bile salt induced diarrhea
steatorrhea and gallstone formation
oxaluria and oxalate stones

55
Q

what is the pharmacological therapy in short bowel syndrome ?

A

antisecretory agents : H2 receptor antagonist
PPI
antimotility agents : loperamide

56
Q

what are the indications of intestinal transplantation in cases of intestinal failure ?

A
  1. failure of home parenteral nutrition
  2. high risk of death attributable to the underlying disease
  3. intestinal failure with high morbidity or low acceptance of HPN
57
Q

what are the signs of failure of HPN ?

A

impending or overt liver failure
central venous catheter related thrombosis
frequent central line sepsis
severe dehydration despite IV fluids

58
Q

what is the clinical presentation of whipple infection?

A

affection of the heart, brain and lungs
peripheral lymphadenopathy
arthritis and arthralgia
abdominal pain
flank pain and hematuria
steatorrhea

59
Q

how is a diagnosis of whipple confirmed ?

A

biopsy
acid-schiff staining of macrophages
electron microscopy
then DNA

60
Q

what is the treatment for whipple disease ?

A

must be treated with antibiotics that cross the blood-brain barrier ( co-trimoxazole) daily for one year

this is preceded by a 2 week course of streptomycin and penicillin or ceftriaxone

61
Q

at what Gy of radiation is damage to the intestine caused ?

A

40

62
Q

when is pelvic irradiation usually used ?

A

gynecological and urinary tract malignancies ( affection of the ileum and the rectum )

63
Q

what does radiation do to the rectum ?

A

radiation proctitis - with diarrhea and tenesmus, with or without blood

64
Q

what can resistant anemia in cases of radiation proctitis be treated with ?

A

argon plasma coagulation

65
Q

why does malbasorption happen in chronic radiation enteritis ?

A

bacterial overrgrowth in dilated segments and mucosal damage

66
Q

what drugs can cause malbasorpttion ?

A

ccholestyramine , neomycin , orlistat

66
Q

how can HIV patientts have malabsorption ?

A

more prone to parasitic infeections which can cause malabsorption

year 5 - GIT Internal medicine (25 decks)

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