Malabsorption

Question 1

What is coeliac’s disease?

Answer 1

T cell mediated autoimmune condition characterised by inflammatory response to dietary gluten. It results in inflammatory and villous atrophy leading to malabsorption.

Question 2

What is coeliac’s disease associated with?

Answer 2

Positive family history,
HLA DQ2 gene,
Other autoimmune diseases eg, diabetes mellitus, autoimmune thyroid disease, IBS

Question 3

What are the signs and symptoms of coeliac’s disease?

Answer 3

1. Chronic or intermittent diarrhoea,
2. Failure to thrive or faltering growth in children,
3. Persistant or unexplained GI symptoms including nausea and vomiting, steatorrhoea.
4. Prolonged fatigue.
5. Sudden or unexplained weight loss.
6. Iron deficiency anaemia
7. Short stature and wasted buttock.
8. Abdominal pain, cramping and distention

Question 4

What are some complications of coeliac’s disease?

Answer 4

Anaemia,
Hyposplenism - at risk of infection from encapsulated organisms,
Osteoporosis, osteomalacia,
Lactose intolerance,
Enteropathy-associated T cell lymphoma,
Subfertility, unfavorable pregnancy outcomes,
Rare: oesophageal cancer and other malignancies

Question 5

What are the investigations for coeliac’s disease?

Answer 5

1. Anti TTG antibodies and IgA levels.
2. Gold standard = endoscopy with biopsies. This is needed to confirm diagnosis.
3. Stool cultures to rule out infective cause of diarrhoea

Question 6

What are biopsy results that support diagnosis of coeliac’s disease?

Answer 6

Villous atrophy,
crypt hyperplasia,
Increase in intraepithelial lymphocytes,
Lamina propria

Question 7

What is the managements of coeliac’s disease?

Answer 7

Lifelong gluten free diet. TTG levels can be checked to check compliance.
Due to hyposplenism everyone should be vaccined against pneumococcal infections with booster every 5 years

Question 8

What is the definition of malnutrition?

Answer 8

BMI < 18.5 or
Unintentional weight loss > 10% in past 6 months

Question 9

What is refeeding syndrome and how can it present?

Answer 9

It describes metabolic abnormalities when feeding a person following period of starvation.
Presents with: hypophosphataemia, hypokalaemia, hypomagnesaemia (increased risk of torsades), abnormal fluid balance

Question 10

What are the clinical consequences of hypophosphataemia?

Answer 10

Impair myocardial contractility leading to heart failure.
Muscle weakness (Phophate is vital for ATP and therefore energy) this leads to resp failure.
Neurological complications eg,
seizures due to ATP disruption.
Haemolysis,
Rhabdomyolysis

Question 11

Which patients are at high risk of refeeding syndrome?

Answer 11

1+ of following: BMI < 16, 15% weight loss in past 6months, little nutrition for past 10 days and hypokalaemia/phosphataemia or magnesaemia before feeding.

Question 12

What is the NICE reccomendation for refeeding?

Answer 12

If person hasn’t eaten for >5 days then re-feed at no more than 50% of requirements for first 2 days