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Gastro > Malabsorption > Flashcards

Malabsorption Flashcards

1
Q

What is the defn of steatorrhea?

A

presence of excess fat in feces, >5% of dietary intake

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2
Q

steatorrhea is often a sign of

A

malabsorption

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3
Q

describe the stool characteristics with steatorrhea

A

floats and there s grease on top of the water
it stinks
it is hard to flush

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4
Q

what are the mechanisms that causes diarrhea in steatorrhea

A
  1. excessive amts of osmotically active particles from malabsorbed dietary components
  2. hydroxylation of 10-hydroxy oleate which accelerates defecation ??? not sure how this fits in
  3. the FA in the stool impari fluid and electrolyte abs
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5
Q

how do you differentiate mal-digestion from absorption

A

d-xylose absorption:
D-Xylose is a monosaccharide, or simple sugar, that does not require enzymes for digestion prior to absorption. Its absorption requires an intact mucosa only. If d-xylose is not absorbed = epithelium problem

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6
Q

What is the secretin test?

A

tests pancreatic insufficiency as the cause of malabsorption

CCK is admin and should stimulates the pancreatic secretion of bicarb

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7
Q

What does the hydrogen breath test test?

A

carbohydrate malabs due to overgrowth of bacteria

*if there is an earlier peak of H+, there is more bacteria in the duodenum/proximal intestine

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8
Q

What is the most common cause of steatorrhea?

A

Pancreatic insufficiency

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9
Q

Why does chronic pancreatitis cause steatorrhea?

A

Do not make lipases

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10
Q

Why does ZES lead to chronic steatorrhea?

A

High gastrin levels increase the secretion of gastric acid which lowers the pH of gastric contents to a point that the lipases are not functional

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11
Q

What are 2 intraluminal insufficiencies that lead to steatorrhea?

A

Lipase and Bile Acid Insufficiencies

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12
Q

What are 4 causes of bile acid insufficiency?

A

Cholestsatic liver disease
Terminal ileecomy
Small bowel overgrowth
Reduced CCK release

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13
Q

What are 4 causes of lipase insufficiency? (this causes steatorrhea)

A

Chronic pancreatic
CF
ZES
Post gastrectomy

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14
Q

Why does decreased CCK lead to steatorrhea?

A

No CCK = GB cannot contral and sphincter of Otti cannot relax, therefore no bible can be released

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15
Q

Why does bacterial overgrowth lead to steatorrhea?

A

The bacteria will de-conjugate the BA = no reabs of BA for recycling = less BA for solubilizing fats reabs

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16
Q

Why does a terminal ileectomy lead to steatorrhea?

A

There is no reabs of BA for recycling = less BA for solubilizing fats

17
Q

Why does cholestatic liver disease lead to steatorrhea?

A

Cannot secrete bile from hepatocytes to ampulla

18
Q

What are the effects of impaired circulation of bile salts?

A
  • Diarrhea/steatorrhea
  • increased proportion of BA conjugated with glycine than taurine
  • increased proportion of deoxycholate in bile
  • a reduced bile salt pool size
19
Q

Malabsorption due to the fact that the cells at the surface of the intestine are immature

A

Celiac Sprue

20
Q

Causes of malabsorption in celiac sprue

A
  1. intestine in secretory state
  2. decreased bile salts
  3. decreased synthesis of complex lipids
  4. decreased CCK
  5. decreased absorptive surface area
21
Q

Celic Sprue increases, decreases, or has no change on the abs of the following:

  • disaccharides
  • fat
  • B12
  • Fe ++
  • Ca ++
  • proteins
A

All decreased except B12 which is unchanged

22
Q

Pathogenesis of celiac sprue

A

Gluten + certain genetic background

23
Q

How is celiac sprue diagnosed?

A

Clinical response to exclusion of gluten from diet

24
Q

Steatorrhea that gets better with administration of steroids

A

Adrenal insufficiency

25
Q

Hypo or hyper thyroid would cause steatorrhea

A

Hyperthryoid

26
Q

Where does fat go for transport after it has been abs?

A

Lymphatics

27
Q

What could cause fat malabs in the lymphatic transport stage?

A 
Lymphatic duct obstruction: 
Lymphoma
Whipple disease
Intestinal lympangectasia
TB
Carcinoid

Gastro (25 decks)

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