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nutrition and digestion > malabsorption 2 W7 > Flashcards

malabsorption 2 W7 Flashcards

1
Q
A
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2
Q

risk factors for malabsorption

A

surgery, radiotherapy
autoimmunity, DM
medications, alcohol
travel history

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3
Q

management of malabsorption?

A

nutritional support - introduce in measured way to mitigate risk of refeeding syndrome

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4
Q

coeliac disease definition?

A

chronic autoimmune-mediated gluten-sensitive enteropathy

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5
Q

what is coeliac disease caused by

A

exposure to cereal prolamins in genetically susceptible individuals:
-wheat
-rye
-barley

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6
Q

presentation of coeliac disease - GI?

A

chronic or intermittent diarrhoea, bloating, weight loss, fatigue, failure to thrive, lactose intolerance
any unexplained persistent GI symptoms
‘coeliac crisis’

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7
Q

presentation of coeliac disease - extra-GI?

A

signs of specific micronutrient deficiencies
neuro symptoms, particularly ataxia
dermatitis herpetiformis
raised liver enzymes
subfertility
metabolic bone disease

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8
Q

diagnosis of coeliac disease?

A

requires ongoing gluten exposure
serology - TTG IgA most widely used
endoscopy, duodenal biopsies

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9
Q

what is the most common nutrient deficiency in coeliac disease

A

iron deficiency

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10
Q

when isn’t a colonoscopy required for Coeliac disease diagnosis?

A

TGA IgA > 50 and symptoms leads to no biopsy diagnosis of Coeliac disease

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11
Q

management of coeliac disease?

A

gluten free diet (lifelong, GF products can be prescribed, adherence is an issue)

annual review (dietary compliance, weight and symptoms, bone health, vaccination status, bloods)

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12
Q

what is non-responsive coeliac disease?

A

ongoing symptoms 12 months after GFD implemented

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13
Q

what to do for non-responsive coeliac disease?

A

rule out other possibilities - slow responder? non-compliance?

is this an associated condition, mimic or refractory coeliac disease?
-repeat OGD and duodenal biopsies - is there atrophy?

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14
Q

non-responsible coeliac disease repeat biopsy - results with atrophy could be caused by?

A

coeliac histological mimics
inadvertent gluten contamination
slow healing
‘supersensitivity’
refractory coeliac sprue (RCD1 and 2)

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15
Q

non-responsible coeliac disease repeat biopsy - results with no atrophy could be caused by?

A

SIBO
microscopic colitis
lactose intolerance
IBD
thyroid disease
DM
PEI
BAM
infection
IBS

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16
Q

what is non-responsive coeliac disease if no explanation is found?

A

refractory coeliac disease (bad news!!)

17
Q

refractory coeliac disease type 1?

A

normal IEL phenotype. treat with tight diet and steroids (budesonide). good 5yr survival

18
Q

refractory coeliac disease type 2?

A

aberrant and/or clonal IEL cell lines
can progress to malignancy
treat with aggressive immune suppression (steroids)
poor 5yr survival

19
Q

what malignancies can RCD progress to

A

enteropathy-associated T cell lymphoma
non-Hodgkin’s lymphoma
small bowel adenocarcinoma

20
Q

infectious enteropathies?

A

tropical sprue
Whipple’s disease
giardiasis
HIV/TB enteropathy

21
Q

other enteropathies?

A

drug-induced enteropathy
autoimmune enteropathy
radiation enteropathy
Crohn’s disease

22
Q

tropical sprue features?

A

recent prolonged travel or living in endemic area.
very rare
presents with malabsorption syndrome (may or may not follow traveller’s diarrhoea. whole small bowel affected. weight loss and folate/B12 deficiency common)
diagnosis - D2 Bx showing villous atrophy, lymphocytic infiltrate. travel history and negative screen for other causes.
antibiotics 3-6 months

23
Q

Whipple’s disease features?

A

affects middle aged men, farmers.
malabsorption syndrome, GI bleeding, migratory arthritis, sacroiliitis, pericarditis/endocarditis, confusion, ataxia, extrapyramidal signs. endoscopy - yellow, dotty. treat with antibiotics

24
Q

giardiasis features?

A

flagellated protozoan infection
malabsorption
stool microscopy, stool antigen ELISA.
D2 Bx showing loss of brush border, villous shortening, trophozoites.
treat with metronidazole

25
Q

drug induced enteropathy caused by which drugs? how is it resolved?

A

caused by NSAIDs, olmesartan, MMR, methotrexate
resolved with drug withdrawal

26
Q

autoimmune enteropathy features?

A

rare
villous atrophy, deep crypt lymphocytosis, minimal intra-epithelial lymphocytosis
treat with systemic steroids, nutrition support

27
Q

radiation enteropathy features?

A

dysmotility, villous atrophy, telangiectasia, strictures, SIBO
treatment - treat coexisting SIBO. low fat, high protein, MCT diet. enteral +/- parenteral support.

28
Q

Crohn’s disease features?

A

malabsorption mediated by mucosal disease, fistulae, surgical resection.
treatment - treat inflammation, treat coexisting SIBO, nutrition support, surgery.

29
Q

SIBO stands for what?

A

small intestinal bacterial overgrowth

30
Q

SIBO definitions?

A

normally 10^3 bacteria/ml present in small bowel
colon has up to 10^12 bacteria/ml
mostly gram negative aerobic bacteria in ileum, and gram positive anaerobes in colon.
in SIBO this balance is lost.

31
Q

SIBO presentation?

A

risk factors
maldigestion, bloating, diarrhoea
B12 deficiency common (folate normal/high)

32
Q

aetiology of SIBO?

A

loss of protective mechanisms

stasis:
-blind loop/post-UGI surgery
-stricture
-diverticulum
-dysmotility (opioids, diabetes, systemic sclerosis, parkinson’s)

systemic immunodeficiency
local mucosal disease (coeliac, crohns, NSAIDs etc)
PPI
PEI

33
Q

diagnosis of SIBO?

A

> 10^3/mL quantitative culture of jejunal fluid (gold standard)

more practical - glucose/hydrogen breath test (rise of >20ppm hydrogen from baseline considered
+ve)

consider radiology for anatomical abnormalities and testing for risk factors or secondary causes

34
Q

treatment of SIBO?

A

rifaxamin 550mg TDS for 10-14 days

35
Q

pancreatic exocrine insufficiency definition

A

insufficient secretion or function of pancreatic enzymes or sodium bicarbonate for normal digestion

36
Q

pancreatic exocrine insufficiency aetiology

A

results from impaired production or drainage of pancreatic enzymes, reduced entero-hormonal stimulation of the exocrine pancreas, or asynchronous digestion due to dysmotility or abnormal anatomy.

37
Q

pancreatic exocrine insufficiency - associated conditions?

A

Chronic pancreatitis (21-94%)
Pancreatic cancer, (20-92%)
Cystic fibrosis (85%)
Pancreatic resection (11-100%)
Acute pancreatitis (30% at 6 months)
Untreated coeliac (11%)
Refractory coeliac (30%)
HIV on ARVs (32%),
Type 1 Diabetes (38%)
Type 2 Diabetes (10-28%)
UGI surgery (9-31%)
Alcohol
Smoking

38
Q

pancreatic exocrine insufficiency - making the diagnosis?

A

history - diarrhoea, abdominal pain, bloating, weight loss
FE1
nutritional blood tests
pancreatic imaging

39
Q

management of pancreatic exocrine insufficiency?

A

pancreatic enzyme replacement therapy (PERT)
refer to dietician
smoking and alcohol cessation

nutrition and digestion (49 decks)

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