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Malabsorption Flashcards

Define and describe malabsorption • List Diagnostic criteria and differential diagnosis • Describe the aetiology and Pathogenesis • Describe the Epidemiology • Outline Therapeutic Management • Provide a prognosis

1
Q

Define malabsorption.

A

Defective mucosal absorption caused by:
defective luminal digestion
mucosal disease
structural disorders

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2
Q

List some common and uncommon causes of malabsorption.

A 
Common causes:
Coeliac disease
Crohn's disease
Post infectious
Biliary obstruction
Cirrhosis
Uncommon causes: 
Pancreatic cancer
Parasites
Bacterial overgrowth
Drugs
Short bowel (including resections)
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3
Q

What are different malabsorptive states?

A

Protein
fat
carbohydrate
vitamins and minerals

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4
Q

List some digestive causes of protein malabsorption.

A

Partial or total gastrectomy (poor mixing)
Exocrine pancreatic insufficiency
Trypsinogen deficiency
Congenital deficiency of intestinal enterokinase

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5
Q

List some absorptive causes of protein malabsorption

A 
Coeliac disease 
Tropical sprue
Short bowel syndrome
Jejunoileal bypass
Defects in neutral AA transporters (Hartsnup disease)
Cystinuria I-III
Oculocerebral syndrome of Lowe
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6
Q

List some digestive causes of fat malabsorption.

A

Less time to mix: gastric resection, autonomic neuropathy, amyloidosis
Decreased micelle formation caused by a decreased bile acid synthesis/secretion: Cirrhosis, Biliary obstruction, CCK deficiency, small intestinal bacterial overgrowth
Decreased Lipolysis: Chronic pancreatitis, cystic fibrosis, Pancreatic/ampullary tumours, Low luminal pH, Excessive calcium ingestion, Lipase/co-lipase deficiency (rare)

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7
Q

List some absorptive causes of fat malabsorption

A

Decreased chylomicron formation and/or mucosal absorption:
Coeliac disease
Chylomicron retention disease

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8
Q

List some post-absorptive causes of fat malabsorption

A

Defective lymphatic transport:
Lymphoma
Whipple disease
Trauma

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9
Q

Name a digestive cause of carbohydrate malabsorption

A

alpha-amylase deficiency

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10
Q

Name some absorptive causes of carbohydrate malabsorption

A

Lactase deficiency
Coeliac disease
Crohn’s disease
sucrase-isomaltase deficiency

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11
Q

List some causes of Vitamin B12 malabsorption

A

Deficiency of gastric intrinsic factor
Pancreatic insufficiency/Z-E syndrome (Reduced release of B12 from R-binding protein)
Ileal Crohn’s disease
Ileal resection

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12
Q

List some causes of Folic acid malabsorption

A

Caused by diseases affecting the proximal small bowel
Coeliac disease
Whipple disease
Alcoholism

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13
Q

What are the fat soluble vitamins?

What could cause malabsorption of these?

A

Vitamins A, D, E and K

Anything that disrupts fat absorption will result in one or more than one deficiency

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14
Q

What are the clinical features of lactose malabsorption (i.e. lactase deficiency)

A

History of the induction of the diarrhoea, abdominal discomfort and flatulence following the ingestion of dairy products.

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15
Q

How is lactase deficiency diagnosed?

A

It is diagnosed clinically, and confirmed using the lactose breath hydrogen test, or the oral lactose intolerance test.

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16
Q

What is tropical sprue?

A

Colonisation of the intestine by an infectious agent or alterations in the intestinal bacterial flora induced by the exposure to another environmental agent.

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17
Q

What are the clinical features of tropical sprue?

A 
Diarrhoea
Steatorrhoea
Weight loss
Nausea
Anaemia
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18
Q

What is the treatment for tropical sprue?

A

Tetracycline + folic acid

19
Q

What is whipple’s disease?

A

A rare infectious bacterial disease caused by Tropheryma whipplei.
There is multi-system involvement and increase in the frequency of HLA-B27.

20
Q

What are the clinical features of whipple’s disease?

A

Weight loss, diarrhoea, steatorrhea, abdominal distension, arthritis, fever, nutritional deficiency symptoms

21
Q

How is whipple’s disease diagnosed?

A

Biopsy and demonstration of T.whipplei in involved tissues by microscopy

22
Q

What is the treatment for Whipple’s disease?

A

Anti-microbial

23
Q

What are the clinical features of Crohn’s disease?

A

Abdominal pain and diarrhoea
Fever and weight loss
Abdominal tenderness, most commonly in the right lower quadrant

24
Q

How is Crohn’s disease diagnosed?

A

Endoscopy
Barium imaging of small bowel mucosal disease, including strictures, ulcerations and fistulae
CT
MRI

25
Q

What is the treatment for Crohn’s disease?

A

Steroids, immunosuppressants (azathioprine), biological therapy (anti-TNF)

26
Q

What does Giardia lamblia/ giardia intestinalis cause?
What are risk factors for contracting this parasitic infection?
What are other intestinal parasites?

A

Giardiasis
Risk factors are travel to areas where the water supply may be contaminated and swimming in ponds
Other parasites: Coccidial, strongyloides

27
Q

What are the clinical features of giardiasis?

A 
Diarrhoea
Flutulence
Abdominal cramps
Epigastric pain
nausea
Significant malabsorption with steatorrhoea and weight loss may develop
28
Q

How is giardia lamblia confirmed in the lab?

A

Stool examination for ova and parasites

Three separate stool samples increases the yield of positive examinations to 80-90%

29
Q

How is giardiasis treated?

A

Metronidazole for 1 week

30
Q

Which pathogens cause small bowel overgrowth?

A

E. coli or Bacteroides.

31
Q

What are the symptoms of small bowel overgrowth?

A

Diarrhoea, steatorrhoea and macrocytic anaemia

32
Q

What lab results would be found in small bowel overgrowth?

A

low cobalamin and high folate levels.

aerobic and or anaerobic colonic-type bacteria in a jejunal aspirate obtained by intubation

33
Q

What is the treatment for small bowel overgrowth?

A

Surgical correction of an anatomical blind loop

Tetracyclines 2-3 weeks

34
Q

In which known disease states should you suspect malabsorption?

A

Those of the liver, pancreas and small bowel

35
Q

What features of past medical history should make you suspect malabsorption?

A

Gastric or small bowel resection
Gastrointestinal diversion (bariatric)
Radiation exposure
Travel

36
Q

What questions should you ask about diarrhoea?

A 
Duration
Malabsorptive stool
Fat globules
Floating
Hard to flush away
Offensive
37
Q

What is easy bruising a sign of?

A

Vitamin C “scurvy” (deficiency)

VItamin K deficiency

38
Q

Name an autosomal recessive skin condition due to impaired zinc uptake.
What are the signs of this?
How is this treated?

A

Acrodermatitis Enteropathica.
The signs are a perioral or acral rash, and alopecia.
It is treated with lifelong zinc supplements.

39
Q

Which skin condition may indicate coeliac disease?
How does it present?
What causes it?

A

Dermatitis herpetiformis.
It presents as itchy blisters on extensor surfaces.
It is caused by sub-epithelial IgA deposition.

40
Q

What can glossitis and angular stomatitis be signs of?

A

Vitamin B deficiency

Iron deficiency

41
Q

What can spooned nails be a sign of?

A

Iron deficiency

42
Q

Which baseline investigations should be carried out?

A 
FBC
Coagulation
LFTs
Albumin
Calcium/Magnesium
Stool culture
43
Q

Which anatomical investigations can be done?

A

Endoscopy

Imaging

44
Q

What should the management of a malabsorption be?

A

Treat the underlying cause
Replace the deficiency
Support nutritionally

GI (59 decks)

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