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Medicine > Malabsorption > Flashcards

Malabsorption Flashcards

1
Q

What is the definition of malabsorption?

A

“Defective mucosal uptake and transport of adequately digested protein, fat, carbohydrates or nutrients”

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2
Q

What is intraluminal digestion?

A

Pancreatic enzyme secretion and emulsification by bile salts

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3
Q

What is terminal digestion?

A

Enzymatic hydrolysis in brush border of small intestine

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4
Q

What is transepithelial transport?

A

Nutrients, fluid and electrolytes transported across epithelium

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5
Q

What can disturbance in electrolyte absorption lead to?

A

Osmotic diarrhoea

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6
Q

What are proteins, starches and triglycerides digested to?

A

Proteins → peptides
Starches → α-dextrins and disaccharides
Triglycerides → fatty acids and monoglycerides

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7
Q

What are a-dextrins and disaccharides hydrolysed by?

A

α-dextrins and disaccharides are hydrolysed by brush border enzymes and absorbed into cells

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8
Q

What do amphipathic bile salts form?

A

tiny spheres called micelles

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9
Q

What do long chain fatty acids require for absorption?

A

bile salts

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10
Q

What happens when Fatty acids and monoglycerides reach the epithelial cells of the villi?

A

Fatty acids and monoglycerides reach the epithelial cells of the villi and diffuse into the cells, leaving micelles behind in chyme

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11
Q

Where are bile salts reabsorbed?

A

the terminal ileum (enterohepatic circulation)

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12
Q

How do you identify steatorrhoea?

A

Stools may float in the pan – difficult to flush

Oily appearance and be foul smelling.

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13
Q

Which vitamins are fat soluble?

A

Vitamins A, D, E and K are fat-soluble

If fat absorption is impaired, deficiencies in these vitamins may occur

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14
Q

How does vitamin D deficiency affect calcium absorption?

A

Calcium absorption is greatly reduced in vitamin D deficiency and sometimes in generalized malabsorption

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15
Q

What is osteoporosis?

A

reduced bone density, inc risk of fragility fractures

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16
Q

What are some causes of osteoporosis?

A

Anorexia, smoking, alcoholism, malabsorption, steroid therapy, vitamin D/ calcium deficiency

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17
Q

How is osteoporosis diagnosed?

A

WHO osteoporosis criteria, DEXA bone scan T-SCORE -2.5 or worse

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18
Q

What is Osteomalacia and what causes it?

A

Definition:
Normal amount of bone but its mineral content is low.

Causes:
Vitamin D deficiency - inadequate sunlight, malabsorption (coeliac, intestinal resection, cholestasis), renal disease.

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19
Q

What can vitamin A deficiency cause?

A

blindness (begins with inability to produce tears)

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20
Q

What can vitamin B1 (thiamine) deficiency cause?

A

Beriberi; Wernickes

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21
Q

What can vitamin B2 deficiency cause?

A

angular stomatis; cheilitis

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22
Q

What can vitamin B6 deficiency cause?

A

polyneuropathy

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23
Q

What can vitamin B12 deficiency cause?

A

anaemia, SCDC

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24
Q

What can vitamin C deficiency cause?

A

scurvy

25
Q

What can vitamin D deficiency cause?

A

osteomalacia

26
Q

What can vitamin E deficiency cause?

A

bleeding disorders

27
Q

What can vitamin K deficiency cause?

A

bleeding disorders

28
Q

What can lead to B12 deficiency?

A

Gastric mucosal atrophy (pernicious anaemia) and terminal ileal disease

29
Q

What does B12 require for absorption?

A

intrinsic factor

30
Q

What is folate necessary for?

A

efficient thymidilate synthesis and production of DNA.

31
Q

3 things to consider in deficiencies

A

Is the patient -
not getting enough in
not absorbing enough
losing too much

32
Q

3 mechanisms of iron deficiency

A

iron intake (dietary)

↓ iron absorption (principally in the duodenum)

↑ iron loss (sloughed mucosal cells, bleeding)

33
Q

What is coeliac disease?

A

Inflammatory condition of the small intestinal mucosa induced by an autoimmune reaction to the ingestion of gluten

34
Q

What can be seen in coeliac disease from a histology point of view?

A

Villous atrophy/ intraepithelial lymphocytosis

35
Q

How common is coeliac disease?

A

1 in 100 in the UK

36
Q

What is the clinical presentation of coeliac disease in infants?

A

impaired growth, diarrhoea, vomiting, abdominal distension

37
Q

What is the clinical presentation of coeliac disease in older children?

A

anaemia, short stature, pubertal delay, rickets, recurrent abdominal pain or behavioural disturbance

38
Q

What is the clinical presentation of coeliac disease in adults?

A

chronic/recurrent iron deficiency anaemia, diarrhoea, abdominal pain, bloating, isolated nutritional deficiencies, reduced fertility, osteoporosis, osteomalacia abnormal liver function tests

39
Q

How is Coeliac disease diagnosed?

A

Clinical history

Serological tests – endomysial (EMA) and tissue transglutaminase (tTG) antibodies

Duodenal biopsy via upper GI endoscopy

40
Q

How is coeliac disease treated/managed?

A

gluten-free diet

41
Q

What can lead to B12 deficiency?

A

Gastric mucosal atrophy (pernicious anaemia) and terminal ileal disease

42
Q

What does B12 require for absorption?

A

intrinsic factor

43
Q

What is folate necessary for?

A

efficient thymidilate synthesis and production of DNA.

44
Q

3 things to consider in deficiencies

A

Is the patient -
not getting enough in
not absorbing enough
losing too much

45
Q

3 mechanisms of iron deficiency

A

iron intake (dietary)

↓ iron absorption (principally in the duodenum)

↑ iron loss (sloughed mucosal cells, bleeding)

46
Q

What is coeliac disease?

A

Inflammatory condition of the small intestinal mucosa induced by an autoimmune reaction to the ingestion of gluten

47
Q

What can be seen in coeliac disease from a histology point of view?

A

Villous atrophy/ intraepithelial lymphocytosis

48
Q

How common is coeliac disease?

A

1 in 100 in the UK

49
Q

What is the clinical presentation of coeliac disease in infants?

A

impaired growth, diarrhoea, vomiting, abdominal distension

50
Q

What is the clinical presentation of coeliac disease in older children?

A

anaemia, short stature, pubertal delay, rickets, recurrent abdominal pain or behavioural disturbance

51
Q

What is the clinical presentation of coeliac disease in adults?

A

chronic/recurrent iron deficiency anaemia, diarrhoea, abdominal pain, bloating, isolated nutritional deficiencies, reduced fertility, osteoporosis, osteomalacia abnormal liver function tests

52
Q

How is Coeliac disease diagnosed?

A

Clinical history

Serological tests – endomysial (EMA) and tissue transglutaminase (tTG) antibodies

Duodenal biopsy via upper GI endoscopy

53
Q

How is coeliac disease treated/managed?

A

gluten-free diet
replace nutritional deficiencies
monitor bone density

54
Q

What are investigations for chronic pancreatitis?

A

Faecal elastase-1
Produced by pancreas and passed in stool largely unaltered

Plain abdominal X-ray

Ultrasound/ CT

MRCP vs ERCP

55
Q

What are some clinical features of pancreatic disease?

A

epigastric pain, often radiating to the back, food or alcohol may exacerbate the pain, weight loss.

56
Q

How is chronic pancreatitis managed?

A 
Remove precipitant (eg. alcohol)
Pain control
Treat diabetes (often need insulin)
Pancreatic enzyme supplements – Creon
Lipase, protease, amylase
Vitamin supplementation

Nerve plexus blocks
Endoscopic stenting of strictures, surgery

57
Q

What is cholestasis?

A

Cholestasis is the impairment of bile formation / bile flow

58
Q

What is Primary sclerosing cholangitis (PSC)?

A

Inflammatory/ fibrotic process affecting intra/extrahepatic bile ducts

Leads to bile duct strictures

Aetiology unknown, but ~80% associated with IBD

Presents as pruritis, fatigue, jaundice

Ultimately leads to cirrhosis and liver failure - only proven treatment is liver transplantation

59
Q

What drug can cause malabsorption?

A

orlistat - inhibits gastric and pancreatic lipase

Medicine (25 decks)

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