Malabsorption Flashcards
What is malabsorption?
Defective mucosal absorption
What might defective mucosal absorption be caused by?
defective luminal digestion
Mucosal disease
Structural disorders
What are some common causes of malabsorption?
Coeliac
Crohns
Pancreatitis
Post infection
Cirrhosis
Biliary obstruction
What different types of malabsorptive states can you get?
protein
Fat
Carb
Vitamin and minerals
Describe protein malabsorption?
Digestion - poor mixing, exocrine pancreatic insufficiency etc
Absorptive - coeliac disease, tropical sprue, SBS etc
Describe fat malabsorption?
Digestive - les time to mix, decreased micelle formations, decreased bile acids etc
Absorptive - decreased chylomicron formation
post absorptive - decreased lymphatic transport
Describe carb malabsorption?
Digestive - pancreatic insufficiency (alpha-amylase deficient)
Absorptive - primary or acquired lactase deficiency
What might iron (mineral) malabsorption be caused by?
GI bleeding - reduced musical surface area (not as common)
What is coeliac disease?
T cell mediated autoimmune disease which prolamin (wheat, barley, rye) intolerance causes villous atrophy and malabsorption
What are the symptoms of coeliac disease?
Diarrhoea + weight loss or anaemia = coeliac until proved otherwise
Stinking stools/steatorrhoea, diarrhoea, abode pain, bloating, nausea + vomiting, ulcers…
1/3 are asymptomatic
How do you diagnose coeliac?
IgA - tTGA test
Biopsy confirms
Decreased B12
Decreased Hb
Decreased ferritin
How do you treat coeliac disease?
Gluten free diet
What is lactose malabsorption?
Deficiency of lactase - can’t break down lactose
What are the symptoms of lactose malabsorption?
Induction of diarrhoea, abode discomfort, flatulence following ingestion of diary products
How do you diagnose lactose malabsorption?
Lactose breath hydrogen test
OR oral lactose intolerance test
How do you treat lactose malabsorption?
Lactose free diet
What is tropical sprue?
Villous atrophy and malabsorption occurring usually in far east etc - cause unknown
Colonisation of the intestine b infection agent or alterations in the intestinal bacterial flora induced by the exposure to another environmental agent
What are the symptoms of tropical sprue?
diarrhoea, steatorrhea, weight loss, nausea, anorexia, anaemia
How do you diagnose tropical sprue?
Biopsy
How do you treat tropical sprue?
Tetracycline and folic acid
What is whipples disease?
A rare disease featuring GI malabsorption which usually occurs in middle ages white males, commonly in europe. Fatal if untreated
Caused by Tropheryma whippeli - produces SYSTEMIC disease
What are the symptoms of whipples disease?
often stars with joint problems, arthritis
Weight loss diarrhoea, steatorrhoea, leading to malabsorption
fever, cough, sweats,
How do you diagnose whipples diseases?
demonstration of T.whipplei in involved tissues by microscopy - done by biopsy - may also see stunted villi
What is the treatment of whipples disease?
Antimicrobial - should include antibiotics that cross the blood brain barrier - usually get rapid improvement in symptoms