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LC Gastroenterology Week 2 > Malabsorption > Flashcards

Malabsorption Flashcards

1
Q

What is malabsorption?

A

Defective mucosal absorption

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2
Q

What might defective mucosal absorption be caused by?

A

defective luminal digestion
Mucosal disease
Structural disorders

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3
Q

What are some common causes of malabsorption?

A

Coeliac
Crohns
Pancreatitis

Post infection
Cirrhosis
Biliary obstruction

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4
Q

What different types of malabsorptive states can you get?

A

protein
Fat
Carb
Vitamin and minerals

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5
Q

Describe protein malabsorption?

A

Digestion - poor mixing, exocrine pancreatic insufficiency etc

Absorptive - coeliac disease, tropical sprue, SBS etc

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6
Q

Describe fat malabsorption?

A

Digestive - les time to mix, decreased micelle formations, decreased bile acids etc

Absorptive - decreased chylomicron formation

post absorptive - decreased lymphatic transport

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7
Q

Describe carb malabsorption?

A

Digestive - pancreatic insufficiency (alpha-amylase deficient)

Absorptive - primary or acquired lactase deficiency

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8
Q

What might iron (mineral) malabsorption be caused by?

A

GI bleeding - reduced musical surface area (not as common)

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9
Q

What is coeliac disease?

A

T cell mediated autoimmune disease which prolamin (wheat, barley, rye) intolerance causes villous atrophy and malabsorption

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10
Q

What are the symptoms of coeliac disease?

A

Diarrhoea + weight loss or anaemia = coeliac until proved otherwise

Stinking stools/steatorrhoea, diarrhoea, abode pain, bloating, nausea + vomiting, ulcers…

1/3 are asymptomatic

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11
Q

How do you diagnose coeliac?

A

IgA - tTGA test
Biopsy confirms

Decreased B12
Decreased Hb
Decreased ferritin

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12
Q

How do you treat coeliac disease?

A

Gluten free diet

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13
Q

What is lactose malabsorption?

A

Deficiency of lactase - can’t break down lactose

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14
Q

What are the symptoms of lactose malabsorption?

A

Induction of diarrhoea, abode discomfort, flatulence following ingestion of diary products

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15
Q

How do you diagnose lactose malabsorption?

A

Lactose breath hydrogen test

OR oral lactose intolerance test

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16
Q

How do you treat lactose malabsorption?

A

Lactose free diet

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17
Q

What is tropical sprue?

A

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

18
Q

What are the symptoms of tropical sprue?

A

diarrhoea, steatorrhea, weight loss, nausea, anorexia, anaemia

19
Q

How do you diagnose tropical sprue?

A

Biopsy

20
Q

How do you treat tropical sprue?

A

Tetracycline and folic acid

21
Q

What is whipples disease?

A

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

22
Q

What are the symptoms of whipples disease?

A

often stars with joint problems, arthritis

Weight loss diarrhoea, steatorrhoea, leading to malabsorption

fever, cough, sweats,

23
Q

How do you diagnose whipples diseases?

A

demonstration of T.whipplei in involved tissues by microscopy - done by biopsy - may also see stunted villi

24
Q

What is the treatment of whipples disease?

A

Antimicrobial - should include antibiotics that cross the blood brain barrier - usually get rapid improvement in symptoms

25
Q

What is Crohns disease?

A

Chronic inflammatory disease of the GI tract characterised by transmural granulomatous inflammation affecting ANY part of the GI tract.

26
Q

What are the symptoms of crohns disease?

A 
Diarrhoea/urgency 
abdo pain (RLQ)
weight loss/failure to thrive 
Fever
Malaise
Anorexia
27
Q

How do you diagnose crohns disease?

A

Endoscopy
barium - rarely used - cobblestoning and rose throw ulcers
Colonoscopy - assess extent of disease, punch out lesions

28
Q

How do you treat crohns?

A

Steroids
immunosuppressants
Azathioprine 6-MP
Biological therapy (anti - TNF)

29
Q

Describe giardia lambila (parasitic infections)

A

Can get it if you travel to areas where water supply might be contaminated, swimming in ponds.

Lives in the duodenum and jejunum

Spread by feacal-oral (increased risk if immunosuppressed, travel, anal sex, playgroups, swimming or from birds and pets)

30
Q

What are some symptoms of giardia lambila?

A

Can be asymptomatic

Diarrhoea (explosive?), flatulence, abdo cramps, epigastric pain ad nausea

Significant malabsorption and steatorrhoea and weight loss may occur

31
Q

How might you diagnose giardia lambila?

A

Stool examination - for ova and parasites (need 3 stools)

32
Q

How would you treat giardia lambila?

A

Metronidazole - 1 week ??

33
Q

Small bowel bacterial overgrowth?

A

Small intestine bacterial overgrowth (SIBO), also termed bacterial overgrowths, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine.

Patients with bacterial overgrowth typically develop symptoms including nausea, bloating, vomiting, diarrhea, malnutrition, weight loss and malabsorptio

The diagnosis of bacterial overgrowth is made by a number of techniques, with the gold standard being an aspirate from the jejunum.

Risk factors for the development of bacterial overgrowth include dysmotility; anatomical disturbances in the bowel, including fistulae, diverticula and blind loops created after surgery, and resection of the ileo-cecal valve; gastroenteritis-induced alterations to the small intestine; and the use of certain medications, including proton pump inhibitors.

Small bowel bacterial overgrowth syndrome is treated with an elemental diet or antibiotics, which may be given in a cyclic fashion to prevent tolerance to the antibiotics, sometimes followed by prokinetic drugs to prevent recurrence if dysmotility is a suspected cause.

34
Q

What past medical history might suggest malabsorption?

A

Gastric of small bowel resection
Gastrointestinal diversion
Radiation exposure
Travel

35
Q

What must you ask in the history when thinking about malabsorption?

A

Travel
Alcohol
Drugs

36
Q

What should you ask specifically about the diarrhoea?

A 
Duration 
Any fat in stools
Floating? 
Hard to flush away 
Smelling?
37
Q

What might easy bruising suggest in malabsorption?

A

Vitamin C - scurvy

Vitamin K deficiency

38
Q

What would glossitis and angular stomatitis indicate?

A

Vitamin B

Iron deficiency

39
Q

What baseline investigations should you do for malabsorption?

A 
FBC
Coagulation 
LFT's
Albumin 
Calcium/magnesium 
Stool culture
40
Q

How should you manage any malabsorption?

A

Treat underlying cause
Replace deficiency
Support nutritionally

LC Gastroenterology Week 2 (6 decks)

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