Malabsorption Flashcards
Name three disorders of the small intestine associated with malabsorption
- Coeliac disease
- Tropical sprue
- Bacterial overgrowth
- Intestinal resection
- Whipple’s disease
- Radiation enteropathy
- Parasite infection
Define coeliac disease
- Autoimmune disorder
- Inflammatory response to gliadin in gluten
- Chronic inflammation, and
- Subtotal villous atrophy of small intestine
Define refractory coeliac disease
Persistence or recurrence of otherwise unexplained malabsorption symptoms and villous atrophy despite adhering to a gluten-free diet
What foods contain gluten?
Cereals: wheat, barley, and rye
Describe the genetics of coeliac disease
- Multi genetic disorder
- Associated with HLA-DQ2 (90%) and DQ8 (8%)
- 10-15% of 1o relatives also affected
Name two risk factors for coeliac disease
- Genetic predisposition: HLA-DQ2/8
- FHx in 1o relative
- Other autoimmune conditions
- T1DM
- Autoimmune thyroid disease
When does coeliac disease present?
- Any age
- Peaks in infancy; 50-60yrs
- F>M
Which presentations should always include coeliac disease as a differential diagnosis?
- Diarrhoea + weight loss
- Anaemia: esp. if iron, folate, or Vit B12 deficiency
List five clinical features of suspected coeliac disease
- Persistent, unexplained abdominal or GI symptoms
- eg. Indigestion; diarrhoea; bloating; constipation
- Faltering growth in children
- Prolonged fatigue
- Unexpected weight loss
- Severe/persistent mouth ulcers
- Unexplained iron, vit B12, or folate deficiency
- T1DM at diagnosis; Autoimmune thyroid disease
- IBS in adults
- 1o relative with coeliac disease
What is involved in a coeliac disease serology test?
- IgA Tissue transglutaminase antibody (tTG) + Total IgA
- Otherwise, IgA endomysial antibody (EMA)
Requires a gluten diet for 6+ wks prior to testing
+ve: refer for endoscopic intestinal biopsy to confirm/exclude
What is the gold standard diagnostic test for coeliac disease?
Duodenal biopsy
Showing subtotal villous atrophy and crypt hyperplasia
Name three complications of coeliac disease
-
Malabsorption
- Anaemia: Iron; folate; vitamin B12 deficiency
- Osteoporosis: calcium/vitamin D malabsorption
- Functional hyposplenism: offer pneumococcal vaccine
- Faltering growth; delayed puberty in children
- Chronic pancreatitis
- Autoimmune hepatitis; PBC; PSC
- Subfertility
- Bacterial overgrowth
- Malignancy: eg. Lymphoma; small intestine adenocarcinoma
Outline the management of coeliac disease
- Gluten-free diet for life
- Education
- Offer annual review:
- Weight; height
- Symptoms
- Consider DEXA scan for osteoporosis
- Consider dietary referral
- Support groups - Coeliac UK
What is Dermatitis herpetiformis?
An uncommon, blistering, sub epidermal eruption of the skin associated with coeliac disease
What is Tropical sprue?
- Malabsorption disease commonly found in tropical regions
- Presents with:
- Chronic diarrhoea
- Malnutrition
- Severe malabsorption
