Malabsorption

Question 1

What is the difference between malnutrition and malabsorption?

Answer 1

Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anaemias.

Question 2

What is malabsorption?

Answer 2

Defective mucosal absorption as a consequence of many pathologies
Eg Defective luminal digestion, mucosal disease and structural disorders

Question 3

What are some of the common causes of malabsorption?

Answer 3

Coeliac disease, Crohns disease, post infection, billary obstruction, cirrhosis

Question 4

What are some of the uncommon causes of malabsorption?

Answer 4

Pancreatic cancer, Paracites (iron deficiency), Bacterial overgrowth, drugs, Surgery and short bowel

Question 5

Malabsorption => disease

Disease => Malabsorption. Which came first?

Answer 5

Well you have to find out!

Question 6

What can a patietn be deficient in?

Answer 6

Protein, fat, carbohydrate, vitamins and minerals

Question 7

What are the digestive abnormalities which can lead to protein malabsorption?

Answer 7

Partial/total
 gastrectomy
Exocrine pancreas insufficiency
Trypsinogen deficiency
Congenital deficiency
 of intestinal enterokinase

Question 8

What are the absorptive abnormalities which can lead to protein malabsorption?

Answer 8

Coeliac disease
Short bowel syndrome
Methionine malabsorption syndrome, Jejunoileal bypass

Question 9

What are the causes of B12 deficiency?

Answer 9

Atrophic gastritis => impaired pepsin/acid secretion
Pancreatic insufficiency/Z-E syndrome (reduced release of B12 from R binding protein
Helminth infections
Ileal crohns disease

Question 10

What are some of the causes of folic acid deficiency?

Answer 10

Diseases of the proximal small bowel
Coiliac disease/ Whipple/ Tropical Sprue
Alcoholism

Question 11

What are the fat soluble vitamins?

Answer 11

A, D, E, K

Question 12

What causes fat soluble vitamin deficiency?

Answer 12

Anything which impairs fat absorption

Question 13

What causes Calcium deficiency?

Answer 13

Renal disease,
hypoparathyroidism, defect in vitamin D receptor ot vitamin D formation.

Coeliac disease or bile acid deficiency also

Question 14

What causes Magnesium deficiency?

Answer 14

Loss of mucasal surface area and luminal binding by malabsorbed fatty acids

Question 15

What causes Iron deficiency?

Answer 15

Reduced mucasal surface area or GI bleeding

Question 16

What causes Zinc defficiency?

Answer 16

Acrodernatitus enteropathcia (defect in Zn transport protein

Question 17

What causes Copper deficiency?

Answer 17

Menkes Disease caused by and inherited disorder of cellular copper transport

Question 18

What is tropical Spruce?

Answer 18

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

Question 19

How is tropical sprue treated?

Answer 19

Tetracycline and folic acid

Question 20

What is Whipples disease?

Answer 20

Infection with Tropheryma whipplei

Question 21

What is Giardia?

Answer 21

Infection with Giardia lambia. Get it from infected water

Question 22

How is giardia treated?

Answer 22

Metronidazole for a week

Question 23

What is small bowel bacterial overgrowth?

Answer 23

Overgrowth of E coli or bacteroides causing diarrhoea, steatorrhea and macrocytic anemia

Question 24

What is the treatment for small bowel bacterial overgrowth?

Answer 24

Surgical correction and cyclic tetracycline antibiotics for life

Question 25

When taking a history for malabsorption, what are important questions to ask?

Answer 25

radiation exposure, Travel history | Abdominal or bariatric surgery, alcohol consumption, drugs

Question 26

What are the GI symptoms of malabsorption?

Answer 26

Diarrhoea: Duration Malabsorptive yellow stool with fat globules, floating, hard to flush away and offensive

Question 27

What are the symptoms of scurvy and what causes it?

Answer 27

Vitamin C deficiency swollen, spongy and purplish gums that are prone to bleeding. loose teeth. bulging eyes (proptosis) bleeding into the skin (severe and easy bruising) scaly, dry and brownish skin. very dry hair that curls and breaks off close to the skin.

Question 28

What causes Acrodermatitis Enteropathica?

Answer 28

Autosomal recessive impaired zinc uptake. Require life long Zn supplements

Question 29

What are the symptoms of Acrodermatitis Enteropathica?

Answer 29

Rash, perioral, acral, alopecia.

Question 30

What is dermatitis herpetiformis?

Answer 30

Itchy blisters on the exterior surface due to sub epithilial IgA deposition. May indicate coeliac disease

Question 31

What is Glossitis and what does it indicate?

Answer 31

Inflammation of the tongue | iron or B vitamin deficiency

Question 32

What is Angular stomatitis and what does it indicate?

Answer 32

ommon inflammatory condition affecting the corners of the mouth or oral commissures. Iron or B vitamin deficiency

Question 33

What does nail spooning indicate?

Answer 33

Iron deficiency (thyroid)

Question 34

What are the investigations for malabsorption?

Answer 34

``` FBC Coagulation LFTs Albumin Calcium/magnesium Stool culture Endoscopy Imaging ```

Question 35

What is the management of malabsorption?

Answer 35

Treat underlying cause Replace deficiency Support nutritionally