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Malabsorption Flashcards

1
Q

What is the difference between malnutrition and malabsorption?

A

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.

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2
Q

What is malabsorption?

A

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

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3
Q

What are some of the common causes of malabsorption?

A

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

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4
Q

What are some of the uncommon causes of malabsorption?

A

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

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5
Q

Malabsorption => disease

Disease => Malabsorption. Which came first?

A

Well you have to find out!

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6
Q

What can a patietn be deficient in?

A

Protein, fat, carbohydrate, vitamins and minerals

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7
Q

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

A 
Partial/total
 gastrectomy
Exocrine pancreas insufficiency
Trypsinogen deficiency
Congenital deficiency
 of intestinal enterokinase
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8
Q

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

A

Coeliac disease
Short bowel syndrome
Methionine malabsorption syndrome, Jejunoileal bypass

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9
Q

What are the causes of B12 deficiency?

A

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

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10
Q

What are some of the causes of folic acid deficiency?

A

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

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11
Q

What are the fat soluble vitamins?

A

A, D, E, K

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12
Q

What causes fat soluble vitamin deficiency?

A

Anything which impairs fat absorption

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13
Q

What causes Calcium deficiency?

A

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

Coeliac disease or bile acid deficiency also

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14
Q

What causes Magnesium deficiency?

A

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

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15
Q

What causes Iron deficiency?

A

Reduced mucasal surface area or GI bleeding

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16
Q

What causes Zinc defficiency?

A

Acrodernatitus enteropathcia (defect in Zn transport protein

17
Q

What causes Copper deficiency?

A

Menkes Disease caused by and inherited disorder of cellular copper transport

18
Q

What is tropical Spruce?

A

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

19
Q

How is tropical sprue treated?

A

Tetracycline and folic acid

20
Q

What is Whipples disease?

A

Infection with Tropheryma whipplei

21
Q

What is Giardia?

A

Infection with Giardia lambia. Get it from infected water

22
Q

How is giardia treated?

A

Metronidazole for a week

23
Q

What is small bowel bacterial overgrowth?

A

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

24
Q

What is the treatment for small bowel bacterial overgrowth?

A

Surgical correction and cyclic tetracycline antibiotics for life

25
Q

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

A

radiation exposure, Travel history

Abdominal or bariatric surgery, alcohol consumption, drugs

26
Q

What are the GI symptoms of malabsorption?

A

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

27
Q

What are the symptoms of scurvy and what causes it?

A

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.

28
Q

What causes Acrodermatitis Enteropathica?

A

Autosomal recessive impaired zinc uptake. Require life long Zn supplements

29
Q

What are the symptoms of Acrodermatitis Enteropathica?

A

Rash, perioral, acral, alopecia.

30
Q

What is dermatitis herpetiformis?

A

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

31
Q

What is Glossitis and what does it indicate?

A

Inflammation of the tongue

iron or B vitamin deficiency

32
Q

What is Angular stomatitis and what does it indicate?

A

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

33
Q

What does nail spooning indicate?

A

Iron deficiency (thyroid)

34
Q

What are the investigations for malabsorption?

A 
FBC
Coagulation
LFTs
Albumin
Calcium/magnesium
Stool culture
Endoscopy
Imaging
35
Q

What is the management of malabsorption?

A

Treat underlying cause
Replace deficiency
Support nutritionally

GI (48 decks)

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