Malabsorption Flashcards
What is the difference between malnutrition and malabsorption?
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.
What is malabsorption?
Defective mucosal absorption as a consequence of many pathologies
Eg Defective luminal digestion, mucosal disease and structural disorders
What are some of the common causes of malabsorption?
Coeliac disease, Crohns disease, post infection, billary obstruction, cirrhosis
What are some of the uncommon causes of malabsorption?
Pancreatic cancer, Paracites (iron deficiency), Bacterial overgrowth, drugs, Surgery and short bowel
Malabsorption => disease
Disease => Malabsorption. Which came first?
Well you have to find out!
What can a patietn be deficient in?
Protein, fat, carbohydrate, vitamins and minerals
What are the digestive abnormalities which can lead to protein malabsorption?
Partial/total gastrectomy Exocrine pancreas insufficiency Trypsinogen deficiency Congenital deficiency of intestinal enterokinase
What are the absorptive abnormalities which can lead to protein malabsorption?
Coeliac disease
Short bowel syndrome
Methionine malabsorption syndrome, Jejunoileal bypass
What are the causes of B12 deficiency?
Atrophic gastritis => impaired pepsin/acid secretion
Pancreatic insufficiency/Z-E syndrome (reduced release of B12 from R binding protein
Helminth infections
Ileal crohns disease
What are some of the causes of folic acid deficiency?
Diseases of the proximal small bowel
Coiliac disease/ Whipple/ Tropical Sprue
Alcoholism
What are the fat soluble vitamins?
A, D, E, K
What causes fat soluble vitamin deficiency?
Anything which impairs fat absorption
What causes Calcium deficiency?
Renal disease,
hypoparathyroidism, defect in vitamin D receptor ot vitamin D formation.
Coeliac disease or bile acid deficiency also
What causes Magnesium deficiency?
Loss of mucasal surface area and luminal binding by malabsorbed fatty acids
What causes Iron deficiency?
Reduced mucasal surface area or GI bleeding
What causes Zinc defficiency?
Acrodernatitus enteropathcia (defect in Zn transport protein
What causes Copper deficiency?
Menkes Disease caused by and inherited disorder of cellular copper transport
What is tropical Spruce?
Colonisation of the intestine by an infectious agent or alterations in intestinal bacterial flora induced by exposure to an environmenta agent
How is tropical sprue treated?
Tetracycline and folic acid
What is Whipples disease?
Infection with Tropheryma whipplei
What is Giardia?
Infection with Giardia lambia. Get it from infected water
How is giardia treated?
Metronidazole for a week
What is small bowel bacterial overgrowth?
Overgrowth of E coli or bacteroides causing diarrhoea, steatorrhea and macrocytic anemia
What is the treatment for small bowel bacterial overgrowth?
Surgical correction and cyclic tetracycline antibiotics for life
When taking a history for malabsorption, what are important questions to ask?
radiation exposure, Travel history
Abdominal or bariatric surgery, alcohol consumption, drugs
What are the GI symptoms of malabsorption?
Diarrhoea:
Duration
Malabsorptive yellow stool with fat globules, floating, hard to flush away and offensive
What are the symptoms of scurvy and what causes it?
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.
What causes Acrodermatitis Enteropathica?
Autosomal recessive impaired zinc uptake. Require life long Zn supplements
What are the symptoms of Acrodermatitis Enteropathica?
Rash, perioral, acral, alopecia.
What is dermatitis herpetiformis?
Itchy blisters on the exterior surface due to sub epithilial IgA deposition. May indicate coeliac disease
What is Glossitis and what does it indicate?
Inflammation of the tongue
iron or B vitamin deficiency
What is Angular stomatitis and what does it indicate?
ommon inflammatory condition affecting the corners of the mouth or oral commissures.
Iron or B vitamin deficiency
What does nail spooning indicate?
Iron deficiency (thyroid)
What are the investigations for malabsorption?
FBC Coagulation LFTs Albumin Calcium/magnesium Stool culture Endoscopy Imaging
What is the management of malabsorption?
Treat underlying cause
Replace deficiency
Support nutritionally
