Malabsorption Flashcards
Which diseases cause GI malabsorption?
Coeliac disease
Chronic pancreatitis
Crohn’s disease
(OHCM)
What is coeliac disease?
T-cell mediated autoimmune disease of the small bowel in which prolamin intolerance causes villous atrophy and malabsorption.
Give 5 symptoms of coeliac disease.
Diarrhoea Weight loss/ failure to thrive Steatorrhoea (fatty stools) Abdominal pain Bloating Nausea Vomiting Ulcers Fatigue, weakness (1/3 are asymptomatic)
Give 5 signs of coeliac disease.
Anaemia Ulcers Angular stomatitis (mouth ulcer) Weight loss Transglutaminase antibodies.
What investigations would you do if you suspect coeliac disease? What would be seen in coeliac disease?
Serology:
Positive IgA tissue transglutaminases, endomysial antibodies. Must be done while person is still eating gluten.
Bloods - ferritin, B12 and folate deficiency anaemias
Endoscopy with duodenal biopsy shows villous atrophy and crypt hyperplasia, reversing on gluten-free diet.
Give 3 potential complications of coeliac disease.
Increased risk of malignancies Anaemia Secondary lactose intolerance Myopathies Neuropathies Osteoporosis
Give 3 epidemiological risk factors for coeliac disease.
Age of presentation infancy or 50-60 years old HLADQ2 (95%) Autoimmune disease Dermatitis hepatoformis Irish Slightly higher in females 1st degree relative with coeliac
Describe the management of coeliac disease.
Avoid gluten! Some gluten-free foods are available on the NHS.
Nutritional supplements.
What happens in chronic pancreatitis?
Irreversible damage to the pancreas.
What causes chronic pancreatitis?
ALCOHOL
Familial, cystic fibrosis, haemochromatosis.
Give 3 symptoms of chronic pancreatitis
Epigastric pain radiating to the back, relieved by sitting forward or heat packs.
Bloating
Weight loss
Steatorrhoea (fat in stools due to exocrine insufficiency)
(PTS)
Symptoms relapse and worsen.
(OHCM)
Give 3 complications of chronic pancreatitis
Diabetes mellitus Local arterial aneurysm Biliary obstruction Splenic vein thrombosis Gastric varices Pancreatic carcinoma (PTS)
Why is FBC NOT used to diagnose chronic pancreatitis?
There may not be enough healthy tissue to produce pancreatic enzymes.
(PTS)
What investigations would you do if you suspect chronic pancreatitis and what would you expect to see?
Radiology - USS/CT - shows pancreatic calcification.
OHCM
Describe the management of chronic pancreatitis.
Decrease alcohol and fat.
Analgesia - coeliac plexus block may give brief relief
Pancreatic enzyme supplements eg lipase
Fat-soluble vitamins eg ‘Multivite’
Glycaemic control - avoid hypoglycaemia.
Prancreatectomy indicated for unremitting pain, weight loss, narcotic abuse.
(OHCM)
