Malabsorption Flashcards
What is global malnutrition?
Failure to absorb all nutrients
What is partial malnutrition?
Failure to absorb selected nutrients
How might global malnutrition present?
Pale, greasy stools (failure of fat absorption)
Foul smelling stools
Weight Loss
What is seen with fat malabsorption?
Steatorrhea
Deficiency of fat soluble vitamins- A,D,E, K and symptoms due to this e.g. clotting deficiency, hyperparathyroidism, poor vision
How can fat malabsorption be investigated for?
72 hour stool collection to check fat levels
What does vitamin A deficiency cause?
Vision problems
Night blindness
What does vitamin D deficiency cause?
Hyperparathyroidism
Osteomalacia
What does vitamin E deficiency cause?
Muscle weakenss
What does vitamin K deficiency cause?
Clotting abnormalities and bleeding
What symptoms might be seen with protein malabsorption?
Muscle atrophy
Oedema
Immune deficiency
What doe carbohydrate malabsorption cause?
Bloating
Diarrhea
Weight loss
Fatigue
Think celiac signs
What malabsorption could cause anaemia?
IDA- Microcytic
B12/Folate deficiency- Macrocytic (Also get degeneration of dorsal columns, cerebellar dysfunction)
What disease cause global malabsorption?
IBD
Coeliac disease
Exocrine pancreatic deficiency
What are some symptoms fo coeliac?
Diarrhoea Bloating Flatulence Weight loss IDA B12 and Folate deficiency
Dermatitis herpetiformis
What skin manifestation is seen in Coeliac patients?
Dermatitis herpetiformis
What are the investigations for coeliac?
Anti TTG
Anti- endomysial proteins
Biopsy to investigate for histological changes seen in coeliac (obtained via OGD)
What are the features of coeliac disease on a biopsy?
Inflammation
Villous atrophy
Crypt hyperplasia
Raised white cells
What type of Ab is Anti- TTG?
IgA
It is a mucosal Ab, also check total IgA in case overall is low
What HLA association is seen in coeliac?
HLA-DQ2
What is the management for coeliac?
Gluten free diet- get dietician input
Rice, Maize, soya and potatoes
What investigations can be done to investigate for coeliac?
Bloods- FBC, Iron studies, B12, Folate
Coeliac Screen- Anti TTG, Anti Endomysial, Total IgA
OGD with biopsy- crypt hyperplasia, inflammation and villous atrophy
What changes are seen on microscopy for coeliac disease?
Villous atrophy
Crypt hyperplasia
White cell infiltration
Why does exocrine pancreatic insufficiency cause malabsorption?
Reduced release of pancreatic enzymes required for the breakdown of foodstuffs.
What can cause exocrine pancreatic insufficiency?
Pancreatitis
Pancreatic cancer
Autoimmune attack
What test can check pancreatic exocrine function?
Faecal elastase 1 level
Serum trypsinogen
If both are reduced it suggest pancreatic insufficiency
What are the symptoms of lactose intolerance?
Diarrhoea
Bloating
Abdominal pain
Flatulence
After eating dairy products
What can be done to diagnose lactose intolerance?
Lactose hydrogen breath test
Increases in hydrogen occur if the lactose is broken down by bacteria instead.
What test can be done to investigate for carbohydrate malabsorption?
D-Xylose in the serum
