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Y1 - Gatrointestinal > Malabsorption > Flashcards

Malabsorption Flashcards

1
Q

What disorders of the small intestine cause malabsorption?

A 
Coeliac
Dermatitis herpetiformis
Tropical Sprue
Bacterial overgrowth
Intestinal resection
Whipple's disease
Radiation enteropathy
Parasite infection
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2
Q

What is coeliac disease?

A

A condition where there is inflammation of the mucosa of the upper small bowel that improves when gluten is taken out of the diet but relapses when it is reintroduced

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3
Q

Which cereals are entirely made of gluten?

A

Wheat
Barley
Rye

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4
Q

What are prolamins?

A

Damaging factors that are resistant to digestion and trigger immune responses

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5
Q

In coeliac disease does mucosal damage decrease towards the duodenum or ileum?

A

Ileum

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6
Q

What are some symptoms of coeliac disease?

A 
Tiredness
Malaise
Diarrhoea
Steatorrhoea
Abdominal pain
Weight loss
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7
Q

How is coeliac disease diagnosed (in all but clear cut cases)?

A

Small bowel biopsy

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8
Q

Other than small bowel biopsy, what else is sufficient to diagnose coeliac disease?

A

Serology - tissue transglutamase

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9
Q

What are the histological features of coeliac disease?

A

Villous atrophy

Crypt hyperplasia

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10
Q

What are the indications for serological testing for coeliac disease?

A 
Persistent diarrhoea
Folate or iron deficiency
Unexplained abnormal LFTs
Family history of coeliac disease
Associated autoimmune disease
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11
Q

What antibodies do standard serological tests use for coeliac disease?

A

IgA

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12
Q

Why might haematology be done for coeliac disease?

A

To check for anaemia and folate deficiency

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13
Q

Why might biochemistry be done for coeliac disease?

A

In severe cases there may be osteomalacia or hypoalbuminaemia

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14
Q

What imaging might be done for coeliac disease?

A

Small bowel barium follow through

or MRI

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15
Q

Why might imaging be done for coeliac disease?

A

Mainly when a complication such as lymphoma is suspected

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16
Q

Why might bone densitometry be done for coeliac disease?

A

There is a risk of osteoporosis

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17
Q

Why might a capsule endoscopy be done for coeliac disease?

A

To look for gut abnormalities when complication is suspected

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18
Q

What may initially be needed in coeliac disease?

A

Replacement vitamins

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19
Q

What is the management for coeliac disease?

A

Gluten free diet for life

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20
Q

What is dermatitis herpetiformis?

A

A blistering, sub-epidermal eruption of the skin associated with gluten-sensitive enteropathy

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21
Q

Is dermatitis herpetiformis common?

A

No

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22
Q

What is the management for dermatitis herpetiformis?

A

Dapsone for the skin

Gluten free diet

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23
Q

What is non-coeliac gluten intolerance?

A

Patients who are sensitive to gluten but coeliac serology is negative and biopsies are normal

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24
Q

What is tropical sprue?

A

Severe malabsorption accompanied by diarrhoea and malnutrition

25
Q

What are the symptoms of tropical sprue?

A

Diarrhoea
Abdominal distension
Weight loss
Anorexia

26
Q

How long after leaving the tropics can tropical sprue present?

A

Can be weeks or many years

27
Q

How is tropical sprue managed?

A

Most see improvement after leaving the sprue area and taking folic acid
Also may require and antibiotic (usually tetracycline)

28
Q

What is bacterial overgrowth usually found in association with?

A

Structural abnormality of the small intestine such as stricture or diverticulum

29
Q

What are the clinical features of bacterial overgrowth?

A

Diarrhoea

Steatorrhoea

30
Q

What causes steatorrhoea?

A

Deficiency in unconjugated bile salts

31
Q

How is bacterial overgrowth diagnosed?

A

Hydrogen breath test

32
Q

What is classed as small bowel syndrome?

A

When less than 1m of continuous small bowel remains

33
Q

Resection of which is better tolerated, jejunum or ileum?

A

Jejunum

34
Q

After ileal resection, which substances tend to be deficient?

A

Bile salts

Vitamin B12

35
Q

Why might diarrhoea occur after ileal resection?

A

The mechanism where oligopeptides that reach the ileum without being absorbed delay gastric emptying to allow more absorption is lost.
Less absorption of fluids leads to diarrhoea

36
Q

What can happen after ileal resection?

A

Bile salt induced diarrhoea
Steatorrhoea and gallstone formation
Oxaluria and oxalate stones
B12 deficiency

37
Q

Why might steatorrhoea and gallstone formation happen after ileal resection?

A

Decreased bile salt absorption means less bile reaching the gallbladder, causing lithygenic bile and gallstone formation

38
Q

What investigations might be done in ileal resection?

A

Imaging of small bowel
Measurement of B12
Bile salt retention test (SeHCAT)
Hydrogen breath test

39
Q

What might jejunal resection lead to?

A

Gastric hypersecretion

40
Q

In which resection might adaptation take place that increases absorption?

A

Jejunal

41
Q

What can intestinal failure result from?

A 
Obstruction
Dysmotility
Surgical resection
Congenital defect
Disease associated loss of absorption
42
Q

What is short bowel syndrome characterised by?

A

Inability to maintain protein-energy, fluid, electrolyte or micronutrient balance

43
Q

When does short bowel syndrome most commonly occur?

A

Following resection for CD
Mesenteric vessel occlusion
Radiation enteritis
Trauma

44
Q

What are the two possible situations that can occur in short bowel syndrome?

A

Shortened small intestine ending at a terminal small bowel stoma
Shortened small intestine in continuity with the colon

45
Q

What is the major problem when the small intestine ends at a terminal small bowel stoma?

A

Sodium and fluid depletion

46
Q

What is Whipple’s disease?

A

A rare infectious bacterial disease

47
Q

What organism is Whipple’s disease caused by?

A

Troptheryma whipplei

48
Q

Who are the majority of Whipple’s patients?

A

Males, usually white and middle aged

49
Q

What are the symptoms of Whipple’s disease?

A 
Arthritis and arthralgia, progressing over years to:
Weight loss
Diarrhoea
Abdominal pain
Fever
Peripheral lymphadenopathy
50
Q

What do blood tests show in Whipple’s disease?

A

Chronic inflammation

Malabsorption

51
Q

How is diagnosis of Whipple’s made?

A

Small bowel biopsy

52
Q

How can T. Whipplei antibodies be identified?

A

Immunochemistry

53
Q

How is T. whipplei managed?

A

Antibiotics that cross the blood brain barrier

Trimethoprim or sulfamethoxazole

54
Q

What are the chronic affects of radiation?

A

Muscle fibre atrophy
Ulcerative changes due to ischaemia
Obstruction due to radiation induced fibrotic structures

55
Q

What areas are most commonly affected by radiation emesis?

A

Ileum

Rectum

56
Q

What symptoms may occur during irradiation?

A

Nausea and vomiting
Diarrhoea
Abdominal pain

57
Q

What does acute radiation damage cause?

A

Radiation proctitis with diarrhoea and tenesmus, with or without blood

58
Q

What are the features of giardia infection?

A

Diarrhoea

Malabsorption with steatorrhoea

59
Q

What is the feature of cryptosporidiosis infection?

A

Malabsorption

Y1 - Gatrointestinal (31 decks)

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