Malabsorption and coeliac

Question 1

What does small bwoel do

Answer 1

Digestion and absorption of key nutrients, ivitamins and minerals. Includes fats, carbs and protein absorption

Question 2

Role of large bowel

Answer 2

Absorb sodium and water

Secrete potassium

Question 3

What does duodenum do

Answer 3

Digests chyme (pancreatic juices and bile meet here) and does absorb iron, selenium and po4 (phosphate)

Question 4

What does jejunum do

Answer 4

Sugars, amino acids and lipids and broken down and absorbed

Ca, zinc, folate and phosphate absorbed

Question 5

What does ileum do

Answer 5

Absorption and digestion of ca, sugars, amino acids, lipids, magnesium

Question 6

What does the terminal ileum do

Answer 6

Absorb and digest b12 and bile acids

Question 7

How does the small bowel absorb nutrients

Answer 7

Some nutrients are absorbed more in some areas than others

Question 8

how may a patient with malabsorption present

Answer 8

Weight loss
Diarrhoea
Clinical syndrome associated with an underlying disease (features typical for Crohn’s)
Clinical syndrome caused by the loss of an essential nutrient (vitamin and mineral deficiency)

Question 9

Clinical investigations for suspected malabsorption

Answer 9

accurate weight, height and BMI plus percentage weight loss in last 3-6 months

Question 10

Blood investigations for suspected malabsorption

Answer 10

FBC, UE, LFT, CRP, albumin, ferritin, b12, folate, vitamin D, clotting, bone profile, selenium zinc and copper, TTG and TSH

Albumin may be low in inflammatory states such as Crohn’s
Clotting profile if abnormal may be caused by Vitamin K deficiency

Question 11

Stool investigations for suspected malabsorption

Answer 11

Calprotectin, culture, faecal elastase, FIT

Question 12

Imaging for suspected malabsorption

Answer 12

Pancreas or biliary tree (MRCP), MR enterography (MRI of small bowel)

Question 13

Structural causes of malabsorption

Answer 13

Bariatric and UGI, whipple’s procedure (pancreas), cholecystectomy, short bowel, colectomy

Question 14

Infectious causes of malabsorption

Answer 14

Whipple’s, tropical sprue, giardia, small bowel bacterial overgrowth, TB
Parasites (e.g. worms and flukes)
Opportunistic infections e.g. CMV, cryptosporidium

Question 15

Diseases in digestive organs leading to malabsorption

Answer 15

acute or chronic pancreatitis, atrophic gastritis, biliary and liver disorders

Question 16

Other causes of mucosal injury leading to malabsorption

Answer 16

radiotherapy, chemo, NSAIDs, nicorandil

Question 17

What can be used as an indicator of

Answer 17

Pancreatic exocrine function

Question 18

In a pt with weight loss and diarrhoea and with alcohol dependency, what tests would you do

Answer 18

faecal elastase- exclude pancreatic exocrine dysfunction 
All bloods
Stool culture - infection
Colonoscopy and biopsy
Pancreatic imaging

Question 19

What can B12 deficiency present as

Answer 19

neuropathy and ataxia

Question 20

what is vitamin d deficney due to

Answer 20

Multifactorial

Question 21

Cause of fat soluble vitamin or fat loss

Answer 21

Pancreas, cholestasis, short bowel

Question 22

Sodium potassium and water balance cause

Answer 22

Colonic disease or loss

Question 23

Protein energy misbalance cause

Answer 23

Short bowel or non functioning gut

Question 24

Ca, PO4 and Mg

Answer 24

tetany, fatigue, myopathy or neuropathy, rarely heart failure

Question 25

Blood test for coeliac

Answer 25

IgA TTG
Add EMA if weak positive
If IgA deficient check igG EMA

Question 26

low selenium, zinc and copper presentations

Answer 26

Selenium- cardiac failure
Copper- kinky hair syndrome
Zinc- poor wound healing

Question 27

What can cause b12 deficiency

Answer 27

terminal ileal absorption involved in this. pernicious anaemia can lead to it