Malabsorption and coeliac Flashcards
What does small bwoel do
Digestion and absorption of key nutrients, ivitamins and minerals. Includes fats, carbs and protein absorption
Role of large bowel
Absorb sodium and water
Secrete potassium
What does duodenum do
Digests chyme (pancreatic juices and bile meet here) and does absorb iron, selenium and po4 (phosphate)
What does jejunum do
Sugars, amino acids and lipids and broken down and absorbed
Ca, zinc, folate and phosphate absorbed
What does ileum do
Absorption and digestion of ca, sugars, amino acids, lipids, magnesium
What does the terminal ileum do
Absorb and digest b12 and bile acids
How does the small bowel absorb nutrients
Some nutrients are absorbed more in some areas than others
how may a patient with malabsorption present
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)
Clinical investigations for suspected malabsorption
accurate weight, height and BMI plus percentage weight loss in last 3-6 months
Blood investigations for suspected malabsorption
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
Stool investigations for suspected malabsorption
Calprotectin, culture, faecal elastase, FIT
Imaging for suspected malabsorption
Pancreas or biliary tree (MRCP), MR enterography (MRI of small bowel)
Structural causes of malabsorption
Bariatric and UGI, whipple’s procedure (pancreas), cholecystectomy, short bowel, colectomy
Infectious causes of malabsorption
Whipple’s, tropical sprue, giardia, small bowel bacterial overgrowth, TB
Parasites (e.g. worms and flukes)
Opportunistic infections e.g. CMV, cryptosporidium
Diseases in digestive organs leading to malabsorption
acute or chronic pancreatitis, atrophic gastritis, biliary and liver disorders
Other causes of mucosal injury leading to malabsorption
radiotherapy, chemo, NSAIDs, nicorandil
What can be used as an indicator of
Pancreatic exocrine function
In a pt with weight loss and diarrhoea and with alcohol dependency, what tests would you do
faecal elastase- exclude pancreatic exocrine dysfunction All bloods Stool culture - infection Colonoscopy and biopsy Pancreatic imaging
What can B12 deficiency present as
neuropathy and ataxia
what is vitamin d deficney due to
Multifactorial
Cause of fat soluble vitamin or fat loss
Pancreas, cholestasis, short bowel
Sodium potassium and water balance cause
Colonic disease or loss
Protein energy misbalance cause
Short bowel or non functioning gut
Ca, PO4 and Mg
tetany, fatigue, myopathy or neuropathy, rarely heart failure
