Malabsorption and Malnutrition Flashcards
what are common causes of malabsorption
coeliac
lactose intolerant
crohn’s
post infcetion
what would the symptom of easy bruising suggest
vit K + C deficiency
what is Acrodermatitis enteropathica (minging dry/flakey red rash) associated with
zinc deficiency
what is Dermatitis Herpetiformis (tiny itchy blisters) associated with
coeliac
what is spooning of the nails associated with
iron deficiency
what is Glossitis + angular stomatitis (red rash on/in mouth) associated with
Vit B + iron deficiency
what is lactose intolerance
inability to adequately digest lactose resulting in a deficiency of lactose
what are the 3 types of lactase deficiency
primary (most common worldwide)
secondary (most common in uk)
congenital
what is primary lactase deficiency caused by
lack of the lactase persistence (LP) allele
what is secondary lactase deficiency caused by
damage to/ infection of the proximal small intestine
what is congenital lactase deficiency caused by
rare autosomal recessive disease
what is the diagnostic test(s) for lactose intolerance
lactose breath hydrogen test
oral lactose intolerance test
treatment of lactose intolerance
lactose free diet
treatment of coeliac disease
gluten free diet
investigations for coeliac disease
IgA anti-tissue transglutaminase test (tTGA) = 1st line
elevated giladin antibodies
confirmative biopsy
what immune cells mediate coeliac disease
T cell
IEL
what causes coeliac disease
expression of HLA-DG2 or HLA-DQ8
what is the cause of malnutrition
nutrient/energy imbalance
when is enteral feeding indicated
inadequate or unsafe oral intake AND a functional, accessible GI tract
what is enteral feeding
supply of food directly to the stomach, duodenum, or jejunum
what are the contra-indications of enteral feeding
severe D or V
intestinal ischaemia
lower GI obstruction
when is parenteral feeding indicated
severe malnutrition
multi-organ failure
unsafe oral and enteral nutritional intake
non-functional/inaccessible/perforated GI tract
give examples of conditions which would cause a non-functional/inaccessible/perforated GI tract
IBD with severe malabsorption
short bowel syndrome
motility disorders
what is refeeding syndrome
potentially fatal shifts in fluid and electrolytes in organ function and metabolic regulation that may result from referring after a period of under nutrition
what are the metabolic features of refeeding syndrome
hypokalaemia
altered glucose metabolism
fluid overload
what are the physiological features of refeeding syndrome
arrhythmias altered levels of consciousness seizure Rest failure cardiovascular collapse death
what patients are at a moderate risk of refeeding syndrome
had little to no nutritional intake for > 5 days
what patients are at a high risk of refeeding syndrome
1 of:
BMI<16
little/no nutritional intake for >10days
low K,Mg,Po before feeding
2 of;
BMI<18.5
little/no nutritional intake >5 days
history of drug/alcohol abuse
what patients are at a extremely high risk of refeeding syndrome
BMI <14
no intake for > 15 days
what BMI is considered underweight
<18.5
what BMI is considered normal
18.5-24.9
what BMI is considered overweight
25-29.9
what BMI is considered obese
30-39.9
what BMI is considered morbidly obese
> 40
what are the ways to measure BMI
Kg/m squared
mid upper arm circumference
how can height be measured
ulnar length
measure standing height
what is the MUST score?
BMI score + weight loss score +acute disease score
what score is a low risk of malnutrition according to MUST
0
what score is a medium risk of malnutrition according to MUST
1
what score is a high risk of malnutrition according to MUST
2 or more
a BMI of >20 gives you what on the MUST score
0
a BMI of 18.5-20 gives you what on the MUST score
1
a BMI of <18.5 gives you what on the MUST score
2
an unplanned weight loss of <5% gives you what on the MUST score
0
an unplanned weight loss of >10% gives you what on the MUST score
2
an unplanned weight loss of 5-10% gives you what on the MUST score
1
what MUST score does a patient who is acutely ill and has no nutritional intake for >5 days get
2
what are the symptoms of coeliac disease
weight loss diarrhoea nutritional deficiencies excess flatus abdominal discomfort
what causes Whipple’s disease
Tropheryma whipplei
what are the symptoms of Whipple’s disease
weight loss diarrhoea steatorrhoea abdominal distension arthritis fever nutritional deficiency
what is the cause of giardiasis
giardia lamblia (parasite)
what are the risk factor for giardiasis
foreign travel
contaminated water supply
what is the diagnosis for giardiasis
stool examination
what is the treatment for giardiasis
metronidazole for 1 week
what are the symptoms for giardiasis
asymptomatic diarrhoea, flatulence abdominal cramps/epigastric pain nausea/vomiting significant malabsorption with steatorrhea + weight loss.
what is the cause of small bowel bacteria overgrowth
E.coli
what are the symptoms of small bowel bacteria overgrowth
diverticula
fistulas
strictures
what is the diagnosis of small bowel bacteria overgrowth
Lab = low cobalamin + high folate
schillings test
what is the treatment of small bowel bacteria overgrowth
tetracycline for 2-3 weeks
