Malabsorption & Coeliac Disease

Question 1

What are the sx of malabsorption?

Answer 1

Diarrhoea/Steatorrhoea
Wt loss
Lethargy

Question 2

What are the signs of malabsorption?

Answer 2

Anaemia (Fe/B12/folate)
Bleeding disorders (vitamin K)
Oedema (decreased protein)
Osteomalacia (vitamin D)
Neuropathy

Question 3

What are the most common causes of malabsorption?

Answer 3

Coeliac disease
Chronic pancreatitis
Chron’s disease

Question 4

What are the rarer causes of malabsorption?

Answer 4

Pancreatic insufficiency (CF/cancer)
Bacterial overgrowth
Infection
Reduced bile (obstruction, cholestyramine, ileal resection)

Question 5

What investigations are appropriate in suspected malabsorption?

Answer 5

Bloods - FBC, Fe studies, B12/folate, Ca, Mg, PO4, lipids, LFTs, TFTs, CRP/ESR, clotting, coeliac serology
Stool studies - MCS, faecal elastase, calprotectin
Endoscopy
OGD + biopsy
Colonoscopy + biopsy
ERCP
Breath hydrogen analysis (bacterial overgrowth)

Question 6

What is coeliac disease?

Answer 6

A gluten sensitive enteropathy

Question 7

What is the underlying pathophysioloy of coeliac disease?

Answer 7

Inflammation of jejunal mucosa in response to gluten
Flattened mucosa due to loss of villi and crypt hyperplasia
Increased intraepithelial lymphocytes

Question 8

How does coeliac disease present?

Answer 8

1/3 asymptomatic
Non specific features IDA (wt loss, fatigue, apthous ulcers)
Diarrhoea
Abdo pain
Bloating
N/V
Dermatitis herpatiforms

Question 9

What investigations are appropriate in suspected coeliac disease?

Answer 9

Bloods
 -FBC (anaemia)
 -clotting (prolonged)
 -bone profile (oestomalacia)
Endomysial antibodies (EMA & TTG)
Duodenal biopsy (gold standard)
Bone densitometry (osteoporosis)

Question 10

What is the management of coeliac disease?

Answer 10

Lifelong gluten free diet
-verify w/ endomysial antibody tests
Small increased risk of small bowel lymphoma/adenocarcinoma

Question 11

What is the underlying pathophysiology of chronic pancreatitis?

Answer 11

Most commonly due to high alcohol intake
Inappropriate enzyme activity, proteins plug pancreatic ducts (ductal HTN)
Fibrosis of parenchyma/disturbed exocrine function

Question 12

How does chronic pancreatitis present?

Answer 12

Epigastric pain (radiates to back, relieved by sitting forwards/hot water bottles)
Wt loss, bloating, steatorrhoea
Brittle diabetes
Obstructive jaundice
Sx relapsing, progressively worsen

Question 13

What is brittle diabetes?

Answer 13

Insulin dependant DM

Sudden swings in glucose level for no apparent reason

Question 14

What investigations are appropriate in suspected chronic pancreatitis?

Answer 14

Amylase/lipase (rarely elevated)
Faecal elastase (elevated)
Trypsinogen (>10 in steatorrhoea)
Transabdominal USS (pseudocyst)
Contrast CT/MRCP (pancreatic calcifications)

Question 15

How is chronic pancreatitis managed?

Answer 15

Analgesia
Creon (lipase) & multivite (ADEK) supplements
Monitoring of blood sugars
Treatment of alcohol abuse (complete abstinence)
Low fat diet
Partial pancreatectomy/pancreaticojejunostomy

Question 16

What are the indications for partial pancreatectomy/pancreaticojejunostomy?

Answer 16

Unremitting pain
Narcotic abuse
Wt loss

Question 17

What are the effects of a vitamin A deficiency?

Answer 17

Xeropthalmia

Night blindness

Question 18

What are the effects of a vitamin A excess?

Answer 18

Liver damage

Teratogenicity

Question 19

What are the effects of a vitamin B1 (thiamine) deficiency?

Answer 19

Beri-beri disease (polyneuropathy)

Wernicke-Korsakoff syndrome

Question 20

What are the effects of a vitamin B3 (niacin) deficiency?

Answer 20

Pellagra (dermaitis, diarrhoea, dementia)

Question 21

What are the effects of a vitamin C deficiency?

Answer 21

Scurvy (gingivitis & bleeding)

Question 22

What are the effects of a vitamin D deficiency?

Answer 22

Rickets/osteomalacia

Question 23

What are the effects of a vitamin D excess?

Answer 23

Hypercalcaemia