Malabsorption DISORDERS

Question 1

What is malabsorption?

Answer 1

A type of chronic diarrhea that is always associated with weight loss.

Fat malabsorption is associated wtih steatorrhea (oily, greasy stools) that float on the water in the toliet.

Question 2

Causes of malabsorption?

Answer 2

1. Celiac disease (gluten sensitive enteropathy), or nontropical sprue
2. Tropical sprue
3. Chronic pancreatitis
4. Whipple disease

Question 3

All forms of fat malabsorption are associated with the following:

Answer 3

1. Hypocalcemia (from Vitamin D def. can lead to osteoporosis)
2. Oxalate over-absorption and oxalate kidney stones
3. Easy bruising and elevated prothrombin time/INR (from Vitamin K malabsorption)
4. Vitamin B12 malabsorption (from either destruction of the terminal ileum or loss of the pancreatic enzyme that is necessary for B12 absorption)

Question 4

Diagnostic Testing for malabsorption?

Answer 4

Best initial test: Sudan black stain of stool (to test for presence of fat)
Most sensitive test: 72-hr fecal fat.

Question 5

Celiac Disease (Gluten-sensitive enteropathy) :

Answer 5

an immune disease in which people can’t eat gluten because it will damage their small intestine.

Question 6

Symptoms of Celiac Disease

Answer 6

• -Malabsorption of iron and microcytic anemia (vs. pancreatic insufficiency, since pancreatic enzymes are not necessary for iron absorption).
• -Folate malabsorption due to destruction of villi (small intestine)
• -Dermatitis herpetiformis (vesicular skin lesions)

Question 7

Diagnostic Testing for Celiac Disease

Answer 7

Best initial test: Anti-gliadin, anti-endomysial, and anti-tissue transglutaminase antibodies.

Most accurate: Small bowel biopsy

D-Xylose testing is abnormal in Celiac disease, Whipple disease and Tropical Sprue because with destruction of the villous lining in the small intestine, D-Xylose can not be absorbed. Rarely necessary test. Ruled out by specific antibody test.

Bowel Biopsy is always necessary for celiac disease.

Question 8

Why is Bowel Biopsy necessary for Celiac Disease?

Answer 8

Because even if Celiac D. is confirmed with positive antibody test, a bowel biopsy rules out bowel wall lymphoma

Question 9

Treatment for Celiac Disease?

Answer 9

• Diet: Eliminate wheat, oats, rye and barley from the diet.
• Beer, whiskey and most vodkas are derived from wheat.
• Make take several weeks for symptoms to resolve.
• Wine is okay.