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AEU (CLB) > Malabsorption & Maldigestion > Flashcards

Malabsorption & Maldigestion Flashcards

1
Q

What 3 proteases are produced by the exocrine pancreas?

A

1) Trypsin
2) Chymotrypsin
1+2 both convert proteins to polypeptides
3) Carboxypolypeptidases

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2
Q

What 3 lipases are produced by the exocrine pancreas?

A

1) Pancreatic lipase
2) Cholesterol esterase
3) Phospholipidase

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3
Q

What is produced by the pancreas to help with carbohydrate digestion?

A

Pancreatic amylase

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4
Q

Why is it important for the pancreas to produce bicarbonate?

A

Because the bicarbonate neutralises the HCl coming from the stomach and provides a suitable environment for pancreatic enzymes to work.

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5
Q

What is the difference between maldigestion and malabsorption?

A

Maldigestion = when normal digestion is impaired whereas malabsorption is when nutrients are digested normally but cannot be absorbed.

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6
Q

What is malassimilation?

A

When maldigestion and malabsorption both occur at the same time

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7
Q

Aside from maldigestion of proteins, carbohydrates and lipids, what else can malassimilation cause?

A
  • Impaired assimilation of fat soluble vitamins
  • Impaired absorption of cobalamin
  • Increased bacterial growth in the small intestine
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8
Q

What are 4 fat soluble vitamins?

A

Vitamin A
Vitamin D
Vitamin E
Vitamin K

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9
Q

What causes increased bacterial growth in the gut?

A

When chyme lies undigested in the upper GI tract, it provides a growth media for bacteria.

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10
Q

Intrinsic factor is essential to permit cobalamin absorption, where is it produced?

A

Intrinsic factor is synthesised by the pancreas

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11
Q

How does exocrine pancreatic insufficiency (EPI) affect intrinsic factor production?

A

EPI - stops production.

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12
Q

What happens to cobalamin absorption when there is increased number of bacteria in the gut?

A

Bacteria take up all of the cobalamin and do not leave enough for the body.

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13
Q

Why do we need cobalamin?

A

Important for correct functioing of nerve cells and red blood cells.

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14
Q

How is cobalamin absorbed in the ileum?

A

1) Cobalamin binds to R proteins secreted by the salivary glands and gastric mucosal cells
2) In the duodenum, protease removes/ cleaves the R protein and cobalamin binds to an intrinsic factor.
3) Cobalamin then undergoes receptor mediated transport in the ileum.

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15
Q

What are the 4 causes of maldigestion?

A
  • Exocrine pancreatic insufficiency
  • Secondary enzyme insufficiency
  • Deficiency of bile acid
  • Loss of brush border enzymes
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16
Q

What is exocrine pancreatic insufficiency (EPI)?

A

Insufficient production of pancreatic enzymes.

17
Q

What do acinar cells do in the pancreas?

A

Produce enzymes for the exocrine pancreas.

18
Q

What are the 4 causes of EPI?

A

1) Pancreatic acinar atrophy
2) Pancreatitis (inflammation)
3) Pancreatic hypoplasia (decreased size)
4) Pancreatic neoplasia

19
Q

What is pancreatic acinar atrophy (PAA)?

A

Destruction of acinar cells.
Can have stage 1 and stage 2 of PAA
Stage 1 = Partial acinar atrophy
Stage 2 = Severe, end stage.

20
Q

What is chronic pancreatitis?

A

Progressive destruction of exocrine and endocrine pancreas

21
Q

What are some of the clinical signs of EPI?

A
  • Weight loss
  • Increased faecal volume
  • Flatulence
  • Abnormal faeces
  • Coprophagia
22
Q

What is the best diagnosis method for EPI?

A
  • TLI blood test (trypsin-like immunoreactivity)
    EPI would cause low TPI levels in blood
23
Q

How can EPI be treated?

A

Restricted fat diet
Give pancreatic enzyme replacement

24
Q

What are the 3 phases of absorption in the small intestine?

A

1) Luminal
2) Mucosal
3) Transportation

25
Q

What pathology can affect the luminal phase?

(Phase refers to micelles in the lumen of the SI)

A
  • Dysmotility (motility can be sped up or slowed down)
  • Pancreatic enzyme deficiency
  • Fat maldigestion
26
Q

What pathology affects the mucosal phase?

(Phase affects the brush border in the SI)

A
  • Brush border enzyme deficiency
  • Brush border protein transport deficiency
  • Enterocyte defects
27
Q

What pathology can affect the transport phase?

A
  • Lymphatic obstruction
  • Obstruction due to neoplasia/ inflammation
  • Vascular compromise
  • Hepatopathy (right sided heart failure)
28
Q

What is primary GI disease?

A

Refers to infiltrative diseases of the gut wall

29
Q

What are the main 3 clinical signs of primary GI disease?

A

Weight loss, diarrhoea, coprophagia

30
Q

What is secondary GI disease?

A
  • Linked to hepatic disease (bile acids not working properly)
  • Right sided cardiac disease
  • Hyperthyroidism (decreases gut transit time)

AEU (CLB) (11 decks)

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