Malabsorption, malnutrition and intestinal failure

Question 1

what is malabsorption

Answer 1

defective mucosal absorption of certain compounds

Question 2

what can cause malabsorption

Answer 2

defective luminal digestion, mucosal disease, structural disorders

Question 3

what diseases are linked to malabsorption

Answer 3

coeliac, crohn’s, post infection, biliary obstruction, cirrhosis, pancreatic cancer

Question 4

what is coeliac disease

Answer 4

abnormal reaction to gluten

Question 5

what does coeliac disease do (immunology)

Answer 5

gliadin in gluten can’t be broken down and so triggers the immune response of IEL T cells (CD4+ and IgA) located in IEl’s. This changes the villous structure which reduces absorption

Question 6

what does coeliac disease do to the gut

Answer 6

can damage enterocytes and reduce absorptive capacities, also inflammation of the mucosa in upper small bowel

Question 7

how do you diagnose coeliac

Answer 7

small bowel biopsy = gols standard, serolgy (IgA), dermatis hepitform rash

Question 8

what genes can cause coeliac

Answer 8

HLA-B8

Question 9

what are some consequences of coeliac

Answer 9

malabsorption (esp fats), steatorrhea, weight loss, anamia, bloating, can increase risk of gallstones and carcinoma

Question 10

what are the symptoms and investigations of lactose deficiency

Answer 10

diarrhoea, abdominal pain, gas after dairy. breath h2 test, oral test

Question 11

what are the symptoms, investigations and treatment for tropical sprue

Answer 11

tropical infectious agent, malabsorption symptoms. biopsy, tetracycline + folic acid

Question 12

what are the symptoms, investigations and treatment for whipple disease

Answer 12

caused by bacteria troph whipplei: malabsorption + fever, abdominal distension, arthritis. biopsy and antimicrobials

Question 13

what is associated with small bowel bacterial overgrowth

Answer 13

high cobalamin and folate levels

Question 14

what parasites can cause malabsorption and how do ou treat

Answer 14

giardia lamblia = metro 1 week, HIV

Question 15

what deficiencies are associated with easy bruising

Answer 15

vit C and vit K

Question 16

what deficiency is associated with glossitis and what is it

Answer 16

swelling of tongue, B vitamins and iron

Question 17

what deficiency is associated with spooning of the nails

Answer 17

iron

Question 18

what is intestinal failure

Answer 18

inability to maintain nutrition or fluid via the intestines

Question 19

what can cause IF

Answer 19

obstruction, dysmotilitym surgical resection, congenital/ genetics

Question 20

what are the 3 types of IF

Answer 20

type 1: self limiting eg surgery (weeks)
type 2: significant/ prolonged (months)
type 3: chronic eg short bowel syndrome

Question 21

what is short bowel syndrome

Answer 21

length of small bowel less than 200cm

Question 22

what is treatment of choice for type 3

Answer 22

parenteral nutrition at home - treat small bowel

Question 23

what is malnutrition

Answer 23

deficiency in energy causing adverse effects

Question 24

what can cause malnutrition

Answer 24

decreased intake, impaired digestion, increased requirements, increases losses

Question 25

what can cause malnutrition

Answer 25

GI dysfunction, sepsis, surgery, trauma, chemo, anorexia, depression, deprivation, dysphagia

Question 26

what are some consequences of anorexia

Answer 26

weakened whole body (infection, collapse, recovery, hypothermia)

Question 27

what factors are in the must score

Answer 27

BMI, % unplanned weight loss, acute disease. score >2 is high risk

Question 28

what other tests can be done to identify malnutrition

Answer 28

grip strength, albumin, urinary creatine

Question 29

what are the main mineral deficiencies associated

Answer 29

vit A, C, D, E, albumin and zinc

Question 30

what are the 4 stages of diatry management

Answer 30

diet, oral supplements, enteral nutrition, parenteral

Question 31

what are the 5 types of enteral nutrition

Answer 31

nasogastric (NG), nasojejunal (NJ), parcutaneous endoscopic gastrostomy (PEG), percutaneous jejunostomy, surgical jejunostomy

Question 32

when would parenteral nutrition be indicated

Answer 32

inadequate oral or enteral, abnormal GI es IbS, radiation enteritis, short bowel