Malabsorption, malnutrition and intestinal failure Flashcards
what is malabsorption
defective mucosal absorption of certain compounds
what can cause malabsorption
defective luminal digestion, mucosal disease, structural disorders
what diseases are linked to malabsorption
coeliac, crohn’s, post infection, biliary obstruction, cirrhosis, pancreatic cancer
what is coeliac disease
abnormal reaction to gluten
what does coeliac disease do (immunology)
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
what does coeliac disease do to the gut
can damage enterocytes and reduce absorptive capacities, also inflammation of the mucosa in upper small bowel
how do you diagnose coeliac
small bowel biopsy = gols standard, serolgy (IgA), dermatis hepitform rash
what genes can cause coeliac
HLA-B8
what are some consequences of coeliac
malabsorption (esp fats), steatorrhea, weight loss, anamia, bloating, can increase risk of gallstones and carcinoma
what are the symptoms and investigations of lactose deficiency
diarrhoea, abdominal pain, gas after dairy. breath h2 test, oral test
what are the symptoms, investigations and treatment for tropical sprue
tropical infectious agent, malabsorption symptoms. biopsy, tetracycline + folic acid
what are the symptoms, investigations and treatment for whipple disease
caused by bacteria troph whipplei: malabsorption + fever, abdominal distension, arthritis. biopsy and antimicrobials
what is associated with small bowel bacterial overgrowth
high cobalamin and folate levels
what parasites can cause malabsorption and how do ou treat
giardia lamblia = metro 1 week, HIV
what deficiencies are associated with easy bruising
vit C and vit K
what deficiency is associated with glossitis and what is it
swelling of tongue, B vitamins and iron
what deficiency is associated with spooning of the nails
iron
what is intestinal failure
inability to maintain nutrition or fluid via the intestines
what can cause IF
obstruction, dysmotilitym surgical resection, congenital/ genetics
what are the 3 types of IF
type 1: self limiting eg surgery (weeks)
type 2: significant/ prolonged (months)
type 3: chronic eg short bowel syndrome
what is short bowel syndrome
length of small bowel less than 200cm
what is treatment of choice for type 3
parenteral nutrition at home - treat small bowel
what is malnutrition
deficiency in energy causing adverse effects
what can cause malnutrition
decreased intake, impaired digestion, increased requirements, increases losses
what can cause malnutrition
GI dysfunction, sepsis, surgery, trauma, chemo, anorexia, depression, deprivation, dysphagia
what are some consequences of anorexia
weakened whole body (infection, collapse, recovery, hypothermia)
what factors are in the must score
BMI, % unplanned weight loss, acute disease. score >2 is high risk
what other tests can be done to identify malnutrition
grip strength, albumin, urinary creatine
what are the main mineral deficiencies associated
vit A, C, D, E, albumin and zinc
what are the 4 stages of diatry management
diet, oral supplements, enteral nutrition, parenteral
what are the 5 types of enteral nutrition
nasogastric (NG), nasojejunal (NJ), parcutaneous endoscopic gastrostomy (PEG), percutaneous jejunostomy, surgical jejunostomy
when would parenteral nutrition be indicated
inadequate oral or enteral, abnormal GI es IbS, radiation enteritis, short bowel
