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Year 1 NME > Nutrition Disorders: Malabsorption > Flashcards

Nutrition Disorders: Malabsorption Flashcards

1
Q

What is malabsorption?

A
  • a disorder that occurs when people are unable to absorb nutrients from their diets
  • this can contribute to clinical outcomes
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2
Q

Does malabsorption take place predominantly with macro or micro nutrients?

A
  • can be both
  • can be one specific macro or micro nutrient or everything
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3
Q

What part fo the GIT does the majority of absorption take place?

A
  • small intesintes
  • duodenum, jejunem and ileum
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4
Q

Is malabsorption long or short term?

A
  • can be both
  • short term = coeliacs flair up
  • long term = bowel resection
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5
Q

Where in the pancreas do endocrine secretions come from?

A
  • islets of langerhans (generally in tail of pancreas)
  • insulin and glucagon secreted directly into blood
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6
Q

Where in the pancreas do exocrine secretions come from?

A
  • acinar cells (generally in the head of the pancreas)
  • pancreatic enzymes and juice are secreted
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7
Q

Malabsorption can be caused by a number of factors. Alterations to secretions in the GIT is one of these, what can happen if enzyme secretions into the GIT are low?

A
  • low enzyme secretion
  • a-amylase = low carbohydrates digestion
  • pancreatic lipase = low fat digestion
  • proteolytic enzymes = low protein digestion
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8
Q

Malabsorption can be caused by a number of factors. Alterations to secretions in the GIT is one of these, what can happen if there are intraluminal (GIT fluid secretions) factors?

A
  • low gastric or pancreartic juice secreted
  • enzymes work at specific pHs
  • high pH in duodenum due to low acid called achlorhydria
  • low pH in duodenum causing Zollinger - Ellinson syndrome.
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9
Q

Malabsorption can be caused by a number of factors. Alterations to secretions in the GIT is one of these, what can happen if there are bile salt deficiencies causes by liver disease?

A
  • lack of fat digestion
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10
Q

What are the 4 main causes of malabsorption?

A

1 - alterations to gastric secretions.

2 - alterations in gastric structure/absorptive capacity.

3 - alteration in gastric motility.

4 - reduction in blood flow

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11
Q

What is autosomal recessive disease?

A
  • autosomal = non sex chromosomes
  • 2 copies of abnormal gene are required to cause disease
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12
Q

Cystic fibrosis is an autosomal recessive disease. What can this do to the GIT?

A
  • blockage of ducts of pancreas due primarily to low Cl-
  • can then cause high Na+ and H2O in cells
  • causes thick pancreatic juice that blocks pancreatic ducts
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13
Q

In a patient with cystic fibrosis, what are some of the nutritional considerations?

A
  • low energy intake
  • impaired nutrient absorption (fat, proteins and carbs)
  • low fat soluble vitamin absorption (ADEK)
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14
Q

How can bowel resection contribute towards malabsorption?

A
  • reduced absorbative capcity
  • reduced secretions into the GIT
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15
Q

How can bowel inflammation contribute towards malabsorption?

A
  • GIT walls are damaged and inflammed (IBS and pancreatitis)
  • secretions and absorption are low
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16
Q

What is coeliac disease?

A
  • immune system disease
  • immune system attacks GIT wall when gluten is eaten
  • malabsorption can occur
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17
Q

In coeliac disease the GIT walls are damaged when the immune system attacks the walls when gluten is eaten? What does this do this do to the villi and cause as a secondary effect?

A
  • causes villous atrophy
  • nutrients can not be absorbed
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18
Q

Coeliac disease is an auto immune disease that damages the GIT, specifically causing villous atrophy. How can this be treated?

A
  • remove gluten from the diet
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19
Q

In coeliac disease which mineral is specifically important to monitor?

A
  • calcium
20
Q

What is inflammatory bowel disease (IBD), and what are the 2 main diseases of IBD?

A
  • chronic inflammation of the GIT
  • crohn’s disease and ulcerative colitis
21
Q

Inflammatory bowel disease is a chronic condition characterised by inflammation of the mucosal surface. What are the common symptoms of IBD?

A
  • reduced quality of life
  • abdominal pain, diarrhoea with and without blood and mucus
  • urgency and tenesmus (needing to go but no stool)
  • weight loss
  • fatigue
22
Q

In inflammatory bowel disease they are often advised to take a routine multivitamin, why is this?

A
  • vitamin and mineral deficiencies are common
  • minerals iron, zinc, copper, beta carotene and folate
  • vitamins B12, B6, E,C,D
23
Q

In inflammatory bowel disease parts of the inflammaed bowel can be removed. If an ileal resection or bacterial overgrowth occurs in Crohns disease, what vitamin and nutrient deficiency can this cause?

A
  • B12 and lactase deficiency
24
Q

In inflammatory bowel disease osteoperosis is common, why?

A
  • low calcium absorption
  • low activity levels due disease
25
Q

Microcytic anaemia is caused by iron deficiency. This can be caused by a low intake, but is more likely to be due to malabsorption. How can inflammatory bowel disease contribute to microcytic anaemia and normacytic anaemia?

A
  • microcytic anaemia = inflammed GIT causing low absorption
  • normocytic anaemia = chronic internal blood loss
26
Q

Gastric ressection can be performed for a number of reasons. What are the most common impairments that may occur?

A
  • impaired motility
  • reduced secretion of a intrinsic factor, enzymes and HCl
  • rapid gastric emptying (‘dumping’)
27
Q

What is intestinal failure?

A
  • term used to describe a variety of diseases or injuries to the small intestine that can result in surgery and resections
  • impair ability to absorb adequate nutrients and water
  • patients eat but do not absorb causing malnourisment and dehydration
28
Q

If a patient has a large bowel resection, which is responsible for the reabsorption of H2O and electrolytes, what can happen?

A
  • diarrhoea as H2O is not absorbed
  • vitamin B12 and biles acids can be affected
29
Q

If a patient has a large bowel resection, this can reduce the reabsorption of H2O and electrolytes. Is this permanent or can the body adapt?

A
  • 6-8 weeks following surgery ileum appears to adapt and losses decrease but still remain at ~400-600mls per day
30
Q

What is dumping syndrome?

A
  • impaired gastric motility
  • symptoms where food leaves the stomach too quickly
31
Q

Dumping syndrome is a symptom where food leaves th stomach too quickly and enters the duodenum. What can this cause in the duodenum?

A
  • chyme is not adequately prepared to allow efficient absorption
  • malabsorption of fluids and nutients occurs
32
Q

Dumping syndrome can be classified as early or late dumping, what are these?

A

1 - early dumping = occurs soon after eating

  • causes sweating, dizziness, faintness, rapid weak pulse and hypotension

2 - late dumping = prolonged

  • causes weakness, cold, faintness and sweating ~2 hours after a meal
33
Q

How can impaired blood flow cause malabsorption?

A
  • impaired transport mechanisms
  • impaired fat transport e.g. congenital lymphangiectasia.
  • impaired monosaccharide transport e.g. congenital primary malabsorption of glucose and galactose
  • vascular disease
34
Q

If pancreatic disease is present, for whatever cause, what can happen to a patient?

A
  • endocrine insufficiency
  • exocrine insufficiency (fats and vitamin D are big concerns)
35
Q

Pancreatic disease can cause exocrine insufficiency. Patients are prescribed enzymes such as creon, when mjust these prescriptions be taken?

A
  • with meals
36
Q

What are the key diagnostic criteria that can all be used or used in isolation for malabsorption?

A

- diarrhoea or change in stool consistency (MAIN ONE)

- abdominal distension (MAIN ONE)

- fatulence or wind (MAIN ONE)

  • loss of weight in adults or growth failure in children
  • hypoproteinaemia (low serum albumin / prealbumin)
  • iron deficiency anaemia or low serum ferritin
37
Q

What is steatorrhea?

A
  • increased fat content in stools
  • a clinical features of fat malabsorption
  • also common in exocrine pancreatic insufficiency (EPI), celiac disease, and tropical sprue
38
Q

Why can fat malabsorption be a big cause of energy intake?

A
  • fats have highest calories/gram so big loss in energy intake
39
Q

How can fat malabsorption be accentuated by low fat products?

A
  • patients are scared of having steatorrhea
  • they swithc to low fat products to avoid this
  • this further accentuates fat malabsorption
40
Q

In patients with fat malabsorption what are treatment options?

A
  • increase calorie intake
  • multivitamin supplement (specifically fat soluble)
41
Q

What is the most common cause of carbohydrate malabsorption?

A
  • lactose malabsorption
  • patients may lack the lactase enzyme
  • unable to digest lactose into galactose and glucose
42
Q

What carbohydrate malabsorption, specifically lactase deficiency cause?

A
  • lactose remains in the GIT causing osmotic diarrhoea.
  • bacteria ferment lactose resulting in symptoms such as abdominal distension, flatulence and explosive watery diarrhoea
43
Q

There are a lot of common nutritional deficiencies in the UK that results from malabsorption. What are 2 of the most common causes of malabsorption?

A

1 - disease of the GIT

2 - ressection of the GIT

  • both cause can chronic diarrhoea and / or self imposed dietary restriction
44
Q

There are a lot of common nutritional deficiencies in the UK that results from malabsorption. What are older and young children specifically at risk of following acute episodes of diarrhoea?

A
  • dehydration with loss of fluid and electrolytes
45
Q

There are a lot of common nutritional deficiencies in the UK that results from malabsorption. What patients with alcoholic liver disease specifically at risk of?

A

– thiamine (B1) deficiency

  • vitamin D deficiency
46
Q

There are a lot of common nutritional deficiencies in the UK that results from malabsorption. What are patients with inflammatory bowel disease specifically at risk of?

A
  • iron, B12, vitamin D, vitamin K, folic acid, selenium, zinc, vitamin B6, and vitamin B1 deficiencies

Year 1 NME (61 decks)

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