Small Intestinal Malabsorption Flashcards
What is malabsorption?
Defective or inadequate digestion and absorption of nutrients from the intestine.
Malabsorption is characterised by defective absorption of?
- fats 2. vitamins 3. proteins 4. carbohydrates 5. electrolytes 6. minerals 7. water
What does malabsorption present as?
- chronic diarrhoea 2. steatorrhea
Malabsorption reslts as a disturbance of?
- Intraluminal digestion: mouth, stomach and small intestine 2. Terminal digestion (involves hydrolysis of carbohydrates and peptides in brush border of small intestine) - impaired mucosal digestion and absorption 3. Transepithelial transport - post mucosal nutrient transport 4. Lymphatic transportation
What are the signs and symptoms of malabsorption?
- pain in the abdomen 2. diarrhea 3. flatulence 4. bloating 5. fat in stool 6. weight loss 7. cramps
What are the major classes of malabsorption syndromes?
- Defective intraluminal digestion 2. Primary mucosal cell abnormalities 3. Reduced small intestine surface area 4. lymphatic obstriuction 5. infections 6. iatrogenic
Name defective intraluminal digestion syndromes?
- pancreatic insufficiency 2. defective bile secretion
What is pancreatic insufficiency?
when the pancreas does not make enough of a specific enzyme the body uses to digest food in the small intestine
Give examples?
- celiac disease 2. diabetes 3. inflammatory bowel disease 4. pancreatic cancer
What is defective bile secretion?
a condition that impairs the production and release of the digestive fluid bile from liver cells
What is the function of bile?
is used in digestion to absorb fats and fat soluble vitamins such as vitamin A, D, E and K
Give examples?
- liver diease - fatty liver 2. having the gallbladder removed 3. Crohns disease 4. IBD
Describe primary mucosal cell abnormalities syndromes?
- defective terminal digestion 2. defective epithelial transport
Describe reduced small intestine surface area syndromes?
- Coeliac disease 2. Crohns disease
Describe lymphatic obstruction syndromes?
- Lymphangiectasia 2. Diseases of lymph nodes - TB, lymphoma
Describe malabsorption syndromes brough about by infections?
- Acute bacterial enteritis 2. Parasitic/protozoal infestation: Significant in HIV 3. Tropical sprue 4. Whipple disease
Describe iatrogenic syndromes?
- Gastrectomy 2. short gut syndrome
Describe the consequences of malabsorption syndromes to the alimentary tract?
- Diarrhoea 2. flatus 3. abdominal pains 4. weight loss 5. mucositis
Describe the hematopoetic consequences of malabsorption syndromes?
anemia
Describe the consequences of malabsorption syndromes to the musculoskeletal syndrome?
- osteopenia 2. tetany
Consequences to the endocrine system?
- Amenorrhoea 2. impotence and infertility from generalised malnutrition 3. Hyperparathyroidism
Cinsequences to the skin?
- Purpura and patechiae 2. Oedema 3. Dermatitis and hyperkeratosis
Consequences to the nervous system?
peripheral neuropathy
What is coeliac disease?
Gluten-sensitve enteropathy
What is it characterised by?
- chronic disease 2. Morphological abnormalities of small intestine mucosa 3. Impaired nutrient absorption 4. Improves on withdrawal of wheat products from diet
Describe the epidemiology?
causcasians
Describe the pathogenesis?
- Primary disorder is sensitivity to gluten - Protein component of wheat and related grains 2. T cell mediated chronic inflammatory reaction - Intraepithelial CD8+ T cells and Lamina propria CD4+ T cells 3. Interplay between/among Genetic factors, host immune response and environmental factors
Describe what is seen during endoscopy?
flat small intestinal mucosa or normal depending on disease stage
Describe what is seen in biopsy?
- Diffuse enteritis with intraepithelial and lamina propria lymphocytes 2. marked mucosal atrophy 3. loss of villi, loss of brush border 4. Upper small intestine shows severe injury
State the symptoms?
- diarrhea 2. failure to thrive in infancy 3. flatulence 4. weight loss and fatigue 5. extraintestinal manifestations as a result of nutrient deficiencies
Describe the diagnosis?
- Clinical documentation of malabsorption 2. Demonstration of intestinal abnormalities by small bowel biopsy 3. Improvement in symptoms and mucosal histology on gluten withdrawal
What is tropical sprue?
postinfectious sprue
Describe the epidemiology?
- common in the tropical region, central and southern Africa, India, South East Asia and Central and South America 2. Affects resident people or visitors 3. Occurs in an endemic form 4. Epidemic outbreaks are documented
What is tropical spruee associated with?
bacterial overgrowth by enterotoxic organisms (E.coli, Haemophilus)
Describe the signs and symptoms?
- Malabsorption ensues within days or weeks after an acute diarrhoeal enteric infection 2. Patients frequently have folate and Vit B12 deficiency 3. Small intestinal injury is evident in all parts of small intestine
What is lactose intolerence?
result of lactase insufficiency
Causes?
- Congenital deficiency: rare 2. Acquired lactase insufficiency: Common, associated with viral and bacterial enteric infection
Consequences of lack of lactase?
lack of lactase results in high levels of lactose
Describe symptoms?
- Resultant osmotic diarrhoea 2. If inherited/ congenital infants develop severe diarrhoea with initiation of milk feeds
