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GI > W3 Malabsorption > Flashcards

W3 Malabsorption Flashcards

1
Q

What is malabsorption?

A

Defective mucosal absorption caused by defective luminal absorption, mucosal disease, structural disorder

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2
Q

What are common causes of malabsorption?

A
  • Celiac disease
  • Crohn’s disease
  • Post-infective
  • biliary obstruction
  • cirrhosis
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3
Q

What are uncommon causes of malabsorption?

A
  • pancreatic cancer
  • short bowel (incl. resection)
  • drugs
  • bacterial overgrowth
  • parasites
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4
Q

What digestive diseases could cause protein malabsorption? (4)

A
  • gastrectomy (poor mixing)
  • exocrine pancreatic insufficiency
  • trypsinogen deficiency
  • congenital deficiency of intestinal enterokinase
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5
Q

What is enterokinase?

A

Enterokinase is an enzyme secreted from duodenal mucosa that changes inactive pancreatic secretion trypsinogen into active trypsin.

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6
Q

What absorptive disease could cause protein malabsorption? (9)

A
  • Celiac disease
  • tropical sprue (causes ulceration)
  • short bowel syndrome
  • jejunoileal bypass
  • Methionine malabsorption syndrome (malt wee)
  • Blue diaper syndrome (tryptophan malabsorption) (blue wee)
  • defect in amino acid transporters e.g. Hartnup disease
  • cystinuria
  • oculocerebral syndrome of Lowe (lysine/arginine)
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7
Q

What is cystinuria?

A

Genetic disorder in which cystine builds up in kidneys and bladder and crystals can form.

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8
Q

What is Hartnup disease?

A

Genetic metabolic disorder associated with defect in amino acid transporters

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9
Q

What is oculocerebral syndrome of Lowe?

A

Genetic metabolic disorder in which kidney is affected leading to increased excretion of amino acids due to Fanconi syndrome (proximal tubule dysfunction)

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10
Q

List 3 causes of digestive fat malabsorption due to poor mixing.

A
  • gastric resection
  • autonomic neuropathy
  • amyloidosis
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11
Q

What is amyloidosis?

A

Disease in which there are changes in proteins that causes them to be deposited in tissues and organs due to DNA mutation

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12
Q

What can cause fat malabsorption in the digestive phase associated with the liver and list 4 examples.

A
  • decreased micelle formation/decreased bile acid synthesis/secretion due to:
  • cirrhosis
  • CCK deficiency
  • small intestinal bacterial overgrowth
  • biliary obstruction
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13
Q

What can cause fat malabsorption in the digestive phase associated with the pancreas and list 6 examples.

A

decreased lipolysis due to:

  • chronic pancreatitis
  • cystic fibrosis
  • pancreatic/ampullary tumours
  • low luminal pH
  • excessive calcium ingestion
  • lipase/co-lipase deficiency
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14
Q

What function does the liver have in the digestive phase of fat?

A

Micellar solubilisation with bile acid

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15
Q

What fuction does pancreas have in the digestive phase of fat?

A

Lipolysis

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16
Q

What can cause fat malabsorption in the absorptive phase and list 4 examples.

A
  • decreased chylomicron formation and or mucosal absorption due to:
  • celiac disease
  • abetalipoproteinemia (problem with transfer protein)
  • hypobetalipoproteinemia (problem with transfer protein)
  • chylomicron retention disease
17
Q

What can cause fat malabsorption in the post-absorptive phase and list 5 examples.

A
  • defective lymphatic transport due to:
  • primary intestinal lymphangiectasia
  • lymphoma
  • Whipple DIsease
  • Trauma
  • Retroperitoneal Fibrosis
18
Q

What is hypobetalipoproteinemia associated with?

A

Low levels of LDL cholesterol

19
Q

What is Primary Intestinal Lymphangiectasia characterised by?

A

Dilated intestinal lymph vessels

20
Q

What can cause carbohydrate malabsorption in the digestive phase and give an examples?

A

-severe pancreatic insufficiency e.g. alpha-amylase deficiency

21
Q

What can cause carbohydrate malabsorption in the absorptive phase and give 6 examples?

A
  • Primary/acquired lactase deficiency
  • Post-infectious lactase deficiency
  • Celiac disease
  • Crohn disease
  • Sucrase-isomaltase deficiency
  • trehalase deficiency
22
Q

List 5 causes of vitamin B12 malabsorption.

A
  • atrophic gastritis
  • deficiency of gastric intrinsic factor
  • pancreatic insufficiency/Z-E syndrome
  • helminth infection/ SI BO
  • Ileal Crohn Disease/Resection
23
Q

What causes folic acid deficiency and give 4 specific examples?

A
  • caused by diseases affecting the proximal small bowel
  • celiac disease
  • whipple disease
  • tropical sprue
  • alcoholism
24
Q

What are the 4 fat soluble vitamins?

A

ADEK

25
Q

How does atrophic gastritis affect vitamin b12 deficiency?

A
  • There is impaired peptin/acid secretion which are essential for the liberation of vitamin b12 from the proteins in food.
  • can also lead to deficiency of gastric intrinsic factor
26
Q

What can cause deficiency of gastric intrinsic factor?

A
  • pernicious anaemia

- antrectomy

27
Q

How does pancreatic insufficiency/Zollinger-Ellison syndrome cause vitamin b12 malabsorption?

A

Both can lead to increased acidity and there is reduced release of b12 from r-binding protein in acidic environment.

28
Q

What is Zollinger-Ellison syndrome?

A

Tumours that form in pancreas or duodenum which produce large amounts of gastrin that leads to excessive acid production.

29
Q

What usually causes magnesium malabsorption?

A
  • Loss of mucosal surface area

- and/or luminal binding by malabsorbed fatty acids i.e. magnesium bound to unabsorbed fatty acids

30
Q

What can cause iron malabsorption?

A
  • reduced mucosal surface area

- GI bleeding

31
Q

What can cause zinc malabsorption and what is it?

A

Acrodermatitis enteropathica - inherited genetic disorder in which there is a defect in the zinc transport protein

32
Q

What can cause copper malabsorption and what is it?

A

Menkes disease (kinky hair disease) - inherited genetic disorder of cellular copper transport

33
Q

What are 3 causes of selective calcium deficiency?

A
  • renal disease
  • hypoparathyroidism
  • inborn defect in the vitamin D receptor or vitamin D formation
34
Q

What types of diseases can cause calcium malabsorption and give 2 examples?

A
  • diseases that reduce intestinal surface area
  • diseases that cause formation of insoluble calcium soaps with long chain fatty acids
  • Celiac Disease
  • Bile acid deficiency

GI (29 decks)

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