Name symptoms of malabsorption and symptoms of associated vitamin deficiencies
- Diarrhoea, steatorrhoea, WL, lethargy
- Anaemia, bleeding disorders, oedema, osteomalacia, neuropathy
Name some causes of malabsorption and their appropriate tests?
- Crohn’s (Calprotectin, colonoscopy + biopsy/CT)
- Coeliac (anti TTG,EMA or endoscopy + biopsy)
- Chronic pancreatitis (ERCP, faecal elastase)
- Pancreatic insufficiency from CF or cancer
- Infection (MCS)
- Bacterial overgrowth in bowel (breath hydrogen analysis)
- Reduced bile e.g. biliary obstruction, cholestyramine (LFTs, ERCP)
- Lactate insufficiency
Describe the histology of coeliac disease
TTG enzymes modify alpha-gliandin. This then mounts and AI response against the mucosa.
- Loss of vili
- Hyperplasia of the crypts
- Increased inter-epithelial lymphocytes
What are the symptoms of coeliac disease
Diarrhoea, steathorea, WL, anaemia (IDA/B12), abdo cramps, fatigue, bloating, N+V, failure to thrive (children), apthous ulcers, atrophic glossitis, dermatitis hepatiformis
Long term risks of coeliac disease
Osteoporosis, small risk of lymphoma, neuropathy, hyposplenism
What are the symptoms of chronic pancreatitis
Weight loss, DM, steatorrhoea, chronic pain, obstructive jaundice
Describe the diagnostic work up of chronic pancreatitis
Bloods: Faecal elastase, trypsinogen, USS, MRCP
+/- signs of alcohol abuse e.g. GGT or macrocytic anaemia
What is the management of chronic pancreatitis
Analgesia, creon, multivite (fat soluble vitamins), blood sugar monitoring, low fat diet
Partial pancreatectomy last line
