malabsorption

Question 1

malabsorption

Answer 1

• inadequate absorption of nutrients from the GI tract

Question 2

macronutrients

Answer 2

carbohydrate, fat, protein

Question 3

micronutrients

Answer 3

vitamins and minerals

Question 4

mucosal (absorption)

Answer 4

• issues relating directly to small intestine wall
• crohn’s, coeliac, surgery

Question 5

crohn’s disease / coeliac

Answer 5

• mucosal
• abnormal epithelium
• deficient absorption

Question 6

surgical resection / bypass / congenital abnormality

Answer 6

• mucosal
• short bowel
• less surface area for absorption

Question 7

cystic fibrosis / pancreatitis

Answer 7

• pre-mucosal
• lactase deficiency
• insufficient digestive agents
• macronutrients not broken down

Question 8

small intestinal bacterial overgrowth

Answer 8

• mucosal/pre-mucosal
• damage to mucosa
• bile salts metabolised by bacteria

Question 9

crohn’s disease

Answer 9

• malabsorption linked to inflammation
  deficiencies include:
• iron deficiency (anaemia)
• B12/folate deficiency
• vitamin D/calcium deficiency

Question 10

coeliac disease

Answer 10

• autoimmune condition
• gluten activates an abnormal mucosal response
• chronic inflammation and damage to small intestine mucosa leading to villous atrophy (villi becoming inflamed)
• fatigue, gastrointestinal symptoms, weight loss
• common complications: anaemia, osteoporosis
• treatment = elimination of gluten from diet

Question 11

short bowel syndrome

Answer 11

• usually secondary to surgery but can be congenital
• may require parental nutrition
• less surface area available for absorption
• osteoporosis and vitamin deficiencies are potential risks
• levothyroxine/warfarin/oral contraceptives/digoxin may need higher doses as small intestine site of absorption and less surface area means less absorption in bloodstream

Question 12

chronic pancreatitis

Answer 12

• chronic inflammation of pancreas leads to impaired function
• affects more males than females
• decrease in pancreatic enzymes
• strong association with long term alcohol consumption

Question 13

cystic fibrosis

Answer 13

• inherited
• decreased chloride secretion, increased sodium absorption = thick mucus
• inhibits absorption
• steatorrhea (too much fat in stools)
• osteoporosis (weak bones)
• malnutrition/weight loss
• treated with pancreatic enzyme supplementation, fat soluble vitamin supplementation, calorie replacement
• intestinal obstruction

Question 14

lactase deficiency

Answer 14

• primary, secondary, congenital or development
• reduce or eliminate dietary lactose intake
• alternative calcium source may be required

Question 15

bacterial overgrowth

Answer 15

• incidence increases with age
• chronic pancreatitis and motility disorders most common causes
• reduced gastric acid- restricts digestion/atrophic gastritis/ drugs
• impaired motility - diabetes/ radiation enteritis, (post surgery loops)

Question 16

fat malabsorption

Answer 16

• problem with digestion (insufficient enzymes/bile) or absorption
• malabsorption more common in coeliac, crohns
• deficiencies of fat-soluble vitamins (A/D/E/K)
• steatorrhea

Question 17

vitamin malabsorption

Answer 17

• poor fat absorption will impact the absorption of vitamins A/D/E/K
• vitamin D - osteoporosis
• vitamin K - clotting problems

Question 18

treatment options for fat malabsorption

Answer 18

• supplement of pancreatic enzymes: lipase, amylase, protease (creon)
• treatment of cystic fibrosis/pancreatitis
• cautions: local irritation, take during or just after a meal (timing is important)
• derived from pork

Question 19

iron malabsorption

Answer 19

• iron deficiency anaemia commonly seen with coeliac, crohn’s, small bowel resection
• potential blood loss with crohn’s ulcerative colitis
• oral iron replacement

Question 20

symptoms of fat malabsorption

Answer 20

steatorrhea - excess fat is lost in stools making them float appear pale and bulky and smell offensive

Question 21

symptoms of protein malabsorption

Answer 21

• muscle wasting
• malnutrition
• oedema

Question 22

symptoms of carbohydrate malabsorption

Answer 22

• bloating
• flatulence
• diarrhoea

Question 23

symptoms of vitamin e malabsorption

Answer 23

neurological problems

Question 24

symptoms of vitamin K malabsorption

Answer 24

coagulation (bleeding) problems

Question 25

symptoms of vitamin A malabsorption

Answer 25

night blindness