GI > Malabsorption > Flashcards

Malabsorption Flashcards

(39 cards)

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1
Q

what is malabsorption?

A

= defective mucosal absorption which is caused by;

(i) defective luminal digestion
(ii) mucosal disease
(iii) structural disorders

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2
Q

what are some common and uncommon causes of malabsorption?

A

Common

  • coeliac disease
  • Crohn’s disease
  • post infection
  • biliary obstruction
  • cirrhosis

Uncommon

  • pancreatic cancer
  • parasittes
  • bacterial overgrowth
  • drugs
  • short bowel
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3
Q

what are 4 states of malabsorption?

A
  • protein
  • fat
  • carbohydrates
  • vitamins & minerals
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4
Q

what are the digestive and absorptive causes of protein malabsorption?

A

Digestive

  • gastrectomy (poor mixing)
  • exocrine pancreatic insufficiency
  • trypsinogen deficiency
  • congenital intestinal enterokizase deficiency

Absorptive;

  • coeliac disease & tropical sprue
  • short bowel syndrome
  • jejunoileal bypass
  • methionine malabsorption syndrome & blue diaper syndrome
  • defects in neutral AA transporters
  • cystinuria I-III
  • oculocerebral syndrome of Lowe
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5
Q

what are the digestive, absorptive and post absorptive causes of fat malabsorption?

A

Digestive;

  • less time to mix gastric resection, autonomic neuropathy, amyloidosis
  • dec micelle formation, decreased bile acid synthesis/secretion, cirrhosis, biliary obstruction, CCK deficiency, small intestinal bacterial overgrowth
  • decreased lipolysis, chronic pancreatitis, cystic fibrosis,, pancreatic/ampullary tumours, low luminal pH, excessive calcium ingestion, lipase/co-lipase defieicny

Absorptive
- decreased chylomicron formation & mucosal absorption, coeliac disease, abettalipoproteinemia, hypobetalipoproteinemia, chylomicron pretension disease

Post-Absorptive
- defective lymphatic transport, primary intestinal lymphangectasis, lymphoma, Whipple disease, trauma, retro-peritoneal fibrosis

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6
Q

what are the digestive and absorptive causes of carbohydrate malabsorption?

A

Digestive;
- severe pancreatic insufficiency (alpha amylase def)

Absorptive
= primary or acquired lactase deficiency 
- post infectious lactase deficiency 
- coeliac disease
- crohn's disease
- sucrase isomaltase deficiency 
- trehalase deficiency
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7
Q

describe the things that lead to vitamin B12, folic acid and fat soluble vitamins malabsorption? (vitamins)

A

Vitt B12 (cobalamin)

  • atrophic gastritis
  • deficiency of gastric intrinsic factors
  • pancreatic insufficiency/Z-E syndrome
  • helminth infections/SI BO
  • leal crohn’s disease/resection

Folic acid;

  • diseases affecting Proxima small bowel
  • coeliac disease/whipple/tropical sprue
  • alcoholism

Gat soluble vitamins (ADEK)
- anteing disrupting fat absorption will result in one or more deficiency

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8
Q

what causes calcium, magnesium, iron, zinc and copper malabosption? (minerals)

A

Calcium;

  • renal disease/hypoparathyroidism
  • inborn defect in Vit D receptor or 1alpha,25-dihydroxy vitamin D formation
  • diseases that reduce intestinal surface area and/or cause formation of insoluble calcium soaps with long chain fatty acids (coeliac disease/bile acid deficiency)

Magnesium;
- caused by loss of mucosal surface area and/or luminal binding my malabsorbed fatty acids

Iron;
- caused by reduced mucosal surface area, but most often caused by GI bleeding

Zinc;
- acrodermatitis enteropathica

Copper;
- menkes disease, caused by inherited disorder of cellular copper transport

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9
Q

what are 5 specific disease states?

A

1) coeliac disease
2) whipple’s disease
3) crohn’s disease
4) parasitic infections
5) small bowel bacterial overgrowth

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10
Q

what is coeliac disease?

A

= exposure to wheat, barley, rye inducing a characteristic mucosal lesion

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11
Q

what causes coeliac disease?

A
  • intestinal antigen presenting cells in people expressing HLA-DQ2 or HLA-DQ8 bind with dietary gluten peptides in their antigen binding grooves activating specific mucosal T lymphocytes cytokines mucosal damage
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12
Q

what are symptoms if coeliac disease?

A
  • spectrum asymptomatic to nutritional deficiencies
  • weight loss
  • diarrhoea
  • excess flatus
  • abdominal discomfort
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13
Q

how would you diagnose and treat coeliac disease?

A

Diagnosis

  • IgA anti-tissue transglutaminase test (tTGA)
  • biopsy confirmative

Treatment;
- gluten free diet

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14
Q

what causes lactose malabsorption?

A

= deficiency of lactase

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15
Q

what are the symptoms of lactose malabsorption?

A
  • diarrhoea
  • abdominal discomfort
  • flatulence
    = following ingestion of dairy productions
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16
Q

how would you diagnose and manage lactose malabsorption?

Study These Flashcards
A

Diagnosis

  • confirmed by lactose breath hydrogen test
  • oral lactose intolerance test

Management;
- lactose free diet

17
Q

what is tropical sprue?

Study These Flashcards
A

disease of small intestine causing malabsorption of food

18
Q

what causes tropical sprue?

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A
  • colonisation of intestine by an infectious agent or alterations in intestinal bacterial flora induced by exposure to another environmental agent
19
Q

what are the symptoms of tropical sprue?

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A 
= diarrhoea
= steatorrhea
= weight loss
= nausea
= anorexia
= anaemia
20
Q

how would you diagnose and treat tropical sprue?

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A

Diagnose
= biopsy

treat
= tetracycline
+ folic acid

21
Q

what is Whipple’s disease?

Study These Flashcards
A

rare bacterial infection affecting joints and digestive system

22
Q

what causes whipple’s disease?

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A

= tropheryma whipplei
(multi system involvement)
+ increase iii frequency of HLA-B27

23
Q

what are the symptoms of whipples disease and how would you diagnose and treat it?

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A

Symptoms

  • weight loss
  • diarrhoea
  • steatorrhea
  • abdominal distension
  • arthritis
  • fever
  • nutritional def symptoms

Diagnosis
- demonstration of T. whipplei in involved tissue by microscopy

Treatment
= anti-microbial

24
Q

what is Crohn’s disease?

Study These Flashcards
A

a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae

25
when do people with Crohn's disease develop malabsorption?
``` In patients with; - extensive ileal involvement - extensive intestinal resections - enterocoelic fistulas - strictures = leading to small intestinal bacterial overgrowth causing malabsorption ```
26
what are symptoms of Crohn's disease?
- abdominal pain - diarrhoea - fever - weight loss - abdominal tenderness (most classically right lower quadrant = RLQ)
27
how would you diagnose and treat Crohn's disease?
Diagnosis; - endoscopy - barium imaging of small bowel mucosal disease incising strictures, ulcerations and fistulae - CT - MRI - colonoscopy = punched out lesions Treatment; - steroids - immuno-suppressants - azatiopkinne 6-MP - biological therapy (anti-TNF)
28
give an example of a parasitic infection that could arise? and other examples of parasites.
= giardia lamblia - coccidial - strongyloides
29
what are the risk factors for developing giardia lamblia ?
- travelling to areas where water supply may be contaminated | - swimming in ponds
30
what are the symptoms of giardia lamblia?
- diarrhoea - flatulence - abdominal cramps - epigastric pain - nausea + malabsorption + steatorrhea + weight loss
31
how would you determine if you have a giardia lamblia infection?
= stool examination for ova and parasites, 3 separate stool samples increases the yield of positive examinations
32
how would you teat giardia lamblia ?
= metronidazole - 1 week
33
what causes small bowel bacterial overgrowth?
- diarrhoea - steatorrhea - macrocytic anaemia (B12) - E. coli and bacteroids - diverticula - fistulas - strictures related to crohn's disease - bypass surgery functional stasis
34
how would you diagnose small bowel bacterial overgrowth in a lab?
- low cobalamin and high folate levels = aerobic and/or anaerobic colonic-type bacteria in jejunal aspirate obtained by intubation. = bacterial overgrowth is best established by a schilling test
35
how would you treat small bowel bacterial overgrowth ?
= surgical correction of an anatomical blind loop | - tetracyclines 2-3weeks
36
what 6 things should you focus on in diarrhoea?
- duration - malabsorbtive stool - fat globules - floating - hard to flush away - offensive
37
describe the 2 important skin conditions you can acquire as a result of malabsorption?
= acrodermatitis enteropathica - autosomal recessive - impaired zinc uptake - rash, perineal, aural, alopecia - life long zinc supplement = dermatitis herpetiformis - may indicate coeliac disease - itchy bilsters - extensor surfaces - sub-epithelial IgA deposition
38
what are 6 baseline investigations that would be done in malabsorption?
- FBC - coagulation - LFTs - albumin - calcium/magnesium - stool culture
39
what are anatomical investigations that can be done?
- endoscopy | - imaging
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