Malabsorption disease

Question 1

What is a common presentation of malabsorption?

Answer 1

Weight loss and diarrhoea in someone with a normal diet

Question 2

When should Coeliac disease be suspected?

Answer 2

• Diarrhoea
• • weight loss / anaemia

Question 3

Pathology of coeliac disease?

Answer 3

• Autoimmune T-cell response to gluten in the small bowel
• => villous atrophy, malabsorption
• HLA DQ2 or HLA DQ8
• Can induce dermatitis herpetiformis

Question 4

Describe the presentation of coeliac?

Answer 4

• Steatorrhoea
• Diarrhoea, abdo pain, bloating
• Nausea, vomiting
• Aphthous ulcers, osteomalacia, weight loss

Question 5

Describe the diagnosis of coeliac disease?

Answer 5

• Duodenal biopsy is gold standard
  
  • Subtotal villous atrophy
• Anti-TTG, IgA antibody
• Anaemia
• Hyposplenism
• Faecal elastase can be used to investigate pancreas problem

Question 6

Describe the treatment for coeliac?

Answer 6

• Lifelong gluten free diet
• Dapsone can reduce itchiness and development of blisters in dermatitis herpetiformis

Question 7

Describe some complications of coeliac disease?

Answer 7

• Anaemia
• Dermatitis herpetiformis
• Osteoporosis
• Hyposplenism (offer flu and pneumococcal vaccinations)
• Increased risk of malignancies

Question 8

What signifies fat malabsorption?

Answer 8

• Bulky, pale, smelly stools that float
  
  • (steatorrhoea)

Question 9

What are the three processes that can lead to malabsorption?

Answer 9

• Intraluminal maldigestion
• Mucosal malabsorption
• Post-mucosal lymphatic obstruction

Question 10

Describe intraluminal maldigestion?

Answer 10

• Deficiency of bile or pancreatic enzymes
• Causes inadequate solubilisation and hydrolysis of nutrients
  
  • => Fat and protein malabsorption
• Can occur with small bowel bacterial overrgowth

Question 11

Describe mucosal malabsorption?

Answer 11

• Results from small bowel resection or epithelial damage
  
  • Diminshed surface area for absorption
  • Depleting bursh border enzyme activity

Question 12

Describe Post-mucosal lymphatic obstruction?

Answer 12

• Obstructed uptake of absorbed lipids into lymphatic vessels
• Leakge into intestinal lumen occurs
  
  • => Protein losing enteropathy

Question 13

Draw a flowchart for the investigations into malabsorption

Answer 13

Question 14

Name some other causes of malabsorption?

Answer 14

• Chronic pancreatitis
• Pancreatic carcinoma
• Cystic fibrosis
• Coeliac disease

Question 15

What are the blood features of hyposplenism?

Answer 15

• Spherocytes
• Target cells
• Howell-Jolly bodies

Question 16

Name some other causes of subtotal villous atrophy?

Answer 16

• Lymphoma
• HIV-related enteropathy
• Zollinger-Ellison syndrome

Question 17

How can malabsorption cause hyposplenism?

Answer 17

Chronic folate deficiency

Question 18

What is pictured here?

Answer 18

• Dermatitis herpetiformis
  
  • Commonly mistaken for eczema