Malabsorption (pie)

Question 1

What is malabsorption ?

Answer 1

Defective mucosal absoption caused by defective luminal digestion, mucosal disease, structural disorders

Question 2

What are the common causes of malabsorption ?

Answer 2

• Coeliacs disease
• Crohns disease
• Post-infectious
• Biliary obstruction
• Cirrhosis
• Short bowel syndrome

Question 3

What are the uncommon causes of malabsorption ?

Answer 3

• Pancreatic cancer
• Parasites
• Bacterial overgrowth
• Drugs
  *

Question 4

What are the general signs/symptoms of GI malabsorption ?

Answer 4

Symptoms:

• Diarrhoea
• Steatorrhoea (increased fat in stool which is hard to flush away/floats)
• Weight loss (anorexia)
• Lethary
• Bloating

Signs:

• Anaemia due to - low iron, B12 or folate
• Bleeding disorders - due to low vit K
• Oedema - due to low protein
• Metabolic bone disease osteomalacia/osteoporosis - due to low Vit D
• Nuerological features e.g. neuropathy

Question 5

What is needed for fat absorption ?

Answer 5

Pancreatic juices (lipases) and bile salts

Question 6

What are the fat soluble vitamins ?

Answer 6

ADEK - anything that affects fat absorption will results in one or more deficiencies of these vitamins

Question 7

What are the signs/symptoms of lactose intolerance ?

Answer 7

Diarrhoea, abdo discomfort & flatulence following ingestion of diary products

Question 8

How is a diagnosis of lactose intolerance diagnosed ?

Answer 8

• Using the lactose breath hydrogen test
• OR the oral lactose intolerance test

Question 9

How is lactose intolerance treated?

Answer 9

Lactose free diet

Question 10

What is tropical sprue?

Answer 10

• A malabsorption disease commonly found in tropical regions - far east, middle east & caribbean
• It is characterised by flattening of the villi and inflammation of the lining of the small intestine.
• Caused by an infectious agent or alterations in the intestinal bacterial flora

Question 11

What are the signs/symptoms of tropical sprue ?

Answer 11

• Diarrhoea
• Steatorrhoea
• Weight loss
• Nausea
• Anorexia
• Anaemia

Question 12

How is tropical sprue diagnosed ?

Question 13

What is the treatment of tropical sprue?

Answer 13

Tetracycline + folic acid

Question 14

What is whipples disease ?

Answer 14

A rare multi-system disorder caused by Tropheryma whippelii infection.

Question 15

Who is whipples disease more common in ?

Answer 15

Those who are HLA-B27 positive and in middle-aged men.

Question 16

What are the clinical features of whipples disease ?

Answer 16

• Malabsorption: diarrhoea, steatorrhoea, weight loss, abdo distension
• Fever
• Large-joint arthralgia
• Lymphadenopathy
• Skin: hyperpigmentation and photosensitivity
• pleurisy, pericarditis

Question 17

How is whipples disease diagnosed ?

Answer 17

By demonstrating T.whippeli in involved tissues by microscopy

Question 18

What is the treatment of whipples disease ?

Answer 18

Oral co-trimoxazole for a year is thought to have the lowest relapse rate +/- preceded by a course of IV penicillin

Question 19

What is small bowel overgrowth syndrome ?

Answer 19

A disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.

Question 20

What are the clinical features of small bowel overgrowth syndrome ?

Answer 20

• chronic diarrhoea, steatorrhoea
• Macrocytic anaemia (low B12)
• bloating, flatulence
• abdominal pain
• High cobalbamin and folate levels

Question 21

How is small bowel bacterial overgrowth syndrome diagnosed ?

Answer 21

• Hydrogen breath test or schilling test
• Small bowel aspiration & culture via intubation

Question 22

What are the causes of small bowel bacterial overgrowth syndrome ?

Answer 22

Risk factors for SBBOS

• neonates with congenital gastrointestinal abnormalities
• scleroderma
• diabetes mellitus
• Diverticula, fistulas, strictures related to crohns disease
• Byspass surgeries

Question 23

What is the treatment of small bowel bactieral overgrowth syndrome ?

Answer 23

• correction of underlying disorder
• antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance.