Small Intestinal Malabsorption

Question 1

What is malabsorption?

Answer 1

Defective or inadequate digestion and absorption of nutrients from the intestine.

Question 2

Malabsorption is characterised by defective absorption of?

Answer 2

1. fats 2. vitamins 3. proteins 4. carbohydrates 5. electrolytes 6. minerals 7. water

Question 3

What does malabsorption present as?

Answer 3

1. chronic diarrhoea 2. steatorrhea

Question 4

Malabsorption reslts as a disturbance of?

Answer 4

1. Intraluminal digestion: mouth, stomach and small intestine 2. Terminal digestion (involves hydrolysis of carbohydrates and peptides in brush border of small intestine) - impaired mucosal digestion and absorption 3. Transepithelial transport - post mucosal nutrient transport 4. Lymphatic transportation

Question 5

What are the signs and symptoms of malabsorption?

Answer 5

1. pain in the abdomen 2. diarrhea 3. flatulence 4. bloating 5. fat in stool 6. weight loss 7. cramps

Question 6

What are the major classes of malabsorption syndromes?

Answer 6

1. Defective intraluminal digestion 2. Primary mucosal cell abnormalities 3. Reduced small intestine surface area 4. lymphatic obstriuction 5. infections 6. iatrogenic

Question 7

Name defective intraluminal digestion syndromes?

Answer 7

1. pancreatic insufficiency 2. defective bile secretion

Question 8

What is pancreatic insufficiency?

Answer 8

when the pancreas does not make enough of a specific enzyme the body uses to digest food in the small intestine

Question 9

Give examples?

Answer 9

1. celiac disease 2. diabetes 3. inflammatory bowel disease 4. pancreatic cancer

Question 10

What is defective bile secretion?

Answer 10

a condition that impairs the production and release of the digestive fluid bile from liver cells

Question 11

What is the function of bile?

Answer 11

is used in digestion to absorb fats and fat soluble vitamins such as vitamin A, D, E and K

Question 12

Give examples?

Answer 12

1. liver diease - fatty liver 2. having the gallbladder removed 3. Crohns disease 4. IBD

Question 13

Describe primary mucosal cell abnormalities syndromes?

Answer 13

1. defective terminal digestion 2. defective epithelial transport

Question 14

Describe reduced small intestine surface area syndromes?

Answer 14

1. Coeliac disease 2. Crohns disease

Question 15

Describe lymphatic obstruction syndromes?

Answer 15

1. Lymphangiectasia 2. Diseases of lymph nodes - TB, lymphoma

Question 16

Describe malabsorption syndromes brough about by infections?

Answer 16

1. Acute bacterial enteritis 2. Parasitic/protozoal infestation: Significant in HIV 3. Tropical sprue 4. Whipple disease

Question 17

Describe iatrogenic syndromes?

Answer 17

1. Gastrectomy 2. short gut syndrome

Question 18

Describe the consequences of malabsorption syndromes to the alimentary tract?

Answer 18

1. Diarrhoea 2. flatus 3. abdominal pains 4. weight loss 5. mucositis

Question 19

Describe the hematopoetic consequences of malabsorption syndromes?

Answer 19

anemia

Question 20

Describe the consequences of malabsorption syndromes to the musculoskeletal syndrome?

Answer 20

1. osteopenia 2. tetany

Question 21

Consequences to the endocrine system?

Answer 21

1. Amenorrhoea 2. impotence and infertility from generalised malnutrition 3. Hyperparathyroidism

Question 22

Cinsequences to the skin?

Answer 22

1. Purpura and patechiae 2. Oedema 3. Dermatitis and hyperkeratosis

Question 23

Consequences to the nervous system?

Answer 23

peripheral neuropathy

Question 24

What is coeliac disease?

Answer 24

Gluten-sensitve enteropathy

Question 25

What is it characterised by?

Answer 25

1. chronic disease 2. Morphological abnormalities of small intestine mucosa 3. Impaired nutrient absorption 4. Improves on withdrawal of wheat products from diet

Question 26

Describe the epidemiology?

Answer 26

causcasians

Question 27

Describe the pathogenesis?

Answer 27

1. Primary disorder is sensitivity to gluten - Protein component of wheat and related grains 2. T cell mediated chronic inflammatory reaction - Intraepithelial CD8+ T cells and Lamina propria CD4+ T cells 3. Interplay between/among Genetic factors, host immune response and environmental factors

Question 28

Describe what is seen during endoscopy?

Answer 28

flat small intestinal mucosa or normal depending on disease stage

Question 29

Describe what is seen in biopsy?

Answer 29

1. Diffuse enteritis with intraepithelial and lamina propria lymphocytes 2. marked mucosal atrophy 3. loss of villi, loss of brush border 4. Upper small intestine shows severe injury

Question 30

State the symptoms?

Answer 30

1. diarrhea 2. failure to thrive in infancy 3. flatulence 4. weight loss and fatigue 5. extraintestinal manifestations as a result of nutrient deficiencies

Question 31

Describe the diagnosis?

Answer 31

1. Clinical documentation of malabsorption 2. Demonstration of intestinal abnormalities by small bowel biopsy 3. Improvement in symptoms and mucosal histology on gluten withdrawal

Question 32

What is tropical sprue?

Answer 32

postinfectious sprue

Question 33

Describe the epidemiology?

Answer 33

1. common in the tropical region, central and southern Africa, India, South East Asia and Central and South America 2. Affects resident people or visitors 3. Occurs in an endemic form 4. Epidemic outbreaks are documented

Question 34

What is tropical spruee associated with?

Answer 34

bacterial overgrowth by enterotoxic organisms (E.coli, Haemophilus)

Question 35

Describe the signs and symptoms?

Answer 35

1. Malabsorption ensues within days or weeks after an acute diarrhoeal enteric infection 2. Patients frequently have folate and Vit B12 deficiency 3. Small intestinal injury is evident in all parts of small intestine

Question 36

What is lactose intolerence?

Answer 36

result of lactase insufficiency

Question 37

Causes?

Answer 37

1. Congenital deficiency: rare 2. Acquired lactase insufficiency: Common, associated with viral and bacterial enteric infection

Question 38

Consequences of lack of lactase?

Answer 38

lack of lactase results in high levels of lactose

Question 39

Describe symptoms?

Answer 39

1. Resultant osmotic diarrhoea 2. If inherited/ congenital infants develop severe diarrhoea with initiation of milk feeds