Fat Malabsorption Causes and Symptoms
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Questions and Answers

What is required for carbohydrates to be absorbed in the small intestine?

  • They must be consumed with proteins.
  • They must be broken down into monosaccharides. (correct)
  • They must be stored in the liver first.
  • They must be ingested at room temperature.

    • Which enzyme is primarily responsible for the initial digestion of dietary starch in the mouth?

  • Lactase
  • Salivary amylase (correct)
  • Maltase
  • Pancreatic amylase

    • What can lead to decreased absorptive intestinal surface area?

  • Prolonged fasting
  • Excessive carbohydrate intake
  • Coeliac disease (correct)
  • High protein diet

    • Which vitamin is primarily absorbed in the ileum?

    <p>Vitamin B12</p> Signup and view all the answers

    What condition results in fat-soluble vitamin malabsorption due to binding with fatty acids?

    <p>Untreated fat malabsorption</p> Signup and view all the answers

    Which factor can cause a deficiency in pancreatic amylase?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is a symptom of carbohydrate malabsorption?

    <p>Flatulence</p> Signup and view all the answers

    Which vitamin absorption is impacted by resections of the distal small bowel?

    <p>Vitamin B12</p> Signup and view all the answers

    What is the gold standard for diagnosing dermatitis herpetiformis?

    <p>OGD with D2 biopsy showing villous atrophy</p> Signup and view all the answers

    Which of the following symptoms is indicative of maldigestion due to exocrine insufficiency?

    <p>Steatorrhoea</p> Signup and view all the answers

    What role does tissue transglutaminase play in the context of coeliac disease?

    <p>It deamidates gluten peptides, increasing their immunogenicity</p> Signup and view all the answers

    Which of these is NOT a typical treatment for dermatitis herpetiformis?

    <p>Immunosuppressive therapy</p> Signup and view all the answers

    Which condition is a most common cause of pancreatic exocrine insufficiency in adults?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    What is a common presentation of chronic pancreatitis?

    <p>Severe pain in the LUQ/epigastrium</p> Signup and view all the answers

    What is a consequence of the CFTR mutation in cystic fibrosis?

    <p>Inappropriate transport of chloride and water</p> Signup and view all the answers

    Which vitamin deficiency is typically associated with exocrine pancreatic insufficiency?

    <p>Fat-soluble vitamins A, D, E, and K</p> Signup and view all the answers

    Which condition is NOT a cause of fat malabsorption?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is a potential consequence of small intestinal bacterial overgrowth?

    <p>Deconjugation of bile acids</p> Signup and view all the answers

    The primary symptom of fat malabsorption is known as:

    <p>Steatorrhea</p> Signup and view all the answers

    Which factor contributes to pancreatic exocrine insufficiency?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    Which of the following best describes the role of cholecystokinin (CCK) in digestion?

    <p>Stimulates the release of pancreatic enzymes</p> Signup and view all the answers

    Abetalipoproteinemia primarily affects which aspect of lipid metabolism?

    <p>Chylomicron secretion</p> Signup and view all the answers

    What could you expect if there is an impairment in the enterohepatic circulation of bile salts?

    <p>Fat malabsorption</p> Signup and view all the answers

    Which abnormality related to bile acid metabolism could lead to malabsorption?

    <p>Inadequate secretion of bile salts</p> Signup and view all the answers

    What is the gold standard for diagnosing small intestinal bacterial overgrowth (SIBO)?

    <p>Positive jejunal aspirate culture</p> Signup and view all the answers

    Which factor is NOT part of managing malabsorption?

    <p>Implementing a strict zero-carb diet</p> Signup and view all the answers

    What is the common therapeutic approach for treating small intestinal bacterial overgrowth?

    <p>Antibiotics to reduce small intestinal bacteria</p> Signup and view all the answers

    Which test is used to assess the malabsorption of specific carbohydrates?

    <p>Lactulose breath test</p> Signup and view all the answers

    What is a potential consequence of using cholestyramine for cholorrhoea?

    <p>Worsening of fat malabsorption</p> Signup and view all the answers

    Which of the following is NOT a goal of managing malabsorption?

    <p>Cure the underlying disease permanently</p> Signup and view all the answers

    What component is typically supplemented in the management of nutritional deficits related to malabsorption?

    <p>Fat-soluble vitamins</p> Signup and view all the answers

    Which group of healthcare professionals is part of the multidisciplinary team (MDT) approach to managing malabsorption?

    <p>Gastroenterologists</p> Signup and view all the answers

    What is the primary action of loperamide in the treatment of diarrhea?

    <p>Binds to opiate receptors in the bowel wall to reduce peristalsis.</p> Signup and view all the answers

    Which of the following patients should not be administered loperamide?

    <p>A patient with bacterial enterocolitis due to Salmonella.</p> Signup and view all the answers

    What should be monitored in patients with chronic malabsorption after bariatric surgery?

    <p>Bone density due to risk of metabolic bone disease.</p> Signup and view all the answers

    Which of the following side effects is considered rare for loperamide?

    <p>Urinary retention</p> Signup and view all the answers

    What is a potential risk associated with the high doses of loperamide?

    <p>Cardiac arrest from prolonged QT interval.</p> Signup and view all the answers

    Which nutrient replacement is indicated for patients with short bowel syndrome?

    <p>Enteral and parenteral feeds.</p> Signup and view all the answers

    What effect does loperamide have on the anal sphincter?

    <p>Increases the tone of the anal sphincter.</p> Signup and view all the answers

    What dietary modification is recommended for patients with coeliac disease?

    <p>A gluten-free diet.</p> Signup and view all the answers

    What distinguishes selective malabsorption from global malabsorption?

    <p>Selective malabsorption is due to localised diseases affecting specific nutrients.</p> Signup and view all the answers

    Which step is NOT involved in the normal process of nutrient absorption?

    <p>Enzymatic breakdown in the stomach</p> Signup and view all the answers

    Under what category would malabsorption due to Crohn's disease fall?

    <p>Acquired malabsorption</p> Signup and view all the answers

    Which condition is considered an example of primary or congenital malabsorption?

    <p>Lactase deficiency</p> Signup and view all the answers

    Chronic diarrhea associated with malabsorption primarily results from a defect in which phase of nutrient uptake?

    <p>Absorption into the intestinal mucosa</p> Signup and view all the answers

    Which statement accurately describes the pathophysiology related to dermatitis herpetiformis?

    <p>It involves mechanical irritation leading to the release of tissue transglutaminase.</p> Signup and view all the answers

    What is the primary mechanism through which tissue transglutaminase affects gluten peptides?

    <p>It enhances the immunogenicity of gluten peptides.</p> Signup and view all the answers

    In the context of exocrine pancreatic insufficiency, which symptom specifically indicates fat maldigestion?

    <p>Steatorrhoea</p> Signup and view all the answers

    What laboratory finding is typically associated with diagnosing chronic pancreatitis?

    <p>Elevated amylase levels</p> Signup and view all the answers

    Which condition is a direct consequence of the CFTR mutation in cystic fibrosis affecting digestive health?

    <p>Reduced pancreatic fluid secretion</p> Signup and view all the answers

    Which of the following describes the significance of OGD with D2 biopsy in diagnosing coeliac disease?

    <p>It reveals villous atrophy in the intestines.</p> Signup and view all the answers

    Which finding would be expected in a patient with exocrine pancreatic insufficiency?

    <p>Malabsorption of fat-soluble vitamins</p> Signup and view all the answers

    What is the initial treatment approach for managing dermatitis herpetiformis?

    <p>Gluten avoidance</p> Signup and view all the answers

    What is a primary consequence of pancreatic duct blockage in cystic fibrosis patients?

    <p>Progressive pancreatic damage</p> Signup and view all the answers

    Which condition is likely to cause inactivation of pancreatic enzymes due to excessive gastric acid?

    <p>Zollinger-Ellison syndrome</p> Signup and view all the answers

    What is a common treatment approach for managing pancreatic insufficiency?

    <p>Pancreatic enzyme replacement</p> Signup and view all the answers

    Which phase of malabsorption is characterized by decreased bile secretion?

    <p>Luminal phase</p> Signup and view all the answers

    What is a potential result of diminished intrinsic factor production?

    <p>Vitamin B12 deficiency due to pernicious anemia</p> Signup and view all the answers

    Which condition results in decreased release of cholecystokinin (CCK)?

    <p>Coeliac disease</p> Signup and view all the answers

    What consequence arises from surgical resection of the pancreas?

    <p>Decreased pancreatic stimulation</p> Signup and view all the answers

    Which of the following contributes to bacterial overgrowth affecting nutrient absorption?

    <p>Decreased pancreatic enzyme activity</p> Signup and view all the answers

    Which imaging technique is best suited for visualizing pancreatic conditions, particularly chronic pancreatitis?

    <p>Magnetic Resonance Cholangiopancreatography (MRCP)</p> Signup and view all the answers

    What test can specifically help distinguish mucosal disease in cases of malabsorption?

    <p>D-xylose test</p> Signup and view all the answers

    In the context of malabsorption investigations, which finding on intestinal biopsy may suggest Crohn's disease?

    <p>Cobblestone appearance of the duodenal mucosa</p> Signup and view all the answers

    What is one of the risks associated with patients who have strictures or adhesions in relation to bacterial overgrowth?

    <p>Decreased intestinal motility</p> Signup and view all the answers

    Which of the following factors is NOT typically investigated when assessing for small intestinal bacterial overgrowth?

    <p>Pancreatic insufficiency</p> Signup and view all the answers

    What is a significant indicator of jejunoileitis as observed through endoscopy?

    <p>Multiple jejunal ulcers</p> Signup and view all the answers

    Which serum antibody tests are essential for evaluating suspected coeliac disease?

    <p>Anti TTG and Anti EMA</p> Signup and view all the answers

    What role does the secretin stimulation test serve in the context of digestive health?

    <p>Diagnosis of pancreatic insufficiency</p> Signup and view all the answers

    What is the primary goal of managing small intestinal bacterial overgrowth (SIBO)?

    <p>To reduce the number of small intestinal bacteria</p> Signup and view all the answers

    Which of the following treatments is specifically indicated for bile acid malabsorption?

    <p>Exogenous conjugated bile acids therapy</p> Signup and view all the answers

    When should antidiarrhoeals such as loperamide be used in the management of diarrhea associated with malabsorption?

    <p>Once infectious causes have been ruled out</p> Signup and view all the answers

    What type of dietary modification is often recommended for individuals with malabsorption issues?

    <p>Avoidance of lactose and other FODMAPs</p> Signup and view all the answers

    What role does the multidisciplinary team (MDT) play in the management of malabsorption?

    <p>They collaborate to assess and optimize patient care</p> Signup and view all the answers

    Which nutrient is commonly supplemented for patients experiencing malabsorption in the context provided?

    <p>Vitamin B12</p> Signup and view all the answers

    What is the potential drawback of using cholestyramine in managing cholorrhoea?

    <p>It may worsen fat malabsorption</p> Signup and view all the answers

    What testing method is considered the gold standard for diagnosing small intestinal bacterial overgrowth?

    <p>Jejunal aspirate culture</p> Signup and view all the answers

    Study Notes

    Causes of Fat Malabsorption

    • Small intestinal disease/resection: Disorders affecting the small intestine or its surgical removal can lead to malabsorption.
    • Small intestinal bacterial overgrowth (SIBO): Excess bacteria in the small intestine can deconjugate bile acids, interfering with fat digestion.
    • Pancreatic exocrine insufficiency: The pancreas fails to produce sufficient digestive enzymes due to conditions like chronic pancreatitis or cystic fibrosis.
    • Disorders of bile acid metabolism: Inadequate synthesis, secretion, or delivery of bile acids can impair fat digestion.
    • Other causes: Rare genetic conditions like abetalipoproteinemia or abnormalities in lymphatic flow can disrupt fat absorption.

    Cardinal Symptoms

    • Steatorrhoea: This is the most common symptom of fat malabsorption, characterized by pale, greasy, foul-smelling, bulky stools that are difficult to flush.

    Protein Digestion & Absorption

    • Digestion begins in the stomach: Gastric pepsins break down proteins.
    • Duodenal enzymes: Proteases from the pancreas further digest proteins into amino acids, dipeptides, and tripeptides.
    • Absorption: Amino acids, dipeptides, and tripeptides are absorbed at the brush border membrane by specific transporters.

    Causes of Protein Malabsorption

    • Pancreatic insufficiency: Inadequate production of pancreatic enzymes, often due to chronic pancreatitis or cystic fibrosis, hinders protein digestion.
    • Reduced intestinal surface area: Conditions like celiac disease damage the intestinal lining, reducing absorptive capacity.

    Carbohydrate Digestion & Absorption

    • Breakdown: Dietary starches and disaccharides are broken down into monosaccharides by salivary and pancreatic amylase.
    • Brush border enzymes: Hydrolyze and absorb the broken-down carbohydrates at the intestinal lining.
    • Undigested carbohydrates: Undergo bacterial fermentation in the colon, leading to symptoms like flatulence, abdominal cramps, and diarrhea.

    Causes of Carbohydrate Malabsorption

    • Pancreatic amylase deficiency: Conditions like pancreatitis or cystic fibrosis can impair amylase production.
    • Reduced disaccharidase activity: A deficiency of enzymes at the brush border can hinder the digestion of disaccharides like lactose, fructose, and sucrose.
    • Decreased intestinal surface area: Conditions like celiac disease can reduce absorptive capacity.
    • Unabsorbable carbohydrates: Certain carbohydrates like sorbitol are poorly absorbed.
    • Congenital deficiencies: Inherited conditions like lactase deficiency and sucrase-isomaltase deficiency impair digestion of specific sugars.

    Vitamin, Mineral, and Trace Element Absorption

    • Primary site: Most vitamins and minerals are absorbed in the proximal half of the small intestine.
    • Vitamin B12: Absorbed in the ileum.
    • Calcium, iron, and folate: Primarily absorbed in the upper small intestine.
    • Fat-soluble vitamins (A, D, E, K): Their absorption is often affected by disruptions in fat absorption.

    Causes of Malabsorption of Vitamins, Minerals, and Trace Elements

    • Small bowel resections: Removal of portions of the small intestine can impair absorption of various nutrients.
    • Distal small bowel resections: Can lead to vitamin B12 deficiency.
    • Distal small intestinal and colonic disease: May cause hypomagnesemia.
    • Fat malabsorption: Excess fatty acids in the intestinal lumen bind to divalent cations like calcium and magnesium, leading to their malabsorption.

    Coeliac Disease

    • Pathophysiology: Gluten, a protein found in wheat, barley, and rye, triggers an immune response in individuals with celiac disease, leading to damage of the small intestinal lining (villous atrophy).
    • Diagnosis: Positive anti-TTG antibody levels are supportive, but the gold standard is an upper endoscopy with duodenal biopsies showing villous atrophy.
    • Treatment: Strict adherence to a gluten-free diet.

    Pancreatic Exocrine Insufficiency

    • Pathophysiology: The pancreas fails to secrete sufficient digestive enzymes and fluids needed for proper digestion.
    • Causes: Chronic pancreatitis, cystic fibrosis, and other conditions can affect pancreatic function.
    • Symptoms: Steatorrhoea (fatty stools), maldigestion of proteins leading to weight loss, bloating, flatulence, and abdominal cramps.
    • Differentials:
      • Chronic pancreatitis: The most common cause in adults; prolonged inflammation and scarring permanently damage the gland.
      • Cystic fibrosis: A genetic disorder affecting chloride and water transport, leading to pancreatic dysfunction.

    Investigations

    • Breath tests: Used to diagnose SIBO and assess specific carbohydrate malabsorption.
    • D-xylose absorption test: Evaluates small bowel mucosal disease.
    • Protein malabsorption tests: Rarely performed, typically used to investigate protein-losing gastroenteropathy.
    • Bile acid malabsorption test (SeHCAT): Helps distinguish bile acid diarrhea from fat malabsorption.
    • Cholestyramine trial: Therapeutic trial of a bile acid-binding resin to assess for cholerrhoea (excessive bile in stool).

    Management

    • Goals:
      • Treat the underlying cause.
      • Control diarrhoea.
      • Address nutritional deficiencies.
      • Improve quality of life.
    • Multidisciplinary approach: Involves dieticians, gastroenterologists, and speech and language therapists.
    • Diarrhoea management: Antidiarrhoeals (e.g., loperamide) are used cautiously, only after ruling out infectious causes.
    • Dietary modifications: Avoiding trigger foods (e.g., FODMAPS) can help manage symptoms.
    • Supplementation: Fat-soluble vitamins, calcium, magnesium, iron, folate, vitamin B12, and zinc are often supplemented.
    • Specific management strategies based on cause:
      • Bile acid malabsorption: Exogenous conjugated bile acids or cholestyramine.
      • SIBO: Antibiotics to reduce bacterial overgrowth.
      • Post-bariatric surgery: Nutrient supplementation.
      • Exocrine pancreatic insufficiency: Balanced fat intake and exogenous pancreatic enzymes.
      • Short bowel syndrome: Enteral and parenteral nutrition.
      • Coeliac disease: Gluten-free diet.
      • Zollinger-Ellison syndrome: High-dose proton pump inhibitors.
    • Monitoring: Regular assessment for micronutrient deficiencies and bone mineral density.

    Loperamide/Imodium

    • Mechanism of action:
      • Opioid receptor agonist in the gut, reducing intestinal motility, increasing transit time, and reducing diarrhoea.
      • Increases anal sphincter tone, reducing incontinence and urgency.
    • Side effects: Common: Nausea, headache, constipation; Rare: CNS toxicity, prolonged QT interval, cardiac arrhythmias.
    • Contraindications:
      • Patients with acute dysentery, ulcerative colitis, bacterial enterocolitis, pseudomembranous colitis.
    • Cautions: Risk of abuse and dependency.

    Malabsorption

    • Impaired absorption of nutrients (fats, carbohydrates, protein, vitamins, electrolytes, minerals, and water)
    • Occurs at any point in the digestive system where nutrient absorption takes place
    • Can be caused by defects in:
      • Luminal processing
      • Absorption into the intestinal mucosa
      • Transport into the circulation
    • Often presents as chronic diarrhoea

    Classification of Malabsorption

    • Global malabsorption: affects whole mucosa, leads to inadequate absorption of nutrients (i.e., coeliac disease)
    • Partial malabsorption: localized disease affecting specific nutrient absorption (i.e., B12 deficiency in pernicious anaemia)
    • Selective malabsorption: specific deficiency (i.e., Primary lactase deficiency)
    • Primary or congenital malabsorption: congenital defects in membrane transport systems
    • Acquired or secondary malabsorption: acquired defects in epithelial absorptive surface (eg, Crohn's disease, coeliac disease, surgical resection, or intestinal bypass)

    Coeliac Disease

    • Diagnosis: Anti-TTG antibody positive is supportive, gold standard is OGD with D2 biopsy showing villous atrophy
    • Treatment: Gluten avoidance

    Pancreatic Exocrine Insufficiency

    • Pancreas secretes ~1.5 liters of alkaline, enzyme-rich fluid daily for digestion.
    • Issues can be due to:
      • Failure of gland to produce fluid
      • Blockage of ducts leading to auto-digestion
      • Reduced CCK/secretin stimulus
      • Nerve impairment
    • Symptoms:
      • Steatorrhoea (fat maldigestion)
      • Weight loss
      • Bloating
      • Flatulence
      • Cramping
      • Deficiency of fat-soluble vitamins A, D, E, K
    • Differentials:
      • Chronic pancreatitis: Most common cause in adults, inflammation and scarring lead to permanent damage and inability to produce pancreatic fluid.
        • Presents as severe pain in LUQ/epigastrium, improved by leaning forward.
        • Elevated amylase
        • Low faecal elastase
      • Cystic fibrosis: CFTR mutation leads to inappropriate transport of chloride and water in lungs and exocrine glands. ~80% of patients with cystic fibrosis develop progressive pancreatic damage from duct blockage by thickened secretions.
      • Gastric, pancreatic, or small bowel resection: Loss of secretin and CCK synthesis, inadequate mixing of chyme with pancreatic enzymes due to rapid gastric emptying.
      • Total or partial pancreatic resection, or postoperative pancreatic duct occlusion.
      • Extensive denervation following lymph node dissection can result in decreased pancreatic stimulation.
      • Rare:
        • Hereditary hemochromatosis: progressive iron deposition in the pancreas.
        • Gastrinoma (Zollinger-Ellison syndrome): inactivation of pancreatic enzymes by excessive gastric acid.
        • Small bowel mucosal disease (eg., coeliac disease): decreased CCK release.
    • Treatment:
      • Address underlying cause
      • Pancreatic enzyme replacement: Creon
        • Taken with meals

    Differential Diagnosis of Malabsorption

    • Based on Malabsorption Pattern

    Luminal Phase

    • Digestive Enzyme Deficiency: Chronic pancreatitis
    • Digestive Enzyme Inactivation: Zolling-Ellison Syndrome
    • Dyssynchrony of enzyme release: Post-Bilroth II procedure
    • Fat Solubilisation:
      • Diminished bile salt synthesis: Cirrhosis
      • Impaired bile secretion: Chronic cholestasis
      • Bile salt de-conjugation: Bacterial overgrowth
      • Increased bile salt loss:
        • Bacterial overgrowth
        • Ileal disease or resection
    • Luminal Availability of Specific Nutrients:
      • Diminished gastric acid: Atrophic gastritis - B12
      • Diminished intrinsic factor: Pernicious anaemia - B12
      • Bacterial consumption of nutrients: Bacterial overgrowth - B12

    Mucosal (Absorptive) Phase

    Investigation

    • In individuals with a history of pancreatitis, excessive alcohol use, or low fecal elastase:
      • Faecal elastase
      • Imaging of the pancreas with MRCP
      • Endoscopic ultrasound evaluation
    • If patients have risk factors for bacterial overgrowth (strictures, adhesions, diverticulosis, blind loops):
      • Breath test for small bacterial overgrowth
    • ** In patients without an identifiable cause/risk factors:**
      • Upper endoscopy and colonoscopy with multiple mucosal biopsies (rule out Crohn's disease)
      • Imaging of the small bowel with CT or MR enterography
      • D-xylose test to establish malabsorption diagnosis and distinguish mucosal disease from conditions that cause maldigestion.

    Bloods

    • Serologic testing for coeliac disease: Anti-TTG, Anti-EMA
    • Faecal elastase to exclude maldigestion due to pancreatic insufficiency

    Endoscopy with biopsy

    • Macroscopic features on endoscopy may suggest the presence of an underlying cause of malabsorption:
      • Cobblestone appearance of duodenal mucosa in Crohn's disease
      • Reduced duodenal folds and scalloping of the mucosa in coeliac disease
      • Multiple jejunal ulcers may indicate jejunoileitis, gastrinoma, or infiltrative disease such as lymphoma

    Imaging

    • Small bowel:
      • Upper gastrointestinal series with small bowel follow-through, CT or MR enterography, wireless video capsule endoscopy
      • provides information about small bowel morphology
      • can identify small bowel diverticulae or anatomical abnormalities associated with bacterial overgrowth
      • radiologic findings generally non-specific and contrast studies are relatively insensitive
    • Pancreas:
      • Pancreatic imaging by CT or MRCP
      • helpful in diagnosing chronic pancreatitis
      • important for distinguishing benign from malignant causes.
      • Secretin stimulation test: most sensitive means of diagnosing pancreatic insufficiency

    Breath Tests

    • Small intestinal bacterial overgrowth (SIBO):
      • Positive glucose or lactulose breath test or positive jejunal aspirate culture, latter being the gold standard
      • Accuracy of breath tests for bacterial overgrowth is limited
    • Malabsorption of specific carbohydrates:
      • Breath tests available to assess the integrity of lactose, fructose, and sucrose absorption

    Other infrequently performed tests

    • D-xylose absorption test:
      • for small bowel mucosal disease
      • used to determine if defects in the intestinal mucosa are responsible for malabsorption
    • Protein malabsorption:
      • Rarely performed
      • intestinal protein loss is more commonly due to protein-losing gastroenteropathy, which can be demonstrated by measuring faecal alpha-1 antitrypsin
    • Bile acid malabsorption:
      • SeHCAT test to differentiate between bile acid diarrhoea and diarrhoea due to fat malabsorption
      • In absence of objective test, patients with diarrhoea due to cholorrhoea can undergo a therapeutic trial with a bile acid-binding resin such as cholestyramine.
      • Resolution of symptoms supports the diagnosis of cholorrhoea.
      • Cholestyramine can make the fat malabsorption worse.

    Management

    • Goals of management:
      • Treat the underlying disease
      • Optimize control of diarrhoea
      • Identify and treat nutritional deficits and monitor for re-occurrence
      • Optimize quality of life

    Management Approach

    • MDT (Multidisciplinary team) approach: Dietician, gastroenterology, SLT
    • Diarrhoea: antidiarrhoeals (eg, loperamide) only once infectious cause is ruled out
    • Dietary modifications: avoidance of triggers (eg, FODMAPS)
    • Supplementation based on aetiology:
      • Fat-soluble vitamins
      • Calcium
      • Magnesium
      • Iron
      • Folate
      • Vitamin B12
      • Zinc
    • Bile acid malabsorption: therapy with exogenous conjugated bile acids can decrease steatorrhoea, cholestyramine
    • Small intestinal bacterial overgrowth:
      • The mainstay of therapy is antibiotics to reduce (rather than eradicate) small intestinal bacteria

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    Description

    This quiz covers the various causes of fat malabsorption, including small intestinal issues and pancreatic insufficiency. Additionally, it discusses cardinal symptoms such as steatorrhoea, providing insight into the digestive process. Test your understanding of fat absorption and related disorders.

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