Malabsorption Overview

Questions and Answers

Which of the following conditions is an example of global malabsorption?

Chronic pancreatitis

Primary lactase deficiency

Pernicious anaemia

Coeliac disease (correct)

What is the first step required for normal nutrient absorption?

Absorption into the intestinal mucosa

Luminal processing (correct)

Transport into the circulation

Digestion in the stomach

Which of the following best describes selective malabsorption?

Deficiency due to congenital defects

Deficiency of a specific nutrient (correct)

Interference with absorption of multiple nutrients

Systemic disease impacting nutrient absorption

What causes malabsorption associated with pancreatic exocrine insufficiency?

Impaired production of pancreatic enzymes Signup and view all the answers

Which of the following conditions is NOT a cause of fat malabsorption?

Chronic gastritis Signup and view all the answers

What is a common symptom associated with malabsorption?

Chronic diarrhoea Signup and view all the answers

What is the term for malabsorption resulting from acquired defects in the epithelial absorptive surface?

Secondary malabsorption Signup and view all the answers

What is a serious risk associated with the use of loperamide?

Toxic megacolon Signup and view all the answers

Which condition involves a deficiency of vitamin B12 due to malabsorption?

Pernicious anaemia Signup and view all the answers

Which antibiotic is known to prolong the QT interval and may interact with loperamide?

Moxifloxacin Signup and view all the answers

In patients with which condition should loperamide be avoided?

Acute ulcerative colitis Signup and view all the answers

Which class of drugs can potentially lead to torsades de pointes when used with loperamide?

Class 1A antiarrhythmics Signup and view all the answers

What should be monitored in patients taking higher than recommended doses of loperamide?

Serial ECGs Signup and view all the answers

What is the primary mechanism responsible for protein digestion in the stomach?

Gastric pepsins Signup and view all the answers

Which symptoms are characteristic of fat malabsorption?

Pale, greasy, foul-smelling stools Signup and view all the answers

What is the consequence of impaired pancreatic bicarbonate secretion?

Decreased protein digestion effectiveness Signup and view all the answers

Coeliac disease is primarily triggered by what dietary component?

Gluten Signup and view all the answers

Which enzyme is released by intestinal cells in response to gluten peptide mechanical irritation?

Tissue transglutaminase Signup and view all the answers

What type of malabsorption is primarily seen in cystic fibrosis related to carbohydrates?

Decreased disaccharidase activity Signup and view all the answers

Which of the following vitamins is absorbed in the ileum?

Vitamin B12 Signup and view all the answers

A deficiency in which enzyme is associated with lactose intolerance?

Lactase Signup and view all the answers

What effect do unabsorbed fatty acids have in the intestinal lumen during malabsorption?

Bind to divalent cations Signup and view all the answers

What is a common symptom of dermatitis herpetiformis in coeliac disease patients?

Intensely pruritic papules Signup and view all the answers

Which condition can lead to a deficiency of fat-soluble vitamins A, D, E, and K?

Chronic pancreatitis Signup and view all the answers

Which factor is NOT a cause of carbohydrate malabsorption?

Excessive fiber intake Signup and view all the answers

What is the most common symptom of malabsorption syndromes?

Diarrhoea Signup and view all the answers

What is the most common cause of pancreatic exocrine insufficiency in adults?

Chronic pancreatitis Signup and view all the answers

Which condition is primarily caused by a CFTR mutation?

Cystic fibrosis Signup and view all the answers

What symptom is commonly associated with malabsorption due to fat malabsorption?

Steatorrhoea Signup and view all the answers

Which of the following could indicate a risk factor for pancreatic insufficiency?

History of pancreatitis Signup and view all the answers

What is the appropriate treatment for pancreatic exocrine insufficiency?

Pancreatic enzyme replacement therapy Signup and view all the answers

What is a common symptom of carbohydrate malabsorption?

Flatulence Signup and view all the answers

Which condition is characterized by excessive fat in the stools?

Chronic pancreatitis Signup and view all the answers

Which diagnostic procedure is indicated when positive coeliac serologies are found?

Upper endoscopy with biopsies Signup and view all the answers

What is a potential consequence of chronic malabsorption related to nutrient deficiencies?

Osteoporosis Signup and view all the answers

Which laboratory finding is indicative of fat malabsorption?

Fractional fat excretion Signup and view all the answers

Which of the following is most likely to result in decreased CCK release?

Small bowel mucosal disease Signup and view all the answers

What laboratory finding can be associated with B12 deficiency?

Macrocytic anemia Signup and view all the answers

What symptom is most commonly seen in patients suffering from severe malabsorption?

Weight loss Signup and view all the answers

What type of dietary assessment would be most useful in diagnosing malabsorption?

Detailed stool analysis Signup and view all the answers

Which imaging technique is commonly used to assess pancreatic conditions?

Magnetic resonance cholangiopancreatography (MRCP) Signup and view all the answers

What test can help to establish malabsorption and differentiate between mucosal disease and maldigestion?

D-xylose test Signup and view all the answers

Which of the following is NOT a typical investigation for conditions related to malabsorption?

Blood glucose level test Signup and view all the answers

In patients suspected of having bacterial overgrowth, which breath test is commonly used?

Glucose breath test Signup and view all the answers

Which therapy is prescribed for bile acid malabsorption?

Cholestyramine Signup and view all the answers

Which nutrient deficiencies should be monitored in a patient with chronic malabsorption?

Calcium and vitamin B12 Signup and view all the answers

What is the main therapeutic approach for managing small intestinal bacterial overgrowth?

Antibiotics Signup and view all the answers

Which condition may exhibit a cobblestone appearance of the duodenal mucosa on endoscopy?

Crohn's disease Signup and view all the answers

What is a common side effect of Loperamide?

Constipation Signup and view all the answers

What dietary modification is recommended for patients with malabsorption due to food sensitivity?

Gluten-free diet Signup and view all the answers

Which imaging approach can help identify small bowel diverticulae?

Upper gastrointestinal series Signup and view all the answers

What is the proposed method for diagnosing pancreatic insufficiency?

Secretin stimulation test Signup and view all the answers

Which enzyme replacement is typically recommended for patients with exocrine pancreatic insufficiency?

Pancreatic enzymes Signup and view all the answers

What is the primary goal of management in conditions associated with malabsorption?

To optimize quality of life Signup and view all the answers

Which of the following is NOT one of the three steps required for normal nutrient absorption?

Excretion Signup and view all the answers

How does protein deficiency lead to edema?

Impaired osmotic balance due to reduced albumin Signup and view all the answers

What is the classification system of malabsorption that refers to a specific deficiency of a nutrient?

Selective malabsorption Signup and view all the answers

Global malabsorption is characterized by which of the following? (Select one)

Diseases affecting the mucosa or reduced absorption area Signup and view all the answers

The process of breaking fat into smaller parts is known as:

Lipolysis Signup and view all the answers

What does Cholecystokinin (CCK) stimulate?

Bile production and pancreatic enzyme secretion Signup and view all the answers

Which form of fat can be moved to the lymphatic system?

Chylomicrons Signup and view all the answers

Steatorrhea is characterized by which of the following stool features?

Pale, greasy, foul-smelling, and bulky Signup and view all the answers

Which condition can lead to fat malabsorption due to deconjugation of bile acids by bacteria?

Small intestinal bacterial overgrowth Signup and view all the answers

Which of the following is the gold standard for diagnosing celiac disease?

Upper endoscopy with duodenal biopsy Signup and view all the answers

In the case of a patient with a past medical history including diabetes, asthma, and IBS, which medication is most likely to have reacted with ciprofloxacin?

Loperamide Signup and view all the answers

Where is bile salt reabsorbed in the body?

Ileum Signup and view all the answers

What can happen if there is a problem with bile salt absorption from the ileum to the colon?

Deficiency of fat-soluble vitamins Signup and view all the answers

What is the primary cause of steatorrhea?

Fat malabsorption Signup and view all the answers

Which condition is characterized by the impaired production of pancreatic enzymes?

Pancreatic exocrine insufficiency Signup and view all the answers

Abetalipoproteinemia is a disorder that results from which of the following?

Inadequate synthesis of apoproteins for chylomicron packaging Signup and view all the answers

Which of the following symptoms is commonly associated with chronic pancreatitis?

Severe pain in the upper left quadrant Signup and view all the answers

Which enzyme is involved in the deamidation of gluten peptides, increasing their immunogenicity?

Tissue transglutaminase Signup and view all the answers

What is a common consequence of chronic malabsorption related to vitamin K deficiency?

Bleeding disorders Signup and view all the answers

What is the first step in the investigation of suspected malabsorption?

Detailed medical history Signup and view all the answers

What is the primary treatment for small intestinal bacterial overgrowth (SIBO)?

Antibiotics Signup and view all the answers

Which nutrient is primarily absorbed in the proximal half of the small intestine?

Iron Signup and view all the answers

What does a low fecal elastase level indicate?

Pancreatic exocrine insufficiency Signup and view all the answers

Chronic malabsorption can lead to which of the following? (Select all that apply)

Anorexia Signup and view all the answers

What type of diet is recommended for patients with celiac disease?

Gluten-free diet Signup and view all the answers

In the context of fat malabsorption, which of the following conditions would most likely lead to increased levels of fecal fat?

All of the above Signup and view all the answers

The mechanism by which bile acids facilitate fat digestion involves their action on: a) Increasing gastric acid secretion, b) Emulsifying fats to form micelles, c) Inhibiting pancreatic enzyme activity, d) Stimulating intestinal motility.

Emulsifying fats to form micelles Signup and view all the answers

What is the main transport mechanism for amino acids across the brush border membrane of the intestinal epithelial cells?

Active transport Signup and view all the answers

In the presence of small intestinal bacterial overgrowth (SIBO), which of the following changes in carbohydrate metabolism is likely to occur?

Increased gas production leading to abdominal discomfort Signup and view all the answers

Which of the following statements about cholecystokinin (CCK) is true?

It is released in response to fatty acids and amino acids. Signup and view all the answers

A patient with pancreatic exocrine insufficiency is most likely to present with which of the following clinical findings?

Steatorrhea and weight loss Signup and view all the answers

Which enzyme's deficiency is primarily responsible for lactose intolerance?

Lactase Signup and view all the answers

Which of the following is a primary complication of untreated celiac disease?

Osteoporosis Signup and view all the answers

What is the role of the D-xylose absorption test in diagnosing malabsorption?

To evaluate carbohydrate absorption in the small intestine Signup and view all the answers

Which condition is characterized by the presence of anti-tissue transglutaminase (anti-TTG) antibodies?

Celiac disease Signup and view all the answers

A patient with chronic pancreatitis may experience pain relief when leaning forward due to which of the following reasons? a) Decreased intra-abdominal pressure b) Improved blood flow to the pancreas c) Reduction of pressure on the diaphragm d) Increased secretion of digestive enzymes

Decreased intra-abdominal pressure Signup and view all the answers

Which of the following nutritional deficiencies is most likely in a patient with extensive ileal resection?

Vitamin B12 Signup and view all the answers

In individuals with coeliac disease, what is the primary pathophysiological change?

Villous atrophy Signup and view all the answers

Which of the following mechanisms does NOT contribute to malabsorption in chronic pancreatitis?

Increased intestinal motility Signup and view all the answers

What is the role of secretin in the digestive process?

Stimulates bicarbonate release from the pancreas Signup and view all the answers

Which of the following conditions is most likely to cause both malabsorption and steatorrhea?

Chronic pancreatitis Signup and view all the answers

In patients with short bowel syndrome, which of the following interventions is most crucial for management?

Parenteral nutrition Signup and view all the answers

Which of the following laboratory findings would be most consistent with fat malabsorption?

Increased levels of fecal fat Signup and view all the answers

In the context of malabsorption syndromes, which vitamin deficiency is particularly associated with the development of peripheral neuropathy?

Vitamin B12 Signup and view all the answers

Which of the following statements regarding celiac disease is true? a) It is an autoimmune disorder with a strong association with HLA-DQ6. b) The primary dietary management includes a gluten-free diet. c) It primarily affects the colon rather than the small intestine. d) Patients are often asymptomatic and only diagnosed through routine screening.

The primary dietary management includes a gluten-free diet. Signup and view all the answers

Which of the following findings would be most indicative of small intestinal bacterial overgrowth (SIBO)?

Elevated hydrogen breath test after lactose ingestion Signup and view all the answers

Which enzyme deficiency is linked to abetalipoproteinemia, impairing fat absorption?

Apolipoprotein B Signup and view all the answers

In a patient with chronic pancreatitis, which of the following symptoms would be least likely?

Weight gain despite a high-calorie diet Signup and view all the answers

A patient presents with malabsorption, weight loss, and a history of multiple gastrointestinal surgeries. Which test would be most useful to evaluate the functional status of the pancreas?

Secretin stimulation test Signup and view all the answers

Which of the following conditions may lead to fat malabsorption due to bile acid deficiency? a) Crohn's disease affecting the ileum b) Celiac disease c) Zollinger-Ellison syndrome d) Biliary atresia

Biliary atresia Signup and view all the answers

A patient with iron deficiency anemia is evaluated for malabsorption. Which of the following conditions is most likely to cause a deficiency in iron absorption?

Celiac disease Signup and view all the answers

Which mechanism of nutrient absorption is primarily affected in patients with villous atrophy associated with celiac disease?

Active transport Signup and view all the answers

Which of the following is a hallmark histological finding in the diagnosis of celiac disease?

Villous atrophy and lymphocytic infiltration Signup and view all the answers

Which vitamin deficiency is associated with malabsorption in patients with chronic pancreatitis due to impaired fat digestion?

Vitamin D Signup and view all the answers

What is the most common cause of secondary lactase deficiency in adults?

Viral gastroenteritis Signup and view all the answers

Which of the following statements regarding the absorption of vitamin B12 is accurate?

It requires intrinsic factor for absorption in the ileum. Signup and view all the answers

A patient presents with frequent diarrhea and is found to have a high concentration of bile acids in the stool. What is the most likely cause?

Bile acid diarrhea due to intestinal resection Signup and view all the answers

In individuals with chronic malabsorption, what is the most likely effect on body weight?

Progressive weight loss Signup and view all the answers

Which test would be the most appropriate for assessing fat malabsorption in a clinical setting?

Fecal fat quantification Signup and view all the answers

A 45-year-old patient presents with diarrhea, weight loss, and a history of small bowel resection. Which of the following would be the most appropriate initial management step?

Order a fecal fat test Signup and view all the answers

Which vitamin deficiency is most commonly associated with fat malabsorption due to pancreatic exocrine insufficiency?

Vitamin K Signup and view all the answers

In a patient diagnosed with small intestinal bacterial overgrowth (SIBO), which of the following treatments is most appropriate?

Broad-spectrum antibiotics Signup and view all the answers

A patient presents with chronic diarrhea, weight loss, and signs of malnutrition. A stool test reveals low fecal elastase. Which of the following conditions is most likely responsible for this finding?

Chronic pancreatitis Signup and view all the answers

Which of the following is a potential complication of untreated malabsorption? a) Osteoporosis, b) Hypertension, c) Hyperlipidemia, d) Diabetes mellitus

Osteoporosis Signup and view all the answers

A 30-year-old male with cystic fibrosis develops pancreatic exocrine insufficiency. Which of the following would be an appropriate recommendation for this patient?

Take pancreatic enzyme replacement therapy with meals Signup and view all the answers

In a patient with bile acid malabsorption, which of the following treatments is most appropriate?

Cholestyramine Signup and view all the answers

Which of the following laboratory tests would best help differentiate between chronic pancreatitis and pancreatic cancer in a patient presenting with weight loss and abdominal pain?

CT scan of the abdomen Signup and view all the answers

Study Notes

Malabsorption Overview

Malabsorption refers to the impaired absorption of vital nutrients, leading to conditions like chronic diarrhea.
Nutrient absorption occurs in three phases: luminal processing, absorption into the intestinal mucosa, and transport into circulation.
Malabsorption can stem from defects in any of these phases.

Classification of Malabsorption

Global malabsorption: Dysfunction affecting mucosa or absorption area, e.g., coeliac disease.
Partial malabsorption: Localized issues affecting specific nutrients, such as B12 deficiency in pernicious anemia.
Selective malabsorption: Specific nutrient deficiencies, e.g., primary lactase deficiency.
Primary malabsorption: Congenital defects in transport systems.
Secondary malabsorption: Acquired conditions such as Crohn's disease or post-surgical changes.

Causes of Fat Malabsorption

Small intestinal disease or resection affecting absorption.
Small intestinal bacterial overgrowth can deconjugate bile acids, impairing fat absorption.
Pancreatic exocrine insufficiency results in inadequate enzyme production.
Disorders of bile acid metabolism, such as inadequate synthesis or obstruction.
Rare genetic conditions like abetalipoproteinemia affect fat absorption.

Cardinal Symptoms

Steatorrhea: Pale, greasy stools that are difficult to flush due to excess fat.

Protein Malabsorption

Begins in the stomach with gastric pepsins; CCK release stimulates pancreatic enzyme secretion.
Causes include pancreatic insufficiency and reduced intestinal surface area.

Carbohydrate Malabsorption

Starch and disaccharides must be converted to monosaccharides for absorption.
Causes include pancreatic amylase deficiency and congenital defects in disaccharidases.

Vitamins and Minerals

Most vitamins and minerals are absorbed in the proximal small intestine; B12 is absorbed in the ileum.
Proximal resections can lead to deficiencies, particularly for water-soluble vitamins.
Fat-soluble vitamins are impacted by conditions affecting fat absorption.

Coeliac Disease

Triggered by gluten in genetically predisposed individuals (HLA DQ2/DQ8).
Symptoms include malabsorption-related diarrhea, weight loss, and nutrient deficiencies.
Diagnosis confirmed by anti-TTG antibodies and duodenal biopsy showing villous atrophy.
Treatment involves strict gluten avoidance.

Pancreatic Exocrine Insufficiency (PEI)

Characterized by insufficient enzyme secretion leading to steatorrhea and protein maldigestion.
Common causes include chronic pancreatitis and cystic fibrosis.
Treatment focuses on pancreatic enzyme replacement and addressing underlying causes.

Symptoms of Malabsorption

Frequent diarrhea with a minimum of three loose stools daily.
Steatorrhea and associated symptoms like weight loss, bloating, and muscle wasting.
Complications include anemia (due to iron, folate, B12 deficiencies) and osteomalacia.

Differential Diagnosis

Assessment includes the phase and nature of the malabsorptive defect.
Consider gastrointestinal diseases, enzyme deficiencies, and conditions affecting bile production.

Investigations

Serological testing for coeliac disease and pancreatic function tests (e.g., fecal elastase).
Upper endoscopy and biopsies to identify mucosal disease.
Imaging studies to assess structural abnormalities.

Management Strategies

Goal: Treat the cause, control diarrhea, and monitor nutritional deficiencies.
Implement dietary modifications to avoid triggers (e.g., FODMAPs).
Nutritional supplementation as needed, addressing fat-soluble vitamins and other deficiencies.
Monitoring for metabolic bone disease in patients with chronic malabsorption.

Loperamide/Imodium

Acts as a synthetic anti-diarrheal agent through opiate receptor binding, reducing peristalsis.
Common side effects include gastrointestinal distress and constipation; rare CNS toxicity noted.### QTc Prolongation and Torsades de Pointes
Higher than normal doses of certain medications can lead to QTc prolongation, which increases the risk of torsades de pointes and potentially cardiac arrest.
Specific drug classes implicated include Class 1A (e.g., quinidine, procainamide) and Class III antiarrhythmics (e.g., amiodarone, sotalol).
Other drugs that prolong the QT interval are antipsychotics (e.g., chlorpromazine, haloperidol) and antibiotics (e.g., moxifloxacin, ciprofloxacin).

Loperamide (Imodium) Considerations

Loperamide is contraindicated in patients with acute dysentery (blood in stools, high fever), acute ulcerative colitis, and bacterial enterocolitis from invasive organisms (Salmonella, Shigella, Campylobacter).
Use is cautioned in patients with pseudomembranous colitis, particularly those with a history of broad-spectrum antibiotic use.
Significant side effects may include ileus, megacolon, and toxic megacolon.

Risk of Abuse and Overdose

Loperamide has the potential for abuse and dependency due to its action as a mu-opioid agonist.
Overdose of loperamide can lead to life-threatening cardiac, respiratory, and central nervous system (CNS) complications.

Drug Interactions and Monitoring

Concomitant use of loperamide with ciprofloxacin, both CYP450 inhibitors, poses a risk for QTc prolongation.
Overdosing on loperamide heightens the risk for torsades de pointes, emphasizing the need for careful management and patient education on drug interactions and adverse reactions.

Summary of Malabsorption

Malabsorption refers to impaired nutrient absorption and can complicate various disease processes.
Clinical history is vital for diagnosing the underlying cause of malabsorption; further investigations should be guided by the most likely diagnosis.

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Description

This quiz explores the clinical concept of malabsorption, a condition affecting the body's ability to absorb nutrients such as fats, carbohydrates, and proteins. It covers the mechanisms involved in nutrient absorption and the potential causes leading to impairment. Understanding these aspects is crucial for diagnosing and managing patients with chronic diarrhoea and related symptoms.