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Malabsorption (Clinical presentation (Malaise/fatigue, Weight loss,…
Malabsorption
Clinical
presentation
Malaise/fatigue
Weight loss
Diarrhoea
(steatorrhoea if bile salt malabs)
Bloating
GI bleeding
(Vit K malabsorption)
Oedema
(low Alb)
Neuropathy
(B12 malabsorption)
Abdo pain
(depending on cause)
Fever
(if infective)
Aetiology
Genetic
Brush border enzyme deficiency
Drugs
Alcohol
Metformin
Autoimmune
Amyloidosis
Coeliac disease
Crohn's disease
Dermatitis herpetiformis
Iatrogenic
Intestinal resection
RT
Infection/inflamm
Tropical sprue, bacterial overgrowth, Giardia, Whipple's
Chronic pancreatitis
Diagnosis
Examination
Abdo - pallor, low BMI, glossitis, angular stomatitis,
apthous ulcers, distension, oedema
PR - mucus, blood, steatorrhoea
History
PC - S+S, any red flags
PMH - autoimm disease, surgery, RT
FH - Coeliac, IBD, malabs
DH - metformin
SH - alcohol, diet, smoking, travel
Investigations
Bloods
FBC (anaemia), Fe studies (low Fe, high TIBC)
B12/folate (may be low), bone profile (vit D, Ca)
LFTs, U+Es, clotting (deranged), lipids, glucose
Coeliac screen
Stool
Culture MCS
A1-antitrypsin and faecal elastase
Bedside
Obs - fever if infective/inflamm
Hydrogen breath test - bact overgrowth
Imaging
Ba follow through
Endoscopy + biopsy
ECRP (pancreatitis)
Management
Medical
Abx
Indication: bacterial overgrowth, tropical sprue
E.g. tetracycline and metronidazole,
co-trimoxazole (Whipple's),
dapsone (dermatitis herpetiformis)
Supplements
Fe, B12, folate
Gluten free diet
Indication: Coeliac, dermatitis
herpetiformis
Conservative
Identify and treat cause
Pathophysiology
By cause
Bacterial overgrowth
Stasis due to abnormal motility (structural/functional)
Backflow to small intestine, doconj bile acids and metab B12
B12 deficiency, steatorrhoea
Tropical sprue
Unknown cause, likely infective
Affects small bowel - steatorrhoea, B12
Whipple's disease
Bacteria trophenyma whippei
Fever, abdo pain, steatorrhoea etc.
Intestinal resection
B12 malabs, bils salt malabs
Small bowel syndrome
Diarrhoea, anaemia, B12
Dermatitis herpetiformis
Gluten sensitive reaction, IgA depot at
dermal-epidermal junction
Often assoc Coeliac disease (asymtomatic)
By syndrome
Stomoch/jejunum
Cu
Menke's kinky hair
Duodenum/jejunum
Ca
Hypocalcemia
Fe
Microcytic anaemia
Small intestine
B1 (thiamine)
Beri beri
Wenicke's encephalopathy
B2 (riboflavin)
Angular stomatitis
B6 (pyridoxine)
Polyneuropathy
Vit E
Neurological deficit
Haemolysis
Phosphate
Weakness
Anorexia
Osteoporosis
Iodine
Goitre
Cretinism
Selenium
Cardiomyopathy
Jejunum
Vit D
RIckets
Osteomalacia
Folate
Macrocytic anaemia
Nicatinamide
Pellagra
Ileum
Vit C (prox)
Scurvy
Vit B12
Macrocytic anaemia
Glossitis
Neuropathy
Definition
Gastrointestinal disorder of
reduced absorption of one
or more key nutrients