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Malabsorption - Coggle Diagram
Malabsorption
Celiac Disease
Pathogenesis
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Antibodies are formed in Celiac Disease (tTG, EMA, DGP)
Presentation
Asymptomatic, Symptomatic is atypical (Amenorrhea, IDA, Osteopenia, Delayed growth and puberty)
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Complications
Collagenous Sprue, Ulcerative ileolitis, enteropathy-associated T-cell lymphocytes
Classification
Pre-mucosal
mpaired nutrient digestion or solubilization in GI tract lumen, decreased lumninal acid/bicarb/enzymes, mixing time, micellar formation
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Type of nuritent
Macronutrients, Vitamins, Macrominerals, Trace Elements
Fat Malabsorption
Causes
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Impaired production/secretion of lipase/colipase (Chronic pancreatitis, pancreatic duct obstruction)
Impaired bile acid production/secretion/transport (Cholestasis, impaired enterohepatic circulation
Loss of small bowel of surface area or function (diffuse mucosal disease, chronic infections, deposition disease, intestinal lymphoma, small bowel resection)
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Signs and Symptoms
Steatorrhea, Weight loss and loss of subcutaneous fat, Oxalate kidney stones, Specific impairments from lack of ADEK vitamins
Oxalate Kidney Stones
Unabsorbed fatty acids binds to calcium -> Less calcium available to bind oxalate -> Increased oxalate absorption -> Oxalate excrete by kidneys -> Potential for Ca-Ox kidney stones
Steatorrhea
72 hr fecal fat assessment, Spot Stool analysis, Evaluate for cause of fat malabsorption
CHO Malabsorption
Causes
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Non-Pathological
Sorbitol, fructose malabsorption
Signs and Symptoms
Watery Diarrhea, Bloating/Flatulence, Crampy Abdominal Pain
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Diagnosis
Stool pH <6, High H2, CO213 breath test, 24 hr urine d-xylose, lactose tolerance test
Anatomic SIte
Stomach, Small bowel, pancreas, Liver, Blood/Lymphatics
Clinical Presentation
Weight loss (due to macronutrient malabsorption and dehydration, most commonly fat)
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Bloating,Diarrhea: CHO malabsorption leading to osmotic diarrhea, secretory diarrhea (fatty acids, bile acids), increased intesntinal gas from bacteiral fermentation
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Pancreatic Insufficiency
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Effects
Fat, CHO, Protein malabsorption, Chronic recurrent abdominal pain, B12 Malabsorption
Diagnosis
Direct tests: Secretin Stimulation Challenge (Gold standard), Stool chymotrypsin, elastase, Indirect tests: Fecal Fat assessment, imaging, trial of pancreatic replacement enzymes
Treatment
Low-Fat Diet, Exogenous pancreatic lipase, Treatment of underlying cause
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