Malabsorption

Question 1

S+S (11)

Answer 1

• Steatorrhea
• LOW
• Weakness
• Anaemia
• Bone pain (osteomalacia)
• Glossitis/angular stomatitis
• Bruising
• Oedema
• Peripheral neuropathy
• Skin rash
• Amenorrhoea

Question 2

Causes (7)

Answer 2

• Gastrectomy/bowel surgery
• Hx of liver/pancreatic disease
• Drugs, ETOH, neomycin
• Crohn’s disease
• Previous RTx
• Hx of diabetes
• RFs for HIV

Question 3

Sequalae (6)

Answer 3

• Fe deficiency
• Hypocalcaemia
• Increased PT
• Decreased cholesterol
• Faecal fat
• Decreased carotene

Question 4

Ix (11)

Answer 4

• Hb
• Fe studies
• B12
• Folate
• Albumin
• Vitamin D
• CMP
• ALP
• INR
• AXR
• Gastroscopy +/- biopsy

Question 5

Macronutrients

Answer 5

• Fat
• Protein
• CHO

Question 6

Micronutrients

Answer 6

• Vitamins
• Minerals - Zn, Selenium, Fe, Copper, Iodine

Question 7

Fat soluble

Answer 7

• A
• D
• E
• K

Question 8

Water-soluble

Answer 8

• Folate
• Thiamine
• Riboflavin
• Niacin
• Pyridoxine
• B12
• Ascorbic acid

Question 9

Macro S+S (4)

Answer 9

• Muscle wasting
• Protein: oedema
• Fat: body fat stores, pressure wounds
• Amenorrhoea, cognition/mood, infections

Question 10

Micro S+S

Answer 10

• Nails - Fe
• Hair/skin - Zn
• Vision - Vitamin A
• Bruising - Vitamin K
• Poor wound healing
• Neuro - Vitamin B
• Bones - Ca/Vitamin D

Question 11

Consequences of malnutrition (8)

Answer 11

• Impaired muscle function
• Decreased bone mass
• Immune dysfunction
• Anaemia
• Decreased cognitive function
• Poor wound healing
• Delayed recovery from surgery
• Increased mortality

Question 12

Prevention - diet

Answer 12

• their diet is low protein –> recommend PO HE/HP nutritional supplements to make sure they’re getting 30% or more of their daily energy requirement

Question 13

Exercise regimens

Answer 13

• 30-60 mins moderate intensity of exercise/day, 150-300 mins/week
• Strength: calisthenics, stair climbing - 2 days/week
• Flexibility - 2 mins/day - for major muscle groups

Question 14

TPN

Answer 14

• AAs - nitrogen balance, muscle maintenance
• Dextrose - energy
• FA emulsion: energy that spares you dextrose –> prevents NAFLD

Question 15

Extra-intestinal manifestations of UC

Answer 15

• Liver - Fatty liver, PSC, cirrhosis, carcinoma of bile duct, amyloidosis
• Blood - VTE, anaemia
• Enteropathy arthritis - large jts spared
• Skin - ulcers, pyoderma, EN
• Ocular - uveitis, conjunctivitis, episcleritis

Question 16

Extra-intestinal manifestations of CD

Answer 16

• PSC less common
• Gallstones
• Renal stones: urate, calcium oxalate
• Pyelonephritis, hydronephrosis (ureteric obstruction), amyloidosis
• Malabsorption - d/t small bowel involvement
• Osteomalacia