Malabsorption (Old version, with sound) - CRASH! Medical Review Series

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Tuesday, October 25, 2022. Gastroenterology: Malabsorption (Diarrhea and/or Steatorrhea) is Pathology of Absorption within the Gastrointestinal Tract. Vitamin Deficiency of Fat-Soluble Vitamins A, D, E, and K is a Consequence and a possible hint of Malabsorption. Aetiology (Ax): 1) Celiac Disease; 2) Chronic Pancreatitis; 3) Tropical Sprue; 4) Whipple's Disease; 5) Cystic Fibrosis (CF); SSx: 1) Steatorrhea (Foul-Smelling, Fat-Laden Feces), 2) Vitamin Deficiency (Hypocalcemia (D), Increased Prothrombin Time [PT] due to Phytonadionopenia), and 3) Weight Loss/Cachexia. Dx: Steatorrhea is Confirmed with A Fecal Fat Test (Positive Test finds Oily Stool). In Celiac Disease (CD), Autoimmune Inflammation localized to the Small Intestine Mucosa (Gliadin Hypersensitivity, a Wheat/Grain Protein) is the Pathophysiology, where Malabsorption is simply due to a Damaged Mucosa. Because the Small Intestine Absorbs Iron, Deficiency of Iron is almost Pathognomonic of CD (Sensitive but not Specific, a good Presumptive Diagnosis) when other Signs And Symptoms are Considered, otherwise a Common Patient Presentation. SSx: 1) Anemia: 1) Pallor, 2) Fatigue, 2) Chronic Diarrhea, 3) Steatorrhea, 4) Weight Loss, 5) Dermatitis Herpetiformis, a Skin Manifestations (Blisters, Papulae and Bullae [Yielding a Yellow Exudate upon Expression]) not Related to a Viral Aetiology (Herpes Simplex Virus which has Oral Mucosa Manifestation). Dx: Serology looking for Antibodies: 1) Anti-Gliadin, 2) Anti-Endomysial, and 3) Anti-tTG (Most Specific and Highly Sensitive Test). However, Confirmation is Done via Biopsy (Small Intestine Assessment for Infiltration Morphology) as Lymphoma localized to the Small Intestine is still Relevant (Most Sensitive Test). Tx is simply the Avoidance of Gluten-containing Foodstuff, Gluten-Free Diet. 2) In Chronic Pancreatitis, Aetiology is Variable: 1) Alcohol-Induced Necrosis, 2) Idiopathic. Lipase, an essential Digestive Enzyme for Lipid Metabolism/Catalysis is Supplied by the Pancreas. SSx: 1) Chronic Diarrhea, 2) Steatorrhea, 3) Weight Loss, 4) History of Repeated Episodes of Acute Pancreatitis (Severe, Dull Abdominal Pain with Emesis; Pancreatic Enzymes Elevation in an Alcoholic), 5) Macrocytic Anemia (Rarely), 6) Progression to Chronic Diarrhea (History Basis). Dx is on the basis of History (Clinical Diagnosis); Imaging on CT and Plain Film (X-Ray) will show Pancreatic Calcifications. Note, Pancreatic Enzymes Amylase and Lipase will often be Normal (Not Reliable for Diagnosis). Tx via 1) Pancreatic Enzyme Supplementation, 2) ADEK Vitamin Supplementation (Fat-Soluble Vitamins), and 3) Vitamin B 12 Supplementation (Usually Alcoholics have Cobalopenia Inherently). 3) Tropical Sprue is a Malabsorptive Disease with an Idiopathic Aetiology (Infectious is likely). Travel History to Tropical Regions is somewhat characteristics and hints towards this Disease. SSx: Diarrhea and Steatorrhea. Dx is via Small Bowel Biopsy (Morphology of Infiltration [Significant Eosinophilia in the Lamina Propria and Duodenal Villous Blunting]). Tx is with 1) Trimethoprim-Sulfamethoxazole (Bactrim), an Antibacterial Folate Antagonist or 2) Doxycycline, a Tetracycline Antibiotic. 3) Third Generation Cephalosporin Ceftriaxone also applies. 4) Whipple's Disease is a Rare, Systemic Chronic Infection by Bacterium Trophyrema whipplei (Gram-Indeterminate) of the Gastrointestinal Tract. Travel History is not a Necessary Element of this Infectious Disease. Dx is via Polymerase Chain Reaction (PCR) Assessment of the Small Bowel Biopsy. Also, on Periodic Acid Schiff (PAS) Staining a PAS-Positive Foamy Macrophage will be a Prevailing Morphology. Tx is with 1) Trimethoprim-Sulfamethoxazole (Bactrim), an Antibacterial Folate Antagonist or 2) Doxycycline, a Tetracycline Antibiotic. 3) Third Generation Cephalosporin Ceftriaxone also applies. Cystic Fibrosis (CF) is a Congenital Genetic Disorder involving the Gastrointestinal Tract and Lungs with Mucus Plugging. History is usually explicative of the Diarrhea and Steatorrhea Symptoms. Dx is known at birth (Sweat Test and Genetic Testing). Tx is only Symptomatic (No known Cure). Goodness, such a struggle with the Diarrhea. My first Subject of CF was a complete Success. Just Kidding. The Best this Mortal can do is 1) GE Referral and 2) Pancreatic Enzyme Replacement Therapy along with 3) Prophylactic Monobactam Antibiotics Aztreonam for Respiratory Symptoms, 4) Anti-inflammatory Agent Ibuprofen (Drug Class NSAID Analgesics (COX Non-Specific)/Propionic Acid Derivatives), 5) Mucolytic Acetylcysteine, 6) a Short Acting Beta 2-Adrenergic Agent, Albuterol and Hope for the Best. MD Paul Bolin, es geht gut--und immer soll. Heil!