Malabsorption

Defective mucosal absorption, caused by defective luminal digestion, mucosal disease or structural disorders

Aetiology

  • Important causes of malabsorption include coeliac disease, Crohn’s disease, short bowel syndrome, cirrhosis and biliary obstruction, lactase deficiency, Whipple’s disease and tropical sprue

Clinical presentation

Diarrhoea

  • Malabsorptive stool
  • May be ‘hard to flush away’ due to fat globules making it float - steatorrhea

Easy bruising

  • Vitamin C deficiency - scurvy
  • Vitamin K deficiency

Skin

  • Acrodermatitis enteropathica
    • Autosomal recessive disorder causing impaired zinc uptake
    • Causes a rash (perioral and acral) and alopecia
    • Management - lifelong zinc supplements
  • Dermatitis herpetiformis - may indicate coeliac disease

Glossitis and angular stomatis

  • B vitamins
  • Iron

Spooning of nails

  • Iron

Initial investigations

  • Bloods - FBC, coagulation, LFTs, albumin, calcium/magnesium
  • Stool culture
  • Endoscopy
  • US/CT/MRI

Management

  • Depends on cause