A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from

Vitamin B12 malabsorption due to ileal resection

Atrophic gastritis unrelated to resection

Constipation due to dietary changes

Which of the following statements about celiac disease is false?

Celiac disease is caused by a viral infection.

Diagnosis requires duodenal biopsy showing villous atrophy

Diarrhea, Malabsorption, iron deficiency anaemia

Patients express HLA DQ2 or DQ8 haplotypes

What is a feature of short bowel syndrome?

Malabsorption leading to diarrhea, dehydration, and malnutrition.

Hypergastrinemia & high gastric secretion is seen

Diarrhea, dehydration and malnutrition

A 55-year-old white woman has had recurrent episodes of alcohol-induced pancreatitis. Despite abstinence, the patient develops postprandial abdominal pain, bloating, weight loss despite good appetite, and bulky, foul-smelling stools. Kidney, ureter, bladder (KUB) x-ray shows pancreatic calcifications. In this patient, you should expect to find which of the following?

Malabsorption of fat-soluble vitamins D and K

Positive fecal occult blood test

Post hepatic Portal Hypertension is caused by

Chronic hepatic venous congestion

MRP 2 and conjugated hyperbilirubinemia associated with which of the following?

Criggler Najjar syndrome type II

Criggler Najjar syndrome type I

Malabsorption Syndromes for UPSC-CMS: High-Yield Internal Medicine Lessons

Malabsorption Basics - Gut's Big Gulp

Definition: Impaired intestinal absorption of one or more dietary nutrients.
Phases of Absorption (L-A-D):
- Luminal: Pancreatic enzymes & bile salts digest food; micelle formation for fats.
- Absorptive (Mucosal): Nutrients cross apical membrane of enterocytes; processing within cell.
- Delivery (Post-mucosal): Transport via lymphatics (fats, fat-soluble vitamins) & portal vein (others).
Mechanisms:
- Pre-mucosal (Luminal): Defective hydrolysis/solubilization (e.g., Pancreatic insufficiency, ↓bile salts, ZES, Bacterial overgrowth).
- Mucosal: ↓Surface area, defective enzyme/transport (e.g., Celiac disease, Whipple's, Tropical sprue, Lactase deficiency).
- Post-mucosal: Obstruction of lymphatics (e.g., Lymphoma, Intestinal lymphangiectasia, TB).

⭐ Definition of steatorrhea: >7g fecal fat/24h on a 100g fat/day diet.

Symptom Spectrum - Telltale Tummy

⭐ Weight loss despite adequate or increased oral intake is a hallmark of malabsorption.

Key GI Symptoms:
- Chronic diarrhea, often steatorrhea (bulky, pale, foul-smelling, greasy stools)
- Abdominal distension, bloating, ↑flatus, borborygmi
- Weight loss (adults), failure to thrive (children), fatigue, anorexia
Nutrient Deficiency Clues (Systemic Impact):
- Anemia (↓Fe, ↓B12, ↓folate): pallor, glossitis, angular stomatitis
- Bleeding (↓Vit K): easy bruising, petechiae, purpura
- Bone pain/fractures (↓Vit D, ↓Ca): osteomalacia, osteoporosis
- Neurological (↓B12, ↓Thiamine): paresthesias, ataxia; Tetany (↓Ca, ↓Mg)
- Edema (↓protein)
- Skin/Mucosal (↓Vitamins, ↓Zinc): dermatitis (e.g., herpetiformis in celiac), hyperkeratosis (↓Vit A), night blindness (↓Vit A)

Diagnostic Toolkit - Gut Sleuthing

Initial Clues:
- Blood tests: CBC (anemia), Albumin (↓), Ca (↓), Vit D (↓), PT (↑).
Fat Malabsorption:
- Sudan III stain (stool, qualitative).
- ⭐ > The gold standard for diagnosing fat malabsorption is quantitative 72-hour fecal fat estimation (>7g/day abnormal).
Carbohydrate Malabsorption:
- D-xylose test: Distinguishes mucosal vs. pancreatic.
  - Normal: >25mg/dL (2h serum), >4g (5h urine).
  - Low in mucosal disease.
- Hydrogen breath tests (lactose intolerance; glucose for SIBO).
Protein Malabsorption: Fecal α1-antitrypsin (protein-losing enteropathy).
SIBO: Jejunal aspirate (>10^5 CFU/mL).

Spotlight Syndromes - Rogues' Gallery

Feature	Celiac Disease	Tropical Sprue	Whipple's Disease
Etiology	Gluten sensitivity (HLA-DQ2/DQ8)	?Infectious; post-infectious enteropathy	Tropheryma whipplei (Gram+ actinomycete)
Key Clinical	Diarrhea, wt loss, anemia, dermatitis herpetiformis	Chronic diarrhea, steatorrhea, megaloblastic anemia (folate/B12↓)	Arthralgia, wt loss, diarrhea, neuro sx (📌 WAND: Wt loss, Arthralgia, Neuro sx, Diarrhea)
Dx Markers	Anti-tTG IgA, Anti-EMA, Anti-DGP; HLA-DQ2/DQ8	↓ Folate, ↓ B12; exclusion	PCR for T. whipplei
Biopsy	Villous atrophy, crypt hyperplasia, ↑IELs	Partial villous atrophy, ↑IELs, chronic inflammation	PAS+ macrophages in lamina propria
Treatment	Lifelong gluten-free diet (GFD)	Tetracycline + Folic acid (months)	Prolonged antibiotics (Ceftriaxone then TMP-SMX)

⭐ Anti-tissue transglutaminase (Anti-tTG) IgA antibodies are the most sensitive and specific serological screening test for Celiac Disease.

High‑Yield Points - ⚡ Biggest Takeaways

Celiac Disease: HLA-DQ2/DQ8 linked; anti-TTG IgA antibodies; villous atrophy on biopsy.

Tropical Sprue: Endemic areas; chronic diarrhea, malabsorption; responds to tetracycline & folic acid.

Whipple's Disease: T. whipplei; arthralgia, weight loss, diarrhea, neurological symptoms; PAS-positive macrophages.

Pancreatic Insufficiency: Steatorrhea; low fecal elastase-1; enzyme replacement therapy.

SIBO: Diagnosed by carbohydrate breath tests (glucose/lactulose) or jejunal aspirate culture.

D-xylose test: Differentiates mucosal disease (impaired absorption) from pancreatic insufficiency (normal absorption).

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