Malabsorption
Paul L. Crotty
Department of Pathology
Tallaght Hospital
October 2007
Outline of lecture
Lymphatic blockage
Primary lymphangiectasia
Obstruction
Major disease entities
Coeliac disease
Chronic pancreatitis
Bacterial overgrowth
Consequences of malabsorption
Chronic pancreatitis?
Coeliac disease?
Cholestatic liver disease?
Bacterial overgrowth?
Key role of duodenal biopsy
Biopsy diagnosis of specific diseases
Giardia infestation, Whipple’s disease
abetalipoproteinaemia, lymphangiectasia
Significantly blunted villi or flat mucosa
(partial or complete villous atrophy)
classically seen in untreated coeliac disease
but can also be seen in other food allergies,
rarely in viral infection, Crohn’s disease,
tropical sprue
Normal mucosa
Patient with malabsorption
with a normal duodenal biopsy
Sensitivity Specificity
AGA
IgA 89% 95%
IgG 99% 86%
Clinical diagnosis
Exclusion of primary small bowel disease
Usually don’t need direct tests of pancreatic
exocrine function