Malabsorption Cases


A 12 month old child is brought into see the paediatrician for failure to thrive. Soon after birth the child's growth drops below the 10th centile. The child has had three episodes of pneumonia and since starting solids mum comments the stools are often pale and offensive. Measure of sweat content demonstrates elevated chloride.

A 50 year old gentleman presents with chronic abdominal pains and pale, floating stools. His has several episodes of alcoholic pancreatitis and one occasion had a prolonged hospital stay after surgery for complications resulting from it. What is the underlying issue now?

A 35 year old female presents with offensive smelling stools for several weeks. She has a history of alternating bowel habit with bouts of diarrhoea and then constipation. She also takes codeine frequently for chronic back pain which she admittedly says also 'slows her down'. A previous colonoscopy was normal and her gastroenterologist concluded she had irritable bowel syndrome.


A 50 year old sees a doctor for chronic diarrhoea and a set of blood tests are drawn. He notes that the patient has a mild anaemia with haemglobin 80mg/dL and normal MCV. He asks for a blood picture which shows a bimodal picture of microcytic and macrocytic cells. He proceeds to order several tests to establish the cause. What are potential explanations and explain the mechanism.

A 60 year old woman undergoes extensive small bowel resection due to severe Crohn's disease. A few months later she develops unexplained bruises appearing on her body over a few weeks. Her doctor orders a clotting profile and platelet count. Why is this occurring? A few weeks later, she suffers a fall and breaks her wrist. The xray confirms the fracture but also show low bone density consistent with osteoporosis. Can you explain this in the context of her previous history?

A 40 year old male presents with weeks of gradually worsening numbness and loss of balance. Ten years earlier he had an emergency partial gastrectomy due to uncontrolled bleeding from a untreated stomach ulcer. He has been on PPI. Explain reasons for his symptoms?

A 45 year with chronic liver disease develops abnormal bowel motions. The stools are bulky and yellow and definitely not pale. What is the mechanism for this.


As part of a work-up for their malabsorption (and whilst waiting for imaging studies and colonoscopy), a patient undergoes the following investigations - 24 hour faecal fat, H2 breath test, pancreatic elastase and Schilling test. Explain the rationale for doing these tests.


A 55 year old male with chronic pancreatic insufficiency is commenced on pancreatic enzyme supplements to improve weight gain. These temporarily work but after a few months he develops recurrent diarrhoea despite compliance to therapy. Give other reasons why he continues to malabsorb.