Malabsorption syndrome associated with carcinoma of the bronchus

Wangel, A. G.; Deller, D. J.

doi:10.1136/gut.6.1.73

Cited by 21 publications

(4 citation statements)

References 15 publications

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“…Similar changes have been reported in conditions other than primary malabsorptive disorders, e.g., after partial gastrectomy , in jejunal diverticulosis (Schiffer, Faloon, Chodos, and Lozner, 1962), in Crohn's disease 260 (Shiner and Drury, 1962), in giardiasis (Cameron, Astley, Hallowell, Rawson, Miller, French, and Hubble, 1962), in ulcerative colitis (Salem, Truelove, and Richards, 1964), and in some cases of malignacy arising from the small intestine (Creamer, 1964;Wangel and Deller, 1965).…”

supporting

confidence: 64%

Morphology and functional cytology of the small intestinal mucosa in malabsorptive disorders and other diseases

Fry¹,

McMinn²

1966

J Clin Pathol

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SYNOPSIS Small intestinal biopsies from 98 patients have been studied macroscopically, histologically, and histochemically, and the results correlated with laboratory and clinical observations. Neither a convoluted nor a flat mucosa can be considered diagnostic for any specific disease. A flat mucosa was found in one adult with intestinal Hodgkin's disease and in another following total gastrectomy.Histochemically all specimens from subjects with coeliac disease and idiopathic steatorrhoea showed a deficiency of succinic dehydrogenase in the epithelial cells, and the histochemical test for this enzyme, although not specific, may be a useful aid to diagnosis, since the degree of deficiency in these diseases was usually grosser than that in any other conditions. Other but variable enzyme deficiencies that may be present in these two diseases showed no correlation with the reduction of succinic dehydrogenase activity, nor was there any correlation between reduced enzyme activities and the severity or otherwise of the clinical features.A number of specimens from patients with conditions other than coeliac disease and idiopathic steatorrhoea that had a normal macroscopic appearance showed some reduction of intracellular enzyme activities histochemically. This was not so in the control group, and if these deficiencies can be confirmed biochemically, then histochemical tests may give an earlier indication of disordered function than macroscopical or routine histological examination.At present neither the macroscopic appearance nor any single histological or histochemical test on the biopsy specimen is diagnostic for a particular disease. These findings must be considered with the clinical details and results of other investigations in establishing a diagnosis.The fact that there are morphological changes in the mucosa of the small intestine in primary malabsorptive disorders, i.e., idiopathic steatorrhoea, coeliac disease, and tropical sprue, is now well established (e.g.

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supporting

confidence: 64%

Morphology and functional cytology of the small intestinal mucosa in malabsorptive disorders and other diseases

Fry¹,

McMinn²

1966

J Clin Pathol

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“…The thoracic duct was not dilated but was obstructed by lymph nodes containing neoplastic masses. Wangel and Deller (1965) report a man with a carcinoma of the bronchus, steatorrhoea, and subtotal villous atrophy. At necropsy patchy subtotal villous atrophy of the duodenum and the jejunum was found.…”

Section: Discussionmentioning

confidence: 98%

Carcinoma, villous atrophy, and steatorrhoea.

Brzechwa-Ajdukiewicz¹,

McCarthy²,

Austad³

et al. 1966

Gut

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EDITORIAL SYNOPSIS There appears to be an increased incidence of carcinoma of the fore and mid gut in patients with villous atrophy of the small intestine.Intestinal reticulosis may arise as a complication of idiopathic steatorrhoea (Gough, Read, and Naish, 1962). Creamer (1964) has suggested that malignancy anywhere in the body may be accompanied by villous atrophy of the small intestinal mucosa. In this paper, seven patients with steatorrhoea and accompanying carcinoma are presented and the possible reasons for this association are discussed.CASE REPORTS CASE 1 A man aged 50 years was in good health until April 1961, when he complained of pain in the right buttock and was treated with phenylbutazone. He afterwards developed watery diarrhoea, passing six to 10 motions daily, which lasted a fortnight. Subsequently his bowels opened four times a day and the stools weie clay coloured and offensive. His appetite was good. Apart from pallor, physical examination was normal.Investigations showed that haemoglobin was 47 % with evidence of iron deficiency. A small intestinal barium meal showed the features of steatorrhoea. Faecal fat was 90 g. in three days. Xylose absorption was normal. A glucose tolerance test (50 g.) produced a rise of 40 mg./100 ml. The patient refused to have a jejunal biopsy.He was followed up in the Out-patient Department and the iron-deficiency anaemia was treated with oral and parenteral iron. When a gluten-free diet was prescribed his weight increased by 8 lb. and a subsequent three-day faecal fat estimation was 26 g. As anaemia persisted in spite of treatment, he was admitted for transfusion during the summer of 1962. A 51Cr-labelled red cell study was carried out and showed an average daily blood loss of 39 4 ml. Faecal fat was 23-9 g. in three days.In December 1962 he was admitted as an emergency because of upper abdominal pain, and after a blood transfusion a laparotomy was carried out, at which an ulcerated annular tumour was found 10 cm. below the duodeno-jejunal flexure. The tumour and 15 cm. of jejunum were resected. Histological examination showed the tumour to be an adenocarcinoma with no lymph node metastases. The jejunum showed partial villous atrophy.He has been in good health since the operation with bowels opening once a day. Haemoglobin has risen to 97%.CASE 2 A man, aged 70 years at the time of death, had had attacks of diarrhoea and lower abdominal pain since 1946. Idiopathic steatorrhoea and megaloblastic anaemia were diagnosed in 1954. He was treated with a gluten-free diet and improved. He was admitted again in 1960 because of diarrhoea and weight loss. On examination he was small, wasted, and pale. Clubbing was present as were abdominal distension and dorsal kyphosis.Investigations revealed 36 g. of fat in a 24-hour stool collection and only 1-7 g. of 25 g. of d-xylose was excreted in the urine in five hours. A glucose tolerance test revealed a maximum rise of 10 mg./100 ml. A jejunal biopsy showed subtotal villous atrophy. Serum albumin was 2-2 g./100 ml. and serum y gl...

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“…In addition, it has been suggested that malignancy anywhere in the body may be associatcd with secondary changes in the small intcstine, leading to hypoplasia or flattening of the mucosa and a subscquent malabsorption [27,28]. A significant protein losing enteropathy follows secondary disorders of the GI lymphatic channcls or ulceration of a region of the mucosa [29,30].…”

Section: Inadequate Food Intakementioning

confidence: 99%

Malignant disease: nutritional implications of disease and treatment

Holmes

Dickerson

1987

Cancer Metast Rev

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Protein-energy malnutrition (PEM) is common in cancer patients and may develop into the syndrome known as 'cancer cachexia'. This is characterised by complex disturbances in carbohydrate, lipid, protein, and electrolyte metabolism. The aetiology is equally complex, with host and therapeutic factors contributing to the reduced food intake and effects on host tissues. Anorexia is of prime importance, differing in its cause from one patient to another and often presenting a barrier to successful nutritional support. Further research is necessary to elucidate the interaction of central and peripheral factors that may be involved in the aetiology of anorexia. Because of the interplay of biochemical, physiological, and psychological consequences of cancer, the nutritional support of the patient presents a considerable challenge to the caring professions.

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Malabsorption syndrome associated with carcinoma of the bronchus

Cited by 21 publications

References 15 publications

Morphology and functional cytology of the small intestinal mucosa in malabsorptive disorders and other diseases

Morphology and functional cytology of the small intestinal mucosa in malabsorptive disorders and other diseases

Carcinoma, villous atrophy, and steatorrhoea.

Malignant disease: nutritional implications of disease and treatment

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