Bile Acid Malabsorption (BAM)

00:01 Bile Acid Malabsorption. Where bile acid would be and its normal physiology would be down in the terminal ileum. Do not get your bile acid confused with your bilirubin.

00:14 One has nothing to do with the other even though bilirubin is a constituent of bile.

00:22 In terms of its biochemistry and physiology, they could not be any more different.

00:27 The topic here is bile acid malabsorption.

00:31 Keep in mind that bile synthesis will take place in the liver, with the help of cholesterol and bile eventually gets stored in your gall bladder as you know.

00:42 It?s then secreted into or enters the second part of duodenum, will do its job in terms of emulsification of your lipid and then finally the bile acids and you should know some of your conjugating enzymes and taurocholic acid, so on and so forth and finally make your way down into the terminal ileum where 80% if not more, every bile acid undergoes what?s known as, well one thing for sure that should ring a bell is enterohepatic circulation, right? So enterohepatic circulation. Where does this occur? The recycling takes place in the terminal ileum.

01:24 With all that in your head, now I give you the permission to move on.

01:29 Caused by ileoresection disease, does that make sense to you? If you?re moving the ileum for whatever reason, maybe it?s small bowel infarction, maybe it?s Crohn?s disease.

01:43 If that ileum is gone, gone is the recycling and results in bile acid malabsorption.

01:49 What?s the problem? You can?t properly reabsorb or metabolize your lipid, correct? Keep going. Limited resection less than 100 cm impairs bowel acid absorption causes diarrhea.

02:04 Liver compensates and prevents the steatorrhea if we talk about limited resection and the treatment here could be something like cholestyramine.

02:13 Extensive resection beyond your 100 cm, then you?re thinking about my goodness there isn?t enough bile that could probably emulsify and metabolize my lipids so therefore I will find lipid in my stool, welcome steatorrhea.

02:29 Due to inadequate liver compensation, in this case, what?s your recommendation? Low fat diet.

02:38 You see how your physiology and biochemistry can help you understand pathology and then will actually help you make the proper recommendations.

02:48 Whipple?s disease: Very rare in the United States, your focus should be on Celiac.

02:54 The reason I bring that up is that those individuals that deal with bacteria such as Tropheryma whipplei will know and should know that there is, they're comparing contrasting Celiac vs. Whipple.

03:07 As far as you?re concerned, Whipple?s disease is quite rare. It is a bacterial disease.

03:11 Celiac disease is the gluten that we talked about and the fact that it is an autoimmune disease.

03:17 Two totally different types of pathogenesis.