14.malabsorption Syndromes
14.malabsorption Syndromes
14.malabsorption Syndromes
MALABSORPTION SYNDROME
Malabsorption syndromes
Malabsorption; A defect in the absorption of one or more nutrients.
Malabsorption syndromes encompass numerous clinical entities that result in chronic diarrhea,
abdominal distention, and failure to thrive.
Epidemiology:
The prevalence of this condition in the United States is 1:133. Crohn's disease is another condition
associated with malabsorption. Its prevalence in the United States is 20–100 per 100,000.
CLINICAL FEATURES
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Diarrhoea, often steatorrhoea -Steatorrhoea-an increase in stool fat excretion of >6% of dietary fat intake
Loose,pale,bulky foul smelling stool that float on water and difficult to flush away
Bloating, flatulence and abdominal discomfort.
Weight loss
Growth retardation, failure to thrive, delayed puberty in children
Swelling or edema
Anaemias, presenting as fatigue and weakness.
Muscle cramp, osteomalacia and osteoporosis
Bleeding tendencies
Other symptoms
• Systemic symptoms, including weakness, fatigue, and failure to thrive.
• Protein sensitivity may be associated with an eczematous rash.
• folate and B-12 malabsorption result in macrocytic anemia.
• Patients with abetalipoproteinemia develop retinitis pigmentosa and ataxia because of chronic fat-
soluble vitamin malabsorption and deficiency (vitamins A and E).
Clinical Presentation
LABORATORY
STUDIES:
The following laboratory
studies are indicated in
malabsorption syndromes:
• Stool analysis
• CBC
• liver function tests
• Total serum protein and
albumin
• Celiac screening
• Imaging Studies, Barium
studies
• Substance tolerance test
• Endoscopy
• Biopsy of Small-Intestinal Mucosa.
Stool analysis:
Reducing substances indicates that carbohydrates have not been properly absorbed. Acidic stool has a pH
level of less than 5.5. This indicates carbohydrate malabsorption, even in the absence of reducing
substances.
CBC : Megaloblastic anemia in patients with folate and vitamin B-12 malabsorption. In patients with
inflammatory bowel disease, the erythrocyte sedimentation rate, C-reactive protein level, or both are
commonly elevated. With bile acid malabsorption, levels of the low-density lipoprotein (LDL)
cholesterol may be low. In patients with liver or biliary disease, the results of liver function tests may be
higher Immunoglobulin G (IgG) and immunoglobulin A (IgA) antigliadin and IgA antiendomysial
antibodies, or especially tissue transglutaminase antibodies, are useful in the diagnosis of gluten- sensitive
enteropathy.
An increase in the exhaled hydrogen concentration following ingestion of an oral carbohydrate load (>20
ppm) indicates carbohydrate malabsorption.
Endoscopy: Gross morphology – gives diagnostic clue –Cobblestone appearance – Crohn’s disease. –
Reduced duodenal folds and scalloping of duodenal mucosa – celiac disease.
Biopsy of Small-Intestinal Mucosa: Primary indications (1) evaluation of a patient either with
documented or suspected steatorrhea or with chronic diarrhea (2) diffuse or focal abnormalities of the
small intestine defined on a small-intestinal series
Barium studies: Evaluation of the patient with presumed or suspected malabsorption. Small-bowel series
-a useful examination to look for anatomical abnormalities, such as strictures and fistulas (as in Crohn's
disease) or blind loop syndrome (e.g., multiple jejunal diverticula), and to define the extent of a previous
surgical resection
TREATMENT:
Replacement of nutrients, electrolytes and fluid may be necessary.
In severe deficiency, hospital admission may be required for parenteral administration.
Pancreatic enzymes are supplemented orally in pancreatic insufficiency.
Dietary modification is important in some conditions: – Gluten-free diet in coeliac disease. –
Lactose avoidance in lactose intolerance. – Food allergic enteropathy need to be on an elimination
diet, avoiding offending food antigens.
Antibiotic therapy will treat Small Bowel Bacterial overgrowth (eg, metronidazole, rifaximin).
Cholestyramine: In children with chronic diarrhea secondary to bile acid malabsorption, the use
of cholestyramine.
Immunosuppressive medications can be used to control autoimmune enteropathy.
Fat intolerance • MCT oil is used to treat patients with poor weight gain that results from fat
malabsorption. • MCT oil does not require traditional fat metabolism and, thus, is more easily absorbed
directly into the enterocyte and is transported through the portal vein to the liver. • Fat-soluble vitamin
supplements are required. • Supplements in patients with fat malabsorption should also include linoleic
and linolenic fatty acids.
Alternative formulas (protein intolerance) • Currently, soy formulas are not considered effective for
the prevention or treatment of nutritional allergies. Instead, use hydrolyzed protein formulas. • High-
degree protein hydrolysate formulas are used to treat infants with a cow's milk allergy, but these formulas
may contain residual tendency of provoking a severe allergic reaction. • In these infants, use formulas
with crystalline amino acids (eg, Neocate, EleCare) as the protein source.
NURSING MANAGEMENT:
6. Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and
discharge needs