2. INTRODUCTION
Malabsorption syndrome refers to a number
of disorders in which the small intestine can't
absorb enough of certain nutrients and fluids.
Nutrients that the small intestine often has
trouble absorbing can be macronutrients
(proteins, carbohydrates, and fats),
micronutrients (vitamins and minerals), or both.
3. Definition
Malabsorption is the inability of the digestive system to absorb one or more of the
major vitamins, minerals, and nutrients
“Brunner’’
Malabsorption is a syndrome associated with a variety of disorders and intestinal
surgical procedures. It interferes with the ability to absorb nutrients and is a result of
a generalized flattening of the mucosa of the small intestine.
“Ignatavicious”
Malabsorption syndrome refers to a number of disorders in which the small intestine
can’t absorb enough of certain nutrients and fluids.
https://www.healthline.com/health/malabsorption
4. ETIOLOGY
Biochemical or
enzyme
deficiencies
•Lactase deficiency
•Biliary tract
obstruction
•Pancreatic
insufficiency
•Cystic fibrosis
•Chronic
pancreatitis
•Zollinger- Ellison
syndrome
Bacterial
proliferation
•Tropical sprue
•Parasitic infection
Small intestinal
mucosal disruption
•Celiac disease
•Whipple’s disease
•Crohn’s disease
Disturbed lymphatic
and vascular
circulation
•Lymphoma
•Ischemia
•Lymphangiectasia
•Heart failure
Surface area loss
•Billroth II
gastrectomy
•Short bowel
syndrome
•Distal ileal
resection
5. PATHOPHYSIOLOGY
Bile salt deficiencies
Bile salt deficiencies
Decreased synthesis of bile in liver
Bile salt deficiency
Malabsorption of fats and fat soluble
vitamins
Enzyme deficiencies
Genetic inheritance, injury to the
intestinal mucosa from viral hepatitis
Lactase deficiency is the most common
disaccharide enzyme deficiency
Without sufficient amounts of this enzyme
body is not able to breakdown lactose
6. Pancreatic Enzyme
Deficiencies
Chronic pancreatitis, cystic fibrosiss
Destruction or obstruction of the
pancreas or insufficient pancreatic
stimulation
Pancreatic enzyme deficiencies
Malabsorption problems – defieciency
of Vit- B12 absorption
Presence of Bacteria
Gastrectomy
Loop bowel can accumulate intestinal contents
results in bacterial overgrowth when peristalsis
is decreased
Bacteria at this site break down bile salts, and
fewer salts are available for absorption
They also can ingest the vit B12
Vitamin B12 deficiency
7. Disruption of the ,mucosal
lining of the smalll intestine
Celiac sprue, tropical sprue, crohn’s
disease and ulcerative colitis
Accumulation of gluten in the diet
with peptidase deficiency
Genetic immune hypesensitivity
response to gluten or its breakdown
products.
In celiac sprue
The absorptive surface area in the
small intestine is lost
Tropical Sprue
Bacterial infectious agent
Tropical sprue
Mucosal changes occur
Malabsoption of fat, folic acid, vit
B12
8. Altered lymphatic
circulation
Lymphoma, crohn’s disease, HF&
constrictive pericarditis causes
lymphatic obstruction
Loss of plasma proteins along with
the loss of minerals, vit B12, folic
acid & lipids
Altered vascular circulation
Small bowel ischemia and radiation
enteritis
Interference with blood flow to the
intestinal mucosa
malabsorption
resection of the ileum results in vit
B12, bile salt and other nutrient
deficiencies
9. Clinical manifestations
Chronic diarrhea
Steatorrhea
Unintentional weight loss
Abdominal distention, pain, weakness
Bloating and flatus
Decreased libido
Easy bruising (purpura)
Anemia
Bone pain ( with calcium and vit D deficiency)
Edema
Serum iron levels are low in protein malabsorption because of insufficient gastric acid
for use of iron
Serum cholesterol levels may be low from decreased absorption and digestion of fat
Low serum calcium levels
10. Diagnosis
Stool studies for quantitative and qualitative fat analysis
Lactose tolerance test
D-xylose absorption test & schilling test
The hydrogen breath test to evaluate carbohydrate absorption
Endoscopy with biopsy of the mucosa
CT scan
X ray
Pancreatic function tests
CBP
11. Management
Avoidance of substances that aggregate malabsorption
Supplementation of nutrients
Surgical management of primary disease
Dietary management includes
Low fat diet for patients who have gallbladder disease, severe steatorrhea
Dietary intake of fat is beneficial to the patient
After a total gastrectomy high protein, high calorie diet & small frequent
meals are recommended.
12. Should provide nutritional supplements according to the deficiency include
Water soluble vitamins such as folic acid and vitamin B complex
Fat soluble vitamins such as vitamin A, Vitamin D & vitamin K
Minerals such as Calcium, iron and magnesium
Pancreatic enzyme such as pancrelipase
Antibiotics to treat tropical sprue, whipples disease – trimethoprim/
sulfamethoxazole
Antidiarrheal agents such as diphenoxylate to control diarrhea and
steatorrhea
Anticholinergics such as dicyclomine hydrochloride may be given before
meals to inhibit gastric motility
IV fluids
