Malabsorption is a clinical term that encompasses defects occurring during the digestion and absorption of food nutrients by and

infections of the gastrointestinal tract. The digestion or absorption of a single nutrient component may be impaired, as in lactose intolerance due to lactase deficiency. When a diffuse disorder, such as celiac disease or Crohn's disease, affects the intestine, the absorption of almost all nutrients is impaired. Although presenting symptoms, such as diarrhea and weight loss, may be common, the specific causes of malabsorption are usually established based on physiologic evaluations. The treatment often depends on the establishment of a definitive etiology for malabsorption. To understand the mechanisms of malabsorption, understanding the normal physiologic process of digestion and absorption by the intestinal tract is necessary. In general, the digestion and absorption of food materials can be divided into 3 major phases: luminal, mucosal, and postabsorptive.[1] The luminal phase is the phase in which dietary fats, proteins, and carbohydrates are hydrolyzed and solubilized by secreted digestive enzymes and bile. The mucosal phase relies on the integrity of the brush-border membrane of intestinal epithelial cells to transport digested products from the lumen into the cells. In the postabsorptive phase, reassembled lipids and other key nutrients are transported via lymphatics and portal circulation from epithelial cells to other parts of the body. Perturbation by disease processes in any of these phases frequently results in malabsorption.

What is malabsorption?
Malabsorption occurs when nutrients are not properly extracted and absorbed from food during the digestive process. This can result in a deficiency of vitamins, proteins, minerals, carbohydrates, and other nutrients that are important for growth and regulation of body systems. Digestive Problems Spotlight y Malabsorption? Join the Discussion Typically, during digestion, nutrients are extracted from food and absorbed by the small intestine. These nutrients are then carried through the bloodstream and into the tissues, muscles and organs to support their functions. In the case of malabsorption, there is a breakdown in this process in the intestine such that nutrients are not properly absorbed, but rather, excreted through the stool. Malabsorption may be temporary, for example, occurring in so-called stomach flu, when vomiting or diarrhea may prevent the efficient absorption of nutrients. This type of malabsorption goes away when the underlying disease resolves. However, chronic (long-lasting) cases of malabsorption are a cause for concern and should be evaluated immediately by a health care professional. Symptoms associated with malabsorption include vomiting, nausea, bloating, chronic diarrhea, muscle wasting, and weight loss. Malabsorption occurring in children can limit their growth. Malabsorption can also lead to other illnesses caused by poor nutrition. Malabsorption is a serious condition that can cause diarrhea or loose stools. Persistent diarrhea can result in dehydration, a potentially life-threatening condition. Seek immediate medical care (call 911) for

symptoms of dehydration, including sunken eyes; lethargy; rapid heart rate; any change in level of consciousness or alertness, such as passing out or unresponsiveness; and loss of skin elasticity. Seek prompt medical care if you or your child is being treated for malabsorption, but symptoms recur or persist.

Diarrhea is the reversal of the normal net absorptive status of water and electrolyte absorption to secretion. Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretory state induced in the enterocytes. In the former case, diarrhea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in lactose malabsorbers. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-induced diarrhea. In osmotic diarrhea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive; diarrheal stools promptly regress with discontinuation of the offending nutrient, and the stool ion gap is high, exceeding 100 mOsm/kg. In fact, the fecal osmolality in this circumstance is accounted for not only by the electrolytes but also by the unabsorbed nutrient(s) and their degradation products. The ion gap is obtained by subtracting the concentration of the electrolytes from total osmolality (assumed to be 290 mOsm/kg), according to the formula: ion gap = 290 [(Na + K) 2]. In secretory diarrhea, the epithelial cells ion transport processes are turned into a state of active secretion. The most common cause of acute-onset secretory diarrhea is a bacterial infection of the gut. Several mechanisms may be at work. After colonization, enteric pathogens may adhere to or invade the epithelium; they may produce enterotoxins (exotoxins that elicit secretion by increasing an intracellular second messenger) or cytotoxins. They may also trigger release of cytokines attracting inflammatory cells, which, in turn, contribute to the activated secretion by inducing the release of agents such as prostaglandins or platelet-activating factor. Features of secretory diarrhea include a high purging rate, a lack of response to fasting, and a normal stool ion gap (ie, 100 mOsm/kg or less), indicating that nutrient absorption is intact.

Complications and sequelae of Diarrhea from the Diseases Database include:

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Hypokalaemia Hypovolaemic shock Sodium levels low (urine) Depletional hyponatraemia Hypernatraemia Hypophosphataemia

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Hypomagnesemia Dehydration Faecal incontinence

What is Diarrhea?
You can say you have diarrhea if you pass stools of liquid consistency more than three times in one day. Diarrhea strikes all ages at one time or another. On average, adults can experience diarrhea as many as four times per year. Usually, when this condition presents it clears up on it's own after a day or two. This is considered acute or short-term diarrhea and usually will not last 3 weeks. Chronic or long-term diarrhea can be dangerous and symptomatic of other problems. Chronic diarrhea is that which lasts longer than three weeks it's usually related to the bowel function disorders.

Related Symptoms
When people have diarrhea, they often experience nausea, abdominal bloating, cramping and the frequent, urgent need go to the toilet. Some causes of diarrhea even present with blood in the stool and fever. What you can look for is dark stools, fever, blood or puss in stools. These are signs that there may be a problem.

What Are Some Causes of Diarrhea?

There are several possible causes for disease some are short-lived while others are more severe and prolonged in nature.
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Bacterial infections can enter the body when they are ingested on tainted food or water. Some common bacteria that instigate bouts of diarrhea are salmonella, campylobacter, Escherichia coli (E. coli), and Shigella. Hepatitis and Rotavirus are two viral infections that have diarrhea as a symptom of their presence. Others include Norwalk, Cytomegalovirus and herpes simplex viruses. Simple intolerance to particular foods can cause diarrhea. It's usually a component in the food such as food coloring, milk sugar (lactose) or other additives. Parasites are microscopic organisms that can be present on food or in water. In the digestive system. Some of the parasites that we might ingest are Giardia lamblia, Cryptosporidium and Entamoeba histolytica. Some medications like blood pressure, antibiotic and antacid medications that contain magnesium. There are several bowel disorders that can have diarrhea as a symptom including Celiac disease and Irritable Bowel Syndrome. In these instances, it's not what you eat so much as the malfunctioning of your intestines. Surgeries such as gallbladder removal and stomach surgery. These changes to the digestive system can through things out of balance. Often times though, the root cause is not found, in part this is because the condition doesn't last long enough (and thankfully so) to be investigated.

Who Gets Diarrhea?

When you have diarrhea, your body expends excessive amounts of the fluids it requires for proper functioning. This condition of dehydration is not safe for anyone, and those who are at greatest risk for extenuating complications are the elderly and young children. Also, people who travel to foreign or undeveloped countries often succumb to bouts of diarrhea due in part to the change in diet, and in part to the higher instances of eating foods contaminated with parasites and bacteria. Usually, the more developed the country, then the less chance there is of eating contaminated foods.

Diarrhea in Children

Children are susceptible to diarrhea as stated above. The most common cause of acute diarrhea in children is rotavirus. Often times the diarrhea runs its course by day 8, or as quickly as day 5.

Signs of Dehydration in Children Include:

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Fever measuring 101.4 & higher Irritability or Listlessness Loss of Elasticity in their Skin Absence of Saliva in the Mouth Diapers Remain Dry for 3 or more hours Dry Eyes When Crying Sunken Abdomen, Eyes, or Cheeks Diarrhea in children is so dangerous because they react quite poorly to medications that are sold for treatment of the symptom. Diarrhea in newborns and infants can be lethal because the dehydration that they experience can kill them very quickly. For this reason, treatment for children focuses primarily on re-hydration. If your child doesn't get relief from the symptoms after 24 hours, then you should take your child to a doctor. Other symptoms to look for are stools that contain blood or pus, or if the stool is black; fevers that run 101.4 Fahrenheit and above, and any dehydration symptoms.

How Do I Identify Dehydration?

Generally, you know you're dehydrated if you experience:
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Light-Headedness Thirst Fatigue Infrequent Urination & Dark Colored Urine Nausea in more severe cases Headaches in more severe cases

When Should I See A Doctor About Diarrhea?

In most cases, diarrhea is just uncomfortable. However, it can become dangerous when the dangers are long-term and severe enough. In severe cases hospitalization may be required. Get to your

doctor if you have a high fever (102 F or more) with diarrhea or if your stool is dark and tarry, severe abdominal or rectal pain, dehydration or if your symptoms last longer than 3 days.

What tests might the doctor do?

If you're experiencing severe symptoms, then your doctor will probably perform tests to determine the cause of your diarrhea. This will help them to decide your course of treatment. Some of the tests include the following:
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Physical examination and medical history. The doctor needs to be aware of eating habits and medications. Stool culture. This analysis will determine what harmful bacteria and other organisms or present in your stool, as well as any other signs of infection. Blood tests will help to determine which diseases are not present. Fasting will determine if allergies or food intolerances are a cause of your diarrhea. Sigmoidoscopy visually examines the inside of the lower part of the colon and the rectum. Colonoscopy allows the doctors to look at the entire colon.

What is the Treatment for Diarrhea?

With diarrhea, the most important action is to replace the fluids and electrolytes that are lost when you pass excess water in your stool. This will help to prevent or relieve symptoms of diarrhea as it runs its course. You want to allow diarrhea to end on its own because stopping it means forcing your body to retain toxins that need to be expelled.

Food Tips
Avoid greasy, fibrous foods, and things that are very sweet. Try not to drink dairy products as these may aggravate your diarrhea. Stick with mainly a liquid intake, and gradually return to soft foods like plain rice, baked skinless chicken, bananas. Remember to chew your food thoroughly as this is the first part of food digestion.

Diarrhea Prevention for Travelers

When you're traveling to foreign countries, there are different foods that may or may not agree with you. Such a thing is unavoidable. Some things you can do to improve you chances of staying well include:
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Avoid all tap water even for brushing teeth and making ice Eat shellfish or meat only when served hot Avoid raw and exotic fish and meat Avoid raw vegetables and fruit. It's less risky if it's fruit you need to peel and you wash and peel it yourself Avoid non-pasteurized dairy products including milk Avoid foods sold by street vendors Drink bottled water only if the seal is unbroken, and hot drinks like tea or coffee (remember not to add non-pasteurized milk) Your doctor may direct you to take antibiotics or other immunizations before you travel. Don't skip this step. In the US, travelers can check with the Center for Disease Control to find out what's required for their specific dates and destination

Diarrhea, the occurrence of loose watery stool, affects everyone periodically. Acute diarrhea describes a sudden onset that can occur due to viral infections, bacterial infections or parasites. Chronic diarrhea, defined by the Cleveland Clinic as three or more loose stools per day for more than one month, indicates the presence of a functional or inflammatory disorder of the bowel. Chronic diarrhea can cause effects in the body that can be serious and life-threatening. Dehydration The colon is the part of the large intestine between the cecum and the rectum and absorbs excess fluids from the partially digested food as it passes through the digestive tract. Disorders, such as irritable bowel syndrome or Crohn's disease, that interferes with the absorptive ability of the intestines cause chronic diarrhea. The loss of fluids results in dehydration, the condition that occurs when the body lacks enough fluid to function properly. If left untreated, dehydration can become serious. Signs of dehydration include thirst, less frequent urination, dry skin, fatigue and dark colored urine, as described by the National Digestive Diseases Information Clearinghouse. In children, parents can notice dehydration by the lack of tears when crying, a high fever, irritability and no we diapers in a 3-hour period. Mild dehydration can be treated with oral rehydration therapy that includes drinking plenty of liquids such as fruit juices, broths and rehydration solutions.

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Electrolyte Imbalance When the intestines fail to absorb fluids, electrolytes, or minerals, remain in the stool and are flushed out in the diarrhea. The body requires the right balance of electrolytes to maintain the chemistry of the blood and support organ functions and help in muscle actions, according to MedLine plus and the National Institutes of Health. The main electrolytes found in the body include sodium, potassium, calcium, magnesium, chloride, phosphate and carbonate. A low level of sodium, known as hyponatremia, can cause confusion, drowsiness, muscle weakness and seizures, as described by the Merck Manual. Hypokalemia, a low level of potassium, can affect the level of sugar in the blood as well as cause muscle weakness, fatigue and confusion. To ensure electrolytes remain in balance, those with chronic diarrhea need to take in electrolytes by drinking the broth and juices instead of just plain water. Malnutrition The small intestine also functions to absorb nutrients. Malfunctions of the small intestine that result in chronic diarrhea can also cause malnutrition. The occurrence of chronic diarrhea has a cause and effect relationship with malnutrition, as described by research published by Kenneth Brown in "The Journal of Nutrition." Conditions of diarrhea inhibit the absorption of nutrients resulting in malnutrition. In addition, malnutrition increases the susceptibility for infections leading to diarrhea. Signs of malnutrition include fatigue, weakness, dizziness, dry skin, decaying teeth, poor growth and learning difficulties.