Malabsorption: impaired transport across the mucosa

Zollinger-Ellison syndrome- Hyperacidity in duodenum inactivates pancreatic enzymes

Whipple’s disease -Bacterial invasion of intestinal mucosa
Lactose intolerance- Deficiency of intestinal lactase results in high concentration of intraluminal
lactose with osmotic diarrhea
Tropical sprue- Unknown toxic factor results in mucosal inflammation, partial villous atrophy
Celiac disease (gluten enteropathy)-Toxic response to a gluten fraction by surface epithelium results in
destruction of absorbing surface
In simple understanding Celiac disease is a digestive disease that damages the small intestine and
interferes with absorption of nutrients from food
People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.

Causes
1. Congenital structural defects or diseases of the pancreas, gall bladder, or liver may alter the
digestive process.
2. Inflammation, infection, injury, or surgical removal of portions of the intestine may also result in
absorption problems; reduced length or surface area of intestine available for fluid and nutrient
absorption can result in malabsorption.
3. Radiation therapy may injure the mucosal lining of the intestine.
4. The use of some antibiotics can also affect the bacteria that normally live in the intestine and
affect intestinal function.

Intestinal malabsorption conditions can be DUE to the following categories:

1. Mucosal (transport) disorders causing generalized mal-absorption (eg, celiac sprue, regional
enteritis, radiation enteritis)
2. Infectious diseases causing generalized malabsorption (eg, small bowel bacterial
overgrowth,Whipple’s disease)
3. Luminal problems causing malabsorption (eg, bile acid deficiency, Zollinger-Ellison
syndrome, pancreatic insufficiency)
4. Postoperative malabsorption (e.g, after gastric or intestinal resection)
5. Disorders that cause malabsorption of specific nutrients (eg, disaccharidase deficiency leading
to lactose intolerance)
6. Symptoms
 Hallmarks of malabsorption syndrome from any cause are diarrhea or frequent, loose,
bulky, and are often grayish,steatorrhea (excessive amount of fat in the stool), and
abdominal distention with cramps, bloating, and increased flatus, weakness, weight loss,
and a decreased sense of well-being due to impaired water and carbohydrate
absorption, and irritation from unabsorbed fatty acids
 Anaemia, with weakness and fatigue due to inadequate absorption of vitamin B12 and
mineral deficiency like iron, and folic acid
 Malnutrition and weight loss due to decreased fat, carbohydrate, and protein
absorption.
 Muscle cramping due to decreased vitamin D, calcium, and potassium levels
  Muscle wasting and atrophy due to decreased protein absorption and metabolism
 Perianal skin burning, itching, or soreness due to frequent loose stools.
 Irregular heart rhythms may also result from inadequate levels of potassium and other
electrolytes.
 Blood clotting disorders may occur due to a vitamin K deficiency.
 Patients with a mal-absorption syndrome, if untreated, become weak and emaciated
because of starvation and dehydration.
 Failure to absorb the fat-soluble vitamins A, D, and K causes a corresponding
avitaminosis.
7. Diagnosis
 History Taking
 Physical Examination
 A stool collection may be ordered for feacal fat measurement; increased feacal fat in the
stool collected indicates malabsorption.
 Endoscopy with biopsy of the mucosa is the best diagnostic tool, biopsy of the small
intestine is performed to assay enzyme activity or to identify infection or destruction of
mucosa.
 Ultrasound, computed tomography scan (CT scan), magnetic resonance imaging (MRI),
other x rays to identify abnormalities of the gastrointestinal tract and can reveal pancreatic
or intestinal tumors that may be the cause
 A complete blood cell count is used to detect anemia.
 Pancreatic function tests can assist in the diagnosis of specific disorders.
8. Medical Management
 Intervention is aimed at avoiding dietary substances that aggravate malabsorption and at
supplementing nutrients that have been lost.
 Common supplements are water-soluble vitamins (e.g, B12, folic acid), fat-soluble vitamins
(i.e, A, D, and K), and minerals (e.g, calcium, iron).
 Dietary therapy is aimed at reducing gluten intake in patients with celiac sprue.
 Folic acid supplements are prescribed for patients with tropical sprue.
 Antibiotics (eg, tetracycline, ampicillin) are sometimes needed in the treatment of tropical
sprue and bacterial overgrowth syndromes. ◼Anti-diarrheal agents may be used to
decrease intestinal spasms.
 Parenteral fluids may be necessary to treat dehydration.
 Diet modifications are required in case of patients suffering from lactose intolerance and
avoid foods which are not easily digestible.
9. Nursing Management
 Fluid and nutrient monitoring and replacement is essential for any
individual with malabsorption syndrome.
 Hospitalization may be required when severe fluid and electrolyte imbalances occur.
 Consultation with a dietician to assist with nutritional support and meal planning is helpful.
 Provides patient and family education regarding diet and the use of nutritional
supplements
 Monitor patients with diarrhea for fluid and electrolyte imbalances.
 Ongoing assessments to determine if the clinical manifestations
related to the nutritional deficits have abated.
 Patient should be encouraged to eat several small, frequent meals throughout the day,
avoiding fluids and foods that promote diarrhea.
 Intake and output should be monitored, along with the number, color, and consistency of
stools.
 Patient education includes information about the risk of osteoporosis related to
malabsorption of calcium