Hassan Mohammad Al-Shehri 2051040085 To Department of Pathology KFU Dr. Tariq Hashm 2007-11-26 To other students of KFU 4th year please DO NOT COPY AND PASTE my assignment. However, you may take general points if you wish and start from there. Again please do not take the exact content and give it to doctor under your name. cuz I’ll give it to doctor and if u do the same we well take both of us. If you are not 4th year student at KFU you may do what ever you want with it.


Malabsorption Syndrome
Malabsorption: is inadequate assimilation of dietary substances due to defects in digestion, absorption, or transport. Malabsorption affects macronutrients (e.g., proteins, carbohydrates, fats) or micronutrients (e.g., vitamins, minerals), causing excessive fecal excretion and producing nutritional deficiencies and GI symptoms. Malabsorption Syndrome: a group of symptoms resulting from disorders in the intestines' ability to absorb nutrients from foods eaten. It may lead to loss of appetite, weight loss, swollen abdomen, muscle cramps, bone pain, and fat in the feces. Anemia, weakness, and tiredness can occur because iron, folic acid, and vitamin B12 are not absorbed in right amounts. Among the many conditions causing this syndrome are stomach or small bowel surgery, celiac disease, tropical sprue, cystic fibrosis, Whipple's disease, and intestinal lymphangiectasia, a disease involving the grouping of the lymph ducts in the intestines.

Digestion and absorption occur in three phases: (1) intraluminal hydrolysis of fats, proteins, and carbohydrates by enzymes (bile salts enhance the solubilization of fat in this phase) (2) digestion by brush border enzymes and uptake of end-products; (3) lymphatic transport of nutrients. Malabsorption occurs when any of these phases is impaired.

A) Incomplete digestive process, which may be due to: - Damage or dysfunction of the pancreas - Reduction or absence of bile salts to emulsify fats for absorption; this can occur in billiary obstruction, liver disease or extensive resection of the small bowel - Excessive transit time, impairing optimal absorption; this can occur in disorders of metabolic rates, inflammatory bowel disease and even prolonged and excessive stress B) Faulty absorption of nutrients due to: - Damage to the absorptive surfaces, as in inflammatory bowel disease and coeliac disease - Impaired enzyme activity e.g. in lactose intolerance - Resection of the absorptive surfaces e.g. in inflammatory bowel disease.

The Major Malabsorption Syndromes: (1) Exocrine Pancreatic Insufficiency (EPI):
It’s the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. EPI is found in patient afflicted with cystic fibrosis. It is caused by a progressive loss of the pancreatic cells that make digestive enzymes. Chronic pancreatitis is the most common cause of EPI in humans. Treatment Often this is treated with Pancreatic Enzyme Products (PEPs), such as pancrelipase, that are used to breakdown fats (lipases), proteins (proteases) and carbohydrates (amylases) into units that can be digested by those with EPI.

(2)Biliary Obstruction:

Biliary obstruction refers to the blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine. Biliary obstruction separated into: (I) Intrahepatic Intrahepatic cholestasis generally occurs at the level of the hepatocyte or biliary canalicular membrane. Causes include hepatocellular disease (e.g., viral hepatitis, drug-induced hepatitis), druginduced cholestasis, biliary cirrhosis, and alcoholic liver disease. (II) Extrahepatic Extrahepatic obstruction to the flow of bile may occur within the ducts or secondary to external compression. Overall, gallstones are the most common cause of biliary obstruction.

(3)Lactose Intolerance:
A disorder characterize by the inability to digest milk sugar (lactose) because of an enzyme lactase deficiency. There are three major types of lactose intolerance: 1. Primary lactose intolerance: Environmentally induced by weaning in non dairy consuming societies. Where industrialized and commercial dairy is uncommon, milk consumption beyond infancy is not common. 2. Secondary lactose intolerance: Environmentally induced, resulting from certain gastrointestinal diseases, including exposure to intestinal parasites such as giardia. 3. Congenital lactase deficiency: A genetic disorder which prevents enzymatic production of lactase. Present at birth, and diagnosed in early infancy. Symptoms and Signs: The effects of unabsorbed substances include diarrhea, steatorrhea, abdominal bloating, and gas. Other symptoms result from nutritional deficiencies. Patients often lose weight despite adequate food intake. Chronic diarrhea is the most common symptom. Steatorrhea is the hallmark of malabsorption. Steatorrhea produces foul-smelling, pale, bulky, and greasy stools. Severe vitamin and mineral deficiencies occur in advanced malabsorption symptoms are related to the specific nutrient deficiency. Treatment: The diet must be adjusted to restrict such foods as milk, cheese, butter, and any other products containing milk.


(4)Coeliac Disease (Non-Tropical Sprue, Coeliac Sprue):
It’s an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages. Coeliac disease is caused by a reaction to gluten (protein found in wheat). Upon exposure to gluten, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the bowel tissue, causing an inflammatory reaction. That leads to flattening of the lining of the small intestine, which interferes with the absorption of nutrients. Symptoms and Signs: Classic symptoms of coeliac disease include diarrhea, weight loss (or stunted growth in children), and fatigue. Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorptionrelated problems and psychosocial problems, while adults generally have malabsorptive problems. Many adults with subtle disease only have fatigue or anemia.

Worth note Tropical Sprue has similar symptoms but it differs in the cause which is unknown. It has been suggested that it is caused by bacterial, viral, amoebal, or parasitic infection.
Tropical sprue is largely limited to within about 30 degrees north and south of the equator. Therefore, if one resides outside of that geographical region, recent travel to the region is a key factor in diagnosing this disease. Treatment The only effective treatment is a lifelong gluten-free diet. Treatment for Tropical sprue: Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline and vitamins B12 and folic acid for at least 6 months.

(5)Idiopathic Inflammatory Bowel Disease:
Crohn’s disease and ulcerative colitis are chronic relapsing disorders of unknown origin. These diseases share many common features and are collectively known as idiopathic inflammatory bowel disease

(I)Ulcerative Colitis (Colitis Ulcerosa, UC):
Ulcerative colitis (UC) is an ulceroinflammatory disease affecting the colon but limited to the mucosa and submucosa except in the most severe cases. UC begins in the rectum and extends proximally in a continuous fashion, sometimes involving the entire colon. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Symptoms and Signs: Patients usually present with diarrhea mixed with blood and mucus, of gradual onset. They also may have signs of weight loss, and blood on rectal examination. The disease is usually accompanied with different degrees of abdominal pain, from mild discomfort to severely painful cramps. Ulcerative colitis is a systemic disease that affects many parts of the body. Sometimes the extraintestinal manifestations of the disease are the initial signs, such as painful, arthritic knees in a teenager. It is, however, unlikely that the disease will be correctly diagnosed until the onset of the intestinal manifestations. 4

Treatment Physicians first direct treatment to inducing a remission which involves relief of symptoms and mucosal healing of the lining of the colon and then longer term treatment to maintain the remission.

(II)Crohn's Disease (Regional Enteritis, CD):
It is one of a group of diseases called inflammatory bowel disease. The disease can affect any area from the mouth to the anus; as a result, the symptoms of Crohn's disease vary between affected individuals (often affects the ileum). Although the cause of Crohn's disease is not known, it is believed to be an autoimmune disease that is genetically linked. There are three major classes of Crohn’s disease: 1. Ileocolic Crohn's: Disease, which affects both the ileum and the large intestine, accounts for 50% of cases 2. Crohn's Ileitis: Affecting the ileum only, accounts for 30% of cases, and 3. Crohn's Colitis: Affecting the large intestine, accounts for the remaining 20% of cases Symptoms and Signs: Abdominal pain may be the initial symptom of Crohn's disease. It is often accompanied by diarrhea, which may or may not be bloody. Flatus and bloating may also add to the intestinal discomfort. Treatment: Treatment is only needed for people exhibiting symptoms. The therapeutic approach to Crohn's disease is sequential: to treat acute disease and then to maintain remission. Once remission is induced, the goal of treatment becomes maintaining remission and avoiding flares. Surgery may be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs within a reasonable time. Comparison between Crohn’s disease and Ulcerative colitis: Feature Crohn’s Ulcerative Colitis
Involves terminal ileum Involves colon Endoscopy Commonly Usually Linear and serpiginous (snake-like) ulcers Depth of inflammation May be transmural, deep into tissues Fistulae Surgical cure Commonly Often returns following removal of affected part Seldom Usually cured by removal of colon, can be followed by pouchitis (Inflammation of the ileal pouch) Smoking Higher risk for smokers Lower risk for smokers Shallow, mucosal Seldom Always Continuous ulcer


Cancer risk



(6)Small Bowel Resection:
Small bowel resection may be recommended for the following: • • • • • • A block in the intestine due to scar tissue or deformities Bleeding, infection, or ulcers due to inflammation of the small intestine (e.g. Crohn's disease) Injuries Cancer Precancerous polyps Benign tumors

List of Common Malabsorped Elements and their Symptoms:
Malabsorbed Nutrient Iron Vitamin B12, folate Vitamins K and C Ca, Mg Protein Vitamins B2 folate, iron Vitamin A K, Mg, Ca, vitamin D and B12, Symptom Anemia (hypochromic, microcytic) Anemia (macrocytic) Bleeding, bruising, petechiae Carpopedal spasm

Edema Glossitis Night blindness

Vitamins B1, B6, B12

Peripheral neuropathy



To other students of KFU 4th year please DO NOT COPY AND PASTE my assignment. How ever, you may take general points if you wish and start from there. If you are not 4th year student at KFU you may do what ever you want with it.