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SYNDROME
Prof. Saleh M. Al-Amri
Consultant, Gastroenterology Unit
College of Medicine & K.K.U.H.
King Saud University
MALABSORPTION SYNDROME
This occurs when the normal digestion and absorption
.of food is interrupted
:PATHOPHYSIOLOGICAL (MECHANISM)
:Is divided intoA) Intraluminal stage
Impaired hydrolysis and solubilization of nutrients
. in the small intestine
B) Intestinal stage
.Abnormalities of small intestinal mucosa) 1
Lactase deficiency
e.g. Congenital or acquired
.Result malabsorption of lactose
Acquired:- i) Coeliac disease
ii) Crohns disease
iii) Infective enteritis
i)
Coeliac disease
CLINICAL MANIFESTATIONS
:History
Diarrhea/steatorrhoea
Weight loss
Symptoms of anaemia
Diarrhoea bulky, floating, malodorous stool
.
difficult to flush
Weight loss may be profound, usually associated
.
with anorexia
Anaemia B12, iron, folate malabsorption.
Patient may complain of dizziness, dyspnoea and
:O/E
.Normal
Pallor
- muscle wasting
:Investigations
:General
CBC
Blood film
.Ca
B12, folate
Iron study
LFT, PT, PTT
:Investigations
:Specific
:Tests of fat absorption
Quantitative fecal fat
Patient should be on daily diet containing 80-100
.
grams of fat
.Fecal fat estimated on 72 H collection
.grams or more of fat/day is abnormal 6
May be due to: - Pancreatic
Small intestinal
Hepatobiliary disease
:14C-Triolein Test
Is triglyceride which is hydrolysed by pancreatic
.
lipase
absorption of metabolism 14CO2
lung
1)
2)
Abnormal
D-xylose test
Abnormal
Normal
C-D-xylose test 14
Abd. Radiograph
Bentiromide test
.CT-abd
Normal
Abnormal
Small intestinal
Bx
Jej culture
Tetracyclin
Then repeat breath test
Classification of Malabsorption
Syndrome
Inadequate digestion:
A.
Postgastrectomy steatorrhea.
Exocrine Pancreatic insufficiency.
Reduced bile salt concentration in
intestine:
I.) Liver Disease
II.) Cholestasis
III.) Bacterial over growth
IV.) Interruption of enterohepatic circulation of
bile salt.
B.
C.
Lymphatic obstruction.
e.g Lymphoma
D.
Pathophysiology
1)
Bile Salt
Impaired intraluminal micelle formation
Malabsorption of fat.
Clinically:
Steatorrhea
Anaemia
B12 def.
Reversed of symptom after antibiotic
treatment.
Diagnosis:
Breath test
Cxylose test
Culture of aspiration (definitive)
Treatment: Antibiotic
Tetracyclin
Ciproflexacin
Metronidazole
Amoxil
Intestinal Lymphoma
Primary
2nd
Affect male = 50 Y.
Feature of malabsorption
Biopsy resemble coeliac sprue
Abdominal pain
Fever
Incomplete respond to gluten free diet.
Absent features of generalized lymphoma.
Complication:
Perforation
Bleeding
Intestinal obstruction
Treatment:
Chemotherapy
Surgery