Malabsorption

Malabsorption refers to impaired absorption of nutrients :

 Defect in digestion
 Defect in absorption
 Acuired
 Congenital
Three steps are required for normal nutrient absorption
• Luminal processing
• Absorption into the intestinal mucosa
• Transport into the circulation and intracellular processing
Malabsorption : classification
1: Generalized defect: present with similar signs and
symptoms:
 abdominal distention
 pale, foul smelling, bulky stools
 muscle wasting
 poor weight gain

A. Exocrine pancreas (Cystic fibrosis ,chronic pancreatitis)

B. Liver(biliary atresia ,neonatal hepatitis)
C. Intestine (resection , celiac disease, cows milk protein allergy)
 Malabsorption
Specific defect: the clinical features of these disorders typically differ
from those of generalized malabsorptive disorders, some present
without gastrointestinal disorders.
A. Intestinal:
 abetalipoproteinemia,
 Hartnup disease,
 disaccharidase deficiency,
 vit.B12 malabsorption,
 Chloride losing diarrhea,
 acrodermatitis enteropathica.
B. Drug induced: sulfasalazine(folate), phenytoin (Calcium)
C. Pancreatic: Specific enzyme deficiency like lipase, Trypsinogen.
 FAT ABSORPTION

 Most dietary lipids are absorbed in the proximal two-thirds of the

jejunum
 more than 94 percent of dietary fat is absorbed, although healthy
neonates may absorb as little as 85 percent
on a diet containing 100 grams of fat per day :the presence of >6 grams of fecal
fat in a 24-hour collection indicates fat malabsorption
 Defect in following steps will lead to fat malabsorption :
 impaired production or activity of pancreatic lipase or colipase
  disorders of bile acid metabolism
 decrease in the absorptive surface area,
 defective apoproteins necessary for the packaging of chylomicrons
 abnormalities in lymphatic flow.
 CARBOHYDRATE ABSORPTION
• Starch, sucrose, and lactose are the most abundant digestible carbohydrates
in the human diet
• must be broken down into their constituent monosaccharides prior to
absorptio
• Impaired absorption of carbohydrates may result from :
– a deficiency in pancreatic amylase
– reduced disaccharidase activity in the small intestinal epithelium
– decreased absorptive intestinal surface area
 In primary carbohydrate malabsorption, single functional elements of
carbohydrate digestion or absorption are missing, such as
– congenital lactase deficiency
– sucrase-isomaltase deficiency
 Secondary carbohydrate malabsorption can occur from diseases leading to a
reduced intestinal absorptive area, such as celiac disease
 PROTEIN ABSORPTION
• gastric pepsins, which are released as proenzymes
(pepsinogen 1 and 2), and undergo autoactivation at low pH
• pancreatic enzymes are secreted as inactive proenzymes
• enterokinase, (from microvillus membrane of duodenal
absorptive cells by the action of bile salts). Enterokinase
converts trypsinogen to trypsin, which then catalyzes the
conversion of all other pancreatic proteases to their active
forms
 Impaired digestion and absorption of dietary protein occurs :
 pancreatic protease secretion and/or activity is
impaired, as in chronic pancreatitis or cystic fibrosis.
 occur in diseases associated with a generalized
reduction of the intestinal absorptive surface.
 Possible clinical consequences include hypoalbuminemia and
protein malnutrition.