This ppt focuses on malabsorption syndrome, its pathophysiology and homoeopathic therapeutics.

1. MALABSORPTION
Presented by FALAQ IKRAM
ROLL NO- 25
BATCH - 2018

2. Definition
Clinical term that encompasses defects occurring during
the digestion and absorption of food nutrients.
Disorders of absorption constitutes a broad spectrum of
condition with multiple etiologies and varied clinical
manifestations.
These problems are associated with diminished intestinal
absorption of one or more dietary nutrients and are
often referred to as the malabsorption syndrome.

3. ETIOLOGY
Malabsorption has many causes.
➔ Inadequate gastric mixing, rapid
emptying, or both
➔ Insufficient digestive agents
➔ Abnormal motility of the
intestine
➔ Abnormal epithelium
➔ Impaired transport

4. ➔ Inadequate gastric
mixing, rapid emptying,
or both
Billroth II gastrectomy
Gastrocolic fistula
Gastroenterostomy
➔ Insufficient digestive
agents
atrophic gastritis
Biliary obstruction and cholestasis
Cirrhosis
Chronic pancreatitis
Cystic fibrosis
Lactase deficiency
Pancreatic cancer

5. ➔ Abnormal motility of the
intestine
Abnormal motility secondary to
diabetes, systemic sclerosis,
hypothyroidism, or hyperthyroidism
Small intestinal bacterial overgrowth
(eg, due to blind loops, diverticula in
the small intestine)
Zollinger-Ellison syndrome (low
duodenal pH)
➔ Abnormal epithelium
Amyloidosis, Celiac disease, Crohn
disease
Ischemia, Radiation enteritis,Tropical
sprue, Whipple disease
➔ Impaired transport
Addison disease
Blocked lacteals due to lymphoma or
tuberculosis
Intrinsic factor deficiency (as in
pernicious anemia)

6. Pathophysiology
Malabsorption results from abnormalities of
the three processes that are essential to
normal digestion::
➔ INTRALUMINAL MALDIGESTION
➔ MUCOSAL MALABSORPTION
.
➔ POST MUCOSAL LYMPHATIC
OBSTRUCTION

7. Intraluminal hydrolysis of fats, proteins and carbohydrates by
enzymes- bile salts enhance the solubilization of fat in this
phase.
Unabsorbed fats trap fat- soluble vitamins (A,D,E,K) and
some minerals, causing deficiency.
Bacterial overgrowth results in deconjugation and
dehydroxylation of bile salts, limiting absorption of fats.
Unabsorbed bile salts → stimulate → → water secretion
from colon →→→ CAUSING DIARRHOEA.
INTRALUMINAL MALDIGESTION

8. Pancreatic enzyme amylase and
brush border enzymes ( on microvilli)
lyse carbohydrates into constituents
(monosaccharides).
Colonic bacteria ferment
unabsorbed carbohydrates → forms
CO2, methane and hydrogen. → →
→ Causes BLOATING and
ABDOMINAL DISTENTION.
INTRALUMINAL MALDIGESTION

9. MUCOSAL MALABSORPTION
Small bowel resection or
conditions (damaging small
bowel) → depleting area for
absorption.
POST MUCOSAL LYMPHATIC
OBSTRUCTION
Prevents uptake and transport of
absorbed lipids into lymphatic vessels
→ causes increase in pressure within
the vessels → leaking in intestinal
lumen → lead to PROTEIN LOSING
ENTEROPATHY.

10. How will you suspect a case of
weight loss to be of
malabsorption?

11. Diarrhoea and weight loss in a
patient with a normal diet are
likely to be caused due to
malabsorption.

12. Night
blindness
(due to
vitamin A
deficiency)
Angular
stomatitis
(due to iron,
Vit B12
deficiency )
Glossitis (due
to iron and
Vit B12
deficiency )
Follicular
hyperkeratos
is (due to vit
A deficiency)

13. Koilonychia
(iron
deficiency)
Clubbing of
nails
Osteomalacia,
Rickets
( due to Ca. &
Vit D)
Muscle wasting (protein
deficiency)
Peripheral neuropathy (vit
b12)

14. Poor wound
healing (Vit
C, protein,
zinc
deficiency)
Purpura and
bruising (vit c, vit k
deficiency)
Distention,
steatorrhoea,
Watery
diarrhoea

15. Complications
Complications depend upon the
severity of the underlying condition.
Malabsorption syndrome can lead to:-
➔ Weight loss
➔ Failure to thrive
➔ Impaired wound healing
➔ Deficient immune system
➔ Decreased energy levels

16. Diagnosis
Diagnosis is clinically done
A detailed patient history
Blood tests to screen for
consequences of malabsorption
Stool fat testing to confirm
malabsorption (if unclear)
Cause diagnosed with endoscopy

17. It is suspected in a patient
with chronic diarrhoea,
weight loss and anaemia.
Patients with malabsorption due to
CHRONIC PANCREATITIS usually have had
prior bouts of acute pancreatitis.
Patients with CELIAC DISEASE can present with
classic lifelong diarrhea exacerbated by gluten
products and may have dermatitis
herpetiformis

18. History taking
If history suggests a
specific cause, testing
should be directed to that
condition.
If no cause is apparent,
blood test can be used as
screening tools.
Patients with cirrhosis
and pancreatic cancer
can present with
jaundice.
Abdominal distention,
excessive flatus, and
watery diarrhea occurring
30 to 90 minutes after
carbohydrate ingestion
suggest deficiency of a
disaccharidase enzyme,
usually lactase.

19. Investigations
Breath tests can be used
to test for lactose intolerance.
Lactose (gut, not being absorbed)
→ bacteria breaks it and produces
hydrogen → excessive hydrogen is
being absorbed (intestine →
bloodstream → lungs)--> hydrogen
is exhaled.
Stool tests (72-hour
stool collection)
These tests are the most reliable
because fat is usually present in the
stool of someone with malabsorption
syndrome.
Blood tests such as:
Vitamin B12, vitamin
D,folate, iron, calcium,
carotene, phosphorus,
albumin

21. Differential
diagnosis
➔ CELIAC DISEASE
➔ INFLAMMATORY BOWEL
DISEASE
➔ PANCREATIC INSUFFICIENCY
➔ TROPICAL SPRUE
➔ LACTOSE INTOLERANCE
➔ BACTERIAL OVERGROWTH
SYNDROME

22. MANAGEMENT
Once diagnosed, management depends upon the
cause.
1. Assure the patient.
2. Complications of malabsorption (such as
dehydration, nutritional deficiencies) must
be corrected first by replacing fluids and IV.
3. Proper fluid intake in order to avoid
dehydration.
4. Proper nutrient dense- diet should be
followed, nutrients which are lacking should
be more in diet.
5. Infections and parasites can be eliminated by
medications.
6. For celiac disease → advice gluten free diet
7. For pancreatic insufficiency → usage of oral
enzymes.
8. Vitamin deficiency → supplements.

23. Homoeopathic Therapeutics

24. ABROTANUM
Southernwood (compositae)
Alternate constipation and diarrhoea; lineteria.
Marasmus of children with marked emaciation,
especially of legs (Iod., Sanic., Tub.)
In marasmus head weak, cannot hold it up. (Aeth.).
Marasmus of lower extremities only.
Ravenous hunger; loosing flesh while eating well (Iod.,
Nat. m., Sanic., Tub.).
Rheumatism following checked diarrhśa
Ill effects of suppressed conditions especially in gouty
subjects.
Food passes undigested.
Pain in stomach; worse at night; cutting, gnawing pain.
Stomach feels as if swimming in water; feels cold.
Gnawing hunger and whining. Indigestion, with
vomiting of large quantities of offensive fluid.
Modalities.--Worse, cold air, checked secretions. Better,
motion.

25. ALUMINA
Pure clay
Constipation: no desire for and no ability to pass stool until
there is a large accumulation (Melil.); great straining, must
grasp the seat of closet tightly; stool hard, knotty, like laurel
berries, covered with mucus; of soft, clayey, adhering to parts
(Plat.). Inactivity of rectum, even soft stool requires great
straining (Anac., Plat., Sil., Ver.).
Diarrhoea when she urinates. Has to strain at stool in order to
urinate.
Talking fatigues; faint and tired, must sit down.
No desire to eat. Can swallow but small morsels at a time.
Constriction of śsophagus.
Diarrhśa on urinating. Evacuation preceded by painful urging
long before stool, and then straining at stool.
Modalities.-- Worse, in morning on awaking; warm room.
Better, in open air; from cold washing; in evening and on
alternate days. Better damp weather.

26. ALOE
SOCOTRINA
Socotrine Aloes (Liliaceae)
Diarrhoea: has to hurry to closet immediately after
eating and drinking (Crot. t.); with want of confidence
in sphincter ani; driving out of bed early in the morning
(Psor., Rum., Sulph.).
Colic: cutting, griping pain in right lower portion of
abdomen; excruciating, before and during stool; all
pains cease after stool, leaving profuse sweating and
extreme weakness; attacks preceded by obstinate
constipation.
Sense of insecurity in rectum, when passing flatus.
Uncertain whether gas or stool will come.
Stool passes without effort, almost unnoticed.
Lumpy, watery stool. Jelly-like stools, with soreness
in rectum after stool. A lot of mucus, with pain in
rectum after stool.
Modalities.--Worse early morning; summer; heat; in
hot, dry weather; after eating or drinking. Better
from cold, open air.

27. IODIUM
Iodine
Ravenous hunger; eats freely and well, yet loses flesh all
the time (Abrot., Nat. m., Sanic., Tub.).
Rapid metabolism: Loss of flesh great appetite.
Hungry with much thirst. Better after eating. Great debility,
the slightest effort induces perspiration.
Throbbing at pit of stomach. Ravenous hunger and much
thirst. Empty eructations, as if every particle of food were
turned into gas. Anxious and worried if he does not eat
(Cina; Sulph). Loss flesh, yet hungry and eating well (Abrot)
Diarrhśa, whitish, frothy, fatty. Constipation, with
ineffectual urging; better by drinking cold milk.
Constipation alternating with diarrhśa (Ant cr).
Suffers from hunger, must eat every few hours; anxious and
worried if he does not eat (Cina, Sulph.); feels > while eating
or after eating, when stomach is full.
Aggravation. - Warmth; wrapping up the head (reverse
of, Hep., Psor.)

28. LYCOPODIUM
Club moss; Wolf’s foot
Emaciation. Debility in morning.
Constipation: since puberty; since last confinement;
with ineffectual urging, rectum contracts and protrudes
during stool, developing piles.
Gastric affections; excessive accumulation of flatulence;
constant sensation of satiety; good appetite, but a few
mouthfuls fill up to the throat.
he feels bloated; fermentation in abdomen, with loud
grumbling, croaking, especially lower abdomen (upper
abdomen, Carbo v. - entire abdomen, Cinch.); fulness
not relieved by belching (Cinch.).
Incomplete burning eructations rise only to pharynx there
burn for hours. Diarrhœa. Inactive intestinal canal.
Ineffectual urging. Stool hard, difficult, small,
incomplete.
Worse, right side, from right to left, from above
downward, 4 to 8 pm;, except throat and stomach which
are better from warm drinks. Better, by motion, after
midnight, from warm food and drink, on getting cold,
from being uncovered.

29. MAGNESIUM
CARBONICUM
Carbonate of Magnesia
When crude magnesia has been taken to "sweeten the
stomach;" if the symptoms correspond, the potentized
remedy will often relieve.
Gastro-intestinal catarrh, with marked acidity.
tendency to constipation after nervous strain
Eructations sour, and vomiting of bitter water.
Constipation after mental shock or severe nervous strain.
Inordinate craving for meat in children of tuberculous
parentage
Diarrhoea: preceded by cutting, doubling-up colic; occurs
regularly every three weeks; stools green, frothy, like scum of
a frog-pond; white, tallow-like masses are found floating in
stool; the milk passes undigested in nursing children
Aggravation. - Change of temperature; every three weeks;
rest; milk, during menses.
Amelioration. - Warm air, but worse in warmth of bed (Led.,
Mer. - better in warmth of bed, Ars.).

30. NATRUM
CARBONICUM
Carbonate of soda
Emaciation with pale face and blue rings around the
eyes, dilated pupils; dark urine; anaemic; milky,
watery skin and great debility.
Aversion to milk; diarrhoea from it.
Ill effects of drinking cold water when overheated.
Very weak digestion, caused by slightest error of
diet. Averse to milk. Depressed after eating. Bitter
taste. Old dyspeptics, always belching, have sour
stomach and rheumatism. Dyspepsia relieved by
soda biscuits.
Worse, sitting, from music, summer heat, mental
exertion, thunderstorm. Least draught, changes of
weather, sun. Better, by moving, by boring in ears
and nose

31. CUNDURANGO
Condor Plant
Stimulates the digestive functions and thus improves
the general health.
Allays the pain in gastralgia accompanying cancer of
stomach.
Painful cracks in corner of mouth is a guiding
symptom of this drug.
Stomach.--Painful affections of the stomach;
ulceration. Vomiting of food and indurations,
constant burning pain. Stricture of śsophagus, with
burning pains behind sternum, where food seems to
stick.
Vomiting of food, and indurations in left
hypochondrium with constant burning pain.
Skin.--Fissures form about the muco-cutaneous
outlets. Epithelioma of lips or anus.

32. ALFALFA
Alfalfa favorably influences nutrition, evidenced
in "toning up" the appetite and digestion
resulting in greatly improved mental and
physical vigor, with gain in weight.
Disorders characterized by malnutrition are
mainly within its therapeutic range.
Increased thirst.
Appetite impaired, but chiefly increased even to
bulimia. He must eat frequently, so that he
cannot wait for regular meals; hungry in
forenoon (Sul). Much nibbling of food and
craving for sweets.

33. SANICULA
AQUA
Mineral spring water
Emaciation, progressive; child looks old, dirty, greasy and
brownish
Constipation: no desire until a large accumulation; after
great straining stool partially expelled, recedes (Sil.,
Thuja); large evacuation of small dry, gray balls, must be
removed mechanically (Sel.).
Stool: hard, impossible to evacuate; of grayish-white
balls, like burnt lime; crumbling from verge of anus (Mag.
m.); with the odor of limburger cheese.
Diarrhoea: changeable in character and color; like
scrambled eggs; frothy, grass-green, turns green on
standing; like scum of a frog pond; after eating, must
hurry from table.
The odor of stool follows despite bathing (Sulph.).
Tongue large, flabby, burning; must protrude it to keep
cool.
Worse, moving arms backward.

34. 1. Davidson’s Principles and Practice of Medicine 23rd Ed.
2. Malabsorption | Johns Hopkins Medicine
3. Overview of Malabsorption - Gastrointestinal Disorders - MSD Manual Professional Edition (msdmanuals.com)
4. Keynotes and characteristics-H C Allen
5. Homoeopathic materia medica by William Boericke
REFERENCE

35. THANK YOU.