This document provides an overview of approaches to evaluating and managing malabsorption syndromes. It discusses the etiology, pathophysiology, clinical features, diagnostic testing and general management strategies for a wide range of conditions that can cause malabsorption including celiac disease, short bowel syndrome, exocrine pancreatic insufficiency, bile acid malabsorption, infections, surgeries, and other disorders. The evaluation involves a detailed history, physical exam, initial lab tests, and may require endoscopic examination, imaging, and specialized tests of digestive and absorptive functions. Management is directed at the underlying cause, correcting nutritional deficiencies, and addressing symptoms.
Approach to a patient with malabsorption Armaan Bhatti
This document discusses the approach to a patient presenting with malabsorption. It begins by describing a case of a 20-year-old woman with weight loss and loose stool for 3 months. It then covers the normal process of digestion and absorption and defines malabsorption. The major causes of malabsorption are described as intestinal (mucosal diseases), pancreatic, liver, gastric, and drugs. Clinical features and relevant history taking are outlined. Specific intestinal conditions like celiac disease and tropical sprue are explained in detail. Investigations and management are also summarized.
Malabsorption syndrome: pathophysiology and diagnosis. Teaching slidesAttività scientifica
Malabsorption syndrome refers to disorders of nutrient absorption in the small intestine. It can affect absorption of carbohydrates, proteins, fats, vitamins, and minerals. Common causes include exocrine pancreatic insufficiency, intestinal infections or inflammation, and celiac disease. Diagnosis involves evaluating patients for symptoms of malabsorption and performing tests like stool tests for fat content, small intestine biopsies, imaging, and nutrient absorption tests. This helps identify the specific nutrients affected and determine the underlying cause of malabsorption.
This document discusses malabsorption syndrome. It begins with an introduction that defines malabsorption as any alteration of the gastrointestinal tract affecting nutrient digestion, absorption or transport. It then covers the pathophysiology, consequences, risk factors, diagnosis and treatment of malabsorption syndrome. The pathophysiology involves premucosal, mucosal and postmucosal aberrations. Diagnosis involves tests of serum, stool, breath and imaging. Treatment focuses on correcting nutritional deficiencies and the underlying cause.
Approach to Malabsorption syndromes for undergraduatesPrasoon Rastogi
Malabsorption results from disturbances in the four phases of nutrient absorption: intraluminal digestion, terminal digestion, transepithelial transport, and lymphatic transport. There are many potential causes of malabsorption including pancreatic insufficiency, bacterial overgrowth, mucosal damage from conditions like celiac disease, and surgical procedures. Symptoms include diarrhea, steatorrhea, weight loss, and nutritional deficiencies. Diagnosis involves tests like stool studies, vitamin assays, imaging, and small intestinal biopsies. Treatment focuses on managing the underlying cause.
Malabsorption syndrome results in chronic diarrhea, abdominal distention, and failure to thrive due to impaired digestion and absorption of nutrients in the small intestine. It can be caused by disorders that affect digestion, nutrient breakdown, micelle formation, brush border enzyme activity, or nutrient transport. Evaluation involves laboratory tests of nutritional deficiencies, imaging of the gastrointestinal tract, and biopsy of the small intestine to identify the specific cause and guide treatment, which focuses on correcting nutritional deficiencies and treating the underlying disorder.
Malabsorption occurs when there is a disruption in the normal digestion and absorption of nutrients in the small intestine. It can cause symptoms like diarrhea, weight loss, and malnutrition. There are several potential causes of malabsorption, including celiac disease, Whipple's disease, bacterial overgrowth, short bowel syndrome, and lactase deficiency. Celiac disease is an immune-mediated reaction to gluten that damages the small intestine and is treated with a gluten-free diet. Whipple's disease is a rare infection caused by Tropheryma whippelii that presents with weight loss and joint pain and is treated with long-term antibiotics. Bacterial overgrowth in the small intestine can also interfere with absorption
Celiac disease is an autoimmune disorder caused by a reaction to gluten, resulting in damage to the small intestine and malabsorption. It is characterized by the absence of intestinal villi and infiltration of lymphocytes into the epithelium. Symptoms include diarrhea, abdominal pain, and malnutrition. Diagnosis is confirmed via small bowel biopsy showing damage to intestinal villi. Treatment requires strict lifelong adherence to a gluten-free diet. Whipple's disease is a rare infection caused by a bacterium that infiltrates the small intestine, causing macrophages to obstruct lymphatic drainage and resulting in malabsorption. It commonly affects the joints and brain and is treated with intravenous antibiotics. Both conditions can lead to complications due to severe vitamin and
This document provides an overview of approaches to evaluating and managing malabsorption syndromes. It discusses the etiology, pathophysiology, clinical features, diagnostic testing and general management strategies for a wide range of conditions that can cause malabsorption including celiac disease, short bowel syndrome, exocrine pancreatic insufficiency, bile acid malabsorption, infections, surgeries, and other disorders. The evaluation involves a detailed history, physical exam, initial lab tests, and may require endoscopic examination, imaging, and specialized tests of digestive and absorptive functions. Management is directed at the underlying cause, correcting nutritional deficiencies, and addressing symptoms.
Approach to a patient with malabsorption Armaan Bhatti
This document discusses the approach to a patient presenting with malabsorption. It begins by describing a case of a 20-year-old woman with weight loss and loose stool for 3 months. It then covers the normal process of digestion and absorption and defines malabsorption. The major causes of malabsorption are described as intestinal (mucosal diseases), pancreatic, liver, gastric, and drugs. Clinical features and relevant history taking are outlined. Specific intestinal conditions like celiac disease and tropical sprue are explained in detail. Investigations and management are also summarized.
Malabsorption syndrome: pathophysiology and diagnosis. Teaching slidesAttività scientifica
Malabsorption syndrome refers to disorders of nutrient absorption in the small intestine. It can affect absorption of carbohydrates, proteins, fats, vitamins, and minerals. Common causes include exocrine pancreatic insufficiency, intestinal infections or inflammation, and celiac disease. Diagnosis involves evaluating patients for symptoms of malabsorption and performing tests like stool tests for fat content, small intestine biopsies, imaging, and nutrient absorption tests. This helps identify the specific nutrients affected and determine the underlying cause of malabsorption.
This document discusses malabsorption syndrome. It begins with an introduction that defines malabsorption as any alteration of the gastrointestinal tract affecting nutrient digestion, absorption or transport. It then covers the pathophysiology, consequences, risk factors, diagnosis and treatment of malabsorption syndrome. The pathophysiology involves premucosal, mucosal and postmucosal aberrations. Diagnosis involves tests of serum, stool, breath and imaging. Treatment focuses on correcting nutritional deficiencies and the underlying cause.
Approach to Malabsorption syndromes for undergraduatesPrasoon Rastogi
Malabsorption results from disturbances in the four phases of nutrient absorption: intraluminal digestion, terminal digestion, transepithelial transport, and lymphatic transport. There are many potential causes of malabsorption including pancreatic insufficiency, bacterial overgrowth, mucosal damage from conditions like celiac disease, and surgical procedures. Symptoms include diarrhea, steatorrhea, weight loss, and nutritional deficiencies. Diagnosis involves tests like stool studies, vitamin assays, imaging, and small intestinal biopsies. Treatment focuses on managing the underlying cause.
Malabsorption syndrome results in chronic diarrhea, abdominal distention, and failure to thrive due to impaired digestion and absorption of nutrients in the small intestine. It can be caused by disorders that affect digestion, nutrient breakdown, micelle formation, brush border enzyme activity, or nutrient transport. Evaluation involves laboratory tests of nutritional deficiencies, imaging of the gastrointestinal tract, and biopsy of the small intestine to identify the specific cause and guide treatment, which focuses on correcting nutritional deficiencies and treating the underlying disorder.
Malabsorption occurs when there is a disruption in the normal digestion and absorption of nutrients in the small intestine. It can cause symptoms like diarrhea, weight loss, and malnutrition. There are several potential causes of malabsorption, including celiac disease, Whipple's disease, bacterial overgrowth, short bowel syndrome, and lactase deficiency. Celiac disease is an immune-mediated reaction to gluten that damages the small intestine and is treated with a gluten-free diet. Whipple's disease is a rare infection caused by Tropheryma whippelii that presents with weight loss and joint pain and is treated with long-term antibiotics. Bacterial overgrowth in the small intestine can also interfere with absorption
Celiac disease is an autoimmune disorder caused by a reaction to gluten, resulting in damage to the small intestine and malabsorption. It is characterized by the absence of intestinal villi and infiltration of lymphocytes into the epithelium. Symptoms include diarrhea, abdominal pain, and malnutrition. Diagnosis is confirmed via small bowel biopsy showing damage to intestinal villi. Treatment requires strict lifelong adherence to a gluten-free diet. Whipple's disease is a rare infection caused by a bacterium that infiltrates the small intestine, causing macrophages to obstruct lymphatic drainage and resulting in malabsorption. It commonly affects the joints and brain and is treated with intravenous antibiotics. Both conditions can lead to complications due to severe vitamin and
This document provides an overview of the approach to malabsorption syndrome. It discusses the mechanisms of malabsorption including defects that can occur in the luminal, mucosal, and post-absorptive phases. It describes specific causes of carbohydrate, protein, and fat malabsorption. Clinical manifestations can range from severe steatorrhea and weight loss to subtle changes on labs. The diagnostic approach involves considering malabsorption based on history and physical, confirming with hematological and biochemical tests, and evaluating the underlying cause with tests like imaging, endoscopy, and nutrient absorption tests.
Malabsorption refers to the disruption of digestion and nutrient absorption. Steatorrhea describes voluminous, foul-smelling stool that floats due to high fat content. Tests for malabsorption include screening tests to identify nutrient deficiencies, quantitative tests to measure nutrient absorption, and diagnostic tests. Small intestinal biopsy can diagnose conditions causing malabsorption such as celiac disease, tropical sprue, and Whipple's disease by examining villous architecture and inflammatory cells. Management involves treating the underlying cause, correcting nutritional deficiencies, and managing diarrhea.
Clinical features and diagnosis of malabsorptionFarshad Mirzavi
The document provides an overview of malabsorption, including its causes, mechanisms, diagnosis, and laboratory tests used for evaluation. It discusses the three key steps required for normal nutrient absorption and lists factors that may damage the intestine and cause malabsorption. Common tests described include stool tests to measure fat, blood tests of vitamin/mineral levels, breath tests for lactose intolerance, imaging to detect structural abnormalities, and biopsy for abnormal cells. Carbohydrate and fat malabsorption are evaluated using tests like D-xylose absorption, lactose tolerance, breath hydrogen, and fecal fat determination. Specific disorders are investigated using antibodies for celiac disease and the Schilling test for pernicious anemia.
INTRODUCTION
Dislocation of the hip is a common injury to the hip joint. Dislocation occurs when the ball–shaped head of the femur comes out of the cup–shaped acetabulum set in the pelvis. This may happen to a varying degree. A dislocated hip, much more common in females than in males, is a condition that can either be congenital or acquired
Definition
• A dislocation is an injury in which a bone is displaced from its proper position
CLASSIFICATION
The relationship of the femoral head to the acetabulum is used to classify the dislocation. The three main patterns are posterior, anterior, and central.
POSTERIOR HIP DISLOCATION
Posterior dislocations account of more than 90% of dislocations and occur when the knee and hip are flexed and a posterior force is applied at the knee.
Posterior hip dislocations occur typically during MVAs, especially head-on collisions, when the knees of the front-seat occupant strike the dashboard. Energy is transmitted along the femoral shaft to the hip joint. If the leg is struck while in an adducted position, a posterior dislocation may result. If the leg is in neutral or an abducted position when struck, an anterior dislocation or fracture/dislocation may occur. In the latter case, the posterior wall of the acetabulum is fractured, making subsequent reduction less stable.
Several classification systems are used to describe posterior hip dislocations.
• The Thompson-Epstein classification is based on radiographic findings.
o Type 1 – With or without minor fracture
o Type 2 – With large, single fracture of posterior acetabular rim
o Type 3 – With comminution of rim of acetabulum, with or without major fragments
o Type 4 – With fracture of the acetabular floor
o Type 5 – With fracture of the femoral head
• The Steward and Milford classification is based on functional hip stability.
o Type 1 – No fracture or insignificant fracture
o Type 2 – Associated with a single or comminuted posterior wall fragment, but the hip remains stable through a functional range of motion
o Type 3 – Associated with gross instability of the hip joint secondary to loss of structural support
o Type 4 – Associated with femoral head fracture
Malabsorption disorders cause insufficient nutrient absorption due to maldigestion or malabsorption. Causes include exocrine pancreas defects, liver diseases, intestinal diseases, and specific defects. Celiac disease is a genetic autoimmune disorder triggered by gluten that causes intestinal damage. Symptoms include diarrhea, failure to thrive, and malnutrition. Diagnosis involves serology and biopsy showing intestinal damage. Treatment is lifelong gluten-free diet. Cow milk protein allergy symptoms develop in infants and include diarrhea, vomiting, and failure to thrive. Lactose intolerance is caused by lactase deficiency leading to diarrhea from intestinal sugar accumulation after milk ingestion. Treatment involves milk elimination or use of lactase supplements.
This document provides an overview of the approach to diagnosing malabsorption syndromes. It begins with an introduction to maldigestion and malabsorption. It then describes the three phases of digestion and absorption - luminal, mucosal, and post-absorptive. Common defects in each phase are discussed along with the clinical features, examination findings, and tests used to diagnose specific nutrient malabsorptions of fat, carbohydrates, proteins, vitamins, and minerals. A variety of imaging, endoscopic, histologic, and other diagnostic tests are described. The document concludes with typical etiologies found for malabsorption syndromes.
Celiac disease is an immune-mediated disorder caused by a permanent gluten intolerance that primarily involves the small intestine. It is characterized by chronic inflammation of the small intestine's mucosa and submucosa. Genetic factors like HLA-DQ2 and DQ8 increase risk, and it is associated with other autoimmune disorders like type 1 diabetes, thyroid disease, and rheumatoid arthritis. The triggers are immunogenic peptides in gluten that are resistant to digestion and cause an immune response and damage to the intestinal lining.
Malabsorption is characterized by defective absorption of nutrients including fats, vitamins, proteins, carbohydrates, electrolytes, and water from the small intestine. The most common presentations are chronic diarrhea and excessive fat in stool. Malabsorption can result from defects in intraluminal digestion, terminal digestion, transepithelial transport, or lymphatic transport of nutrients. Common causes discussed in the document include cystic fibrosis, celiac disease, tropical sprue, Whipple's disease, and abetalipoproteinemia.
Mal absorption syndrome is a group of disorders marked by
Indigestion
Excessive nutrients loss in stools
Abnormal absorption of dietary constituents
It is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.
Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anemia.
Malabsorption constitutes the pathological interference with the normal physiological sequence of body.
Malabsorption syndrome is a condition where the small intestine is unable to absorb enough nutrients and vitamins from food. It can be caused by congenital defects, infections, diseases, surgeries, or medications. Symptoms include abdominal pain, weight loss, diarrhea, and deficiencies of nutrients. Tests like stool samples, blood tests, imaging, and biopsies can help diagnose the specific cause. Treatment depends on the underlying cause but often involves replacing lost nutrients through dietary changes or supplements.
The document discusses the importance of the gastrointestinal tract and its functions of digestion and absorption. It provides details on the digestion of carbohydrates, proteins, lipids, and vitamins/minerals in the GI tract. Key enzymes and their sites of action are identified. Malabsorption syndromes are then examined, including causes, classification, epidemiology, clinical presentation, and relevant laboratory studies. Overall, the document emphasizes the critical role of proper GI function for overall health and nutrition.
This document discusses various causes of malabsorption syndromes including celiac disease, tropical sprue, bacterial overgrowth syndrome, Whipple's disease, and protein losing enteropathy. It covers the etiology, symptoms, diagnosis, and treatment of each condition. Diagnostic tests mentioned include the Schilling test for B12 absorption, D-xylose absorption tests, small bowel biopsy, and blood tests. The document emphasizes that malabsorption can result from defects in nutrient absorption as well as excessive intestinal fluid and electrolyte secretion.
This document discusses malabsorption syndromes and their evaluation. It begins by defining maldigestion and malabsorption. Common causes of malabsorption discussed include exocrine pancreatic insufficiency, bacterial overgrowth, and intestinal inflammation. A variety of tests are described to evaluate for fat, carbohydrate, protein and micronutrient malabsorption. These include fecal fat tests, D-xylose absorption tests, lactose breath tests, and Schilling tests. Endoscopy, imaging, and biopsy are also used in the diagnostic workup.
Malabsorption occurs when there is a disruption in the digestion and absorption of nutrients in the gastrointestinal tract. Common symptoms include bulky pale stools, diarrhea, weight loss and muscle wasting. Laboratory findings may show increased fecal fat, low albumin and nutrient levels like calcium and vitamins. Ms. Sakina presented with weakness, fatigue and bulky pale stools. Testing found iron deficiency anemia and low calcium. A small bowel biopsy showed features consistent with celiac disease.
Malabsorption syndromes result in chronic diarrhea, abdominal distention, and failure to thrive due to disorders that impair the intestinal absorption of nutrients. Causes can be congenital or acquired and affect the digestion, transport, or absorption of carbohydrates, fat, protein, or other nutrients across the intestinal mucosa. Common symptoms include chronic diarrhea, abdominal distention and pain, nausea, and vomiting. A thorough dietary history is important to differentiate malabsorption syndromes from more common causes of diarrhea.
This document discusses diarrhea, irritable bowel syndrome (IBS), and malabsorption syndrome. It defines diarrhea and describes the pathophysiology of osmotic, secretory, and inflammatory diarrhea. It discusses the causes, clinical features, and management of acute diarrhea. It then addresses IBS, covering its pathophysiology, clinical features, diagnosis, and management. Finally, it defines malabsorption syndrome and lists several disorders that can cause it, and describes the clinical features, pathophysiology, investigations, and management.
Malabsorption syndrome occurs when nutrients are not properly absorbed and transported by the body. It can be caused by maldigestion, mucosal abnormalities, or bacterial contamination impairing the breakdown or uptake of nutrients. Diagnosis involves blood tests, stool analysis, imaging and specialized absorption tests to identify nutritional deficiencies and underlying causes like celiac disease, tropical sprue, or pancreatic insufficiency. Naturopathic treatment aims to eliminate toxins, provide complete rest for self-healing, and use a healing diet and yoga to help restore normal digestion and absorption.
This document discusses malabsorption and provides details about normal digestion and absorption in the GI tract. It describes how malabsorption can result from problems with luminal digestion by the pancreas, mucosal digestion by small bowel enzymes, or mucosal absorption. Specific examples covered include fat maldigestion due to chronic pancreatitis interfering with pancreatic lipase secretion, and disaccharide maldigestion due to lactase deficiency. The document emphasizes that the small bowel has backup systems for digesting proteins and carbohydrates, but not for fat digestion, explaining why steatorrhea is the predominant manifestation of pancreatic insufficiency.
Malabsorption results from defects in intraluminal digestion, terminal digestion, transepithelial transport, and lymphatic transport. It is characterized by weight loss, abdominal distention, diarrhea, and steatorrhea. Causes of malabsorption include cystic fibrosis, celiac disease, lactase deficiency, environmental enteropathy, abetalipoproteinemia, microscopic colitis, graft-versus-host disease, and Whipple's disease. Histological examination often reveals villous atrophy, increased intraepithelial lymphocytes, and lipid-laden macrophages in the lamina propria.
This document discusses malabsorption, including its definition, mechanisms, and approaches to evaluation. Malabsorption occurs when nutrients are not adequately digested or absorbed in the gastrointestinal tract. It may result from problems with nutrient breakdown, uptake, or transport. The evaluation of malabsorption involves considering the patient's history and risk factors, performing initial tests to detect common causes or malnutrition, and utilizing more specialized testing as needed to identify specific disorders. A thorough workup aims to identify the underlying disease or condition responsible for impairing digestion and absorption.
This document discusses the pathophysiology, evaluation, and management of chronic diarrhea in children. It begins by defining chronic, persistent, and protracted diarrhea. Worldwide, chronic diarrhea is a major cause of childhood death, with rotavirus, cryptosporidium, and giardia being common causes in developing countries. The document outlines the steps to evaluate chronic diarrhea, including stool tests, intestinal microbiology, screening for celiac disease, tests of intestinal function, and imaging/endoscopy if needed. Common causes discussed include cow's milk protein allergy, tropical sprue, celiac disease, and intestinal lymphangiectasia. Management involves nutritional rehabilitation, identifying and avoiding food triggers, antibiotics for infections,
This document provides an overview of the approach to malabsorption syndrome. It discusses the mechanisms of malabsorption including defects that can occur in the luminal, mucosal, and post-absorptive phases. It describes specific causes of carbohydrate, protein, and fat malabsorption. Clinical manifestations can range from severe steatorrhea and weight loss to subtle changes on labs. The diagnostic approach involves considering malabsorption based on history and physical, confirming with hematological and biochemical tests, and evaluating the underlying cause with tests like imaging, endoscopy, and nutrient absorption tests.
Malabsorption refers to the disruption of digestion and nutrient absorption. Steatorrhea describes voluminous, foul-smelling stool that floats due to high fat content. Tests for malabsorption include screening tests to identify nutrient deficiencies, quantitative tests to measure nutrient absorption, and diagnostic tests. Small intestinal biopsy can diagnose conditions causing malabsorption such as celiac disease, tropical sprue, and Whipple's disease by examining villous architecture and inflammatory cells. Management involves treating the underlying cause, correcting nutritional deficiencies, and managing diarrhea.
Clinical features and diagnosis of malabsorptionFarshad Mirzavi
The document provides an overview of malabsorption, including its causes, mechanisms, diagnosis, and laboratory tests used for evaluation. It discusses the three key steps required for normal nutrient absorption and lists factors that may damage the intestine and cause malabsorption. Common tests described include stool tests to measure fat, blood tests of vitamin/mineral levels, breath tests for lactose intolerance, imaging to detect structural abnormalities, and biopsy for abnormal cells. Carbohydrate and fat malabsorption are evaluated using tests like D-xylose absorption, lactose tolerance, breath hydrogen, and fecal fat determination. Specific disorders are investigated using antibodies for celiac disease and the Schilling test for pernicious anemia.
INTRODUCTION
Dislocation of the hip is a common injury to the hip joint. Dislocation occurs when the ball–shaped head of the femur comes out of the cup–shaped acetabulum set in the pelvis. This may happen to a varying degree. A dislocated hip, much more common in females than in males, is a condition that can either be congenital or acquired
Definition
• A dislocation is an injury in which a bone is displaced from its proper position
CLASSIFICATION
The relationship of the femoral head to the acetabulum is used to classify the dislocation. The three main patterns are posterior, anterior, and central.
POSTERIOR HIP DISLOCATION
Posterior dislocations account of more than 90% of dislocations and occur when the knee and hip are flexed and a posterior force is applied at the knee.
Posterior hip dislocations occur typically during MVAs, especially head-on collisions, when the knees of the front-seat occupant strike the dashboard. Energy is transmitted along the femoral shaft to the hip joint. If the leg is struck while in an adducted position, a posterior dislocation may result. If the leg is in neutral or an abducted position when struck, an anterior dislocation or fracture/dislocation may occur. In the latter case, the posterior wall of the acetabulum is fractured, making subsequent reduction less stable.
Several classification systems are used to describe posterior hip dislocations.
• The Thompson-Epstein classification is based on radiographic findings.
o Type 1 – With or without minor fracture
o Type 2 – With large, single fracture of posterior acetabular rim
o Type 3 – With comminution of rim of acetabulum, with or without major fragments
o Type 4 – With fracture of the acetabular floor
o Type 5 – With fracture of the femoral head
• The Steward and Milford classification is based on functional hip stability.
o Type 1 – No fracture or insignificant fracture
o Type 2 – Associated with a single or comminuted posterior wall fragment, but the hip remains stable through a functional range of motion
o Type 3 – Associated with gross instability of the hip joint secondary to loss of structural support
o Type 4 – Associated with femoral head fracture
Malabsorption disorders cause insufficient nutrient absorption due to maldigestion or malabsorption. Causes include exocrine pancreas defects, liver diseases, intestinal diseases, and specific defects. Celiac disease is a genetic autoimmune disorder triggered by gluten that causes intestinal damage. Symptoms include diarrhea, failure to thrive, and malnutrition. Diagnosis involves serology and biopsy showing intestinal damage. Treatment is lifelong gluten-free diet. Cow milk protein allergy symptoms develop in infants and include diarrhea, vomiting, and failure to thrive. Lactose intolerance is caused by lactase deficiency leading to diarrhea from intestinal sugar accumulation after milk ingestion. Treatment involves milk elimination or use of lactase supplements.
This document provides an overview of the approach to diagnosing malabsorption syndromes. It begins with an introduction to maldigestion and malabsorption. It then describes the three phases of digestion and absorption - luminal, mucosal, and post-absorptive. Common defects in each phase are discussed along with the clinical features, examination findings, and tests used to diagnose specific nutrient malabsorptions of fat, carbohydrates, proteins, vitamins, and minerals. A variety of imaging, endoscopic, histologic, and other diagnostic tests are described. The document concludes with typical etiologies found for malabsorption syndromes.
Celiac disease is an immune-mediated disorder caused by a permanent gluten intolerance that primarily involves the small intestine. It is characterized by chronic inflammation of the small intestine's mucosa and submucosa. Genetic factors like HLA-DQ2 and DQ8 increase risk, and it is associated with other autoimmune disorders like type 1 diabetes, thyroid disease, and rheumatoid arthritis. The triggers are immunogenic peptides in gluten that are resistant to digestion and cause an immune response and damage to the intestinal lining.
Malabsorption is characterized by defective absorption of nutrients including fats, vitamins, proteins, carbohydrates, electrolytes, and water from the small intestine. The most common presentations are chronic diarrhea and excessive fat in stool. Malabsorption can result from defects in intraluminal digestion, terminal digestion, transepithelial transport, or lymphatic transport of nutrients. Common causes discussed in the document include cystic fibrosis, celiac disease, tropical sprue, Whipple's disease, and abetalipoproteinemia.
Mal absorption syndrome is a group of disorders marked by
Indigestion
Excessive nutrients loss in stools
Abnormal absorption of dietary constituents
It is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.
Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anemia.
Malabsorption constitutes the pathological interference with the normal physiological sequence of body.
Malabsorption syndrome is a condition where the small intestine is unable to absorb enough nutrients and vitamins from food. It can be caused by congenital defects, infections, diseases, surgeries, or medications. Symptoms include abdominal pain, weight loss, diarrhea, and deficiencies of nutrients. Tests like stool samples, blood tests, imaging, and biopsies can help diagnose the specific cause. Treatment depends on the underlying cause but often involves replacing lost nutrients through dietary changes or supplements.
The document discusses the importance of the gastrointestinal tract and its functions of digestion and absorption. It provides details on the digestion of carbohydrates, proteins, lipids, and vitamins/minerals in the GI tract. Key enzymes and their sites of action are identified. Malabsorption syndromes are then examined, including causes, classification, epidemiology, clinical presentation, and relevant laboratory studies. Overall, the document emphasizes the critical role of proper GI function for overall health and nutrition.
This document discusses various causes of malabsorption syndromes including celiac disease, tropical sprue, bacterial overgrowth syndrome, Whipple's disease, and protein losing enteropathy. It covers the etiology, symptoms, diagnosis, and treatment of each condition. Diagnostic tests mentioned include the Schilling test for B12 absorption, D-xylose absorption tests, small bowel biopsy, and blood tests. The document emphasizes that malabsorption can result from defects in nutrient absorption as well as excessive intestinal fluid and electrolyte secretion.
This document discusses malabsorption syndromes and their evaluation. It begins by defining maldigestion and malabsorption. Common causes of malabsorption discussed include exocrine pancreatic insufficiency, bacterial overgrowth, and intestinal inflammation. A variety of tests are described to evaluate for fat, carbohydrate, protein and micronutrient malabsorption. These include fecal fat tests, D-xylose absorption tests, lactose breath tests, and Schilling tests. Endoscopy, imaging, and biopsy are also used in the diagnostic workup.
Malabsorption occurs when there is a disruption in the digestion and absorption of nutrients in the gastrointestinal tract. Common symptoms include bulky pale stools, diarrhea, weight loss and muscle wasting. Laboratory findings may show increased fecal fat, low albumin and nutrient levels like calcium and vitamins. Ms. Sakina presented with weakness, fatigue and bulky pale stools. Testing found iron deficiency anemia and low calcium. A small bowel biopsy showed features consistent with celiac disease.
Malabsorption syndromes result in chronic diarrhea, abdominal distention, and failure to thrive due to disorders that impair the intestinal absorption of nutrients. Causes can be congenital or acquired and affect the digestion, transport, or absorption of carbohydrates, fat, protein, or other nutrients across the intestinal mucosa. Common symptoms include chronic diarrhea, abdominal distention and pain, nausea, and vomiting. A thorough dietary history is important to differentiate malabsorption syndromes from more common causes of diarrhea.
This document discusses diarrhea, irritable bowel syndrome (IBS), and malabsorption syndrome. It defines diarrhea and describes the pathophysiology of osmotic, secretory, and inflammatory diarrhea. It discusses the causes, clinical features, and management of acute diarrhea. It then addresses IBS, covering its pathophysiology, clinical features, diagnosis, and management. Finally, it defines malabsorption syndrome and lists several disorders that can cause it, and describes the clinical features, pathophysiology, investigations, and management.
Malabsorption syndrome occurs when nutrients are not properly absorbed and transported by the body. It can be caused by maldigestion, mucosal abnormalities, or bacterial contamination impairing the breakdown or uptake of nutrients. Diagnosis involves blood tests, stool analysis, imaging and specialized absorption tests to identify nutritional deficiencies and underlying causes like celiac disease, tropical sprue, or pancreatic insufficiency. Naturopathic treatment aims to eliminate toxins, provide complete rest for self-healing, and use a healing diet and yoga to help restore normal digestion and absorption.
This document discusses malabsorption and provides details about normal digestion and absorption in the GI tract. It describes how malabsorption can result from problems with luminal digestion by the pancreas, mucosal digestion by small bowel enzymes, or mucosal absorption. Specific examples covered include fat maldigestion due to chronic pancreatitis interfering with pancreatic lipase secretion, and disaccharide maldigestion due to lactase deficiency. The document emphasizes that the small bowel has backup systems for digesting proteins and carbohydrates, but not for fat digestion, explaining why steatorrhea is the predominant manifestation of pancreatic insufficiency.
Malabsorption results from defects in intraluminal digestion, terminal digestion, transepithelial transport, and lymphatic transport. It is characterized by weight loss, abdominal distention, diarrhea, and steatorrhea. Causes of malabsorption include cystic fibrosis, celiac disease, lactase deficiency, environmental enteropathy, abetalipoproteinemia, microscopic colitis, graft-versus-host disease, and Whipple's disease. Histological examination often reveals villous atrophy, increased intraepithelial lymphocytes, and lipid-laden macrophages in the lamina propria.
This document discusses malabsorption, including its definition, mechanisms, and approaches to evaluation. Malabsorption occurs when nutrients are not adequately digested or absorbed in the gastrointestinal tract. It may result from problems with nutrient breakdown, uptake, or transport. The evaluation of malabsorption involves considering the patient's history and risk factors, performing initial tests to detect common causes or malnutrition, and utilizing more specialized testing as needed to identify specific disorders. A thorough workup aims to identify the underlying disease or condition responsible for impairing digestion and absorption.
This document discusses the pathophysiology, evaluation, and management of chronic diarrhea in children. It begins by defining chronic, persistent, and protracted diarrhea. Worldwide, chronic diarrhea is a major cause of childhood death, with rotavirus, cryptosporidium, and giardia being common causes in developing countries. The document outlines the steps to evaluate chronic diarrhea, including stool tests, intestinal microbiology, screening for celiac disease, tests of intestinal function, and imaging/endoscopy if needed. Common causes discussed include cow's milk protein allergy, tropical sprue, celiac disease, and intestinal lymphangiectasia. Management involves nutritional rehabilitation, identifying and avoiding food triggers, antibiotics for infections,
1. Malabsorption syndromes can involve defects in digestion or absorption of nutrients and present with symptoms of nutrient deficiencies.
2. Celiac disease is an immune-mediated disorder triggered by ingestion of gluten that results in damage to the small intestine and malabsorption. It is diagnosed through small bowel biopsy and treatment is a lifelong gluten-free diet.
3. Tropical sprue is a malabsorption syndrome of the small intestine seen in tropical regions, whose cause is thought to be an infectious agent. It resembles celiac disease and improves with antibiotic treatment.
This document discusses chronic diarrhea, its causes, types, risk factors, pathogenesis, evaluation, diagnosis and management. It describes two main types of chronic diarrhea - type 1 which begins as acute diarrhea that persists for over 2 weeks, and type 2 which is chronic diarrhea in a child with an inherent defect. Common causes include malnutrition, infections, malabsorption, hormonal issues and various diseases. A thorough clinical history and physical examination are important for diagnosis.
Steatorrhea, Chyluria, Gallstone (Cholelithiasis), Pancreatitis (Chronic and ...akash mahadev
Tropical sprue is a malabsorption syndrome caused by intestinal infections that damages the small intestine. It presents with chronic diarrhea, weight loss, and multiple nutritional deficiencies. Broad spectrum antibiotics and folic acid are the primary treatment and typically result in rapid clinical response. Celiac disease is a similar but distinct disorder where the immune system reacts to gluten, damaging the small intestine and impairing absorption of nutrients. It is treated through maintaining a strict gluten-free diet. Both can result in steatorrhea, or fatty diarrhea, due to the reduced ability of the small intestine to absorb dietary fat.
This document discusses chronic diarrhea and its causes and management. It defines persistent diarrhea as acute diarrhea lasting over 2 weeks, while chronic diarrhea has a more insidious onset and is usually due to non-infectious causes lasting over 2 weeks. Common causes of persistent diarrhea include malnutrition, infections, and food allergies. Chronic diarrhea requires further evaluation to identify underlying inflammatory, malabsorptive, intestinal, metabolic, or other conditions as the cause. Management of both involves rehydration, controlling diarrhea, identifying the cause, and rehabilitation.
The document discusses malabsorption syndromes and provides details about celiac disease. It defines celiac disease as an immune-mediated disorder caused by ingestion of gluten, which damages the small intestine mucosa. Key points include that celiac disease is diagnosed by small bowel biopsy showing villous atrophy and response to gluten-free diet, and that complications can include lymphoma, ulcerative jejunoileitis and dermatitis herpetiformis.
This document defines and describes malabsorption syndrome, which occurs when the small intestines fail to absorb nutrients from digested food. It is caused by various intestinal disorders that disrupt digestion and absorption. Symptoms include fatty stool, weight loss, abdominal discomfort, and deficiencies of specific vitamins and minerals. Diagnosis involves stool and biopsy tests and imaging. Treatment focuses on addressing the underlying cause, replacing deficiencies, and managing symptoms like fatty stool. Diet modifications and supplements are often needed long-term.
This document discusses the approach to chronic diarrhea in children. It defines chronic diarrhea and outlines its pathophysiology and types. A wide range of potential causes are described. The clinical approach involves a detailed history, laboratory evaluation including celiac serology, and consideration of functional diarrhea in young children. Management focuses on hydration, nutrition, and treating any underlying disease. Probiotics may help in some cases while antidiarrheal medications can improve symptoms but have side effects.
This document discusses malabsorption syndrome and its pathophysiology. It begins by defining maldigestion and malabsorption, and then describes the normal digestive and absorptive processes. It identifies several potential causes of malabsorption, including impaired luminal hydrolysis, impaired mucosal function, and impaired nutrient removal from the mucosa. Specific causes involving the digestion and absorption of fats, proteins, carbohydrates, vitamins, and minerals are then outlined. Compensatory roles of the colon are also mentioned.
The document discusses the approach to malabsorption. It defines maldigestion as defective intraluminal hydrolysis of nutrients and malabsorption as defective mucosal absorption. While this distinction can be useful, the clinical presentation of maldigestion and malabsorption are similar. Malabsorption can be caused by diseases of the small intestine, pancreas, liver, biliary tract or stomach. The mechanisms that cause malabsorption can affect processes in the lumen, mucosa or postmucosally. Specific nutrient malabsorptions like fat, protein, carbohydrates, vitamins and minerals are then discussed in detail.
Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It has a prevalence of approximately 0.5-1% and is an autoimmune response to gluten proteins found in wheat, rye, and barley. Diagnosis requires a small bowel biopsy showing villous atrophy and positive serologic markers. Treatment involves a lifelong gluten-free diet to improve symptoms, reverse nutritional deficiencies, and prevent complications like osteoporosis and intestinal lymphoma.
This document discusses Celiac disease, including its various classifications, pathogenesis, clinical manifestations, diagnosis, treatment, and management. Some key points:
- Celiac disease is a small intestinal malabsorption disorder triggered by ingestion of gluten in genetically susceptible individuals. It is characterized by villus atrophy and improves with a gluten-free diet.
- It can present as classic, atypical, silent, or potential forms. Diagnosis requires serology testing and small intestinal biopsy showing villus damage.
- Treatment is lifelong adherence to a strict gluten-free diet. Management also includes correcting nutritional deficiencies and monitoring for complications like osteoporosis.
- Non-responsive or refractory c
ACUTE LIVER FAILURE - APPROACH AND MANAGEMENTNishant Yadav
Acute liver failure is a clinical syndrome resulting from massive necrosis or impairment of hepatocytes, leaving insufficient liver function. It impairs synthetic, excretory, and detoxifying liver functions. Pediatric acute liver failure is defined by evidence of liver dysfunction within 8 weeks, uncorrectable coagulopathy, and no evidence of chronic liver disease. Causes include viral infections, drugs, and metabolic disorders. Management involves transport to a specialized center, intensive care, supportive care, measures for raised intracranial pressure, coagulopathy, sepsis, and potential liver transplantation.
This document discusses absorption and malabsorption in the gastrointestinal tract. It defines malabsorption as disorders that disrupt digestion and nutrient absorption, which can lead to malnutrition. The major causes of malabsorption discussed are luminal maldigestion, mucosal maldigestion, and mucosal malabsorption. Tests used to evaluate malabsorption are described, including screening tests to identify nutrient deficiencies and quantitative tests to measure nutrient absorption like fecal fat tests. Biopsy and imaging tests can further identify the specific cause of malabsorption.
This document discusses various causes of congenital and chronic diarrhea in children. It defines diarrhea and describes different types including osmotic, secretory, and chronic nonspecific diarrhea. Specific conditions covered include glucose-galactose malabsorption, celiac disease, cystic fibrosis, tufting enteropathy, microvillus inclusion disease, congenital chloride diarrhea, intestinal lymphangiectasia, abetalipoproteinemia, and immunodeficiency-related diarrhea. The diagnostic approach and management strategies for each condition are summarized.
Malabsorption syndrome is a clinical term that encompasses defects occurring during the digestion and absorption of food nutrients by the gastrointestinal tract. It is characterized by defective absorption of fats, vitamins, proteins, carbohydrates, electrolytes, and water. Malabsorption can be caused by issues with intraluminal digestion, terminal digestion, transepithelial transport, or lymphatic transport. Common causes include celiac disease, tropical sprue, chronic pancreatitis, cystic fibrosis, and inflammatory bowel disease. Symptoms include chronic diarrhea, steatorrhea, weight loss, fatigue, and nutritional deficiencies. Diagnosis involves tests for steatorrhea, Schilling tests, D-xylose tests, imaging
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2. INTRODUCTION
Malabsorption refers to impaired absorption of nutrients.
Maldigestion: impaired digestion of nutrients within the intestinal
lumen or at the terminal digestive site of the brush border
membrane of mucosal epithelial cells.
Although malabsorption and maldigestion are
pathophysiologically different, the processes underlying digestion
and absorption are interdependent.
3. INTRODUCTION
Three steps are required for normal nutrient absorption :
Luminal and brush border processing.
Absorption into the intestinal mucosa.
Transport into the circulation.
Disruption in any of the 3 processes above can result in
malabsorption.
May be due to congenital defects in the membrane transport
systems of the small intestinal epithelium or from acquired
defects in the epithelial absorptive surface.
7. CLINICAL FEATURES
Depend on the extent and type of the
malabsorbed nutrient.
May be global as in Celiac disease or
partial due to specific nutrient
malabsorption as in Vitamin B12
deficiency.
Symptoms: Chronic diarrhea,
anorexia, flatulence, abdominal
distention, IBS like sx, failure to gain
weight, a fall in growth chart
percentiles.
Signs:
muscle wasting, loss of
subcutaneous fat with subsequent
loose skin folds.
Edema is usually associated with
protein-losing enteropathy.
8. CLINICAL FEATURES
Signs:
Perianal excoriation and gaseous abdominal distention with
carbohydrate malabsorption.
Perianal and circumoral rash with acrodermatitis enteropathica.
Abnormal hair with Menkes syndrome.
Digital clubbing with cystic fibrosis and celiac disease.
Osteopenia or increased risk of fractures due to celiac disease or
fat-soluble vitamin deficiency.
The nutritional consequences of malabsorption are more dramatic in
toddlers because of the limited energy reserves and higher
proportion of calorie intake being used for weight gain and linear
growth.
If malabsorption is untreated, linear growth slows, and with
prolonged malnutrition, death can follow.
9. DIAGNOSIS
History:
onset of diarrhea- at birth or early infancy or later childhood
nature of the diarrhea- explosive diarrhea in CHO malabsorption
or foul-smelling, greasy large volume stools in CF.
after introduction of a particular food as in celiac disease or
CMPI.
ROS - abdominal pain, weight loss, joint pains, rashes
Family History
Physical examination for signs of specific nutrient malabsorbed.
Plot growth parameters.
10. DIAGNOSIS
Routine labs:
Stool for culture, O & P, Guaiac, wbc’s - r/o Inflammatory disease or
Infection.
Stool pH, reducing substances- CHO malabsorption.
Stool Giardia Antigen.
Stool for qualitative fat on a random specimen and later may need
72hr stool for quantitative fat- steatorrhea.
CBC and Peripheral smear for Acanthocytes – Abetalipoproteinemia,
Neutropenia – Schwachman syndrome.
Anti-endomysial Ig A and Ig G, Anti-TTG Ig A and Ig G (specially
in Ig A deficient patients), Serum Ig A – Celiac disease.
Specific tests for CHO, fat, protein, vitamin/mineral malabsorption.
11. BASED ON PREDOMINANT NUTRIENT
MALABSORBED
Presence of acidic stool, > 2+
reducing substances with a hx
of explosive diarrhea.
Breath H2 tests for lactose,
fructose or sucrose
malabsorption.
Specifically, small bowel
mucosal biopsies to test for
disaccharidase levels.
Primary deficiency:
enzyme levels low with
normal villous
morphology.
Secondary deficiency: low
enzyme levels with partial
or total villous atrophy.
12. BASED ON PREDOMINANT NUTRIENT
MALABSORBED
Assess for stool fat- age dependent:
preterm: 65-70% absorbed, full-
term: 90% dietary fat absorbed,
older children > 95% absorbed.
Start with random stool specimen
for qualitative fat by Sudan stain or
for fat globules. (Gold std is a 72hr
stool for fat).
Patient should eat 70-120g/day fat
in diet: >14g/day stool fat is
abnormal.
Stool fat concentration > 8% -
pancreatic exocrine insufficiency.
Look for underlying cause: CF-
sweat chloride test, Low serum
cholesterol, TG and VLDL, LDL in
Abetalipoproteinemia, Vitamin
ADEK levels, PT.
13. BASED ON PREDOMINANT NUTRIENT
MALABSORBED
Hypoalbuminemia – check urine
proteins (renal disease), liver
disease/decreased intake.
Stool Alpha-1 antitrypsin for
PLE.
Signs of Nicotinamide
deficiency due to low tryptophan
levels in Hartnup disease:
dermatitis, diarrhea, dementia
and death.
14. BASED ON PREDOMINANT NUTRIENT
MALABSORBED
Stool for Na and Chloride levels,
check osmotic gap of stool.
Zinc and ALP levels
Ceruloplasmin and Copper
Serum B12 and FA, Anti-parietal cell
antibodies, IF levels.
EGD and colonoscopy for IBD,
Celiac disease
Imaging studies: non-specific.
Histology for Microvillous inclusion
disease, tufting enteropathy.
Pancreatic exocrine insufficiency:
sweat test(CF), Stool elastase, Serum
trypsinogen- screen- low in
Pancreatic insufficiency in CF and
Schwachman syndrome.
Gold std: Duodenal aspirate for
HCO3, trypsinogen, lipase after
secretin and CCK stim.
16. DIAGNOSIS OF INTESTINAL MUCOSAL
DISORDERS
Histologic examination of small
bowel mucosal biopsies.
Mucosal involvement can be
patchy, especially in celiac disease
and intestinal lymphangiectasia.
Periodic acid–Schiff (PAS)
staining of mucosal biopsies and
electron microscopy are necessary
in congenital diarrhea to assess
congenital microvillus atrophy.
Autoimmune enteropathy: Sx
occur after the 1st 6 mo of life
with chronic diarrhea,
malabsorption, and failure to
thrive.
17. In contrast to gluten-sensitive enteropathy, an increase in intra-
epithelial lymphocytes is not a prominent feature of autoimmune
enteropathy.
Specific serum anti- enterocyte antibodies can be identified in ≥50%
of patients by indirect immunofluorescent staining of normal small
bowel mucosa and kidney.
Extra intestinal autoimmune disorders are usual.
Exclude underlying primary immune deficiency, particularly in boys
with other autoimmune features (diabetes mellitus), because a
proportion have underlying Immune dysregulation,
Polyendocrinopathy, Enteropathy, X linked (IPEX) syndrome.
Treatment: immune suppression drugs including prednisone,
azathioprine, cyclophosphamide, cyclosporine, and tacrolimus.
Bone marrow transplantation is curative for children with IPEX
syndrome.
18. BILE ACID MALABSORPTION
Primary bile acid malabsorption -
mutation of the ileal sodium–bile
acid co transporter gene.
Secondary bile acid
malabsorption - ileal disease,
such as in Crohn disease, and
following an ileal resection.
Presents as congenital diarrhea,
steatorrhea, interruption of
enterohepatic circulation of bile
acids, and reduced plasma
cholesterol levels.
Treatment: restriction of dietary
fat, cholestyramine - an anion-
binding resin.
19. BACTERIAL OVERGROWTH
Gastric acid pH, small bowel motility and the migrating motor
complex, the ileocecal valve, mucosal defenses such as mucin and
immunoglobulins prevent bacterial overgrowth in the small bowel.
Bacterial overgrowth can result from clinical conditions that alter
the gastric pH or small bowel motility, including disorders such as
partial bowel obstruction, diverticula, short bowel, intestinal
duplications, diabetes mellitus, idiopathic intestinal pseudo-
obstruction syndrome, and scleroderma.
Prematurity, immunodeficiency, and malnutrition are other factors
associated with bacterial overgrowth of the small bowel.
Bacterial overgrowth leads to inefficient intraluminal processing of
dietary fat and to steatorrhea due to bacterial deconjugation of bile
salts, vitamin B12 malabsorption, and microvillus brush border
damage with malabsorption.
20. Overproduction of d-lactate (the
isomer of l-lactate) can cause stupor,
neurologic dysfunction, and shock
from d-lactic acidosis
Diagnosis: culturing small bowel
aspirate or by lactulose hydrogen
breath test.
Treatment: treat the cause of partial
obstruction.
Initial treatment with 2-4 wk of
metronidazole can provide relief for
many months.
Cycling of antibiotics including
azithromycin, trimethoprim-
sulfamethoxazole, ciprofloxacin, and
metronidazole is required.
Occasionally, antifungal therapy is
required to control fungal overgrowth
of the bowel.
21. IMMUNODEFICIENCY DISORDERS
Malabsorption can occur with congenital immunodeficiency
disorders, and chronic diarrhea with failure to thrive is often the
mode of presentation.
Malabsorption due to giardiasis or nonspecific enteropathy with
bacterial overgrowth can occur.
Malabsorption associated with immunodeficiency is exacerbated by
villus atrophy and secondary disaccharidase deficiency.
In chronic granulomatous disease, phagocytic function is impaired
and granulomas develop throughout the GI tract, mimicking Crohn
disease.
In addition to failure to thrive, it is important to consider that
malabsorption associated with immunodeficiency is often
complicated by micronutrient deficiencies, including vitamins A, E,
and B12 and calcium, zinc, and iron.
22. MALNUTRITION IN IBD
IBD is associated with malnutrition due to decreased intake,
malabsorption due to diarrhea and inflammation, chronic steroid use,
results in growth failure and micronutrient deficiencies.
Optimizing nutritional status and growth are key priorities in the
management of IBD in children and adolescents.
Energy intake should meet the added costs of catch-up growth and are
usually in the range of 40-70 kcal/kg ideal body weight per day.
Protein requirements are higher in Crohn disease (1-1.5 g/kg/day).
24. TREATMENT
Principles: 1. treat the underlying cause
2. treat the diarrhea
3. treat associated nutrient deficiencies.
Loperamide is used to treat diarrhea.
Avoid beverages with high sugar as soft drinks.
Nutrition consultation.
Supplement with iron, folic acid in celiac disease pts.
Fat-soluble vitamin deficiency: supplement with water soluble forms of Vit A,
D, E, K -5-10 times of RDA.
Dietary restrictions can help restore normal mucosal function: Gluten-free diet
in celiac disease.
Elimination of specific Carbohydrates, as in lactose intolerance.
MCT instead of LCT in diet –steatorrhea, as in short gut syndrome.
Pancreatic insufficiency: Low fat diet and supplementation with encapsulated
pancrealipase enzyme.
Each capsule has 30,000IU , 1 with each meal and ½ with snacks. Needs to be
adjusted based on age and weight.
25. REFERENCES
Kliegman: Nelson Textbook of Pediatrics, 19th edition. Chapter 330:
Disorders of Malabsorption, pages:1305-1322.e3
Walker-Smith et al, Chronic Diarrhea and Malabsorption (Including
Short Gut Syndrome): Working Group Report of the First World
Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.
Journal of Pediatric Gastroenterology and Nutrition, 35, 2002.
www.uptodate.com – Clinical features and diagnosis of
malabsorption.
www.uptodate.com - Overview of treatment of malabsorption.