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.
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
This document discusses sepsis in obstetrics and gynecology. It defines sepsis and its spectrum, outlines diagnostic criteria and risk factors. Common causes are infections during labor, delivery or postpartum. The pathophysiology involves an exaggerated immune response leading to organ dysfunction. Investigations and management of sepsis are medical emergencies focusing on IV fluids, antibiotics, source control and vasopressors to support blood pressure. Prevention emphasizes antibiotic prophylaxis for at-risk groups like GBS carriers.
This document discusses the causes, evaluation, and management of chronic diarrhea lasting more than 4 weeks. It outlines various non-infectious etiologies including secretory, osmotic, steatorrheal, inflammatory, dysmotility, and factitial causes. A thorough history and physical exam are important to evaluate for underlying conditions and guide diagnostic testing. Management involves a curative approach if a treatable cause is found, suppressive therapy if elimination of triggers is possible, or empirical treatment with anti-diarrheal medications and fluid/electrolyte replacement.
Travellers diarrhea is a common and potentially disabling condition affecting travellers abroad. It is defined as three or more unformed stools within 24 hours accompanied by symptoms like nausea, vomiting or abdominal cramps. The highest risk areas are Central and South America, Africa, Asia and Mexico. Causative agents include bacteria like Campylobacter, viruses like norovirus and parasites like Giardia. Treatment involves oral rehydration, antimicrobial therapy if bloody diarrhea is present, and supportive care with antidiarrheal medications. Prevention focuses on hand washing and avoiding contaminated food and water.
Graves' disease is the most common cause of thyrotoxicosis, accounting for 60-80% of cases. It is an autoimmune disorder causing hyperthyroidism due to thyroid stimulating immunoglobulins that activate the TSH receptor. Symptoms include anxiety, heat intolerance, palpitations, weight loss and goiter. Treatment involves antithyroid medications, radioactive iodine therapy or surgery to control the hyperthyroidism. Radioactive iodine is often the preferred treatment option. Graves' disease can also cause eye changes and pretibial myxedema. Managing the condition during pregnancy requires careful titration of antithyroid medications.
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
This document discusses disorders of menstruation, including amenorrhea (absence of menstrual period), premenstrual syndrome (PMS), and menorrhagia (heavy menstrual bleeding). Amenorrhea can be primary (periods never start) or secondary (periods stop) and has many potential causes including pregnancy, breastfeeding, menopause, hormonal imbalances, medications, and structural issues. PMS involves physical and emotional symptoms in the one to two weeks before a woman's period, and is thought to be related to cyclic hormone changes. Menorrhagia is heavy or prolonged bleeding and can be caused by hormone imbalances, uterine fibroids, polyps, medications, and other medical conditions. Diagn
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
This document discusses sepsis in obstetrics and gynecology. It defines sepsis and its spectrum, outlines diagnostic criteria and risk factors. Common causes are infections during labor, delivery or postpartum. The pathophysiology involves an exaggerated immune response leading to organ dysfunction. Investigations and management of sepsis are medical emergencies focusing on IV fluids, antibiotics, source control and vasopressors to support blood pressure. Prevention emphasizes antibiotic prophylaxis for at-risk groups like GBS carriers.
This document discusses the causes, evaluation, and management of chronic diarrhea lasting more than 4 weeks. It outlines various non-infectious etiologies including secretory, osmotic, steatorrheal, inflammatory, dysmotility, and factitial causes. A thorough history and physical exam are important to evaluate for underlying conditions and guide diagnostic testing. Management involves a curative approach if a treatable cause is found, suppressive therapy if elimination of triggers is possible, or empirical treatment with anti-diarrheal medications and fluid/electrolyte replacement.
Travellers diarrhea is a common and potentially disabling condition affecting travellers abroad. It is defined as three or more unformed stools within 24 hours accompanied by symptoms like nausea, vomiting or abdominal cramps. The highest risk areas are Central and South America, Africa, Asia and Mexico. Causative agents include bacteria like Campylobacter, viruses like norovirus and parasites like Giardia. Treatment involves oral rehydration, antimicrobial therapy if bloody diarrhea is present, and supportive care with antidiarrheal medications. Prevention focuses on hand washing and avoiding contaminated food and water.
Graves' disease is the most common cause of thyrotoxicosis, accounting for 60-80% of cases. It is an autoimmune disorder causing hyperthyroidism due to thyroid stimulating immunoglobulins that activate the TSH receptor. Symptoms include anxiety, heat intolerance, palpitations, weight loss and goiter. Treatment involves antithyroid medications, radioactive iodine therapy or surgery to control the hyperthyroidism. Radioactive iodine is often the preferred treatment option. Graves' disease can also cause eye changes and pretibial myxedema. Managing the condition during pregnancy requires careful titration of antithyroid medications.
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
This document discusses disorders of menstruation, including amenorrhea (absence of menstrual period), premenstrual syndrome (PMS), and menorrhagia (heavy menstrual bleeding). Amenorrhea can be primary (periods never start) or secondary (periods stop) and has many potential causes including pregnancy, breastfeeding, menopause, hormonal imbalances, medications, and structural issues. PMS involves physical and emotional symptoms in the one to two weeks before a woman's period, and is thought to be related to cyclic hormone changes. Menorrhagia is heavy or prolonged bleeding and can be caused by hormone imbalances, uterine fibroids, polyps, medications, and other medical conditions. Diagn
Hashimoto's thyroiditis is an autoimmune condition that is a common cause of hypothyroidism.
In Hashimoto's thyroiditis, the body mounts an immune reaction against its own thyroid gland tissue, leading to inflammation of the gland (thyroiditis).
Thyroid gland is an endocrine gland. It secretes triiodothyronine (T3) and its prohormone, thyroxine (T4).
These hormones act on the basic metabolic rate, protein synthesis etc.
Gestosis is a multiorgan systemic complication of pregnancy characterized by various symptoms. It is caused by imbalances in prostaglandins that impact vascular resistance and platelet activation. Risk factors include age over 40, primigravida under 17 or over 30, family history, chronic conditions like hypertension and diabetes, and multiple gestation. Preeclampsia is defined as new hypertension and proteinuria developing after 20 weeks of pregnancy. Eclampsia involves preeclampsia with seizures. HELLP syndrome is a variant associated with hemolysis, elevated liver enzymes and low platelets, more common in multiparous women over 25. Early identification and treatment of pregestosis, a preclinical form, can help prevent severe
Rickets is caused by a lack of vitamin D, calcium, or phosphate which leads to softening and weakening of the bones due to defective mineralization of bone matrix. It results from vitamin D deficiency which prevents proper absorption of calcium and phosphate from the diet. Symptoms include bone pain, skeletal deformities, increased fractures, and impaired growth. Treatment involves addressing the underlying cause by increasing vitamin D, calcium, and phosphate intake.
Iron deficiency anemia is the most common type of anemia globally. It results from inadequate iron intake or absorption to meet physiological needs. Common symptoms include pallor, weakness, and fatigue. Diagnosis involves blood tests showing microcytic hypochromic anemia, low serum iron and ferritin levels, and high total iron binding capacity. Treatment consists of oral iron supplementation in the form of ferrous salts to replenish iron stores.
Anaemia is defined as a low level of haemoglobin in the blood. It diminishes the blood's ability to carry oxygen. Normal haemoglobin levels vary based on age, sex, and life stage. When haemoglobin levels are subnormal, the body compensates by increasing oxygen release and blood flow. Common symptoms of anaemia include tiredness, weakness, and fatigue. Anaemia is classified and diagnosed based on red blood cell size, shape, and laboratory findings. Causes include iron deficiency, vitamin deficiencies, genetic disorders, and underlying chronic diseases.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
Vitamin B12 deficiency can result from decreased absorption in the ileum, decreased intrinsic factor production in the stomach, inadequate dietary intake, or prolonged medication use. Clinical manifestations include neurological, psychiatric, hematological and cutaneous issues. Screening is recommended for those with risk factors or suspected symptoms. Treatment involves intramuscular B12 injections or high dose oral replacement, indefinitely for irreversible causes or until deficiency is corrected for reversible causes. Prevention focuses on supplementation in high risk groups.
A 39-year-old male with a history of diabetes presented with abdominal pain, vomiting, lethargy, and dehydration. On examination, he had diffuse abdominal tenderness but no guarding or rigidity, and normal bowel sounds. He had been non-compliant with his insulin regimen. The most likely diagnosis is diabetic ketoacidosis.
A 62-year-old male diabetic presented with fever, right upper quadrant pain, and tachycardia. CT showed findings consistent with emphysematous cholecystitis.
A 42-year-old male diabetic with poor glucose control presented with facial asymmetry and was found to have right facial nerve palsy, suggesting an
This document summarizes information about gonorrhea (Neisseria gonorrhoeae), including:
1. The history of gonorrhea identification and treatment, from ancient Greek beliefs to the development of antibiotics and culture techniques in the 19th-20th centuries.
2. Details on the pathogenesis, clinical manifestations, diagnosis, and treatment of common and complicated gonorrheal infections affecting the urethra, cervix, rectum, pharynx, and other sites.
3. Descriptions of local complications like epididymitis and pelvic inflammatory disease, and systemic complications including disseminated gonococcal infection.
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
Vit b12 deficiency causes and managementrajeetam123
This document discusses vitamin B12 deficiency, including its structure, dietary sources, absorption, transport, storage, and metabolic roles. It also covers the causes, manifestations, and laboratory findings of B12 deficiency. The key points are:
1. Vitamin B12 is essential for DNA synthesis and fatty acid/amino acid metabolism. Deficiency can cause megaloblastic anemia and neurological issues.
2. Dietary sources are animal products. Absorption requires intrinsic factor in the ileum. Deficiency can be caused by pernicious anemia or other issues impairing absorption.
3. Manifestations include megaloblastic anemia, neurological changes, and other issues. Laboratory findings show macro
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
1. Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue with scar tissue. It impairs liver function and can result from various causes like chronic alcoholism or hepatitis.
2. Symptoms may include jaundice, ascites, bruising easily, and confusion. Complications arise as the disease progresses and can affect other organs.
3. Diagnosis involves blood tests, imaging, and biopsy showing nodular regeneration of liver tissue and fibrosis. Treatment focuses on managing complications and their underlying causes.
Intermittent claudication is one of the most common symptoms of peripheral arterial disease (PAD), which is caused by atherosclerosis narrowing and stiffening the arteries that supply blood to the limbs. The main treatment options for intermittent claudication include risk factor modification through smoking cessation, glycemic control, blood pressure control, and lipid lowering; exercise therapy through regular walking sessions; and pharmacologic treatment including pentoxifylline and cilostazol which are FDA-approved for claudication. Revascularization procedures may also be considered if other treatments are ineffective.
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Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
Chronic gastritis is a chronic inflammation of the gastric mucosa that commonly results from infection by Helicobacter pylori in 90% of cases. Other causes include NSAID use, smoking, stress, and ischemia. H. pylori infection leads to increased acid secretion and damage to the gastric epithelium. Chronic gastritis is classified based on location and cause, and is usually asymptomatic, though pain, dyspepsia, and fatigue may occur. Diagnosis involves endoscopy, biopsy, and urease testing. Treatment focuses on H. pylori eradication therapy using antibiotic combinations for 10-14 days along with diet and lifestyle modifications. Complications include ulcers, gastric cancer, and
This document discusses urethritis and its causes. It begins by defining urethritis as inflammation of the urethra, which can cause discharge and dysuria. The main causes of urethritis discussed are infectious agents like Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma genitalium. Non-infectious causes like trauma are also mentioned. Gonococcal urethritis and chlamydial urethritis are then described in more detail, outlining their clinical features, diagnosis, treatment and complications. The document concludes with a discussion of the syndromic approach to treating ureth
Hypothyroidism is the failure of the thyroid gland to produce enough hormones. It can cause hypertension, dyslipidemia, infertility and other issues if untreated. It is most common in females and prevalence increases with age. Thyroid dysfunction is more common in diabetics than the general population. Screening is recommended for diabetics and those with risk factors like autoimmune disease or family history. A TSH test is used to diagnose, and levothyroxine replacement is the standard treatment, with dosage based on weight. Subclinical hypothyroidism may also be treated in high risk groups.
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.
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.
Hashimoto's thyroiditis is an autoimmune condition that is a common cause of hypothyroidism.
In Hashimoto's thyroiditis, the body mounts an immune reaction against its own thyroid gland tissue, leading to inflammation of the gland (thyroiditis).
Thyroid gland is an endocrine gland. It secretes triiodothyronine (T3) and its prohormone, thyroxine (T4).
These hormones act on the basic metabolic rate, protein synthesis etc.
Gestosis is a multiorgan systemic complication of pregnancy characterized by various symptoms. It is caused by imbalances in prostaglandins that impact vascular resistance and platelet activation. Risk factors include age over 40, primigravida under 17 or over 30, family history, chronic conditions like hypertension and diabetes, and multiple gestation. Preeclampsia is defined as new hypertension and proteinuria developing after 20 weeks of pregnancy. Eclampsia involves preeclampsia with seizures. HELLP syndrome is a variant associated with hemolysis, elevated liver enzymes and low platelets, more common in multiparous women over 25. Early identification and treatment of pregestosis, a preclinical form, can help prevent severe
Rickets is caused by a lack of vitamin D, calcium, or phosphate which leads to softening and weakening of the bones due to defective mineralization of bone matrix. It results from vitamin D deficiency which prevents proper absorption of calcium and phosphate from the diet. Symptoms include bone pain, skeletal deformities, increased fractures, and impaired growth. Treatment involves addressing the underlying cause by increasing vitamin D, calcium, and phosphate intake.
Iron deficiency anemia is the most common type of anemia globally. It results from inadequate iron intake or absorption to meet physiological needs. Common symptoms include pallor, weakness, and fatigue. Diagnosis involves blood tests showing microcytic hypochromic anemia, low serum iron and ferritin levels, and high total iron binding capacity. Treatment consists of oral iron supplementation in the form of ferrous salts to replenish iron stores.
Anaemia is defined as a low level of haemoglobin in the blood. It diminishes the blood's ability to carry oxygen. Normal haemoglobin levels vary based on age, sex, and life stage. When haemoglobin levels are subnormal, the body compensates by increasing oxygen release and blood flow. Common symptoms of anaemia include tiredness, weakness, and fatigue. Anaemia is classified and diagnosed based on red blood cell size, shape, and laboratory findings. Causes include iron deficiency, vitamin deficiencies, genetic disorders, and underlying chronic diseases.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
Vitamin B12 deficiency can result from decreased absorption in the ileum, decreased intrinsic factor production in the stomach, inadequate dietary intake, or prolonged medication use. Clinical manifestations include neurological, psychiatric, hematological and cutaneous issues. Screening is recommended for those with risk factors or suspected symptoms. Treatment involves intramuscular B12 injections or high dose oral replacement, indefinitely for irreversible causes or until deficiency is corrected for reversible causes. Prevention focuses on supplementation in high risk groups.
A 39-year-old male with a history of diabetes presented with abdominal pain, vomiting, lethargy, and dehydration. On examination, he had diffuse abdominal tenderness but no guarding or rigidity, and normal bowel sounds. He had been non-compliant with his insulin regimen. The most likely diagnosis is diabetic ketoacidosis.
A 62-year-old male diabetic presented with fever, right upper quadrant pain, and tachycardia. CT showed findings consistent with emphysematous cholecystitis.
A 42-year-old male diabetic with poor glucose control presented with facial asymmetry and was found to have right facial nerve palsy, suggesting an
This document summarizes information about gonorrhea (Neisseria gonorrhoeae), including:
1. The history of gonorrhea identification and treatment, from ancient Greek beliefs to the development of antibiotics and culture techniques in the 19th-20th centuries.
2. Details on the pathogenesis, clinical manifestations, diagnosis, and treatment of common and complicated gonorrheal infections affecting the urethra, cervix, rectum, pharynx, and other sites.
3. Descriptions of local complications like epididymitis and pelvic inflammatory disease, and systemic complications including disseminated gonococcal infection.
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
Vit b12 deficiency causes and managementrajeetam123
This document discusses vitamin B12 deficiency, including its structure, dietary sources, absorption, transport, storage, and metabolic roles. It also covers the causes, manifestations, and laboratory findings of B12 deficiency. The key points are:
1. Vitamin B12 is essential for DNA synthesis and fatty acid/amino acid metabolism. Deficiency can cause megaloblastic anemia and neurological issues.
2. Dietary sources are animal products. Absorption requires intrinsic factor in the ileum. Deficiency can be caused by pernicious anemia or other issues impairing absorption.
3. Manifestations include megaloblastic anemia, neurological changes, and other issues. Laboratory findings show macro
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
1. Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue with scar tissue. It impairs liver function and can result from various causes like chronic alcoholism or hepatitis.
2. Symptoms may include jaundice, ascites, bruising easily, and confusion. Complications arise as the disease progresses and can affect other organs.
3. Diagnosis involves blood tests, imaging, and biopsy showing nodular regeneration of liver tissue and fibrosis. Treatment focuses on managing complications and their underlying causes.
Intermittent claudication is one of the most common symptoms of peripheral arterial disease (PAD), which is caused by atherosclerosis narrowing and stiffening the arteries that supply blood to the limbs. The main treatment options for intermittent claudication include risk factor modification through smoking cessation, glycemic control, blood pressure control, and lipid lowering; exercise therapy through regular walking sessions; and pharmacologic treatment including pentoxifylline and cilostazol which are FDA-approved for claudication. Revascularization procedures may also be considered if other treatments are ineffective.
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
Chronic gastritis is a chronic inflammation of the gastric mucosa that commonly results from infection by Helicobacter pylori in 90% of cases. Other causes include NSAID use, smoking, stress, and ischemia. H. pylori infection leads to increased acid secretion and damage to the gastric epithelium. Chronic gastritis is classified based on location and cause, and is usually asymptomatic, though pain, dyspepsia, and fatigue may occur. Diagnosis involves endoscopy, biopsy, and urease testing. Treatment focuses on H. pylori eradication therapy using antibiotic combinations for 10-14 days along with diet and lifestyle modifications. Complications include ulcers, gastric cancer, and
This document discusses urethritis and its causes. It begins by defining urethritis as inflammation of the urethra, which can cause discharge and dysuria. The main causes of urethritis discussed are infectious agents like Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma genitalium. Non-infectious causes like trauma are also mentioned. Gonococcal urethritis and chlamydial urethritis are then described in more detail, outlining their clinical features, diagnosis, treatment and complications. The document concludes with a discussion of the syndromic approach to treating ureth
Hypothyroidism is the failure of the thyroid gland to produce enough hormones. It can cause hypertension, dyslipidemia, infertility and other issues if untreated. It is most common in females and prevalence increases with age. Thyroid dysfunction is more common in diabetics than the general population. Screening is recommended for diabetics and those with risk factors like autoimmune disease or family history. A TSH test is used to diagnose, and levothyroxine replacement is the standard treatment, with dosage based on weight. Subclinical hypothyroidism may also be treated in high risk groups.
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.
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.
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
Malabsorption syndrome refers to disorders resulting from impaired absorption of nutrients in the small intestine. It can be caused by genetic factors (primary) or other gastrointestinal diseases (secondary). Common causes include lactase deficiency, celiac disease, and cystic fibrosis. Lactase deficiency results in inability to digest lactose due to lack of the lactase enzyme. Celiac disease is an immune-mediated response to gluten that damages the small intestine. It has a strong genetic component and is diagnosed through biopsy of the small intestine.
Malabsorption syndrome refers to disorders resulting from impaired nutrient absorption in the small intestine. It can be caused by genetic or other gastrointestinal diseases. Lactase deficiency is one cause of malabsorption syndrome, resulting from a lack of the lactase enzyme needed to break down lactose in milk. Symptoms include diarrhea, bloating, and weight loss when consuming dairy. The severity depends on whether it is congenital, transient in infants/preemies, or develops later in life. Treatment involves removing dairy from the diet or using lactase supplements.
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.
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.
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.
Chronic diarrhea can be caused by osmotic, secretory, inflammatory, or malabsorptive etiologies. A thorough history, physical exam, and testing are needed to determine the underlying cause. Key tests include stool studies, blood work, imaging, and endoscopy. Treatment depends on the identified cause but may include medications to reduce diarrhea, replace lost nutrients, address underlying infections or inflammatory conditions, and treat any structural abnormalities.
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.
Fat, protien, lipids, carbohydrate Malabsorption and Chronic PancreatitisRebilHeiru2
Malabsorption is discussed among with chronic pancreatitis. This was a seminar presented at Gasteroenterology Unit at Adama Hospital Medical college. Fat, lipid, carbohydrate, minerals and vitamins absorption physiology and Pathologies with their approach to diagnosis and Mangement.
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 of diarrhea in children. It begins by describing normal intestinal function, including digestion, fluid and electrolyte transport, and the mechanisms that maintain equilibrium. Diarrhea occurs when there is increased intestinal secretion, reduced absorption, or a combination of both. Common causes of diarrhea in children include infectious diarrhea from bacteria or viruses, malabsorption from conditions like cystic fibrosis or coeliac disease, food allergies, and surgical resections of the intestine. Understanding the normal physiology and mechanisms of diarrhea allows clinicians to better diagnose and treat children with gastrointestinal issues.
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.
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, and environmental enteropathy. Microscopic findings depend on the specific condition but may include villous blunting, increased intraepithelial lymphocytes, and lipid vacuoles.
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.
The document discusses several disorders of carbohydrate metabolism including galactosemia, hereditary fructose intolerance, lactose intolerance, hypoglycemia, and diabetes mellitus. Galactosemia is caused by a deficiency of enzymes needed to break down galactose and can cause liver damage, jaundice, and intellectual disability if untreated. Hereditary fructose intolerance is caused by a lack of the aldolase B enzyme needed to break down fructose and consumption of fructose can lead to liver failure. Lactose intolerance is caused by a lack of the lactase enzyme resulting in gastrointestinal issues upon consuming dairy. Hypoglycemia and diabetes mellitus are disorders characterized by low
This document discusses common symptoms and treatments for colds, flu, and other minor illnesses. It covers symptoms like coughing, fever, body pain, sneezing, runny nose, sore throat, and ear infections. It also mentions several over-the-counter treatments for relief of pain, coughs, congestion, and immunity support including cough syrup, nasal spray, throat spray, vitamins, and medicines.
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It presents in stages, beginning with a painless sore and progressing to a rash and lesions on mucous membranes if left untreated. Without treatment, it can spread throughout the body and cause damage to internal organs, nerves, and blood vessels. Syphilis is treated with antibiotics, most commonly penicillin, with the treatment depending on which stage the infection is in. Congenital syphilis can occur if an infected mother transmits the bacterium to her fetus during pregnancy.
Varicella zoster virus causes both chickenpox and shingles. It is one of eight herpesviruses that infect humans. Chickenpox results from initial exposure to the virus and presents as a mild childhood illness characterized by a rash. The virus can remain dormant in nerves after chickenpox and reactivate later in life to cause shingles, a painful dermatomal rash. Complications are more common in adults, immunocompromised individuals, and neonates exposed maternally. Treatment focuses on antiviral medication for severe or complicated cases. Vaccination provides effective prevention against chickenpox.
This document discusses seborrheic dermatitis, a chronic papulosquamous skin condition characterized by yellowish, waxy, branny scaling along areas with sebaceous glands like the scalp, face, and trunk. It commonly affects infants under 3 months of age and adults between 40-70 years old. While the exact cause is unknown, factors like sebum production, microbial effects of Malassezia fungi, and genetic and environmental factors may play a role. The document describes the various clinical presentations in infants and adults and treatments involving topical antifungals, corticosteroids, keratolytics, and systemic antifungals.
1. Regular exercise during pregnancy can help maintain health and reduce common discomforts like backaches. Activities like walking, swimming, and low-impact aerobics are generally safe if a woman was active before pregnancy.
2. Some medical conditions may make exercise inadvisable during pregnancy. A woman should consult her healthcare provider before beginning or continuing an exercise routine.
3. Exercise should be discontinued if a woman experiences symptoms like chest pain, abdominal pain, headaches, or changes in fetal movement, and she should consult her provider.
This document provides information about the benefits of yoga for men. It begins with an introduction to different types of yoga including hot yoga, vinyasa, ashtanga, hatha, power, iyengar, kundalini and kaiut yoga. It then lists 10 specific yoga poses that are beneficial for men, describing how to perform each pose. Finally, it outlines some of the key benefits of yoga for men, including improved sex life, prevention of injuries, muscle building, enhanced productivity, and boosted immune system.
This document contains summaries of various pathological conditions:
- Schwannoma is a usually benign nerve sheath tumor composed of Schwann cells that normally produce myelin.
- Glioblastoma is the most aggressive brain cancer, with non-specific initial symptoms like headaches and nausea.
- Melanoma is a skin cancer that develops in pigment cells and has a tendency to spread and cause serious illness.
- Leiomyosarcoma arises from the muscular part of the uterus and is a malignant smooth muscle tumor.
This document summarizes ischemic heart disease and angina pectoris. It discusses the main symptoms of angina as chest pain triggered by exertion that is relieved by rest. The most common cause is atherosclerosis. Diagnosis involves EKG, stress testing, and sometimes coronary arteriography. Treatment includes identifying and modifying risk factors, using nitrates, calcium channel blockers or beta blockers for crisis and long-term management, and potentially mechanical revascularization. The document also summarizes acute myocardial infarction including typical symptoms, EKG and enzymatic criteria for diagnosis, clinical classification, potential complications, and management in the hospital.
Urethritis is an inflammation of the urethra that is usually caused by a sexually transmitted disease like chlamydia or gonorrhea. Symptoms can include urethral discharge and burning during urination. Diagnosis involves examination for discharge and testing samples of urine or urethral secretions for bacteria and viruses. Treatment involves antibiotics to cure the infection as well as avoiding sexual activity until completion of treatment to prevent spread. Complications can include epididymitis, cystitis, and pelvic inflammatory disease if left untreated.
Psychomotor development refers to the origination of movement through conscious mental activity. There are three stages of psychomotor development: cognitive, associative, and autonomous. Children progress through average milestones of motor and cognitive development like head control, sitting, walking, and language skills between 6 months and 30 months. Factors like genetics, environment, and maternal psychological health can influence a child's development. Screening tests are used to check that development is appropriate.
Pharyngitis, commonly known as a sore throat, is inflammation of the pharynx usually caused by viral infections like the common cold. Symptoms include soreness, difficulty swallowing, and fever. While most cases are viral and self-limiting, bacterial infections like strep throat require antibiotics. Proper diagnosis involves examination of the throat and potential testing. Treatment focuses on relieving symptoms for viral cases and antibiotics for bacterial infections. Maintaining good hygiene can help prevent pharyngitis.
Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It can be caused by bacterial or viral infections. Bacterial meningitis requires urgent treatment to prevent permanent damage. Symptoms may include fever, headache, neck stiffness, and confusion. Diagnosis involves spinal fluid analysis. Treatment involves antibiotics and supportive care. Vaccines exist to prevent some common causes of bacterial meningitis.
Gigantism is a rare condition caused by excessive growth hormone production, usually from a noncancerous pituitary tumor, resulting in abnormal growth and size in children. Symptoms include increased height and size of body parts like hands and feet. Diagnosis involves blood tests to measure growth hormone levels and MRI scans to detect pituitary tumors. Treatment aims to stop growth hormone overproduction and may include surgery to remove tumors, medication to shrink tumors or block hormone effects, and gamma knife radiosurgery for tumors not accessible by traditional surgery.
This document summarizes information about oxytocin and prolactin. Oxytocin is produced in the neurohypophysis and causes uterine contractions during birth. It also targets the uterine wall and breast area to eject milk. Hypersecretion can cause increased heart rate, decreased blood pressure, nausea and vomiting, and cardiac arrhythmia. Hyposecretion may result in difficult labor and breastfeeding. Prolactin is produced in the adenohypophysis and stimulates mammary glands to produce milk. It has a half-life of 20-30 minutes. Hypersecretion in females can cause menstrual irregularities and infertility, while in males it can cause hypogonadism and decreased ejaculate volume.
Down syndrome is a genetic condition where a person is born with an extra chromosome 21. This extra genetic material causes delays in physical and mental development. The most common type is Trisomy 21, where there are three copies of chromosome 21 in every cell. People with Down syndrome often have characteristic facial features and health issues such as heart defects and hearing problems. While development is slower, people with Down syndrome can lead healthy lives with the right support and treatment.
Constipation is a common problem in children that causes infrequent or difficult bowel movements. It is usually temporary and caused by factors like diet changes, lack of physical activity, or medication side effects. Symptoms include painful bowel movements and stool that is hard or large. Treatment focuses on increasing fiber intake, fluid consumption, and using stool softeners under a doctor's guidance. Maintaining a regular toilet routine and physical activity can help prevent constipation.
Bronchitis is an inflammation of the bronchial tubes that connect the trachea to the lungs. It can be acute (lasting less than 3 weeks) or chronic. Acute bronchitis is usually caused by viruses and causes a cough with mucus, while chronic bronchitis is often caused by long-term smoking and causes daily cough and congestion. Symptoms include cough, wheezing, chest tightness and difficulty breathing. Treatment focuses on relieving symptoms and quitting smoking can help prevent chronic bronchitis.
Syphilis is a contagious bacterial infection caused by Treponema pallidum that is transmitted through sexual contact or from mother to baby. It has four stages: primary, secondary, latent, and tertiary. In the primary stage, a painless sore called a chancre appears at the site of infection and may spread a rash. In the secondary stage, a rash spreads over the body along with other symptoms. The latent stage has no symptoms. In the tertiary stage, symptoms involve damage to internal organs like the brain, heart, and nerves, which can cause problems like paralysis or insanity. It is diagnosed through physical exams, fluid tests, or blood tests depending on the stage. Without treatment
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
বাংলাদেশ অর্থনৈতিক সমীক্ষা (Economic Review) ২০২৪ UJS App.pdf
Malabsorption
1. MALABSORPTION
Malabsorption syndromes include a number of different
clinical manifestations, that result in chronic diarrhea,
abdominal distention, and failure to thrive.
Causes of malabsorption
Congenital
Acquired
Affect one or more of the different steps in the
intestinal hydrolysis and subsequent transport of
nutrients.
The major site of absorption is the small intestine
Carbohydrate, fat, or protein malabsorption is
caused by a disorder in the intestinal processes of
digestion, transport, or both of these nutrients
across the intestinal mucosa into the systemic
circulation.
A congenital abnormality in the digestive or
absorptive processes or, more commonly, a
2. secondarily acquired disorder of such processes
may result in malabsorption.
Digestion and absorption
Luminal phase:- dietary fats, proteins and
carbohydrates – solubilized by digestive enzymes
and bile – Deficiency in lipase and proteases leads
to lipid and protein malabsorption
Mucosal phase:- brush-border hydrolase activity –
more common primary or secondary lactase
deficiency
Postabsorptive phase:- hydrolyzed nutrients are
transported via lymphatic and portal circulation –
Impairs of chylomicrons and lipoproteins may
cause fat malabsorption or protein-losing
enteropathy Absorption of carbohydrates
Of the carbohydrates most commonly present in
the diet (starches, sucrose, lactose), only starches
require preliminary luminal digestion by salivary
and, more importantly, pancreatic amylases.
Despite the slow development of pancreatic
amylase, whose secretion reaches adult levels only
at 1 year of life, cooked starch malabsorption is
rare in infants because of the activity of the brush-
border glucoamylase that develops early in life.
Causes
3. Causes include the following:
Carbohydrate malabsorption
Starch molecules are primarily digested by
salivary and pancreatic amylase, but
glucoamylase in the intestinal brush boarder
also assists in digestion.
Pancreatic insufficiency impedes the digestion
of large starch molecules.
Absence or reduction of the brush border
disaccharidases causes selective carbohydrate
malabsorption.
Transient reduction of these enzymes is
common after an infection in the intestine,
particularly a viral infection, because intestinal
villi and microvilli may be damaged.
Glucoamylase and maltase are most resistant
to the depleting effects of mucosal injury that
result from infection, whereas lactase is the
most sensitive because of its predominant
distribution near the tips of the villi.
Lack of sucrase and isomaltase is, by far, the
most frequent congenital enzyme deficiency.
This enzyme deficiency is inherited in an
autosomal recessive manner.
4. Congenital lactase deficiency is exceedingly
rare, but adult-type lactase deficiency (also
called adult-type hypolactasia) is very common
in some ethnic groups.
A congenital deficiency in the glucose
galactose transporter (SGLT-1) is inherited in
an autosomal recessive manner.
Small bowel bacterial overgrowth of normal
flora alters the intraluminal metabolism of
carbohydrates and results in their
malabsorption. This entity should also be
suspected in children with diarrhea-
predominant irritable bowel syndrome.
Bacteria ferment carbohydrates into smaller
osmotically active molecules and organic
acids. Increased osmolarity causes fluid from
systemic circulation to enter the intestinal
lumen, resulting in diarrhea.
Organic acids stimulate motility and may
directly injure the intestinal mucosa.
Fermentation eliminates the reducing
substances and lowers the pH of the stool.
5. The production of lactate and short-chain fatty
acids in the human colon can result in systemic
acidosis. In particular, a syndrome of D-lactic
acidosis may develop when specific bacteria
that are capable of producing this uncommon
and poorly cleared D isomer of lactate exist in
the intestinal flora.
Bile acids are usually recycled by
enterohepatic circulation. Many factors can
prevent this recirculation. Bacterial overgrowth
of normal flora and growth of abnormal flora
are the most common causes of altered
intraluminal metabolism of bile acids.
A congenital deficiency in the sodium–bile acid
cotransporter results in primary bile acid
malabsorption. The resulting diminished
transport of bile acids from the intestinal lumen
allows intestinal flora to deconjugate bile acids.
Deconjugated bile acids directly inhibit the
carbohydrate transporters, reduce intraluminal
pH levels, and damage the enterocyte. They
may also directly stimulate the colon to secrete
fluid, contributing to diarrhea.
Fat malabsorption
6. Increased delivery of fat to the colon results in
diarrhea and soft, pasty, foul-smelling stools.
However, the gas causes stools to float.
Consequences include the malabsorption of fat-
soluble vitamins A, D, E, and K and insufficient
energy intake due to the high energy value of
dietary lipids.
Exocrine pancreatic insufficiency is the principal
condition that results in severe fat
malabsorption. Pancreatitis, pancreatic cancer,
pancreatic resection, cystic fibrosis,
Shwachman-Diamond syndrome, Johnson-
Blizzard syndrome, and Pearson syndrome can
all result in pancreatic insufficiency.
Significant obstructive biliary or cholestatic liver
disease or extensive intestinal mucosal
disease, such as occurs in celiac disease, may
also result in severe steatorrhea.
Impaired bile production or secretion is seen in
liver or biliary tract disease. Inflammation or
resection of the ileum impedes enterohepatic
circulation, which results in a reduced bile acid
pool.
Bacterial overgrowth in the small bowel
deconjugates bile acids, thereby inactivating
their ability to help lipids form a micelle. These
7. syndromes result in moderate lipid
malabsorption.
Abetalipoproteinemia is a rare disorder with
autosomal recessive inheritance. Absence of
the lipoproteins results in cytoplasmic lipid
accumulation in the enterocyte. Lymphatic
transport of long-chain fats is impaired in
patients with abetalipoproteinemia,
lymphangiectasia, and protein-losing
enteropathy, resulting in moderate fat
malabsorption.
Protein malabsorption
Protein malabsorption is a fairly common result
of exocrine pancreatic enzyme deficiency, as
occurs in patients with cystic fibrosis.
Protein malabsorption that results from
congenital enterokinase deficiency is well-
described but rare.
Creatorrhea, loss of protein in the stool (ie,
protein-losing enteropathy), is often caused by
the leakage of protein from the serum due to
inflammation of the mucosa, as in Crohn
disease, celiac disease, and protein sensitivity
syndromes.
8. Congenital lymphangiectasia, a developmental
disorder in which dilation and dysfunction of
intestinal lymphatics occurs, often in association
with limb edema (Milroy disease), may present
with severe protein-losing enteropathy without
mucosal injury.
Vitamin malabsorption
Malabsorption of vitamin B-12 and folate is
associated with tropical spruce, a disorder that
is acquired after travel to tropical areas.
Vitamin B-12 is absorbed in the ileum, and
absorption requires an intrinsic factor made in
the gastric parietal cell. Intrinsic factor
deficiency that results from atrophic gastritis or
absence (from resection) or disease of the
terminal ileum (the predominant site of active B-
12) results in vitamin B-12 malabsorption.
Symptoms
Diet history: Obtain a complete history of the
patient's diet, including the amount and type of
fluids, solid foods, and formula ingested. Caregivers
should keep a detailed journal of the patient's diet
and symptoms for a minimum of 1 week.
The proper amount of fluid for most young
children is around 100 mL/kg/d. Fluid intake that
exceeds this amount may result in looser stools,
9. which causes a referral for a suspected but
nonexistent malabsorption.
Fat is important for slowing the movement of
food through the intestine via hormonal
mechanisms. Fat intake of less than 3 g/kg/d
may contribute to toddler's diarrhea, especially
in the setting of excessive free fluid and
carbohydrate intake (eg, as occurs with large
amounts of fruit juice intake). Thus, history is
important in differentiating the common toddler's
diarrhea from the rarer malabsorption
syndromes.
In the United States, juice is commonly
introduced into the diet in the latter portion of
the first year of life. Purple grape juice has a
high osmolarity, which can cause osmotic
diarrhea. The transport of fructose into
enterocytes is not active and relatively
inefficient. Apple and pear juice contain a high
fructose-to-glucose ratio, and consumption of
these juices can result in fructose
malabsorption and diarrhea. Because sorbitol
and fructose compete for the same intestinal
transporter, ingesting them together may result
in the malabsorption of these sugars.
GI tract symptoms: GI tract symptoms are common
in patients with malabsorption syndromes, and
symptoms range from mild abdominal gaseous
distention to severe abdominal pain and vomiting.
Chronic or recurrent diarrhea is by far the most
common symptom.
Abdominal distention and watery diarrhea, with
or without mild abdominal pain, associated with
10. skin irritation in the perianal area due to acidic
stools are characteristic of carbohydrate
malabsorption syndromes.
Periodic nausea, abdominal distention and pain,
and diarrhea are common in patients with
chronic Giardia infections.
Vomiting, with moderate-to-severe abdominal
pain and bloody stools, is characteristic of
protein sensitivity syndromes or other causes of
intestinal injury (eg, inflammatory bowel
disease).
Recurrent abdominal pain has been implicated
as a symptom of dietary disorders, although
psychological variables that relate to an
elevated anxiety level have clouded the
certainty of this relationship. Malabsorption
syndromes can definitely cause abdominal pain
or irritability (particularly seen in celiac disease).
Failure to identify the cause of malabsorption
can result in the misdiagnosis of a physiologic
syndrome as a behavioral disorder. Some
dietary items may cause symptoms only when
they are taken alone or with other specific
dietary items.
Poor appetite is common in food sensitivity
syndromes. The child becomes conditioned to
refuse foods that cause inflammatory reactions
of the intestine. However, this is not typically
obvious in celiac disease. Malabsorption
syndromes not associated with inflammatory
reactions typically cause an increase in appetite
(eg, cystic fibrosis), unless the associated
11. abdominal gaseous distention hampers intake
and induces early satiety.
Stool characteristics
Patients with toddler's diarrhea often have loose
stools with undigested food particles. This
should not be taken to imply the presence of
true malabsorption.
Frequent loose watery stools may indicate
carbohydrate intolerance.
Pasty or loose foul-smelling stools indicate fat
malabsorption, also termed steatorrhea. This
symptom is commonly seen
in Giardiainfections, enterokinase deficiency,
hepatic and pancreatic dysfunction, and protein
sensitivity syndromes.
Bloody stools are seen in patients with protein
sensitivity syndromes and not in disaccharidase
and pancreatic enzyme deficiencies or in
patients with giardiasis.
Other symptoms
Systemic symptoms, including weakness,
fatigue, and failure to thrive, are systemic
consequences of chronically poor nutrient
absorption. Malabsorption of carbohydrates,
fats, or proteins can cause failure to thrive,
whereas folate and B-12 malabsorption result in
macrocytic anemia.
Patients with abetalipoproteinemia develop
retinitis pigmentosa and ataxia because of
12. chronic fat-soluble vitamin malabsorption and
deficiency (vitamins A and E).
Treatment
When a child suffers from malnutrition, malabsorption is
just one of the possible causes. She might be
undernourished because she’s not getting enough of the
right types of food, or she has digestive problems that
prevent her body from digesting them. She also might
have a combination of these problems.
Before prescribing a treatment, the pediatrician must
determine the cause. This can be done in one or more of
the following ways.
The pediatrician may test the child’s ability to digest
and absorb specific nutrients. For example, the
doctor might have her drink a solution of milk sugar
(lactose) and then measure the level of hydrogen in
her breath afterward. This is known as a lactose
hydrogen breath test.
The pediatrician may collect and analyze stool
samples. In healthy people, only a small amount of
the fat consumed each day is lost through the stool.
If too much is found in the stool, it is an indication of
malabsorption.
Collection of sweat from the skin, called a sweat
test, may be performed to see if cystic fibrosis is
present. In this disease, the body produces
insufficient amounts of certain enzymes necessary
13. for proper digestion and an abnormality in the
sweat.
In some cases the pediatrician might request that a
pediatric gastroenterologist obtain a biopsy from the
wall of the small intestine, and have it examined
under the microscope for signs of infection,
inflammation, or other injury.
Reference:-
Kapitan Pediatrics Book
GHAI Essential Pediatrics (Eighth Edition)
Health line ( https://www.healthline.com )
WebMd ( https://www.webmd.com )
Mayo Clinic ( https://www.mayclinic.org )
My Self