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.

1. MALABSORPTION SYNDROME
INTESTINAL DISORDERS
BY JAMES NYIRENDA.

2. Definitions
This a condition in which there is failure of the
small intestines to absorb the products of digestion
(Bloom ,2005).
Malabsorption is a syndrome associated with a
variety of disorders in which there is a disruption
of digestion and nutrient absorption.

3. Aetiology and Classification
The fundamental basis of this syndrome is
faulty absorption of one or more essential
nutrients as a result of a large variety of
diseases. Faulty absorption is commonly due to
either faulty digestion, where nutrients are not
changed into an absorbable nature, or

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because nutrients which have been
digested are not being transported
across the brush border of the villi.

5. Diseases that Cause Malabsorption
1. Coelic disease- a condition where the mucosal lining of
the small intestine is damaged by ingestion of gluten.
2. Dermatitis herpertiform-
3. Tropical sprue- The condition may be related to
environmental factors such as toxins in food, infection, or
parasites.
4. Bacterial over growth.

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5. Whipple’s disease (stunted growth of villi). A
rare disease that usually affects middle-aged men.
The condition may be caused by a bacterial
infection. Symptoms include chronic fever,
darkening of skin pigment, diarrhea, joint pain, and
weight loss
6. Short bowel syndrome-reduced length of
bowels as a result of surgery or a birth defect.
(reduced surface area)

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7. Lactase deficiency-Cause Lactose
intolerance; is digestive problem where the body is
unable to digest lactose, a type of sugar mainly found in
milk and dairy products due lactase deficiency.

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8. Parasitic infestation e.g. Giardia intestinalis;
Giardia Lamblia is the most common of these
parasites and is contracted by ingesting un-
purified water causes selective malabsorption

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9. Chrohn’s Disease- inflammatory or
ulcerative condition of the gastrointestinal
10. chronic pancreatitis- lack of digestive
enzymes.

10. Clinical Manifestations
The patient who is admitted to hospital with malabsorption may be in
a state of starvation and therefore acutely ill.
1. Steatorrhoea: this is excretion in faeces of more than 7g of fat daily.
The stools are characteristically pale, bulky, offensive, and difficult to
flush down the toilet.
2. Wasting: due to failure of absorption of essential body building
nutrients. Weight loss may not be evident by weighing because the
patient may have ascites and/or oedema.

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3. Abdominal distension, borborygmi (sounds of
flatus in the abdomen), flatulence, and abdominal
discomfort due to increased bulk of intestinal
contents and gas production.

12. Signs and Symptoms of specific
deficiencies COMMONLY SEEN
1. Fatigue due to anaemia and/or hypokalaemia
2. Oedema due to hypoproteinaemia and/or anaemia
3. Tetany due to hypocalcaemia
4. Haemorrhage (in the form of ecchymosis, purpura) due to
failure of absorption of vitamin K.
5. Anaemia due to iron deficiency

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6. Decreased libido
7. Glossitis and stomatitis due to folic acid and vitamin B
dificiencies
8. Osteoporosis, osteomalacia, and bone pain due to
hypocalcaemia and vitamin D deficiency
9. Infections due to globulin deficiency

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10. Pigmentation of skin and mucous membranes due to
hypoadrenalism
11. Hypotension, hypothermia, and inhibition of growth
due to depression of endocrine activity
12. Mental changes occur, particularly in gluten
enteropathy.

15. Diagnosis
Stool analysis for bacterial growth and
parasites. For example isolating cysts of Giardia
Lamblia.
Jejunal biopsy showing the mucosal
appearance which may show malignancy, Villi
atrophy. The biopsy can be obtained through
jejunoscopy

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Radiological:-
Ultra Sound scan, Computed Tomography and Magnetic
Resonance Imaging
Barium meal - small intestine is dilated, segmented and loss of
the normal feathery appearance of jejunum

17. Medical and Nursing Management
The principles of treatment are:
1. To treat or remove the primary cause, e.g. gluten-free diet
in celiac disease, pancreatic extract by mouth in chronic
pancreatic disease or antibiotic therapy in diverticulosis

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2. To replace the specific deficiencies
detected. Intravenous therapy is often
necessary to achieve this.
3. To reduce the symptoms associated with
steatorrhoea

19. Drugs
Drugs prescribed for the patient with malabsortion will be
dictated by the underlying cause and any known deficiencies,
e.g.:
Anti-bacterials, example Metronidazole can be used
Mode of action; it is bactericidal. It inhibits bacterial DNA
synthesis thereby leading to death of the bacteria

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Dose: 200 – 400mg TDS PO for 7 -10 days.
Side; dry mucous membranes, metallic taste.
NOTE: Drugs are selected according to the
cause to eliminate the causative organism

21. A. Diet
.
1. Gluten free diet for celiac disease.
2. Low fibre diets.
3. Low fat as medium chain triglycerides.
4. No irritant diet, for instance with a lot of spices.

22. Parenteral fluids and feeding with
supplements of the deficient elements.
Total parenteral nutrition via central venous line can be
required.
Management of some individuals with malabsorption
syndrome may require injections of vitamin B12 and oral
iron supplements. The doctor may also prescribe
enzymes to replace missing intestinal enzymes, or anti-
spasmodics to reduce abdominal cramping and
associated diarrhoea.

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People with cystic fibrosis and chronic pancreatitis
require pancreatic supplements. Those with
lactose intolerance or gluten enteropathy (non-
tropical sprue) will have to modify their diets to
avoid foods that they cannot properly digest.

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When an oral diet is tolerated the patient is usually
prescribed a high protein, low fat, high calorie diet
with added nutritional supplements. A specific diet
should be prescribed where applicable, e.g. a
gluten-free diet for a patient with coelic disease

25. NURSING MANAGEMENT
The 3 main areas to be assessed are:
1. Problems associated with diarrhoea and steatorrhoea
(incontinence, excoriation of the perianal area and fatigue)
2. Problems associated with ensuring that the patient receives
adequate nourishment
3. Psychological status. Depression, grief and anger may be a
response to the loss of normal good health

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The nurse should also provide full general nursing
care to a very ill patient who is on complete rest in
bed. Special attention should be paid to the mouth
and pressure area care, as well as deep breathing
exercises.

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THE END