Malabsorption - Definition, etiology, clinical manifestations, diagnosis and management of malabsorption

1. MALABSORPTION SYNDROME
By
Y.V.Vanaja
Lecturer
Vijay Marie college of Nursing

2. INTRODUCTION
 Malabsorption syndrome refers to a number
of disorders in which the small intestine can't
absorb enough of certain nutrients and fluids.
Nutrients that the small intestine often has
trouble absorbing can be macronutrients
(proteins, carbohydrates, and fats),
micronutrients (vitamins and minerals), or both.

3. Definition
Malabsorption is the inability of the digestive system to absorb one or more of the
major vitamins, minerals, and nutrients
“Brunner’’
Malabsorption is a syndrome associated with a variety of disorders and intestinal
surgical procedures. It interferes with the ability to absorb nutrients and is a result of
a generalized flattening of the mucosa of the small intestine.
“Ignatavicious”
Malabsorption syndrome refers to a number of disorders in which the small intestine
can’t absorb enough of certain nutrients and fluids.
https://www.healthline.com/health/malabsorption

4. ETIOLOGY
Biochemical or
enzyme
deficiencies
•Lactase deficiency
•Biliary tract
obstruction
•Pancreatic
insufficiency
•Cystic fibrosis
•Chronic
pancreatitis
•Zollinger- Ellison
syndrome
Bacterial
proliferation
•Tropical sprue
•Parasitic infection
Small intestinal
mucosal disruption
•Celiac disease
•Whipple’s disease
•Crohn’s disease
Disturbed lymphatic
and vascular
circulation
•Lymphoma
•Ischemia
•Lymphangiectasia
•Heart failure
Surface area loss
•Billroth II
gastrectomy
•Short bowel
syndrome
•Distal ileal
resection

5. PATHOPHYSIOLOGY
Bile salt deficiencies
Bile salt deficiencies
Decreased synthesis of bile in liver
Bile salt deficiency
Malabsorption of fats and fat soluble
vitamins
Enzyme deficiencies
 Genetic inheritance, injury to the
intestinal mucosa from viral hepatitis
 Lactase deficiency is the most common
disaccharide enzyme deficiency
 Without sufficient amounts of this enzyme
body is not able to breakdown lactose

6. Pancreatic Enzyme
Deficiencies
Chronic pancreatitis, cystic fibrosiss
Destruction or obstruction of the
pancreas or insufficient pancreatic
stimulation
Pancreatic enzyme deficiencies
Malabsorption problems – defieciency
of Vit- B12 absorption
Presence of Bacteria
Gastrectomy
Loop bowel can accumulate intestinal contents
results in bacterial overgrowth when peristalsis
is decreased
Bacteria at this site break down bile salts, and
fewer salts are available for absorption
 They also can ingest the vit B12
Vitamin B12 deficiency

7. Disruption of the ,mucosal
lining of the smalll intestine
Celiac sprue, tropical sprue, crohn’s
disease and ulcerative colitis
Accumulation of gluten in the diet
with peptidase deficiency
Genetic immune hypesensitivity
response to gluten or its breakdown
products.
In celiac sprue
The absorptive surface area in the
small intestine is lost
Tropical Sprue
 Bacterial infectious agent
 Tropical sprue
 Mucosal changes occur
 Malabsoption of fat, folic acid, vit
B12

8. Altered lymphatic
circulation
Lymphoma, crohn’s disease, HF&
constrictive pericarditis causes
lymphatic obstruction
Loss of plasma proteins along with
the loss of minerals, vit B12, folic
acid & lipids
Altered vascular circulation
Small bowel ischemia and radiation
enteritis
Interference with blood flow to the
intestinal mucosa
malabsorption
 resection of the ileum results in vit
B12, bile salt and other nutrient
deficiencies

9. Clinical manifestations
 Chronic diarrhea
 Steatorrhea
 Unintentional weight loss
 Abdominal distention, pain, weakness
 Bloating and flatus
 Decreased libido
 Easy bruising (purpura)
 Anemia
 Bone pain ( with calcium and vit D deficiency)
 Edema
 Serum iron levels are low in protein malabsorption because of insufficient gastric acid
for use of iron
 Serum cholesterol levels may be low from decreased absorption and digestion of fat
 Low serum calcium levels

10. Diagnosis
 Stool studies for quantitative and qualitative fat analysis
 Lactose tolerance test
 D-xylose absorption test & schilling test
 The hydrogen breath test to evaluate carbohydrate absorption
 Endoscopy with biopsy of the mucosa
 CT scan
 X ray
 Pancreatic function tests
 CBP

11. Management
 Avoidance of substances that aggregate malabsorption
 Supplementation of nutrients
 Surgical management of primary disease
 Dietary management includes
 Low fat diet for patients who have gallbladder disease, severe steatorrhea
 Dietary intake of fat is beneficial to the patient
 After a total gastrectomy high protein, high calorie diet & small frequent
meals are recommended.

12.  Should provide nutritional supplements according to the deficiency include
 Water soluble vitamins such as folic acid and vitamin B complex
 Fat soluble vitamins such as vitamin A, Vitamin D & vitamin K
 Minerals such as Calcium, iron and magnesium
 Pancreatic enzyme such as pancrelipase
 Antibiotics to treat tropical sprue, whipples disease – trimethoprim/
sulfamethoxazole
 Antidiarrheal agents such as diphenoxylate to control diarrhea and
steatorrhea
 Anticholinergics such as dicyclomine hydrochloride may be given before
meals to inhibit gastric motility
 IV fluids