| ID | 44 |
|---|---|
| Name | MALABSORPTION |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation : 1. Confirm Steatorrhoea by faecal fat. In malabsorption fat excretion > 7gm/day. 2. Xylose absorption test: usually done to differentiate pancreatic or intestinal causes, a. Intestinal- less absorption, b. Pancreatic- normal. Patient is advised to digest 25gm of D-xylose, then after two hours blood level of xylose is determined; if blood level is more then 30gm/dl indicates normal absorption. Abnormal absorption most frequently seen in tropical & non tropical sprue. 3. Barium follow through- to detect diverticula, fistulae, string sign, flocculation & segmentation. 4. Jejunal biopsy- flattening of the mucosa with partial or total villous atrophy or crohn’s granulomata. 5. Pancreatic function test. 6. General investigation for deficiency-a. Blood film b. Vitamin B12 assay, c. Serum protein d. Electrolytes. 7. Hydrogen breath test. |
| Management | Management: A. General: 1. Corrction of deficiency, such as fluid, electrolyte, vitamins, blood, iron etc. 2. Fat restricted diet in case of Steatorrhoea. B. Specific measures: Treatment of cause, such as: 1. Tropical sprue a. Folic acid 5mg t.d.s for 2 weeks, b. Cap. Tetracycline 250 mg 6 hourly for 1 month, c. If remission, Folic acid 5mg daily as mainte-nance dose for life long. Multivitamins are found helpful. 2. In gluten sensitive enteropathy, gluten free diet for 2 years. If fails further 2 years trial; if fails life long gluten free diet should be given. 3. Treatment of intestinal T.B- see treatment of tuberculosis in the section of respiratory disease. 4. Crohn’s disease- may be treated with high protein, vitamin, electrolyte & high fibre diet with sulphasalazine or mesalazine with or without steroid. 5. Ulcerative colitis- please see in the text. 6. Bacterial over growth- may be treated with metronidazole or other appropriate antimicrobial preparation. |
| Introduction | Malabsorption is a wide term used in the clinical practice to denote a state of complex disorders of digestion & absorption of food staff, such as fat, protien, carbohydrate, minerals, electrolytes & vitamins, resulting diarrhoea, abdominal pain and distension, loss of weight, anemia or other evidence of specific deficiency. However some patients complain only of vague ill health and diagnosis may not be made for many years. Malabsorption may be of selective absorption defect of a particular food staff or combination of a few or all. |
| History | |
| Etiology | Etiology: Malabsorption may result from abnormalities in any of the three phases of digestion & absorption. A. Intraluminal maldigestion : if there is deficiency of pancreatic enzyme & bile, protein & fat malabsorption results. a) Deficiency of pancreatic enzymes occurs in - i. Chronic pancreatitis ii. Cystic fibrosis iii Carcinoma of the pancreas iv Zollinger Ellison syndrome v. Post gastrectomy steatorrhoea. b) Deficiency of bile occurs in- i. Chronic liver disease, ii. Cholestasis. iii Abnormal bacterial proliferation in the intestine, iv Drugs- calcium carbonate, neomycin etc. B. Mucosal malabsorption: Diseases & conditions which diminish the small intestinal mucosal surface area for absorption and deplete mucosal brush border enzymes activity (which are essential for hydrolysis of disaccharides and different peptides). So, in mucosal disorders malabsorption of all nutrients occur. a) Primary mucosal diseases- i. Coeliac disease ii. Tropical sprue, iii. Salmonellosis. iv. Lymphoma v. Whipple’s disease, vi. Bacterial overgrowth vii. Lactase deficiency (congenital or secondary) viii. Radiation enteritis, ix. Intestinal tuberculosis. b) Small intestinal resections (short bowel syndrome) C. Postmucosal or Postabsorptive disorder: Obstruction of lymphatic system causes impaired transport of absorbed lipids and lipoproteins. This results in leakage into the intestinal lumen, leading to steatorrhoea & protein-losing enteropathy. D. Others- endocrine & metabolic disorders |
| Clinical Features | Clinical features: The patient can present in various ways- 1. Steatorrhoea- the patient complains of diarrhoea, with passage of pale, bulky, offensive stool which floats on water; or only diarrhoea. 2. Abdominal pain. 3. Loss of weight. 4. Anemia. 5. Features of deficiency of essential nutrients, such as iron, folic acid, vitamins, minerals, electrolytes. 6. Protein malabsorption results in progressive emaciation, oedema (pitting on pressure), bone pain etc. 7. Carbohydrate malabsorption causes, abdominal distension, belching, hypoglycaemia etc |
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