DR.
EMEJE ISAAC PAUL
University of Jos.
Dr. Emeje Isaac Paul 1
Definition:
-It is a state arising from abnormality in absorption
of food nutrients across the gastrointestinal
tract(GIT).
-Impairment can be of single or multiple nutrients
depending on the abnormality.
-This may lead to malnutrition and a variety of
anaemias. Dr. Emeje Isaac Paul 2
Malabsorption constitutes the
pathological interference with the
normal physiological sequence of body
such as:
Digestion(intraluminal process),
Absorption (mucosal process) and
Transport (postmucosal events) of
nutrients.
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Causes of malabsorption:
Intestinal malabsorption can be due to:
1. digestive failure caused by enzyme
deficiencies
2. structural defects
3. mucosal abnormality
4. infective agents
5. systemic diseases affecting GIT
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1. Due to digestive failure:
• Pancreatic insufficiencies:
• cystic fibrosis
• chronic pancreatitis
• carcinoma of pancreas
• Bile salt insufficiency:
• obstructive jaundice
• bacterial overgrowth
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2. Due to structural defects :
•Inflammatory bowel diseases commonly: Crohn's
Disease
• Gastrectomy and gastro-jejunostomy
• Fistulae, diverticulae and strictures.
• Infiltrative conditions such as amyloidosis, lymphoma.
•Short bowel syndrome.
•Eosinophilic gastroenteropathy etc.
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3. Due to mucosal abnormality:
-Coeliac disease
4. Due to enzyme deficiencies:
-Lactase deficiency inducing lactose intolerance
- Disaccharidase deficiency
- Enteropeptidase deficiency
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5. Due to infective agents:
-Whipple's disease
-Intestinal tuberculosis
-Tropical sprue
-Parasites e.g. Giardia lamblia.
6. Due to other systemic diseases affecting GI
tract:
-Hypothyroidism and hyperthyroidism
-Diabetes mellitus
-Hyperparathyroidism and Hypoparathyroidism
-Carcinoid syndrome
-Malnutrition. Dr. Emeje Isaac Paul 8
Symptoms of malabsorption
Symptoms can abe
1.Extraintestinal
2.Intraintestinal
Diarrhoea, often steatorrhoea is the most common feature. It is
due to impaired water, carbohydrate and electrolyte absorption.
Othersymptoms include:
- Weight loss
-Growth retardation
-Swelling or edema
-Anaemias
-Muscle cramps and bleeding tendencies.
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Dr. Emeje Isaac Paul 10
1.Celiac sprue
- common cause of malabsorption
- Age: ranging from first year of life
through the eighth decade.
Etiology: not known.
But three factors can contribute:
1. environmental.
2. immunologic.
3. genetic factors.
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1. Environmental factor:
- There is association of the disease with gliadin,
a component of gluten that is present in wheat.
2. Immunologic factor:
- Serum antibodies are detected such as anti-
gliadin.
3. Genetic factor:
- Almost all patients express the HLA-DQ2 allele
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Diagnosis:
- A small-intestinal biopsy should be done
for suspected patients.
- The hallmark of celiac sprue is the
presence of an abnormal small-intestinal
biopsy.
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2.Tropical Sprue
- Caused by infectious agents including
Giardia lamblia, Yersinia enterocolitica,
Clostridum difficile.
-it tends to involve the distal small bowel.
-total villous atrophy is uncommon.
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3.Crohn’s Disease
It is an inflammatory bowel disease
Marked by patchy areas of
inflammation anywhere in GIT
from mouth to anus .
Body’s immune system attacks GIT
leading to chronic inflammation.
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4. Short Bowel Syndrome
-Following resection, diarrhea and/or
steatorrhea can appear due to decrease
in the area of the absorptive surface area.
-Other symptoms include cramping,
bloating and heartburn.
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5.Bacterial Overgrowth Syndrome
- There is proliferation of colonic-type
bacteria within the small intestine.
- Due to stasis caused by impaired
peristalsis . This lead to diarrhea and
malabsorption.
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Pathophysiology:
* Bacterial over growth leads to:
1. Metabolize bile salt resulting in deconjugation of bile
salts;
Bile Salt and malabsorption of fat.
2. Damage of the intestinal villi by:
Bacterial invasion
Toxin/.
Metabolic products
Damaged villi cause total villous atrophy.
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6. Whipple's Disease
Cause: by the bacteria Tropheryma whipplei.
Effect:
Chronic multisystem disease associated with diarrhea,
steatorrhea, weight loss, arthralgia, and central nervous
system (CNS) and cardiac problems .
Diagnosis:
- identification of T. whipplei by polymerase chain reaction
(PCR).
- PAS-positive macrophages in the small intestine and other
organs with evidence of disease.
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* Management of malabsorption syndrome:
Replacement of nutrients, electrolytes and fluid may
be necessary.
In severe deficiency, hospital admission may be
required for parenteral administration.
Pancreatic enzymes are supplemented orally in
pancreatic insufficiency.
Dietary modification is important in some conditions:
Gluten-free diet in coeliac disease.
Lactose avoidance in lactose intolerance.
Antibiotic therapy will treat Small Bowel Bacterial
overgrowth.
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