Malabsorption syndrome

CHN

1. Malabsorption syndrome

2. 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. Micronutrients , as opposed to  macronutrients  (protein, carbohydrates and fat), are comprised of vitamins and minerals which are required in small quantities to ensure normal metabolism, growth and physical well-being.

4. Maldigestion  means incomplete breakdown of nutrients in the gastrointestinal tract, usually due to lack of digestive enzymes. Malabsorption  means impaired transport of nutrients from the intestine into the blood.

5. Due to infective agents Gastrointestinal tuberculosis  is defined as infection of the peritoneum, hollow or solid  abdominal  organs, and  abdominal  lymphatics with Mycobacterium tuberculosis  organisms.  Gastrointestinal tuberculosis   is relatively rare in the United States and is the sixth most common extrapulmonary location.

6. The small intestine  is a  major target in HIV  infection . Small intestinal disease  causes malabsorption  of fat  and disaccharides  and  may contribute to the weight loss seen in advancing  HIV  infection.

7. Parasites : such as intestinal coccidia and microsporidia in malabsorption syndrome  is limited. All the patients infected with intestinal coccidia were HIV sero-negative. Celiac disease is the most common cause of  malabsorption syndrome  in both adults and children.

8. Celiac disease , sometimes called  celiac   sprue or gluten-sensitive enteropathy , is an immune reaction to eating gluten, a protein found in wheat, barley and rye. If you have  celiac disease , eating gluten triggers an immune response in your small intestine.

9.   Whipple disease  is a rare bacterial infection that most often affects joints and digestive system.  Whipple disease  interferes with normal digestion by impairing the breakdown of foods, such as fats and carbohydrates, and hampering body's ability to absorb nutrients.

10. Tropical Sprue  is a rare digestive disease in which the small intestine's ability to absorb nutrients is impaired (malabsorption). Consequently, nutritional deficiencies and abnormalities in the mucous lining of the small intestine may be present.

11. Due to structural defects INFLAMMATORY BOWEL DISEASE  ( IBD ) is a term for two conditions ( Crohn's disease  and ulcerative colitis) that are characterized by chronic  inflammation  of the gastrointestinal (GI) tract. Prolonged  inflammation  results in damage to the GI tract.

12. Systemic sclerosis  is a  chronic  autoimmune disease with an unknown etiology. it is characterized by abdominal pain, diarrhea, pseudo-obstruction,  malabsorption

13. Diverticulitis Fistulas : A  fistula  is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs.  Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation.

14. Post gastroctomy, post vagotomy or gastro-jejunoctomy Radiation entritis

15. Due to mucosal abnormalities Celiac disease Crohn’s disease: Crohn's disease  is an  inflammatory bowel disease (IBD). It causes inflammation of digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.

16. Cow’s milk intolerance Soya milk intolerance Fructose malabsorption: fructose intolerance , occurs when cells on the surface of the intestines aren't able to break down fructose  efficiently.  Fructose  is a simple sugar, known as a monosaccharide, that comes mostly from fruit and some vegetables.

17. Due to enzyme insufficiency Lactose deficiency: Lactose intolerance  is a condition in which people have symptoms due to the decreased ability to digest  lactose , a sugar found in dairy products. Those affected vary in the amount of  lactose  they can tolerate before symptoms develop. Symptoms may include abdominal pain, bloating, diarrhea, gas, and nausea.

18. Sucrose intolerance Pancreatic insufficiency : Pancreatic Insufficiency  (EPI) is a condition which occurs when the  pancreas  does not make enough of a specific enzyme the body uses to digest food in the small intestine. The  pancreas  is a glandular organ. That means the  pancreas  secretes juices that maintain the proper function of the body.

19. Deficient or ineffective bile salts Intestinal disaccharides deficiency

20. Due to digestive failure Chronic pancreatitis Carcinoma of pancreas Zollinger - Ellison syndrome  is a rare condition in which one or more tumors form in pancreas or the upper part of small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes stomach to produce too much acid.

21. Obstructive jaundice : jaundice resulting from blockage of the bile ducts or abnormal retention of bile in the liver. Bacterial overgrowth

22. Due to other systemic disease affecting GI tract Hypothyroidism and hyperthyroidism Addison's disease , also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Symptoms generally come on slowly and may include abdominal pain, weakness, and weight loss.

23. Diabetes mellitus  (DM), commonly known as  diabetes , is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated,  diabetes can cause many complications.

24. Mastocytosis  is a condition that occurs when mast cells accumulate in skin and/or internal organs such as the liver, spleen, bone marrow, and small intestines. The signs and symptoms vary based on which part(s) of the body are affected. 

25. Mast cells plays an important p rotective role as well, being intimately involved in wound healing, immune tolerance, defense against pathogens. Mast cell is a immune system of vertebrae. It gives imflammatory resonse.that give res p onse to produce he p arine and histamine.

26. Amyloidosis : is a rare disease that occurs when a substance called amyloid builds up in your organs. Amyloid is an abnormal protein that is produced in your bone marrow and can be deposited in any tissue or organ.

27. Carcinoid syndrome  is a paraneoplastic  syndrome comprising the signs and symptoms that occur secondary to  carcinoid  tumors. 

28. Hypogammaglobulinemia  is an immune disorder characterized by a reduction in all types of gamma globulins, including antibodies that help fight infection. It may be congenital (present at birth), related to medication; it may be due to a kidney or gastrointestinal condition, cancer or severe burns.

29. DRUG INDUCED Laxative or antacids Neomycin cholestyramine

30. CLINICAL MANIFESTATIONS Many symptoms differ depending on the specific nutrient or nutrients that aren’t being absorbed properly. Other symptoms are a result of a deficiency of that nutrient, which is caused by its poor absorption.

31. Fats.  have light-colored, foul-smelling stools that are soft and bulky. Stools are difficult to flush and may float or stick to the sides of the toilet bowl. Protein.  have dry hair, hair loss, or fluid retention. Fluid retention is also known as edema and will manifest as swelling.

32. Certain sugars.  have bloating, gas, or explosive diarrhea. Certainvitamins.  have anemia, malnutrition, low blood pressure, weight loss, or muscle wasting.

33. Malabsorption may affect people based on age or gender. women may stop menstruating, and children may not grow properly. Their weight or rate of weight gain may be significantly below that of other children of a similar age and gender.

34. DIAGNOSTIC EVALUATION BLOOD TEST: These tests measure the level of specific nutrients in blood, such as vitamin B-12, vitamin D, folate, iron, calcium, carotene, phosphorus, albumin, and protein. A lack of one of these nutrients may not necessarily mean have malabsorption syndrome. It can mean you’re not choosing foods with healthy levels of nutrients. Normal levels of these nutrients suggest that malabsorption is not the problem.

35. STOOL TEST: Stool tests can measure fat in samples of stool, or feces. These tests are the most reliable because fat is usually present in the stool of someone with malabsorption syndrome.

36. RADIOLOGY TEST : Imaging tests, which take pictures of digestive system, may be done to look for structural problems. For instance, doctor could request a CT scan to look for thickening of the wall of small intestine, which could be a sign of Crohn’s disease.

37. Breath tests  can be used to test for lactose intolerance. If lactose isn’t being absorbed, it enters the colon. Bacteria in the colon break down the lactose and produce hydrogen gas. The excess hydrogen is absorbed from intestine, into bloodstream, and then into  lungs. then exhale the gas. If have hydrogen gas in breath after ingesting a product containing lactose, may have lactose intolerance.

38. A biopsy will likely be done using an endoscopy. A tube is inserted into mouth and sent through esophagus and stomach and into small intestine to take a small sample of cells.

39. MANGEMENT Treatment depends on cause and may include a special diet, medication to replace intestinal enzymes or reduce spasms, and vitamin or mineral supplements, such as B12 and iron.

40. 1. Replacements of nutrients, electrolytes and fluid may be necessary. In severe deficiency, hospital admission may be required for parentral administration. Surgery may need long term total parentral nutrition. Pancreatic enzymes are supplemented orally in insufficiency.

41. 2. Bacterial overgrowth usually respond well of course of antibiotics. Use of cholestyremine to bind bile acid will help reducing diarrhea in bile acid malabsorption.

42. 3. Dietary modification is important in some conditions. Life-long avoidance of particular food or food constituent may be needed in celiac disease.