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Absorption

1. MALABSORPTION SYNDROME

2. DEFINITION Malabsorption syndrome is a group of disorders marked by subnormal absorption of dietary constituents and thus excessive loss of nutrients in the stools, which may be a defect in digestion or a mucosal abnormality or lymphatic obstruction.

3. CAUSES Gall bladder and pancreatic diseases Lymphatic obstruction Vascular impairment Bowel resection Mild to moderate steatorrhea Iron deficiency anemia Intestinal parasitosis

4. CLINICAL MANIFESTATIONS Chronic diarrhea Abdominal distension Failure to thrive Flatulence Anorexia Fatigue Loss of weight Malnutrition and growth failure

5. CONT…… Stools may be loose and bulky in celiac disease, pasty and yellowish in exocrine pancreatic insufficiency. It may be liquid as water and mistaken for urine in infants with congenital chloride diarrhea or passed with noise and flatus in case of sugar intolerance. Malabsorption and chronic diarrhea is manifested in three major categories , i.e. Impaired digestion, intestinal malabsorption and carbohydrate malabsorption .

6. INVESTIGATIONS History of illness and characteristic stool General health and appearance Routine stool examination Fecal fat studies D- xylase test Intestinal biopsy Sweat chloride test for cystic fibrosis Exocrine pancreatic function test in steatorrhea Serology for celiac disease Breath analysis for carbohydrate malabsorption Lactose tolerance test Radiology like barium meal study help to detect structural problems Serum IgA , antigliadin antibodies represent reliable screening test for celiac disease

7. MANAGEMENT Symptomatic control of diarrhea is desirable. In celiac disease , a strict gluten free diet is the cornerstone of management. Rice and maize are nontoxic and act as wheat substitutes. In cystic fibrosis , the diet is introduced gradually with simple nutrients which are tolerated. Diet should be planned with food items rich in protein and sugar. Vegetable fats rich in polyunsaturated fatty acid are preferred to the animal fats. Pancreatic supplements, antacids, sodium bicarbonate and antihistamine are essential.

8. CONT…….. Suitable antibiotics, additional salt during summer months and prostaglandin analogue are used. Breathing exercises with chest physiotherapy are encouraged to prevent pulmonary complications. Gene therapy is now available for cystic fibrosis. Treatment of carbohydrate malabsorption consists of excluding glucose and galactose from diet. A period of intravenous nutrition is usually indicated in serious cases.

9. NURSING MANAGEMENT Assessment Intake and output Daily weight Vital signs Serum electrolytes and GI functions Improvement of nutritional status and supplementation of deficient nutrients or substituting them. Restoration of fluid and electrolyte balance by oral and parenteral therapy. Relief of pain by medications, fowler's position and comfort.

10. CONT……. Administer Analgesics, antiflatulents and antidiarrheal agents Maintenance of skin integrity specially of perianal area. Health education to the parent about general cleanliness, nutrition, hydration, danger signs, home care and follow up for necessary medical help. Relief of fear and anxiety about long-term illness

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