Malabsorption syndrome

By:-
Ms. Sarungbam Sarju Devi
Asst. Professor
RINPS
 TERMs

◼ Malabsorption: impaired transport across the

mucosa

◼ Zollinger-Ellison syndrome- Hyperacidity in

duodenum inactivates pancreatic enzymes

◼ Whipple’s disease -Bacterial invasion of intestinal

mucosa
 TERMs

◼ Lactose intolerance- Deficiency of intestinal lactase

results in high concentration of intraluminal lactose
with osmotic diarrhea

◼ Tropical sprue- Unknown toxic factor results in

mucosal inflammation, partial villous atrophy
 TERMs
◼ Celiac disease (gluten enteropathy)-Toxic response
to a gluten fraction by surface epithelium results in
destruction of absorbing surface
◼ In simple understanding Celiac disease is a
digestive disease that damages the small intestine and
interferes with absorption of nutrients from food
◼ People who have celiac disease cannot tolerate
gluten, a protein in wheat, rye, and barley.
 Definition

◼Mal-absorption is the inability of the digestive

system to absorb one or more of the major
vitamins (especially vitamin B12), minerals (ie,
iron and calcium), and nutrients (ie, carbohydrates,
fats, and proteins).
◼Diseases of the small intestine are the most
common cause of mal-absorption.
 Causes
◼ Normally .Protein, fats, and carbohydrates
(macronutrients) normally are absorbed in the small
intestine; the small bowel also absorbs about 80% of the
eight to ten litres of fluid ingested daily.

◼ A fault in the digestive process may result from failure

of the body to produce the enzymes needed to digest
certain foods.
 Causes
◼Congenital structural defects or diseases of the
pancreas, gall bladder, or liver may alter the
digestive process.

◼Inflammation, infection, injury, or surgical

removal of portions of the intestine may also
result in absorption problems; reduced length or
surface area of intestine available for fluid and
nutrient absorption can result in malabsorption.
 Causes
◼Radiation therapy may injure the mucosal lining
of the intestine.

◼The use of some antibiotics can also affect the

bacteria that normally live in the intestine and
affect intestinal function.
 Pathogenesis
◼ The main purpose of the gastrointestinal tract is to digest
and absorb nutrients (fat, carbohydrate, protein, and
fiber), micronutrients (vitamins and trace minerals),
water, and electrolytes.
◼ Digestion involves both mechanical and enzymatic
breakdown of food.
◼ Mechanical processes include chewing, gastric churning
◼ Enzymatic hydrolysis is initiated by intra-luminal
processes requiring gastric, pancreatic, and biliary
secretions. The final products of digestion are absorbed
through the intestinal epithelial cells.
Intestinal malabsorption conditions can be DUE
to the following categories:

◼Mucosal (transport) disorders causing

generalized mal-absorption (eg, celiac sprue,
regional enteritis, radiation enteritis)
◼ Infectious diseases causing generalized mal-
absorption (eg, small bowel bacterial
overgrowth, Whipple’s
disease)
◼ Luminal problems causing malabsorption (eg,
bile acid deficiency, Zollinger-Ellison
syndrome, pancreatic insufficiency)
◼Postoperative malabsorption (e.g, after gastric
or intestinal resection)
◼Disorders that cause malabsorption of specific
nutrients (eg, disaccharidase deficiency leading
to lactose intolerance)
Small overview
 Symptoms
▪ Hallmarks of malabsorption syndrome from any
cause are diarrhea or frequent, loose, bulky, and are
often grayish,steatorrhea (excessive amount of fat in
the stool), and abdominal distention with cramps,
bloating, and increased flatus, weakness, weight loss,
and a decreased sense of well-being

▪ due to impaired water and carbohydrate absorption,

and irritation from unabsorbed fatty acids
 Symptoms

◼Anaemia, with weakness and fatigue due to

inadequate absorption of vitamin B12 and
mineral deficiency like iron, and folic acid

◼Malnutrition and weight loss due to decreased

fat, carbohydrate, and protein absorption.

◼Muscle cramping due to decreased vitamin D,

calcium, and potassium levels
 Symptoms
◼ Muscle wasting and atrophy due to decreased protein
absorption and metabolism

◼ Perianal skin burning, itching, or soreness due to

frequent loose stools.

◼ Irregular heart rhythms may also result from inadequate

levels of potassium and other electrolytes.

◼ Blood clotting disorders may occur due to a vitamin K

deficiency.
 Symptoms

◼Patients with a mal-absorption syndrome,

if untreated, become weak and emaciated
because of starvation and dehydration.

◼ Failure to absorb the fat-soluble vitamins A,

D, and K causes a corresponding avitaminosis.
 Diagnosis

◼ History Taking

◼ Physical Examination

◼A stool collection may be ordered for feacal fat

measurement; increased feacal fat in the stool collected
indicates malabsorption.

◼ Endoscopy with biopsy of the mucosa is the best

diagnostic tool.biopsy of the small intestine is performed
to assay enzyme activity or to identify infection or
destruction of mucosa.
Diagnosis

◼ Ultrasound, computed tomography scan (CT scan),

magnetic resonance imaging (MRI), other x rays to
identify abnormalities of the gastrointestinal tract and
can reveal pancreatic or intestinal tumors that may be
the cause

◼ A complete blood cell count is used to detect anemia.

◼ Pancreatic function tests can assist in the diagnosis of

specific disorders.
 Medical Management

◼Intervention is aimed at avoiding dietary

substances that aggravate malabsorption and at
supplementing nutrients that have
been lost.

◼Common supplements are water-soluble vitamins

(e.g, B12, folic acid), fat-soluble vitamins (i.e, A,
D, and K), and minerals (e.g, calcium, iron).
 Medical Management

◼Dietary therapy is aimed at reducing gluten

intake in patients with celiac sprue.

◼Folic acid supplements are prescribed for

patients with tropical sprue.

◼ Antibiotics (eg, tetracycline, ampicillin) are

sometimes needed in the treatment of tropical
sprue and bacterial overgrowth syndromes.
 Medical Management

◼Anti-diarrheal agents may be used to decrease

intestinal spasms.

◼Parenteral fluids may be necessary to treat

dehydration.

◼Diet modifications are required in case of

patients suffering from lactose intolerance and
avoid foods which are not easily digestible.
 Nursing Management
◼Fluid and nutrient monitoring and replacement
is essential for any individual with
malabsorption syndrome.

◼Hospitalization may be required when severe

fluid and electrolyte imbalances occur.

◼Consultation with a dietician to assist with

nutritional support and meal planning is
helpful.
Nursing Management
◼provides patient and family education
regarding diet and the use of nutritional
supplements
◼monitor patients with diarrhea for fluid and
electrolyte imbalances.
◼ongoing assessments to determine if the
clinical manifestations related to the
nutritional deficits have abated.
Nursing Management

◼ patient should be encouraged to eat several small,

frequent meals throughout the day, avoiding fluids
and foods that promote diarrhea.

◼ Intake and output should be monitored, along with

the number, color, and consistency of stools.

◼ Patient education includes information about the risk

of osteoporosis related to malabsorption of calcium.
 Assignment

◼ PREPARE NURSING DIAGNOSIS OF THIS

CONDITION AND SUBMIT WHEN CLASS
RESUME