Malabsorption De Vera, Jestha Marie Bernadette Dela Cruz, Ciara Mae Dela Cruz, Fatima

Malabsorption Defective absorption of fats, fat-soluble and other vitamins, proteins, carbohydrates, electrolytes and minerals, and water Most common clinical presentation is CHRONIC DIARRHEA Hallmark: Steatorrhea Cause excessive fecal excretion and produce nutritional deficiencies and GI symptoms

Malabsorption occurs when any of these digestive functions is impaired: 1.INTRALUMINAL DIGESTION – Proteins, carbohydrates and fats are broken-down into assimilable forms. 2.TERMINAL DIGESTION – Hydrolysis of carbohydrates and peptides in the brush border of the small intestinal mucosa 3.TRANSEPITHELIAL TRANSPORT – Nutrients, fluid & electrolytes are transported across the epithelium of the small intestine for delivery to the intestinal vasculature – Absorbed fatty acids  triglycerides + cholesterol  chylomicrons  intestinal lymphatic system

COMMON CAUSES OF MALABSORPTION MechanismSpecific Disease MaldigestionChronic pancreatitis, cystic fibrosis, pancreatic carcinoma Bile Salt deficiencyCirrhosis, cholestasis, bacterial overgrowth, impaired ileal reabsorption, bile salt binders Inadequate Absorptive surfaceMassive intestinal resection, gastrocolic fistula, jejunoileal bypass Lymphatic obstructionLymphoma, Whipple’s disease, intestinal lymphangiectasia Vascular diseaseConstrictive pericarditis, right-sided heart failure, mesenteric arterial or venous insufficiency Mucosal diseaseInfection (esp.Giardia, Whipple’s disease, tropical sprue), Inflammatory diseases, radiation enteritis, eosinophilic enteritis, ulcerative jejunitis, mastocytosis, biochemical abnormalities

Work-ups Timed (72 h) quantitative stool collection Fat malabsorption: >6g in 24 h Complete blood count Small intestinal mucosal biopsy Short or absent villi Mononuclear infiltrate Epithelial cell damage Hypertrophy of crypts

Treatment Broad-spectrum antibiotics Tetracycline for up to 6 months Folic Acid