My Clinical Notes

• Characterised by defective absorption of fats, fat soluable and other vitamins, protein, carbohydrates, electrolytes and minerals and water
• Due to disturbance of at least one of the these normal digestive functions;
  • Intraluminal digestion – including secreted enzymes and emulsification
  • Terminal digestion – involves the hydrolysis of carbohydrates and peptides at the brush border of the small intestinal mucosa
  • Transepithelial transport – in which nutrients, fluid and electrolytes are transported across the epithelium of the small intestine to the intestinal vasculature

 

Major malabsorption syndromes

• Defective intraluminal digestion
  • Pancreatic insufficiency
  • Zollinger-Ellison syndrome – inactivation of pancreatic enzymes by excess gastric acid secretion
• Primary mucosal cell abnormalities
  • Defective terminal digestion
    • Disaccharide deficiency (e.g. lactose intolerance)
    • Bacterial overgrowth causing brush border damage
  • Defective epithelial transport
• Reduced small intestinal surface area
  • Coeliac disease
  • Crohn disease
• Lymphatic obstruction
  • Lymphoma
  • TB and tuberculous lymphadenitis
• Infection
  • Acute infectious enteritis
  • Parasitic infestation
  • Tropical sprue
  • Whipple disease
• Iatrogenic
  • Subtotal or total gastrectomy
  • Short gut syndrome following surgical resection
  • Distal ileal resection or bypass

 

Clinical consequences of malabsorption syndrome

• Alimentary tract; diarrhoea, flatus, pain, weight loss, steatorrhoea
• Haematopoietic syndrome – anaemia and bleeding
• Musculoskeletal syndrome – osteopenia and tetany
• Endocrine system – amenorrhoea, impotence, infertility, hyperparathyroidism
• Skin – purpura and petechiae, oedema and dermatitis
• Nervous system – peripheral neuropathy
• The malabsorption syndromes most common in the West are;
  • Coeliac disease
  • Pancreatic insufficiency
  • Crohn disease

This entry was posted on Monday, February 25th, 2008 at 5:12 pm and is filed under Gastrointestinal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.