Malabsorption syndrome - PowerPoint PPT Presentation

Loading...

PPT – Malabsorption syndrome PowerPoint presentation | free to download - id: 3be5ab-ZDcyZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Malabsorption syndrome

Description:

Malabsorption syndrome By: Dr. Elias S. Dr. Maruf A Malabsorption Impaired absorption of one or more dietary nutrients A pathophysiologic state with multiple ... – PowerPoint PPT presentation

Number of Views:3937
Avg rating:3.0/5.0
Slides: 19
Provided by: selamhighe
Learn more at: http://www.selamhigherclinic.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Malabsorption syndrome


1
Malabsorption syndrome
  • By
  • Dr. Elias S.
  • Dr. Maruf A

2
Malabsorption
  • Impaired absorption of one or more dietary
    nutrients
  • A pathophysiologic state with multiple
    etiologies/varied clinical manifestations
  • Dietary nutrient absorption in small b.
  • Ca., iron, folic acid absorbed in proximal SB
  • Cobalamine, bile acid in the ileum
  • Glucose, a.a., lipids throughout the SB
  • Malabsorption could be
  • Primary (congenital defects)
  • Secondary (acquired defects)
  • Clinical Sx usually due to
  • Malabsorption of fat /or carbohydrate (with
    water electrolyte Mal.)
  • Steatorrhea ? main feature in most cases

3
Nutrient malabsorption
Intestinal secretion
Diarrhea Steatorrhea Watery D. Inflammatory D.
Inflammation
4
mechanisms
  • Luminal phase (processing defect)
  • Digestive enzyme deficiency / inactivation
  • ?bile salt synthesis ?Excretion ?loss bile
    salt de-conjugation
  • ?gastric acid ?intrinsic factor (p. anemia)
  • Bacterial consumption of nutrients
  • Mucosal phase
  • Epithelial transport defect inflammations
    infections
  • Brush border hydrolysis defect
    ?congenital/acquired disacharidase deficiency
  • Post-absorptive phase
  • Enterocyte processing Abetalipoproteinemia
  • Lymphocytic obstruction intestinal
    lymphangectasia

5
causes
  • Exocrine pancreatic insufficiency ch.
    Pancreatitispancreatic CAcystic fibrosis
  • Inactivation of pancreatic lipase
    Gastrinoma(ZES) drugs (orlistat)
  • ?bile acid (impaired micelle
    formation)parenchymal liver D.cholestatic liver
    D.
  • Bacterial overgrowthAnatomic stasis(blind
    loop,stricture,fistula)Functional stasis(DM,
    scleroderma)
  • Interrupted interohepatic circulation of bile
    acid(ileal resection, crohns D.)
  • Drugs(bind or precipitate bile salt) neomycin,
    chlestyramine
  • Impaired mucosal absorbtion/mucosal loss or
    defectintestinal resection or bypassinflammation
    /infiltration/infect.(celiac sprue, tropical
    sprue,whippls disease, lymphoma,mastocytosis,
    eosinophilic e.,scleroderma, crohns D., )
  • Impaired nutrient transportlymphatic
    obstruction(lymphoma, lymphangectasia)CHF
  • Genetic disorders disacharidase defficiency
    Agamaglobulinemia Abetalipoprotinemia
  • Endocrine/Metabolic disorders DM
  • Hyperthyroidism adrenal
    insufficiency
  • carcinoid syndrome

6
Clinical featuresDepend on the cause and severity
  • Glabal
  • Diffuse mucosal involvement
  • Impaired absorption of all nutrients
  • Classic manifestationDiarrhea(steatorrhea)weight
    loss
  • Majority sub clinical
  • E.g.. Celiac disease
  • Partial (isolated)
  • 2 to diseases that interfere with absorption of
    specific nutrientsE.g.Pernicious Anemia
    Lactase deficiency

7
Signs symptoms
8
Clinical Evaluation
  • In 75-80 of cases
  • Dx by expert Hx P/E focused lab tests
  • 25 - need extensive study/ Hospitalization
  • Hx -
  • Diarrhea- duration, consistency, frequency
    stool characteristics, Volume
    time of occurrence, association
    with diet etc.
  • Bloating,borborigmi, flatus
  • Abdominal pain
  • Sxs of extra intestinal manifestation (joint
    pain, mouth ulcer..)
  • Previous abd. Surgery
  • medication
  • Alcohol intake
  • Recurrent PUD
  • DM , CLD
  • Falmily Hx celiac disease, crohns D.)
  • Risk factors HIV infection

9
  • P/E thorough examination
  • Look for ?signs of specific nutrient
    Malabsorption?extraintestinal signs
  • Lab.
  • CBC, PT, serum protein, ALP
  • Checks for depletion of iron,folate, B12, Vit D,
    Vit K)
  • RFT,electrolytes
  • Stool exam
  • Additional tests
  • Serum carotene, cholesterol, albumin, iron,
    folate cobalamine

10
Tests for steatorrhea
  • Quantitative test
  • 72hr stool fat collection gold standard
  • gt 6gm/day pathologic
  • Pts with steatorrhea - gt20gm/day
  • Modest elevation in diarrheal disease (may not
    necessarily indicate Malabsorption)
  • Qualitative tests
  • Sudan lll stain
  • Detect clinically significant steatorrhea ingt90
    of cases
  • Acid steatocrit a gravimetric assay
  • Sensitivity 100, specificity 95 , PPV 90
  • NIRA (near infra reflectance analysis)
  • Equally accurate with 72hr stool fat test
  • Allows simultaneous measurement of fecal fat,
    nitrogen, CHO

11
Schilling test
  • To determine the cause of cobalamine(B12)
    malabsorbtio
  • Helps to asses the integrity of gastric,
    pancreatic and ileal functions.
  • Abnormal cobalamine absorbtion inpernicious
    anemia, ch. Pancreatitis, Achlorohydria,
    Bacterial overgrowth, ileal dysfunction
  • The test
  • Administering 58Co-labeled cobalamine p.o.
  • Cobalamine 1mg i.m. 1hr after ingestion to
    saturate hepatic binding sites
  • Collecting urine for 24 hr (dependant on
    normal renal bladder function)
  • Abnormal - lt10 excretion in 24 hrs

12
Schilling test cont.
13
D-xylose test
  • D-xylose
  • A Pentose monosacharide absorbed exclusively at
    the proximal SB
  • Used to asses proximal SB mucosal function
  • The test
  • After overnight fast, 25gm D-xylose p.o.
  • Urine collected for next 5 hrs
  • Abnormal test - lt4.5 gm excretion show
    duodenal / jejunal mucosal D.
  • False ve results Renal dysfunction
    Inadequate urine sample
  • Impaired gastric
    empyting, ascitis

  • Drugs(ASA,indometacin, Neomycin)

14
  • Othe tests for carbohydrate malabsorbtion
  • Lactose tolerance test
  • P.o. 50gm lactose
  • Bloood glucose at 0,60,120 min.
  • BG lt20mg/l devt of Sxs diagnostic
  • Breath tests (hydrogen,4Co2,13Co2)
  • Test for bacterial overgrowth
  • Quantitative bacterial count from aspirated SB.
    Normal count lt 10?/ml (jejunum)
    gt 10?/ml (ileum)
  • Tests for pancreatic insufficiency
  • Stimulation of pancreas through adm. Of a mealor
    hormonal secretagogues , then analysis of
    duodenalfluid
  • Indirect tests schilling test
  • Tests for protein malabsorption Enteral
    protein loss ? measuring alpha-1 antitirypsin
    clearance

15
Endoscopy
  • Gross morphology gives diagnostic clue
  • Cobblestone appearance crhons D.
  • Reduced duodenal folds and scallopngof duodenal
    mucosa celiac disease
  • Use of vital dyes to identify villous atrophy
  • Biopsy to establish Dx
  • For pts with documented steatorrheaor ch.
    Diarrhea
  • Lesions seen classifid in to three
  • Diffuse,specific e.g. whippls Disease
  • Patchy, specific crohns D., lymphoma
    infectious causes
  • Diffuse,non-specific celiac sprue, Tropical
    sprue
    autoimmune enteropathy
  • Suspected distal pathology - push enteroscopy

    wireless capsule endoscopy

16
(No Transcript)
17
Barium studies
  • Important information about the gross anatomy and
    morphology of SB
  • Upper GI series with SB follow through
  • Enteroclysis
  • double contrast study by passing a tube into
    proximal SB and injecting barium
    methylcellulose
  • Normal study doesnt exclude SB disease

18
(No Transcript)
About PowerShow.com