1. Malabsorption 9/14/2015 1

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3. CONDITIONS OF MALABSORPTION Malabsorption: is the inability of the digestive system to absorb one or more of The major vitamins( B12) Minerals (iron& calcium) Nutrients (carbohydrates,fats& proteins). Interruptions in the complex digestive process may occur anywhere in the digestive system and cause decreased absorption. Diseases of the small intestine are the most common cause of malabsorption. 9/14/2015 3

4. The conditions that cause malabsorption can be grouped into the following categories:  Mucosal disorders; causing generalized malabsorption (celiacsprue, regional enteritis, radiation enteritis).  Infectious diseases causing generalized malabsorption (small bowel bacterial overgrowth)  Luminal problems causing malabsorption(pancreatic insufficiency) 9/14/2015 4

5. Pathophysiology Postoperative malabsorption ( gastricorintestinal resection). Disorders that cause malabsorption of specific nutrients 9/14/2015 5

6.  The hallmarks are diarrhea or frequent, loose, bulky, foul smelling stools that have increased fat content &are often grayish.  Abdominal distention, pain, increased flatus, weakness, weight loss, &a decreased sense of well-being.  The chief result of malabsorption is malnutrition, manifested by weight loss and other signs of vitamin and mineral deficiency (eg, easy bruising, osteoporosis, anemia). 9/14/2015 6

7.  Patients with a malabsorption syndrome,if untreated, become weak & emaciated because of starvation & dehydration  Failure to absorb the fat-soluble vitamins A, D,and K causesa corresponding avitaminosis. 9/14/2015 7

8.  Stool for quantitative &qualitative fat analysis.  Lactose tolerance tests, D-xylose absorption tests  Endoscopy with biopsy of the mucosa is the best diagnostic  Biopsy of the small intestine is performed to assay enzyme activityor to identify infection or destruction of mucosa.  Ultrasound studies, CT scans, & x-ray findings can reveal pancreatic or intestinal tumors that may be the cause.  A complete blood cellcount is used to detect anemia  Pancreatic function tests can assist in the diagnosis of specific disorders. 9/14/2015 8

9.  Intervention is aimed at avoiding dietary substances that aggravate malabsorption & at supplementing nutrients that have been lost.  Common supplements are water-soluble vitamins(eg, B12, folic acid), fat-soluble vitamins (ie, A, D, and K), &minerals (eg,calcium, iron).  Dietary therapy is aimed at reducing gluten intake in patients with celiac sprue. 9/14/2015 9

10.  Folic acid supplements are prescribed for patients with tropical sprue  Antibiotics(eg, tetracycline, ampicillin) are sometimes needed in the treatment of tropical sprue & bacterial overgrowth syndromes.  Antidiarrheal agents may be used to decrease intestinal spasms.  Parenteral fluids may be necessary to treat dehydration. 9/14/2015 10

11.  The nurse provides patient & family education regarding diet& the use of nutritional supplements (Chart 38-2).  It is important to monitor patients with diarrhea for fluid & electrolyte imbalances.  Patient education includes information about the risk of osteoporosis related to malabsorption of calcium 9/14/2015 11