Malabsorption syndromes steatorrhea

Malabsorption syndrome Steatorrhea Tropical sprue Idiopathic hypercalcemia... 

It should be noted that deficiency states for some vitamins (e.g., pantothenic acid) are practically unknown in human beings. In such cases, deficiency states may be simulated by feeding the subject an appropriate vitamin antagonist. In another series of situations, vitamin deficiencies can be brought about by interfering with their absorption intentionally or may be the result of a disease process. Thus, fat-soluble vitamin deficiency may develop in cases of fat malabsorption syndromes (steatorrhea) sprue, pancreatic insufficiency, and bile duct obstruction. 

Malabsorption syndrome (steatorrhea, diarrhea, flatus, failure to thrive)... 

Whipple s disease is a rare malabsorption syndrome, which usually occurs in men aged 30-60 years of age. It is caused by a bacterium, Tropheryma whippelii, which infiltrates the mucosa of the small intestine. The symptoms are characterised by arthritis, steatorrhea, weight loss, abdominal pain, fever and weakness. Treatment consists of prolonged administration of antibacterial drugs and the correction of nutritional deficiencies. 

Glucocorticoid antagonism Idiopathic hypercalcemia Malabsorption syndrome Sarcoidosis Steatorrhea Tropical sprue... 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Several diseases, called malabsorption syndromes, result in the lack of absorption of a number of nutrients. Their consequent loss in the feces dearly is not desirable. Malabsorption of lipids, which occurs more frequently than malabsorption of any other class of nutrient, can result in diarrhea and steatorrhea. Steatorrhea, production of feces with a high fat content, derives its name from "stearic add," a fatt> acid, With severe steatorrhea, over 30 g fat may appear in the feces per day. The problem can be elicited by liver diseases that piev ent the pn>duction of bile salts and thus impair the absorption of fats. 

Bile acid malabsorption leading to chronic diarrhea occurs when there is ileal disease (e.g., Crohn s disease), or after resection of the terminal deum it may also occur following cholecystectomy and in some patients with irritable bowel syndromed The malabsorption of bile salts produces diarrhea by two different mechanisms. When significant bile salt depletion occurs, the deficiency of intraluminal bile salts leads to fat malabsorption and steatorrhea. More commonly, malabsorption of bile salts in the ileum leads to increased concentrations of bile salts in the colon where they alter water and electrolyte absorption. This leads to net secretion of water into the lumen and diarrhea. Bile salt malabsorption is probably an underdiagnosed condition and should be suspected in patients with unexplained chronic diarrhea. 

Malnutrition may also result from disease of the gastrointestinal tract. Among the malabsorption syndromes, carbohydrate malabsorption due to inborn errors of metabolism, the dumping syndrome resulting from gastrectomy, and steatorrhea will be discussed [136]. 

Badenoch (1954) found one patient with chronic hypochromic anemia, achlorhydria, and gastric atrophy whose response to fecal excretion tests with radioactive vitamin Bn was the same as in patients with pernicious anemia. There is, of course, reason to suppose that this patient will develop pernicious anemia in the future. The same applies to patients after total gastrectomy in whom results with this test have been the same as in patients with pernicious anemia, even though anemia has not yet developed. In patients suffering from a malabsorption syndrome with or without steatorrhea, there may be defective absorption of vitamin B12 but with little or no improvement when intrinsic factor is given (Badenoch et ah, 1954 Baker and Mollin, 1955). 

If there is free hydrochloric acid in the gastric juice, or if there is little or no response to vitamin B12, efforts must be made to exclude a malabsorption syndrome. Conway (1952) found that, of 131 cases originally diagnosed as Addisonian pernicious anemia, 8 fell into the age group under 30 years. One had died from refractory macrocytic anemia. Of the other seven patients four had occult steatorrhea. Alimentary symptoms were trivial. In three of these four patients the anemia was refractory to liver extract and in the fourth it responded incompletely, with persistent... 

Dietary modification will differ due to the cause of the malabsorption syndrome. In general, the diet should be high in calories and protein, but some disorders require the elimination of certain carbohydrates, proteins, or amino acids. Persistent diarrhea may be dealt with by a soft or fiber-restricted diet Furthermore, a modification of fat intake is beneficial for example, the common practice of incorporating medium chain triglycerides (8- and 10-carbon chains) into the diet. Medium chain triglycerides substitution can reduce the steatorrhea and the losses of calcium, sodium, and potassium observed in many malabsorption syndromes. 

Abetalipoproteinemia or Bassen-Kornzweig syndrome, a potentially disabling, familial disease characterized by lack of plasma TGs, malabsorption of fat-soluble vitamins, liver steatosis, steatorrhea, and other symptoms, is linked to mutations in the MTP functional subunit [52,53],... 

Pancreatic enzyme replacement or supplement when enzymes are absent or deficient, such as with chronic pancreatitis, cystic fibrosis, or ductal obstruction from cancer of the pancreas or common bile duct to reduce malabsorption treatment of steatorrhea associated with bowel resection or postgastrectomy syndrome PO 1-3 capsules ortablets before or with meals or snacks. May increase to 8 tablets/dose. 

Gastric stasis and hypochlorhydria secondary to vagotomy diarrhea and steatorrhea Dumping syndrome, malabsorption, lack of intrinsic factor, hypoglycemia Malabsorption, renal oxalate stones, metabolic acidosis, diarrhea Malabsorption, diabetes mellitus... 

The most important adverse effects resulting from the oral administration of neomycin are intestinal malabsorption and superinfection. Individuals treated with 4 to 6 g/day of the drug by mouth sometimes develop a spruelike syndrome with diarrhea, steatorrhea, and azotorrhea. Overgrowth of yeasts in the intestine also may occur this is not associated with diarrhea or other symptoms in most cases. 

Carbohydrate Malabsorption 318 The Dumping Syndrome 318 Steatorrhea Idiopathic Steatorrhea Celiac Disease or Nontropical Sprue... 

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