1 Malabsorption syndromes Malabsorption syndromes Maria Papp, M.D, Ph.D Maria Papp, M.D, Ph.D 2 nd nd Department of Medicine, University Department of Medicine, University of Debrecen of Debrecen, Debrecen Debrecen, Hungary , Hungary Small bowel ● Complex organ involved in many different Complex organ involved in many different functions: functions: – process of digestion process of digestion – absorption of nutrients, electrolytes, water, bile salts absorption of nutrients, electrolytes, water, bile salts and drugs and drugs ● Length Length: : ~ 7-8 m, 8 m, internal surface internal surface: : ~ 3 m 3 m 2 2 (200m (200m 2 ) Malabsorption syndrome ≠ Enteropathy
14
Embed
Malabsorption syndromes - unideb.hugastro.unideb.hu/Malabsorption.pdf · Alteration of digestive processes (intraluminal phase) Type of alterationType of alteration Causing condition
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
Malabsorption syndromesMalabsorption syndromes
Maria Papp, M.D, Ph.DMaria Papp, M.D, Ph.D22ndnd Department of Medicine, UniversityDepartment of Medicine, University of Debrecenof Debrecen,,
DebrecenDebrecen, Hungary, Hungary
Small bowel
●● Complex organ involved in many different Complex organ involved in many different functions: functions: –– process of digestionprocess of digestion–– absorption of nutrients, electrolytes, water, bile salts absorption of nutrients, electrolytes, water, bile salts
and drugsand drugs
●● LengthLength: : ~~ 77--8 m, 8 m, internal surfaceinternal surface: : ~~ 3 m3 m 2 2 (200m(200m22))
Malabsorption syndrome≠
Enteropathy
2
Definitions
●● MaldigestionMaldigestion: defective hydrolysis of nutrients: defective hydrolysis of nutrients
●● MalabsorptionMalabsorption: : defective crossing through the defective crossing through the intestinal wall by products of normal digestionintestinal wall by products of normal digestion–– SelectiveSelective malabsorptionmalabsorption: : involve only specific involve only specific
substratessubstrates–– Global malabsorptionGlobal malabsorption: : generalizedgeneralized
●● Malabsorption Malabsorption syndromesyndrome: : complex of symptoms complex of symptoms secondary to maldigestion and/or malabsorption, secondary to maldigestion and/or malabsorption, realizing when the extension of the disease realizing when the extension of the disease exceeds the ability of intestine compensation.exceeds the ability of intestine compensation.
●● Alteration of digestive processesAlteration of digestive processes●● Alteration of uptake and transport caused by damageAlteration of uptake and transport caused by damage or or
reduction of absorption surfacereduction of absorption surface●● MiscellaneousMiscellaneous
Signs and symptomsSigns and symptoms●● Modification of the luminal content with persistenc e of Modification of the luminal content with persistenc e of
nutrients in the lumennutrients in the lumen (diarrhea, steatorrhea, meteorism, abdominal discomfort)
●● Decreased tissue utilization of nutrients, with defi ciency Decreased tissue utilization of nutrients, with defi ciency manifestationsmanifestations (paleness, asthenia, loss of weight, delay or stop of growth, edemas, mucosal, skin and adnexal dystrophy, amenorrhea, tetany, bone pain, hemorrhagic and neurological manifestations, hemeralopia, recurrent infections)
Malabsorption syndromes
Montalto MMontalto M.. Dig Dis.Dig Dis. 20020088
3
Alteration of digestive processes (intraluminal phase)
Type of alterationType of alteration Causing conditionCausing condition ConsequenceConsequence
Deficit of enzymes● Brush borderBrush borderαααα-Glucosidaseβ-Galactosidase (lactase)Enterokinase●●Pancreatic exocrinPancreatic exocrinsecretionsecretionAmylaseProteaseLipase
●● One of the commonOne of the commonestest chronic disorderchronic disorderss in Europe (1%) in Europe (1%) associatedassociated with severewith severe morbiditymorbidity..
●● AutoimmunAutoimmunee disorderdisorder which is which is precipitated by ingestion precipitated by ingestion of of gluten gluten (storage(storage protein of protein of wheatwheat, , barleybarley, , rye) rye) in in a a geneticallygeneticallypredisposed personpredisposed person..
●● 90% of the cases are unrecognized in childhood, how ever 90% of the cases are unrecognized in childhood, how ever autoimmunautoimmunee processes are ongoingprocesses are ongoing..
●● GlutenGluten--free diet is an effective treatment of the disease free diet is an effective treatment of the disease and and prevent complications. prevent complications.
●● AAutoantibodies against transglutaminase develop an d appear in utoantibodies against transglutaminase develop and appear in the circulationthe circulation dduring the course of the diseaseuring the course of the disease. . These These antibodies are detectable by laboratory methods.antibodies are detectable by laboratory methods.
Celiac disease – pathogenesis
Green P. N Engl J MedGreen P. N Engl J Med.. 20072007
Does not develop unless a person has alleles that
encode for HLAHLA--DQ2 or DQ8DQ2 or DQ8
7
Celiac disease – detection of antibodies
Celiac disease – damage of the small intestinal wall
8
Celiac disease – signs and symptoms
● Iron-deficiency anemia● Lactose intolerance● Failure to thrive,
short stature, delay of puberty
● Hair loss, dry skin ● Eye and tongue redness● Problem with
● Chronic inflammatory bowel disease with multifactorial etiology
● Any part of the digestive tract could be involved (segmentary manner)
● Typical endoscopic and histologic findings● Frequent complications: development of
stenosis and fistulae (! bacterial overgrowth)● Clinical presentation is variable according to
different localizations– Ileum: selective malabsorption of B12 vitamin and
bile salts (diarrhea not always be present)
– Extensive jejuno-ileal: malabsorption and steatorrhea are more severe
– Colon: diarrhea with presence of blood, abdominal pain
10
„Short-bowel syndrome”
● In patients who have undergone a large surgical resection of the small bowel
● Clinical manifestations are various and depend on localization and extension of resection
● Causes of malabsorption:– loss of absorption surface– impaired synthesis of gastrointestinal hormones– accelerated intestinal transit– possible loss of the ileocecal valve (retrograd bac terial
migration – small intestinal bacterial overgrowth)
Circulatory alterations – hematic and lymphatic I.
● Mucosal ischemic injury → atrophy of the enterocytes
● Global malabsorption with diarrhea, steatorrhea, loss of proteins, weight loss and other signs of malnutrition
● Main alterations:– chronic mesenteric ischemia(arteriosclerosis, vasculitis, infective arteritis,
● Systemic sclerosis: – common (50-90%) and affects many site of GI tract– typically results from the fibrosis (collagen deposi tion)– impaired intestinal motility, digestion, absorption and excretion– reduce hematic flow, lymphatic obstruction