Definition – A state in which absorption of one or more substance by the small intestine is reduced. It commonly effects fat, vitamins, electrolytes, iron and amino acids.
Small intestine – consists of three part
i) Duodenum, ii) Jejunum, iii) ileum
Duodenum receives pancreatic enzymes from the pancreas and bile from the liver and gall bladder which are important in aiding digestion and absorption. Peristalsis also aids digestion and absorption by churning up food and mixing it with intestinal secretions. Small projections (villi) and smaller projection (microvillus) increase the surface area of the duodenal lining, allowing for greater absorption of nutrients. Jejunum and ileum are largely responsible for absorption of fats and other nutrients.
A) Disorders of Intraluminal digestion-
i) deficiency of pancreatic lipase
ii) deficiency of bile acids
iii) If a large number of bacteria present, some of them may deconjugate bile acid.
B) Disturbance of gastric function- after gastric surgery.
C) Disorders of transport in the mucosal cell.
i) celiac disease
ii) tropical sprue
iv) crohn’s disease
D) Disorders of transport from the mucosal cells rarely it happens – due to blockage of lymphatic system
Symptoms – Symptoms of malabsorption are diverse in nature and variable in severity. A few patients have apparently normal bowel habit but diarrhea is usual and may be watery and voluminous. Bulky, pale, offensive stools which float in the toilet. Abdominal distension broborygmi, cramps, weight loss and undigested food the stool may be present. Some patients complain only of malaise and lethargy.
Diagnosis and investigations
1) Investigate small intestine
2) Investigate Pancreas
3) Investigate bile salt malabsorption
Modern treatment – According to the cause.