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Malabsorption

Definition
  • Impaired absorption of nutrients from the gastrointestinal tract.
Causes
  • Mucosal: Coeliac disease, tropical sprue, Crohn’s disease, radiation enteritis, Whipple’s disease.
  • Luminal: Pancreatic insufficiency (chronic pancreatitis, cystic fibrosis), bile salt deficiency (cirrhosis, cholestasis).
  • Postoperative: Gastric bypass, bowel resection.
  • Infective: Giardiasis, bacterial overgrowth, tuberculosis.
Clinical Features
  • Diarrhoea: Steatorrhoea (pale, smelly, sticky stools).
  • Weight loss despite normal or increased appetite.
  • Anaemia and fatigue.
  • Bruising and bleeding due to vitamin K deficiency.
  • Bone pain and fractures due to vitamin D and calcium malabsorption.
  • Peripheral neuropathy due to vitamin B12 deficiency.
Investigations
  • Blood tests: Full blood count, vitamin levels (e.g., B12, D), coagulation profile.
  • Stool tests: Faecal fat estimation, faecal elastase (pancreatic function).
  • Small bowel biopsy (e.g., for suspected coeliac disease).
  • Imaging: Abdominal ultrasound, CT, or MRI.
  • Hydrogen breath test: To detect bacterial overgrowth.
  • Endoscopy and colonoscopy with biopsies if needed.
Management
  • Treatment is focused on the underlying cause (e.g., gluten-free diet for coeliac disease).
  • Pancreatic enzyme supplementation: For pancreatic insufficiency.
  • Bile salt replacement for bile salt deficiency.
  • Dietary modifications: High-calorie diet, vitamin and mineral supplementation.
  • Antibiotics for bacterial overgrowth or specific infections.
Complications
  • Nutritional deficiencies leading to conditions like osteoporosis, anaemia, or neuropathies.
  • Growth retardation in children.

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