Discuss vitamin c, it's deficiency, sources, clinical features, differential Dr, and treatment options.

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Discuss vitamin c, it's deficiency, sources, clinical features, differential Dr, and treatment options.

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Malabsorption

Outline
• Normal digestion and absorption
• Classification of malabsorption
• Tests of malabsorption
• Clinical approach to diagnosis
• Management principles

Definition
• Malabsorptive syndromes are conditions that
cause insufficient assimilation of ingested
nutrients as a result either of maldigestion or
malabsorption.

Malabsorption vs. Maldigestion

Def: Decreased/impaired intestinal absorption
of macronutrients and/or micronutrients
• “malabsorption” – defect in mucosal
phase
• “maldigestion” – defect in intraluminal
phase

Normal Digestion and Absorption
• Mechanical mixing
• Enzyme and bile salt
production
• Mucosal function
• Blood supply
• Intestinal motility
• Commensal gut flora

Fat Digestion and Absorption

Carbohydrate and Protein Digestion and
Absorption
Protein  Oligopeptides  AA
Pancreatic proteases

Digestion

Mucosal peptidases

Absorption

Distribution

CHO  Oligosaccharides  Sugars
Pancreatic amylase

Mucosal disaccharidases

Absorption
• Three steps are required for normal nutrient
absorption:
• Luminal and brush border processing
• Absorption into the intestinal mucosa
• Transport into the circulation

Classification of Malabsorption
• Luminal
• Mucosal
• Postabsorptive

• Global/Total
• Partial
• Selective

• Overt
• Subclinical
• Asymptomatic

• CHO
• Protein
• Fat

Phase and nature of malabsorptive defect
Luminal phase
A. Substrate hydrolysis
1. Digestive enzyme deficiency - Chronic pancreatitis
2. Digestive enzyme inactivation - Zollinger-Ellison
syndrome

3. Dyssynchrony of enzyme release, inadequate mixing Post Billroth II procedure.

Phase and nature of malabsorptive defect
B. Fat solubilization
1. Diminished bile salt synthesis - Cirrhosis
2. Impaired bile secretion - Chronic cholestasis
3. Bile salt de-conjugation - Bacterial overgrowth

4. Increased bile salt loss - Ileal disease or resection.

Phase and nature of malabsorptive defect
C. Luminal availability of specific nutrients
1. Diminished gastric acid Atrophic gastritis vitamin B12
2. Diminished intrinsic factor Pernicious anemia
- vitamin B12
3. Bacterial consumption of nutrients

Phase and nature of malabsorptive defect
Mucosal phase
A. Brush border hydrolysis
1. Congenital disaccharidase defect Sucrase-isomaltase deficiency
2. Acquired disaccharidase defect Lactase deficiency
B. Epithelial transport
1. Nutrient-specific defects in transport Hartnup's disease
2. Global defects in transport Celiac sprue.

Phase and nature of malabsorptive defect
Postabsorpti...

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