The root cause of malabsorption syndrome lies in the inadequate absorption of essential nutrients due to various diseases. This can stem from issues in digestion, where nutrients aren’t properly broken down for absorption, or from difficulties in transporting digested nutrients across the brush border of the intestinal villi.

Diseases contributing to malabsorption include:

Celiac disease
Dermatitis herpetiformis
Tropical sprue
Bacterial overgrowth
Whipple’s disease (resulting in villi growth impairment)
Short-bowel syndrome
Lactase deficiency
Parasitic infestations like Giardia intestinalis.

The classification

The classification of malaasorption syndrome involves categorizing it based on the underlying causes and mechanisms. It can be broadly classified into two main types:

Primary Malabsorption: This type occurs due to intrinsic defects within the digestive system, such as enzyme deficiencies or structural abnormalities in the intestinal lining. Examples include:
- Celiac disease
- Dermatitis herpetiformis
- Short-bowel syndrome
Secondary Malabsorption: This type is secondary to other medical conditions or factors that affect the absorption process, such as inflammation, infection, or surgical interventions. Examples include:
- Tropical sprue
- Bacterial overgrowth
- Whipple’s disease
- Lactase deficiency
- Parasitic infestations, like Giardia intestinalis

Clinical Manifestations

Patients admitted to the hospital with malabsorption may present with the following features:

Steatorrhea: excretion of more than 7g of fat daily in feces. Stools are typically pale, bulky, foul-smelling, and difficult to flush.
Wasting: Failure to absorb essential nutrients leads to muscle wasting and weight loss. However, weight loss may not be apparent due to ascites and/or edema.
Abdominal Distension: Increased bulk of intestinal contents and gas production can cause abdominal distension, accompanied by borborygmi (audible bowel sounds) and flatulence. Patients may experience abdominal discomfort.

Signs and Symptoms

Signs and Symptoms of Specific Deficiencies in Malabsorption:

Fatigue: resulting from anemia and/or hypokalemia.
Edema: due to hypoproteinemia and/or anemia.
Tetany: caused by hypocalcemia.
Hemorrhage: manifested as ecchymosis or purpura due to vitamin K deficiency.
Anemia: results from iron deficiency.
Decreased Libido.
Glossitis and stomatitis result from deficiencies in folic acid and vitamin B.
Bone Conditions: include osteoporosis, osteomalacia, and bone pain due to hypocalcemia and vitamin D deficiency.
Increased Susceptibility to Infections: Due to globulin deficiency.
Pigmentation of Skin and Mucous Membranes: Resulting from Hypoadrenalism.
Hypotension, hypothermia, and inhibition of growth: due to depression of endocrine activity.
Mental changes are particularly observed in gluten enteropathy.

Diagnosis

Stool Analysis: Checking for bacterial growth and parasites, such as isolating Giardia lamblia cysts.
Jejunal Biopsy: Obtaining mucosal samples via jejunoscopy to assess for malignancy or villi atrophy.
Radiological Tests:
- Ultrasound Scan
- Computed Tomography (CT) Scan
- Magnetic Resonance Imaging (MRI)
- Barium Meal: Revealing dilation, segmentation, and loss of normal appearance in the small intestine, particularly the jejunum.
Complete Blood Cell Count (CBC): To screen for anemia.
Ultrasound Scan: May detect pancreatic or intestinal tumors.

Medical and Nursing Management

Address the underlying cause: Treat or remove the primary cause, such as implementing a gluten-free diet for celiac disease or administering pancreatic extract for chronic pancreatic disease. Antibiotic therapy may be needed for conditions like diverticulosis.
Compensate for malabsorption: In cases where specific treatment is not feasible, like after extensive stomach or intestine resections, focus on increasing the intake of essential nutrients and calories to overcome malabsorption.
Correct deficiencies: Replace specific deficiencies identified through intravenous therapy when necessary to ensure proper nutrient levels.
Alleviate symptoms: Implement strategies to reduce symptoms associated with steatorrhea, such as dietary modifications or medication.

Drugs

The medications prescribed for patients with malabsorption will depend on the underlying cause and any identified deficiencies. For example:

Antibiotics: Metronidazole is commonly used.
- Mechanism of action: It is bactericidal, inhibiting bacterial DNA synthesis and leading to bacterial death.
- Dosage: Typically 200–400 mg three times a day orally for 7–10 days.
- Side effects: May include dry mucous membranes and a metallic taste.

Management:

A. Diet:

Gluten-free diet for celiac disease.
Low-fiber diets.
Incorporation of low-fat sources such as medium-chain triglycerides.
Avoidance of irritants like spicy foods.

B. Parenteral Fluids and Feeding:

Total parenteral nutrition via a central venous line may be necessary for severe cases.

Supplementation:

Vitamin B12 injections and oral iron supplements may be required.
Enzyme replacement therapy may be prescribed for those lacking intestinal enzymes.
Anti-spasmodic medications can help reduce abdominal cramping and diarrhea.

Specific Conditions:

Individuals with cystic fibrosis or chronic pancreatitis may need pancreatic supplements.
Those with lactose intolerance or non-tropical sprue (gluten enteropathy) should modify their diets to avoid triggering foods.

Once an oral diet is well tolerated, patients are typically prescribed a high-protein, low-fat, high-calorie diet supplemented with additional nutritional supplements. Specific dietary plans, such as a gluten-free diet for individuals with celiac disease, should be implemented as needed. Nurses play a crucial role in educating patients about the significance of adhering to their prescribed diet and ensuring compliance. They should assist patients in understanding the importance of their diet regimen and encourage consistent intake. Additionally, maintaining strict records of fluid intake and food consumption through fluid balance and food intake charts is essential.

Specific nursing management:

When caring for patients with malabsorption syndrome, nurses should employ a problem-solving approach such as the nursing process due to the diverse causes and severity levels of the syndrome. The main areas of assessment include:

Management of Diarrhea and Steatorrhea-Related Problems:
- Addressing issues like incontinence, perianal excoriation, and fatigue.
Ensuring Adequate Nutritional Intake:
- Focusing on strategies to ensure patients receive sufficient nourishment despite malabsorption challenges.
Psychological Assessment:
- Assessing for signs of depression, grief, or anger, which may arise from the loss of normal health,.

In addition to these assessments, nurses should provide comprehensive general care to severely ill patients who require complete bed rest. Special attention should be given to oral hygiene, pressure area care, and promoting deep breathing exercises to maintain overall well-being.

Malabsorption Syndrome | Etiology, Nursing Care Management

Introduction

Etiology