Malabsorption syndrome

Inadequate absorption of food elements from the intestine results in an excessive loss of nutrients in the stool, a symptom of the malabsorption syndrome. When nutrients are not absorbed properly in the small intestine, this is known as a malabsorption syndrome. Chronic diarrhea and stomach distension are characteristics of this condition, and failure to thrive is a long-term complication.

Causes

• Digestive defects such as lactose deficiency, cystic fibrosis, and chronic pancreatitis.
• An absorptive defect in the mucosal transport system- Primary forms of absorptive defects are:
  • Celiac disease or food allergies: Also called "gluten-induced enteropathy," this is a permanent intolerance of the intestines to wheat gelatin and a similar protein. A child will have problems growing, like not gaining weight, having diarrhea all the time, having a swollen stomach, losing muscle mass, not eating much, and being cranky. Diet management, such as a gluten-free diet and giving up wheat, rye, barley, and oats grains, is part of the treatment.
  • Primary enzyme deficiencies are sucrase-isomaltase deficiency
  • Secondary to infection or inflammatory bowel diseases- such as ulcerative colitis, and Hirschsprung disease.
• A mal-absorptive disorder, like short bowel syndrome, is caused by a decrease in the mucosal surface area, which is caused by an anatomical defect. Short bowel syndrome in children can be caused by Volvulus, jejunal atresia, gastroschisis, damage to the digestive tract, Crohn's disease, necrotizing enterocolitis, and other conditions.

A condition that can lead to malabsorption are:

• Severe malnutrition
• Intestinal parasitosis and protozoal infestation like giardiasis
• Bacterial gastroenteritis
• Enzyme deficiency
• Celiac disease
• Decreased mucosal surface area for absorption due to atrophy of villous.
• Inflammatory bowel disease.

Clinical features

• Chronic diarrhea,
• abdominal distension,
• failure to thrive.
• Anorexia,
• weight loss,
• fatigue,
• leading to malnutrition
• growth failure.
• Changed stool characteristics such as loose and bulky stool, watery stool, stool passage with noise, and flatus.
• Anemia

Diagnosis

• History and physical examination to find out underlying factors and typical features.
• Laboratory investigation: stool routine examination
• Investigation according to an underlying condition such as pancreatic function test in fatty diarrhea.
• Barium meal/enema study to find out structural diarrhea.

Management

• Promotion of adequate nutritional support.
• Start with simple nutrition which is tolerable.
• Avoid food that is allergic or which aggravates the problem such as avoiding a glucose diet in carbohydrate malabsorption.
• Provide supplement of iron, folic acid, multivitamins, and calcium.
• Provide extra supplements of protein and calories to serve malnourished children.
• Management of underlying condition:
• Suitable anti-protozoal, antibiotic, and antihelminthic according to a condition.
• Management of inflammatory bowel disease
• Control and management of diarrhea: ORS, zinc tablet, antiprotozoal, and antibacterial drugs are necessary.

Nursing management

• Assess for frequency and characteristics of stool, vital signs, serum electrolyte level, feeding pattern, fluid status, and other clinical features.
• Administer fluid orally or parental to maintain fluid and electrolyte levels.
• Improve nutritional status by appropriate diet and supplementation of deficient nutrition.
• Administer medicine as prescribed such as analgesics, antiflatulents, antidiarrheal, etc.
• Maintain skin integrity and hygiene of perineal care.
• Provide reassurance and support to minimize fear and anxiety.