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Disorders Of Absorption Notes

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Lecture 16 Disorders of absorption

Definitions o Malabsorption
 Failure of intestinal processes of digestion, transport, or both of nutrients across intestinal mucosa into systemic circulation o Malnutrition
 Outcome of Malabsorption
 Deficiency of nutrients such as energy, protein, vitamins &minerals causes measurable adverse effects on tissues, function or clinical outcome Mechanisms of absorption o Three types
 Luminal processing

• Carbs, fats and proteins hydrolysed and solubilised (pancreatic
& bilary action)
 Mucosal absorption

• Uptake of saccharides and peptides, lipids processed and packaged for cellular export
 Transfer into circulation

• Absorbed nutrients enter vascular or lymphatic circulation o Where can it go wrong?
 Luminal processing

• Surgery- inadequate mixing

• Pancreatic insufficiency

• Cholestasis- inadequate bile (blockage of duct- stones, cancer etc.)
 Mucosal absorption

• Brush border defects- coeliac

• Inflammation- Crohns
 Transfer into circulation

• Lymphatic disease- lymphangiectasis

• Enterocyte processing- abetalipoproteinaemia o Rare, autosomal recessive. Cannot transmit fats properly Signs and symptoms o General
 Varied presentation
 Multiple systems affected
 Depends upon underlying aetiology
 Can be asymptomatic o Presenting features
 Pain & bloating

• Inflammation or obstruction (Crohns)

• Bacterial fermentation & gaseous distension (norm gut flora change)
 Weight loss

• Often indicates small bowel pathology

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