Malabsorption

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Lactose intolerance is one of type of malabsorption syndrome, a collection of conditions that cause problems in getting nutrients to the body. There are four of these types of conditions. A person can have problems absorbing only one type of nutrient, such as lactose. A person can have problems producing or delivering gastric juices into the stomach, or pancreatic digestive enzymes, or bile from the gallbladder. A person may have a congenital or developmental problem in the small intestine such that once nutrients are absorbed through the intestinal wall, the water-soluble material must be transported to the liver for processing (see Chapter 6). If there is something wrong with this part of the circulatory system, nutrients will not be used properly. Some forms of cancer and parasitic infections can cause these transport problems.

These conditions lead to deficiencies in nutrients, primarily in proteins and lipids. The combination of inadequate amino acid absorption and insufficient iron results in iron deficiency anemia. Long-term malabsorption will cause a deficiency in vitamin B12, which also causes anemia. As stated in Chapter 6, the liver makes most of the proteins found in blood. If the liver does not get enough building blocks for the proteins, their concentrations, especially of albumin, will decrease. Albumin is an important blood protein in maintaining osmotic pressure between the blood and tissues. If the albumin levels get too low, water will leave the blood and pool in body cavities.

If lipids are not absorbed properly, the volume of stool increases, and it becomes frothy and very foul smelling, a condition called steatorrhea. If the pancreas does not produce enough lipase, triglycerides are not broken apart, and they remain in the intestines and will be lost as part of the feces. If the gallbladder does not contribute bile to the small intestine, micelles are not formed from cholesterol and long chain fatty acids, and these chemicals are not absorbed. If fats are not absorbed, neither are the fat-soluble vitamins A, D, E, or K. Deficiencies of vitamin A can result in night blindness. Inadequate vitamin D will lead to decreased calcium absorption and eventually to weakened bones. Vitamin E is important in preventing damage to cells from chemicals produced in metabolism. Low levels of vitamin K can lead to bleeding due to low blood clotting factor concentrations.

The symptoms of malabsorption syndromes are similar. They all lead to weight loss, anemia, diarrhea, and abdominal distress. If this occurs in children, they may not grow to the height that they should, due to inadequate nutrients during growth spurts. In very young children, malabsorption may lead to a general failure to grow and develop normally.

Therapy for malabsorption conditions depends on the cause of the problem. If there is an underlying disease, it must be addressed and the malabsorption will be eliminated. If the malabsorption cannot be cured, supplements of vitamins and trace minerals like calcium, magnesium, and iron are used. Substitutions can be made for the triglycerides that cannot be absorbed. Short and medium length fatty acids can be absorbed without being made into micelles.

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