Malabsorption – chronic disorder of processes of digestion, transport and absorption of nutrients in a small intestine. Symptoms of malabsorption include diarrhea, , belly-aches, hypovitaminosis, weight loss, an astenovegetativny syndrome, violation of electrolytic exchange, anemia. Diagnostics of a syndrome of malabsorption is based on laboratory (OAK, a koprogramma, blood biochemistry) and tool methods (a X-ray analysis of a small intestine, MSKT, ultrasonography of an abdominal cavity). Treatment is directed to elimination of the reasons of malabsorption, correction of vitamin, microelement, proteinaceous and electrolytic deficiency, dysbacteriosis.
Malabsorption (violation of absorption in intestines) is the syndrome which is characterized by set clinical the manifestations (diarrhea, , polyhypovitaminosis, weight loss) developing owing to violation of digestive and transport functions of a small intestine that in turn leads to pathological changes of a metabolism. The congenital syndrome of malabsorption is diagnosed in 10% of cases; its manifestations demonstrate soon after the birth or in the first 10 years of life of the child. Frequency of the acquired malabsorption correlates with prevalence prichinno of significant diseases (gastrogenny, gepatobiliarny, pankreatogenny, enterogenny, etc.).
In gastroenterology the syndrome of malabsorption is classified by severity: the first (easy) degree (loss in weight to 10 kilograms, the general weakness, decrease in working capacity and some symptoms of hypovitaminoses), the second (average weight) degree (weight loss more than on 10 kilograms, the expressed polyhypovitaminosis, violation of a water and electrolytic homeostasis, anemia, decrease in level of sex hormones), the third (heavy) degree (considerable deficiency of body weight, heavy polyvitaminic and electrolytic insufficiency, osteoporosis, the expressed anemia, hypostases, spasms, serious endocrine violations).
By origin distinguish a congenital syndrome of malabsorption (at the patients having congenital diseases of fermental system – Shvakhmana-Daymond's syndrome, , Hartnup's disease and other pathologies connected with insufficiency of enzymes and violation of transport of substances in cages mucous intestines) and the acquired malabsorption syndrome (as a result of enterit, Whipple's disease, a syndrome of a short gut, chronic pancreatitis, cirrhosis and other acquired diseases of digestive tract).
At patients with a syndrome of malabsorption changes from intestines are noted: diarrhea, , swelling and rumbling, sometimes morbidity in a stomach. Pain is, as a rule, localized in the top part of a stomach, can irradiate in a waist or have the surrounding character if chronic pancreatitis takes place. Patients with insufficiency have lactases of pain of skhvatkoobrazny character.
At malabsorption the quantity a calla, as a rule, is considerably increased, the kcal has a kasheobrazny or watery consistence, fetid. At a holestaza and violation of absorption of fatty acids of kcal gets a greasy luster (sometimes fat impregnations) and becomes colourless (). From nervous system the astenovegetativny syndrome – weakness, fatigue, apathy is shown. It is connected with violation of a water and electrolytic homeostasis and insufficiency of substances, necessary for nervous system.
Pathological changes of integuments: dryness, pigmentary spots, dermatitis, eczema, a hair loss, fragility and turbidity of nails, ekhimoza – are connected with a vitamin deficiency and minerals. For the same reasons it is often noted glossit (a language inflammation). The lack of vitamin K is shown by formation of petekhiya (red points on skin) and hypodermic hemorrhages.
At heavy violations of electrolytic exchange and the lowered blood protein content at patients the expressed peripheral hypostases, ascites are noted (a liquid congestion in an abdominal cavity). All patients suffering from a malabsorption syndrome are inclined to the progressing decrease in body weight. Deficiency of vitamins E and B1 leads to heavy frustration of nervous system – to paresteziya, any neyropatiya. Hypovitaminosis And leads to "night blindness" (disorder of twilight sight). A consequence of insufficiency of B12 vitamin – megaloblastny anemia (often develops at the persons having a disease Krone and a syndrome of a short gut).
Violation of exchange of electrolytes is shown by spasms and muscular pains (deficiency of calcium in combination with insufficiency of vitamin D leads to osteoporosis), at the gipokaltsiyemiya which is combined with a gipomagniyemiya at patients Hvostek and Trusso's positive symptoms are noted, the symptom of "The muscular roller" speaking about violation of neuromuscular conductivity is characteristic of a gipokaliyemiya. At insufficiency of zinc and copper there is rash on skin. At a secondary syndrome of malabsorption at patients the symptomatology characteristic of the disease which served as the reason of its development is also noted.
The main complications of a syndrome of malabsorption are connected with a lack of the nutrients coming to blood: anemia (iron deficiency and vitaminzavisimy megaloblastny), the fertility violations, neurovegetative frustration, dystrophy, polyorgan pathologies connected with polyhypovitaminosis and insufficiency of minerals.
At a malabsorption syndrome the main signs come to light by laboratory blood test, a calla, urine. In the general blood test symptoms of anemia can be noted (iron deficiency and B12-scarce), insufficiency of vitamin K influences protrombinovy time (there is a lengthening). In the biochemical analysis note the level of albumine in blood, calcium and alkaline phosphatase. The research of amount of vitamins is conducted.
Research the calla shows increase in its daily volume (at starvation – reduction). Koprogramma reveals presence in Calais of muscle fibers and starch. At some fermental nedostatochnost the calla can change . At suspicion on violations of absorption of fatty acids carry out the test on .
Before collecting a calla it is necessary for a research that the patient used about 100 grams of fat a day for several days. Then collect a daily allowance of kcal and define amount of fat in it. Normal it there should not be more than 7 grams. If the content of fats in Calais exceeds this value, it is possible to suspect malabsorption. At amount of fat more than 14 grams are probable functional violations in work of a pancreas. In case of heavy extent of malabsorption and at a tseliakiya with a stake a half and the fats which were more arrived with food is removed.
Functional tests for identification of violations of absorption in a small intestine – D-ksilozny the test and the test of Shilling (assessment of absorption of B12). As an additional diagnostic measure conduct a bacteriological research a calla. At a radiological research it is possible to reveal symptoms of a disease of a small intestine: blind loops thin, in some loops can be formed horizontal levels of liquid or gas, interintestinal anastomoza, diverticulums, striktura, ulcerations are visible.
When performing ultrasonography of an abdominal cavity, MSKT and magnetic and resonant tomography abdominal organs are visualized and their pathologies which can be the prime cause of the developed malabsorption syndrome are diagnosed. Endoscopy of a small intestine reveals Whipple's disease, and an intestines limfoangioektaziya, allows to take material for a histologic research, to aspirirovat intestines contents for a bacteriological research (regarding an excess obsemeneniye of a small intestine microorganisms and presence of pathological flora).
As additional diagnostic measures estimate a condition of external secretion of a pancreas (sekretin-tseruleinovy, bentriaminovy, LUND and PABK tests, determination of level of immunoreactive trypsin); reveal a syndrome of excess bacterial growth (respiratory hydrogen and carbonic tests); diagnose insufficiency of lactase (lactoknowing test).
In therapy of a syndrome of malabsorption a priority is treatment of the disease which served as the reason to development of this state.
Depending on severity and expressiveness of clinical symptoms the gastroenterologist appoints to the patient a special diet, vitamins and minerals, electrolytic and proteinaceous mixes are parenterally entered. Dysbacteriosis is corrected with the help about - and eubiotik, carry out a regidratation (restoration of the liquid lost by an organism). If the main disease demands surgery, then carry out by the patient surgical treatment concerning the main pathology. Operations are often appointed the patient having a disease Krone, an intestines limfangiektaziya, a disease of Girshprunga, and also heavy complications of inflammatory diseases of intestines.
Preventive measures against development of a syndrome of malabsorption have to be directed first of all to prevention of the diseases promoting its emergence – violations of work of bodies of a digestive tract, inflammations of intestines, pancreas, liver, endocrine frustration. At congenital defects of enzymatic system timely detection of this or that fermental insufficiency and its medicamentous correction will be preventive measures.
The forecast at malabsorption
Sometimes in mild cases the syndrome of malabsorption is corrected by means of a diet. In other cases the forecast at this disease directly depends on the course of the main pathology, expressiveness of violations of absorption and insufficiency of intake of substances in blood.
If the major factor which caused emergence of this syndrome is eliminated, correction of consequences of long dystrophy can demand a long time. Progressing of malabsorption threatens with development of terminal states and can conduct by a lethal outcome.