MALABSORPTION
SYNDROME
By
Mr. Ravi Rai Dangi
Assistant Professor
Fellowship in Neonatal Nursing
MSc. Child Health Nursing

DEFINITION
Mal absorption syndrome is a group of disorders marked by
 Indigestion
 Excessive nutrients loss in stools
 Abnormal absorption of dietary constituents

 It is a state arising from abnormality in absorption of food
nutrients across the gastrointestinal tract.
 Impairment can be of single or multiple nutrients
depending on the abnormality. This may lead to
malnutrition and a variety of anemia.
 Malabsorption constitutes the pathological interference
with the normal physiological sequence of body.

CAUSES:
 Bile salt insufficiency:
 Obstructive jaundice
 Bacterial overgrowth
 Infection
Acute infectious enteritis
Parasitic infections, such as giardia, or helminthiasis

 Pancreatic disease
 Chronic pancreatitis
 Carcinoma of pancreas

Structural defects:
 Inflammatory bowel diseases commonly: Crohn's
Disease

Gastrectomy

Gastro-jejunostomy

Short bowel syndrome.

 Lymphatic obstruction
 Intestinal lymphoma
 Intestinal Tuberculosis

 It is a pathologic dilation of
lymph vessels. When it occurs
in the intestines of dogs, and
more rarely humans, it causes
a disease known as "intestinal
lymphangiectasis"
Lymphangiectasis

 PEM
 Iron deficiency anemia
 Severe Steatorrhea due to cystic fibrosis, celiac
disease

CLINICAL MANIFESTATION
 Chronic diarrhea
 Abdominal distension
 Failure to thrive
 Flatulence
 Anorexia

 Fatigue
 Weight loss
 Direct consequence of malabsorption which leads to
malnutrition and growth failure
 Malabsorption syndrome and chronic diarrhea is
manifested with three major categories, these are- impaired
digestion, intestinal malabsorption and carbohydrate
malabsorption.

Impaired Digestion
 It occurs due to exocrine pancreatic insufficiency also
results in chronic diarrhea and malabsorption.
 Due to cystic fibrosis, lipase deficiency and crohn’s
disease.
 It is manifested as frequent loose pasty, greasy stools with
undigested fat and offensive cheesy smell.

Intestinal Malabsorption
 presented with chronic diarrhea as loose or liquid stool.
 These patients have steatorrhea
 This condition is usually associated with celiac disease,
food protein sensitivity, giardiasis, immunodeficiency,
malnutrition and bacterial overgrowth

Carbohydrate Malabsorption
 It may be presented as chronic diarrhea due to
fermentation.

INVESTIGATION
 History of illness
 Physical examination
 Routine stool examination

 Fecal fat studies for steatorrhea
 D-Xylose test ( performed to diagnose conditions that present
with malabsorption of the proximal small intestine)
 Intestinal biopsy
 Radiology test- barium meal study to detect structural defect

Specific test- like
 Sweat chloride test for cystic fibrosis (sweat test
measures the concentration of chloride that is excreted
in sweat)
 Blood serology test for celiac disease,
 Hydrogen breath analysis for carbohydrate
malabsorption
 Lactose tolerance test

MANAGEMENT
 Replacement of electrolytes and fluid by parental
administration.
 Adequate nutrition intake considering the specific defect.
 Control the diarrhea
 Dietary modification is important in some conditions:
Gluten-free diet in coeliac disease.
Lactose avoidance in lactose intolerance.

 Antibiotic therapy will treat Small Bowel Bacterial
overgrowth.
 In cystic fibrosis, the diet should be planned with food
items rich in protein and sugar.
 For carbohydrate malabsorption give glucose and
galactose free diet.
 Pancreatic supplements, antacid and antihistamine are
essential.

NURSING MANAGEMENT

Assessment
 Daily intake output
 Daily weight
 Vital signs
 Serum electrolyte
 GI Function
 Characteristic of Stool

Nursing Diagnosis
 Diarrhea related to indigestion secondary to mal
absorption
 Imbalanced nutrition less than body requirement related
to indigestion secondary to diarrhea.
 Fluid and electrolyte imbalance related to indigestion
secondary to mal absorption

 Knowledge deficit related to hospitalization and mal
absorption disease
 Fear and anxiety related to hospitalization (in parents and
child)

Nursing Intervention
 Improvement of nutritional status by appropriate diet
planning and supplementation of deficient nutrition.
 Restoration of fluid and electrolyte balance by oral and
parenteral therapy
 Continuous monitoring and recording of patient’s
condition

 Relief of pain by medication and anti-diarrheal agents for
diarrhea as prescribed by doctor
 Maintenance of skin integrity specially perineal area
 Health education to parents about general cleanliness,
nutrition, hydration, danger sign, homecare and follow-up,
for necessary medical help.
 Relief of fear and anxiety about long term illness and
hospitalization by appropriate explanation, reassurance
and necessary support.

Bibliography
Books
 Wongs , Essentail Of Pediatric Nursing , Elsevier
Publisher, 10th Edition , Page no 732-733
 Parul data, Pediatric Nursing, 3rd edition, Jaypee
Publisher, page no 279-280
Reference
 https://www.healthline.com/health/malabsorption
 https://nurseslabs.com/diarrhea/#nursing-assessment