MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A....
Transcript of MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A....
![Page 1: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/1.jpg)
Malabsorption Syndromes
Dr. Omar Saadah, MBBS, MRCP, CABP,DCHA. Professor & Consultant of Pediatric Gastroenterology,
Hepatology & NutritionPediatric DepartmentKing Abdul Aziz university Hospital
![Page 2: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/2.jpg)
CELIAC DISEASE
• Immune Mediated Gluten sensitive enteropathy
![Page 3: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/3.jpg)
Clinical manifestations
• Chronic diarrhea• Steatorrhea• Edema• Abdominal distension• Recurrent mouth ulcers• Growth failure
![Page 4: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/4.jpg)
Clinical manifestation
![Page 5: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/5.jpg)
Laboratory abnormalities
• IDA (Hemoglobin, MCV, MCH)• Hypoalbumenia• Rickets (Ca +2, Ph+2, ALP)• Serology:
– Tissue transglutaminase antibody– Endomysial antibody– Antigliadin antibody
![Page 6: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/6.jpg)
Diagnosis
Normal mucosa
Abnormal mucosa
![Page 7: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/7.jpg)
Complications
Rickets / OsteomalaciaOsteoporosisGrowth failureRefractory anemiaAutoimmune disordersSmall bowel malignancy
![Page 8: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/8.jpg)
Treatment
• Gluten free diet• Life long
![Page 9: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/9.jpg)
Cystic fibrosis
• AR• Cystic fibrosis transmembrane conductance
regulator (CFTR) gene mutation• The product of this gene is a chloride ion
channel important in creating sweat, digestive juices, and mucus
• Dehydration of body secretion
![Page 10: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/10.jpg)
Cystic fibrosis
• Two main organs affected:
Pancreas
Lungs
![Page 11: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/11.jpg)
Diagnosis
• Sweat chloride test (chloride more than 80)• Genetic testing for mutation
![Page 12: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/12.jpg)
Treatment
• Pancreatic enzyme supplement• Fat soluble vitamin supplement• Chest physiotherapy• Treating chest infections• Nutritional support
![Page 13: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/13.jpg)
Giardiasis
![Page 14: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/14.jpg)
Clinical manifestation
• Chronic diarrhea• Growth failure• Abdominal ditesnion
![Page 15: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/15.jpg)
Diagnosis
• Stool microscopy• Duodenal aspirate• Histopathology
![Page 16: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/16.jpg)
Treatment
• Metronidazole • Tinidazole
![Page 17: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/17.jpg)
Lymphangiectasia
![Page 18: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/18.jpg)
Clinical pictuures
• Edema (Unilateral or bilateral)• Chronic diarrhea• Staatorrhea
![Page 19: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/19.jpg)
Laboratory
• Lymphopenia• Hypopgamaglobulinemia• hypoalbuniemia
![Page 20: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/20.jpg)
LymphangiectasiaLymphangiectasiaLymphangiectasiaLymphangiectasia
Congenital or acquired
Protein-losing enteropathy
Steatorrhoea
![Page 21: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/21.jpg)
Endoscopy
White opaque spots on the
Small intestinal mucosa
![Page 22: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/22.jpg)
Histopathology
![Page 23: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/23.jpg)
Capsule endoscopy
![Page 24: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/24.jpg)
Treatment
• Low fat diet• High protein diet• MCT• Surgery for localized disease
![Page 25: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/25.jpg)
Abetalipoproteinemia
![Page 26: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/26.jpg)
Genetics
AR condition
Microsomal Triglyceride Transfer Protein Gene Mutation
Microsomal Triglyceride Transfer Protein (MTTP)
Essential for Synthesis of Apolipoprotein B
![Page 27: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/27.jpg)
Symptoms
Infancy:• Diarrhea• Steatorrhea• Abdominal distention
Later:• Spinocerebellar disorder• Retinitis Pigmentosa
![Page 28: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/28.jpg)
• Blood film
Normal Acanthocytes
![Page 29: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/29.jpg)
Normal Fundus Retinitis Pigmentosa
![Page 30: MalabsorptionSyndromes - kau · MalabsorptionSyndromes Dr. Omar Saadah, MBBS, MRCP, CABP,DCH A. Professor & Consultant of PediatricGastroenterology, Hepatology& Nutrition PediatricDepartment](https://reader035.fdocuments.us/reader035/viewer/2022081409/6087cd0bc60c92792535ab24/html5/thumbnails/30.jpg)
Treatment
• Low fat diet• Supplement with MCT• High protein and calories• Vitamin E supplement