MALABSORPTION

DR.JEENA RAJ
DEPARTMENT OF PATHOLOGY
 Definition:
Defective absorption-->

⚫ fats,
⚫ fat-and water-soluble vitamins,
⚫ proteins,
⚫ carbohydrates,
⚫ electrolytes,
⚫ minerals,
⚫ water
Characterized by:

⚫weight loss,
⚫anorexia,
⚫abdominal distention,
⚫borborygmi,
⚫ muscle wasting
⚫ steatorrhea
 Types of diarrhea
1. Secretory diarrhea--> isotonic stool and
persists during fasting
2. Osmotic diarrhea-->due to osmotic forces
exerted by unabsorbed luminal solutes.
3. Malabsorptive diarrhea--
>inadequate nutrient absorption-->
steatorrhea.
4. Exudative diarrhea --> purulent,
bloody stools that continue during fasting.
Malabsorption results from disturbance

⚫(1) Intraluminal digestion,

⚫(2) Terminal digestion,
⚫(3) Transepithelial transport,
⚫(4) Lymphatic transport of absorbed
lipids.
 Cystic Fibrosis
⚫Defects in intestinal and pancreatic ductal
chloride ion secretion.
⚫Leads to interference with bicarbonate, sodium &
water secretion--> defective luminal hydration.
⚫Meconium ileus--> 10% of newborns with cystic
fibrosis.
⚫Intraductal concretions Obstruction,
lowgrade chronic pancreatitis, autodigestion of the
pancreas --> exocrine pancreatic insufficiency .
Celiac Disease

⚫ Anemia, diarrhea, bloating, and fatigue.

Silent celiac disease:
⚫positive serology and villous atrophy
without symptoms.
Latent celiac disease:
⚫positive serology is not accompanied by
villous atrophy.
Pathogenesis
 Microscopy

⚫ 1.Increased number of intraepithelial CD8+ T

lymphocytes. 2. Crypt hyperplasia
⚫ 3. villous atrophy.

⚫ Increasednumbers of plasma cells, mast cells, and

eosinophils,
Environmental (Tropical) Enteropathyh
⚫ syndrome of stunted growth and
impaired intestinal function
⚫ Many pathogens are endemic in
these communities
⚫ histologic features are more similar
to those of severe celiac disease.
⚫ a cycle of mucosal injury, malnutrition,
infection, and inflammation.
Lactase (Disaccharidase) Deficiency
⚫Lactase--> apical brush border membrane
of the villous absorptive epithelial cells.
⚫The defect is biochemical, biopsies are
generally unremarkable.
Congenital
⚫ AR
⚫ Mutation in the gene encoding lactase.
⚫ Explosive diarrhe--> after milk ingestion.
⚫ Symptoms abate -->milk and milk products are
terminated.

Acquired
• Downregulation of lactase gene expression.
• associated with enteric viral or bacterial
infections
 Abetalipoproteinemia
⚫ Autosomal Recessive
⚫ An example of a transepithelial transport defect .
⚫ Mutation in the microsomal triglyceride transfer
protein -->monoglycerides and triglycerides
accumulate within the epithelial cells.
⚫ Lipid vacuoles in small intestinal epithelial
cells .
⚫ In infancy--> failure to thrive, diarrhea, and steatorrhea.
⚫ Deficiencies of fat-soluble vitamins, and lipid
defects in plasma membranes--> acanthocytic red
cell (spur cells) in peripheral blood smears.
Burr cell
 Microscopic Colitis

⚫ Collagenous colitis and lymphocytic

colitis.
⚫ Idiopathic diseases
⚫ Chronic, non bloody, watery diarrhea
without weight loss.
⚫ Findings on radiologic and endoscopic
studies typically are normal.
 Collagenous colitis,

⚫ Seenin middle-aged and older

women.
⚫ Dense subepithelial collagen layer,
increased numbers of intraepithelial
lymphocytes and a mixed
inflammatory infiltrate within the
lamina propria.
 Lymphocytic colitis

⚫Histologically similar
⚫Subepithelial collagen layer is of normal
thickness
⚫Increase in intraepithelial lymphocytes.
⚫ Celiac and autoimmune diseases,
including thyroiditis, arthritis, and
autoimmune or lymphocytic gastritis.
Graft-Versus-Host Disease

⚫ After allogeneic hematopoietic stem

cell transplantation.

⚫ Due to targeting of antigens on the recipient’s

epithelial cells by donor T cells
.
⚫ Epithelial apoptosis, particularly of
crypt cells.
⚫ Watery diarrhea.
 Whipple disease

⚫ Any organ of the body but principally affects

the intestine, CNS, and joints.
⚫ Cause by a gram-positive, Tropheryma
whippelii.
⚫ Lymphadenopathy, hyperpigmentation,
polyarthritis, and central nervous system
complaints.
Hallmark:

Mucosa laden with distended periodic acid-

Schiff-positive macrophages in the lamina
propria
Thank you