malabsorptionsyndrome

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Malabsorption Syndrome

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Malabsorption is not a specific disease but occurs as a consequence of some underlying disorder of the small bowel or pancreas. It is the inadequate assimilation of one or more nutrients in the gastrointestinal tract due to defects in digestion, absorption or transport. Malabsorption affects macronutrients such as proteins carbohydrates and fats or micronutrients such as vitamins and minerals, causing excessive fecal output and producing nutritional deficiencies and GI symptoms.

Malabsorption syndrome is a group of symptoms resulting from disorders in the intestines ability to absorb nutrients from foods eaten. It may lead to loss of appetite, weight loss, swollen abdomen, muscle cramps, bone pain and fat in the feces. Anaemia, tiredness and weekness can occur because iron, folic acid and vitamin B12 are not absorbed in the right amounts. In some cases the hair around the anus becomes greasy.

Digestion and absorption of nutrients occur in three sequential phases: intraluminal digestion, mucosal digestion and absorption, and delivery of nutrients to the circulation. Many diseases cause chronic malabsorption by interfering with these processes. Some of these include:

Inflammatory bowel disease,
This is a microscopic infiltration of the intestinal wall with inflammatory cells. The cause is unknown, although it is suspected to have an immune basis

Intestinal neoplasia, such as lymphosarcoma, adenocarcinoma and leiomyosarcoma

Intestinal bacterial overgrowth, which is characterized by an overgrowth of normal intestinal flora (bacteria) usually secondary to various gastrointestinal diseases, but occasionally as a primary entity.

Infectious enteropathies, such as bacterial, viral, fungal, parasitic, rickettsial

Short bowel syndrome, (Small intestine insufficiency)
This syndrome is created after a large portion of the intestinal tract is surgically removed for any number of reasons. The remaining bowel is too short to provide an adequate surface for digesting and absorbing nutrients, and malabsorption often develops.

Lymphangiectasia,
This is an obstructive (blockage) disorder involving the lymphatic system of the gastrointestinal tract. This results in protein being lost through the gastrointestinal tract and causes profound hypoproteinemia or low protein levels.

Villous atrophy (wheat-sensitive enteropathy)
Idiopathic Villous atrophy is one of the primary diseases of the small intestine. The villi are microscopic hairlike structures that make up the absorptive surface of the small bowel. In a dog with villous atrpphy these structures are blunted and poorly developed. Idiopathic villous atrophy where the intestine lining withers away for no reason occurs often in German Shepherd Dogs.

Small intestinal bacterial overgrowth
Small Intestinal Bacterial Overgrowth (SIBO) has been identified as another cause of malabsorption. German shepherds have an increased incidence. Affected dogs develop an abundant and abnormal bacteria flora in the small intestine, which causes foul-smelling diarhea. Some cases have been associated with EPI, inflammatory bowel disease or stagnant loops of bowel caused by intestinal surgery. In German Shepherd Dogs the condition may be related to a specific immune deficiency. In the majority of cases, the cause of the bacterial overgrowth is unknown. In many cases the cause of malabsorption can be identified through special diagnostic tests, including stool analysis and intestinal biopsy.

Exocrine Pancreatic Insufficiency
Exocrine Pancreatic Insufficiency (EPI) refers to the failure of the pancreas to secrete digestive enzymes normally. EPI is often characterized by diarrhea and weight loss, often despite the presence of a normal or increased appetite. EPI in dogs is usually due to a condition called pancreatic acinar atrophy, or PAA. EPI can be diagnosed on the basis of a blood test, and is usually treated with pancreatic enzyme replacements, which usually result in an improvement of the symptoms. If EPI is accompanied by diabetes or other conditions, it can be more difficult to treat.

Symptoms of Malabsorption Syndrome

vorasous appetite with weight loss

Increased or decreased appetite

large greasy and smelly stools

greasy hair around dogs anus

Soft stool or watery diarrhea

Stools containing undigested food

increased frequency of defecation and stool volume

depression

abdominal discomfort

borborygmus (noise coming from the gastrointestinal tract)

flatulence (gas)

vomiting

Diagnosis of malabsorption can be tricky so it is vital to have a knowledge of all history and clinical signs. Diagnostic tests may also be necessary:

1. Complete blood count (CBC)
2. Biochemical Profile
3. Urinalysis
4. Fecal Examination
5. Fecal Bacterial Cultures
6. Abdominal radiographs (x-Rays)
7. Radioimmunoassay of serum trypsinlike immunoreactivity (TLI), a blood test to rule out EPI that often presents with similar signs
8. Folate and cobalamin (vitamin B12)levels which are blood tests that assess for malabasorption and bacterial overgrowth
9. Endoscopic examination and biopsy

Treatment depends on the underlying cause as different disorders need different treatment therapies. These may include:

1. Dietary modification
2. Pancreatric enzyme replacement
3. Antibiotic Therapy
4. Anti-inflamatory therapy
5. Chemotherapy