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Malabsorption Syndrome
Pathyphysiology
17
Nursing
Graduate
02/06/2013

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Term

Malabsorption Syndrome

 

Pathophysiology

Definition
Malabsorption syndrome is associated with a variety of disorders and intestinal surgical procedures. It interferes with the ability to absorb nutrients and is a result of a generalized flattening of the mucosa of the small intestine. With various disorders, physiologic mechanisms limit absorption of nutrients because of one or more of these abnormalities: bile salt deficiencies, enzyme deficiencies, presence of bacteria, disruption of the mucosal lining of the small intestine, altered lymphatic and vascular circulation , and decrease in the gastric or intestinal surface area.
Term
Common Manifestations
Definition

-Chronic Diarrhea

-Steatorrhea

-Edema

Term
Diarrhea
Definition
Occurs as a result of unabsorbed nutrients, which add to the bulk of the stool, and unabsorbed fat.
Term
Steatorrhea (greater than normal amounts of fat in the feces)
Definition
Result of bile salt deconjugation, nonabsorbed fats, or bacteria in the intestine.
Term
Edema
Definition
Cause by hypoproteinemia
Term
Nutrition Managment Intervention
Definition

Low-fat diet for patients with galbladdder disease, cyctic fibrosis and severe steatorrhea 

High-protein, high-calorie diet and small frequent meals are recommended for patients with a total gastrectomy.

Lactose-free diets for patient with lactase deficiency.

Gluten-free diets for those with celiac sprue.

 

Rationale- Nutrition managment is used to improve or resolve malabsorption.

Term
Nutritional supplements Intervention
Definition

Supplements for specific deficiency:

Water-soluable vitamins (folic acid and vitamin B complexes)

Fat-soluable vitamins (vitamin A, vitamin D, vitamin K)

Minerals (Calcium, iron, magnesium)

Pancreatic enzymes (pancrelipase)

 

-Rationale: Nutritional supplements are necessary for proper absorption

 

Term
Drug Therapy Intervention
Definition

Antibiotics are used to treat tropical sprue, Whipple's disease, and other disorders involving bacterial growth

Antidiarrheal agents, anticholinergics, and IV fluids

 

Rationale: Antibiotics are used to treat the diseases that cause malabsorption.

 Drug therapy is used to control the clinical manifestations of malabsorption. 

Term
Skin Protection Intervention
Definition

Use medicated wipes

Clean with mild soap and warm water after each stool

Provide a sitz bath several times per day

Apply a thin coat of vitamin A& D ointment after each stool

Keep patient off affected buttock area

Cover open areas with thin DuoDerm 

Observe for fungal or yeast infections

 

Rationale: Special skin care is used because chronic diarrhea can cause problems to perineal area. These interventions decrease the risk of problems caused by chronic diarrhea.

Term
Laboratory studies
Definition

A decrease in mean corpuscular volume (MCV), Mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) indicates hypochromic microcytic anemia resulting form iron deficiency.

Serum iron levels are low in protein malabsorption because of insufficient gastric acid for the use of iron.

Serum cholesterol levels are low from decreased absoprtions and digestion of fat. 

Low calcium levels may indicate malabsorption of vitamin D and amino acids

Term
Diagnostic Tests
Definition

Schilling test measures urinary excretion of vitamin B12 for diagnosis of pernicious anemia and other malabsorption syndromes

Biopsy of the small intestine is used for the diagnosis of tropical sprue or celiac sprue

Ultrasonography is used to diagnose pancreatic tumors and tumors in the small intestine that is causing the malabsorption

Term
Trimethoprim/sulfamethoxazole
Definition
Used to treat tropical sprue
Term
Tetracycline and metronidazole
Definition

Used to treat bacterial overgrowth that can be caused by a variety of disorders 

 

Term
Diphenoxylate hydrochloride
Definition
Antidiarrheal used to decrease diarrhea
Term
Dicyclomine hydrochloride
Definition
Anticholinergic used to inhibit gastric otility
Term
Potential Complications
Definition

Chronic diarrhea-monitor frequency and characteristics of bowl movements

Steatorrhea-monitor for frequent loose stools, do an quantitative fecal fat analysis to determine steatorrhea

Edema-monitor for redness, swelling, and fluid retention

Skin breakdown-monitor redness, swelling, pain on perineal area

Term
Follow-up Evaluation
Definition

Laboratory values return to normal levels

Decreased diarrhea

No steatorrhea in stool

Decreased edema

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