CLINICAL MANIFESTATIONS OF MALABSORPTION



There are a large number of diseases associated with malabsorption, only some of which are listed in . In many of these diseases the major clinical manifestations may not be related directly to malabsorption. In others the defects are highly specific, such as pernicious anemia with selective malabsorption of vitamin Bi2 or osteomalacia or rickets with poor absorption of calcium. In this brief discussion we shall be concerned only with the symptoms and signs associated with the more general forms of malabsorption, especially those forms including malabsorption of fat.

Early Manifestations. The early manifestations of malabsorption may be subtle and easily missed. There is usually a change in bowel habits with somewhat more bulky and sometimes oily stools that are difficult to flush (they are sticky and tend to float because of increased gas content). This may be associated with some weight loss, fatigue, depression, and a sense of bloating. Nocturia may be noted, thought to be caused by nocturnal reabsorption of excessive intestinal fluid. It is impor­tant to consider the diagnosis at this early stage in order to define the cause of malabsorption and to institute appropriate treatment.

Late Manifestations. The major late manifes­tations of the malabsorption syndrome are sum­marized in . By and large they repre­sent the results of specific deficiencies secondary to malabsorption. Typically these patients are wasted with poor muscle mass but have distended abdomens with hyperactive bowel sounds. They tend to be hypotensive and often have increased pigmentation of the skin. Abdominal pain is uncommon except in the presence of certain specific disorders, e.g., chronic pancreatitis or primary in­testinal lymphoma. At this time the clinical di­agnosis is easy to make. The determination of the specific cause of the malabsorption may be more difficult.