The large intestine
Paul Ong, Rachel Skittrall in Gastrointestinal Nursing, 2017
Any factor that leads to the accumulation of excessive dietary nutrients in the intestinal lumen can lead to an osmotic diarrhoea. The absorption of water from the lumen of the intestines is reliant upon adequate absorption of nutrients. Malabsorption is a condition characterised by an inability to absorb certain nutrients. Carbohydrates have a major impact in osmotic diarrhoea. This condition is present in patients with coeliac disease where, as a result of damage to intestinal epithelial cells (caused by eating gluten), there is a lactose intolerance, in which damaged intestinal enterocytes (epithelial cells) fail to produce the enzyme lactase required to break down lactose (a disaccharide – too large to be absorbed) to glucose and galactose (monosaccharides – small enough to be absorbed). This means lactose stays within the intestinal lumen and exerts an osmotic effect, retaining water in the lumen and causing an osmotic diarrhoea. Damage to enterocytes by pathogens such as rotavirus and salmonella or inflammatory damage associated with autoimmune conditions such as Crohn's disease can reduce the ability of enterocytes to complete digestion and absorb nutrients. The corresponding buildup of unabsorbed nutrients in the intestine leads to retention of water in the intestinal lumen generating an osmotic diarrhoea.
Assessing the role of intestinal absorption, permeability, and nutrition in AIDS patients
Ronald R. Watson in NUTRIENTS and FOODS in AIDS, 2017
Malabsorption in HIV-infected patients may significantly contribute to weight loss, malaise, morbidity, and to uncertainties about the bioavailability of medical therapy as well as to diminished success and reduced tolerance of nutritional support. Regarding all these aspects, malabsorption correlates to both a reduced quality of life and diminished survival. Therefore, symptoms of malabsorption such as diarrhea, steatorrhea, weight loss, or signs of nutritional deficiencies should initiate a careful workup for treatable etiologies of malabsorption. In the first step this requires performing stool cultures for identifiable bacteria, ELISA or microscopy for giardiasis, and specific staining for Cryptosporidia. With a positive pathogen identified, this should be treated before further diagnostic tests are performed.
Primary Biliary Cirrhosis Bench to Bedside
Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso in The Pathophysiology of Biliary Epithelia, 2020
Jaundice usually follows months or years later; however, in 10% of patients, jaundice may be the presenting symptom. Darkening of the skin, hirsutism, anorexia, diarrhea, and weight loss may also be present. Less commonly, patients may present with a complication of portal hypertension, such as variceal bleeding or ascites, as evidence of more advanced liver disease. Occasionally, patients may present with problems related to cholestasis, such as severe osteoporosis or fat-soluble vitamin deficiency. Some patients present with malabsorption, but this is usually more common in patients with advanced disease. PBC may be associated with cutaneous changes such as generalized hyperpigmentation and facial xanthelasmata. The latter changes result from raised total cholesterol concentration.
Nutrition Intake and Nutrition Status of Pancreatic Cancer Patients: Cross-Sectional and Longitudinal Analysis of a Randomized Controlled Exercise Intervention Study
Published in Nutrition and Cancer, 2022
Dorothea Clauss, Ingeborg Rötzer, Christine Tjaden, Thilo Hackert, Joachim Wiskemann, Karen Steindorf
Moreover, our results suggest that the patients have apparently eaten an adequate diet. This can be seen in the good energy supply of the patients. Also, the fact that only two patients received parenteral nutrition shows that the energy amount was obtained mainly from food and not from supplements. However, we do not know whether they were also sufficiently nourished. Metabolic parameters such as albumin and C-reactive protein (CRP) provide important additional information about whether the energy intake was adequate, or whether malabsorption is present or not. For example, Hypoalbuminemia, defined as a serum albumin level <35 g/L, is a common surrogate marker of malnutrition (32). Malabsorption is the inadequate absorption of nutrients from food into the body’s circulation (3) due to a disruption of flow of pancreatic enzymes. An inadequate intake of nutrients combined with a pathologic process of increased nutrient consumption may result in a catabolic state (1). In addition to metabolic parameters such as albumin and CRP, a stable body weight may also be used as a marker for an adequate energy intake. The body weight of our study population was stable or increased minimally over the study period. If this aspect of stable body weight is taken into account, the energy intake of our patients would seem to have been adequate. However, we had no data on albumin or CRP, so we could not conclude with certainty whether the nutrients that the patients ingested with their food were actually absorbed by their bodies.
Dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya
Published in South African Journal of Clinical Nutrition, 2020
Kenneth Kipngeno Tonui, Eunice Njogu, Agatha Christine Onyango
Data from 24-hour dietary recall provided more insights on adequacies in the nutritional intakes of the respondents. Energy intakes of the respondents did not meet the requirements as only 47.4% and 50.0% of the females met the requirements (Table 1). According to ROK,7 HIV infection and opportunistic infections that are frequent amongst HIV-seropositive clients interfere with an individual’s ability and desire to eat. As such, dietary intakes are reduced, which results in malabsorption. Energy intakes amongst the respondents could have been the result of clinical symptoms aligned with HIV and AIDS, which hinder dietary intakes amongst HIV-seropositive persons. This is in reference to notions developed by Kuria11 and Montgomery,12 which indicate that HIV-seropositive clients present with different clinical symptoms including anorexia, fatigue, vomiting, mouth sores, fever, diarrhoea, nausea, depression, metabolic disturbances, and anti-retroviral drug side effects. These symptoms are a significant hindrance to dietary intake. Inadequate knowledge and food insecurity amongst the HIV-seropositive persons exacerbated the situation, hence rendering the PLWHA more predisposed to malnutrition.
A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25 percent
Published in Scandinavian Journal of Primary Health Care, 2020
Jens K. Munk, Lise Bathum, Henrik L. Jørgensen, Bent S. Lind
Based on the recommendation from the Danish Health Authority [16], starting 1 January 2017 we imposed a moderate intervention by requiring the general practitioners to choose one of six possible indications for requesting a vitamin D measurement. These six indications were 1) ‘Low sun exposure/veiling’, 2) ‘Monitoring of treatment with vitamin D’, 3) ‘Skeletal pain, osteoporosis, neural or muscular symptoms’, 4) ‘Hyperparathyroidism, hyper- or hypocalcemia’, 5) ‘Gastrointestinal malabsorption’, and 6) ‘Other’. These six indications were shown in a pop-up window in the electronic request system used by the general practitioners (WebReq) when a vitamin D test was requested. When ‘Other’ was chosen, the general practitioner had to write the indication. No verification of the chosen indications was performed. The intervention was not implemented on the island of Bornholm, which was therefore used as a control group.
Related Knowledge Centers
- Anemia
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- Gastrointestinal Tract
- Malnutrition
- Potassium
- Sodium
- Small Intestine
- Nutrient
- Vitamin