WEEK 1 INITIAL POST

Protein Malabsorption

Malabsorption syndromes have a genetic foundation, making them inherited disorders attributed to endocrine, systemic dysfunctionality, and central nervous system processes. Typically, diagnostic testing for protein insufficiency is not undertaken until the patient is an adult since most people exhibit no symptoms. In the case of progressive malabsorption disorders, genetics play a role due to their influence on food preferences since the patient is elderly (Andreas & Chicaiza, 2021). Notably, edema is the initial indication of protein deficit. The patient’s abdomen and limbs are swollen due to fluid loss induced by low serum albumin levels. Due to their history of malabsorption syndrome and poor dentures, malnutrition may have contributed to the patient’s current clinical symptoms.

Besides, hunger-related protein deficit results from a complex range of physiologic responses stimulated in the case. Aging is often accompanied by a loss of appetite and denture, triggering a food consumption decline. Age-related decrease in appetite makes it difficult for the elderly patient to consume enough food to meet their dietary demands. Further, malabsorption syndrome is characterized by a buildup of fluid in the body’s tissues and, consequently, a lower food intake (Kaur et al., 2019). Edema persists as the fluids cannot be contained within the typical limitations of capillary blood vessel walls. Fluid retention inside the vasculature is primarily governed by albumin concentration, influencing oncotic pressure.

The endothelial cells are essential for salt and water retention as they regulate the amount of fluid movement from blood vessels to the surrounding tissues. This volume loss or hypovolemia induces an incline in antidiuretic hormone (ADH) (Handler & Orloff, 2021). In conjunction with the plasma renin’s aggressive response, it exacerbates the edema brought on by the cells’ excessive salt retention. Moreover, there is a need to note the viable variation in response since other characteristics like gender or age can influence malabsorption. For instance, women are bound to seize their menstruation processes, whereas the height in younger children may not develop normally. Also, there is a chance that their weight gain level is much lower than the norm for children of the same gender or age.

References

Andreas, S., & Chicaiza, H. (2021). Abdominal distension and lower extremity edema. Journal of the American College of Emergency Physicians Open, 2(6), e12599.

Handler, J. S., & Orloff, J. (2021). Antidiuretic hormone. Annual Review of Physiology, 43(1), 611-624.

Kaur, D., Rasane, P., Singh, J., Kaur, S., Kumar, V., Mahato, D. K., … & Kumar, S. (2019). Nutritional interventions for elderly and considerations for the development of geriatric foods. Current Aging Science, 12(1), 15-27.

• The role genetics plays in the disease.

Malabsorption syndrome is the failure of nutrient absorption in the small intestine. The digested nutrient are unable to be absorbed by the intestinal mucosa due to deficiencies of enzymes, such s pancreatic lipase, or inadequate secretion of bile salts, or inadequate reabsorption of bile. However, there is not enough information about what type of malabsorption, thus it is unable to determine if genetics are the cause. If the malabsorption syndrome is caused by Celiac Disease which is an  autoimmune disease that damages the small intestinal villous epithelium when people digest of gluten. Celiac Disease is a strong genetic predisposition.  The resident is a genetically susceptible individual and was born with it.

• Why the patient is presenting with the specific symptoms described.

Celiac Disease is autoimmune disease, that means immune system attack its own tissue and cause injury to the small intestinal epithelial cells. The tissues in the small intestine are damaged by own immune system and fail to transmit the digested nutrients and electrolytes. The resident has generalized edema due to lack of sufficient plasma proteins secondary to protein malnutrition.

• The physiologic response to the stimulus presented in the scenario and why you think this response occurred

         The resident’s autoimmune system attack own tissues of the small instill epithelial cells. Villus of the epithelial cells get injured and become atrophy which cause decease surface area and decrease digestive enzymes. Even epithelial cell production increase to compensate for the tissue lost, the increased cell production is not sufficient, and the cells are not mature enough to maintain absorptive function. Thus, the small intestine decrease carbohydrate absorption, protein absorption, and fat absorption. Damage of mucosal cells causes inflammation which  lead to diarrhea that causes electrolytes and protein lost. At the same time, due to damage of mucosal cells, the body decrease intestinal hormones such as secretive and cholecystokinin, there fore, it decreases pancreatic function.  Hypoalbuminemia and hyponatremia may contribute the generalized edema. 

• The cells that are involved in this process.

       The cells that are involved in this process are epithelial cells in the small intestinal. CD4+ T-cell-mediated autoimmune, antibody and complement activation attack and injury the villi of the epithelial cells. 

• How another characteristic (e.g., gender, genetics) would change your responseThe age, cognitive function, mobility function, difficulty in swallowing, mental illness, competencies of the caregivers are factors to contribute the malnutrition. This resident is 83 years old and possibly is unable to take care himself. He might need assistant in feeding. He might have difficulty in swallowing. He might have some mental illnesses such as depression or schizophrenia, which may have problems in thought process. He might be neglect by his caregivers. There are so many factors that may cause malnutrition. In addition, heart failure, kidney injury, cirrhosis, or drugs might contribute generalized edema. 

An 83-year-old skilled nursing facility resident presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient has been diagnosed with protein malnutrition. Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

Introduction. When we eat healthy foods, our bodies reap the benefits of the vitamins and minerals in the food. However, some bodies may fail to absorb the required vitamins and minerals in the body systems through the small intestine. In the present case, the 83-year-old resident reveals symptoms of malabsorption syndrome, such as generalized edema of extremities and abdomen and protein malnutrition. The edema is present due to the lack of protein in the bloodstream. This patient’s albumin level should be low.  Suryawanshi, Vig, Masih, and Joseph (2018) indicate that malabsorption syndrome is a condition of the small intestine where the small intestine fails to absorb nutrients, which involves damage to the mucosal lining of the small intestine where most of the nutrient absorption takes place.

1. The role genetics plays in the disease: Malabsorption syndrome is considered genetic. This condition is inherited in an, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and conditions. This is because one of the malabsorption syndromes conditions (hereditary folate malabsorption) is an inherited condition characterized by a systemic and central nervous system. Therefore, in some cases, genes play a critical part in advancing malabsorption conditions.
2. Why is the patient presenting with the specific symptoms described? The patient presents the stated symptoms because her body can not absorb the required nutrients from the diet, leading to malnutrition. On the other hand, malabsorption syndrome causes abdominal swelling due to excessive fluid trapped in the body’s tissues, which often limits the patient’s ability to eat. Abreu, Bento, Oliveira, and Morgado (2016) found that malabsorption syndrome interferes with the processes involved in the digestive system causing impaired absorption of almost all nutrients. However, symptoms vary depending on the specific nutrients not being absorbed efficiently in the body.
3. 3. The physiologic response to the stimulus presented in the scenario and why you think this response occurred: The 83-year patient exhibited signs of malnutrition due to a lack of sufficient intake of nutrients in the body. It is worth noting that malabsorption occurs when the function of the gastrointestinal tract is malfunctioning and nutrient intake decreases. This causes nutrient-related deficiencies. In addition, Kaur, Jadeja, Garg, Rai, and Mogra (2016) indicated that digestion and absorption of nutrients in the gastrointestinal system need extensive interaction between motor, sensory, and absorptive processes. In this case, any interference in the interaction causes disturbances and diseases that may lead to malabsorption.
4. The cells involved in this process: Malabsorption is a condition of the intestine that causes nutrient intake impairment; thus, the cells involved in the process are the intestinal epithelial cells. These cells are organized into crypts and villi and line the intestinal lumen helping it carry the primary functions of digestion and absorption of nutrients. Malabsorption conditions alter the normal functioning of the cells, causing a reduction in the ability to absorb nutrients into the body. According to Patnayak et al. (2016), when diffuse conditions such as Crohn’s disease or celiac disease affect the intestinal epithelial cells, the absorption of almost all vitamins and minerals is impaired.
5. How another characteristic (e.g., gender, genetics) would change your response? Several medical experts argue that malabsorption may affect individuals based on other factors, such as gender, age, and genetics. For instance, children with malabsorption may stop growing properly as their weight or the rate of gaining weight may fall significantly below that of other kids of the same gender and age. Therefore, gender, age, genetics, and ethnicity may advance malabsorption syndrome across populations.

References

Abreu, R., Bento C., Oliveira, L. and Morgado, T. (2016). Malabsorption syndrome as a rare cause of nephrocalcinosis. Clinical Cases in Mineral and Bone Metabolism, 13(3):247-248. doi: 10.11138/ccmbm/2016.13.3.247.

Kaur, A., Jadeja, P., Garg, N., Rai, S.J., & Mogra, N. (2016). Evaluation of small intestinal biopsies in malabsorption syndromes. Annals of Pathology and Laboratory Medicine, 3.

Patnayak R, Suresh V, Jena A, Madhu K, Phaneendra BV, Reddy V. (2016). The maladies of malabsorption. Journal of Pediatric Neurosciences, 11(1):74-6.

Suryawanshi, M. K., Vig, T., Masih, D., & Joseph, R. (2018). Lower Intestinal Langerhans Cell Histiocytosis Masquerading as Chronic Malabsorption Syndrome and Failure to Thrive in a Child: A Rare Case Presented with a Succinct Review of Recent Literature, Indian Journal of Medical and Pediatric Oncology, 39(4):543-545.

                                                                              The Role of Genetics 

              Malabsorption syndrome can be inherited, causing deficits in the gastrointestinal system. The defects acquired cause defects in absorbing specific nutrients essential to the body’s functioning. A condition such as Primary intestinal lymphangiectasia, which is acquired through genes, causes an effect on the absorption of proteins essential in the body. Primary intestinal lymphangiectasia (PIL) is a GIT disorder that results in dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and causing loss of protein in the body. (Ensari, 2014) The disease may also be related to Hennekam syndrome, a genetic disease that causes a defect in the lymphatic system, thus affecting lymph transportation throughout the body.

                                                              Reason For The Presenting Symptoms

              The malabsorption syndrome will cause lymph leakage into the bowel lumen, leading to the body’s loss of proteins. The leakage of lymph to the bowel lumen also has resulted in edema of the abdomen. (Keller & Layer, 2014) Hypoalbuminemia also occurs due to lost protein resulting in peripheral edema; Edema is due to hypoproteinemia, which causes the bilateral swelling of the extremities (Ensari, 2014).

                                                             Physiological Response to The Stimulus and Why It Occurred

             The patient has been diagnosed with protein malnutrition because the ingested protein is not absorbed into the body. The patient does not have dentures, and therefore the initial process of digestion of mechanical breakdown of food is impaired. Digestive enzymes also are introduced; therefore, with no dentures, it may affect optimal absorption. (Keller & Layer, 2014) 

                                                                                       Cells Involved

            Protein is broken first into amino acids, dipeptides, and tripeptides which are absorbed in the cells of the intestinal walls. Caco-2 cells are present in the intestinal wall, and it helps in the absorption and transport of nutrient around the body. The Caco-2 cells are characterized by a well-differentiated brush border on the apical tight junctions and also have microvillus that enables effective absorption and transportation. (Suzuki, 2020)

                                                                                       Effect of Age

            Age can be a factor that affects the general health of a person since the body is not able to process protein less efficiently. Therefore, the body requires more protein intake to maintain muscle mass. In the above case, I could have considered age as a cause of the presenting symptoms if the patient had no previous history of malabsorption. But the two factors can lead to protein malnutrition in older persons.

                                                                                            References

Ensari, A. (2014). The Malabsorption Syndrome and Its Causes and Consequences. Pathobiology of Human Disease,                1266–1287. https://doi.org/10.1016/B978-0-12-386456-7.03804-1 Links to an external site. 

Keller, J., & Layer, P. (2014). The Pathophysiology of Malabsorption. Viszeralmedizin, 30(3), 7–7.                                                https://doi.org/10.1159/000364794 Links to an external site. 

Suzuki, T. (2020). Regulation of the intestinal barrier by nutrients: The role of tight junctions. Animal Science Journal,              91(1). https://doi.org/10.1111/asj.13357 Links to an external site. 

Vignes, S., & Bellanger, J. (2008). Primary intestinal lymphangiectasia (Waldmann’s disease). Orphanet Journal of Rare             Diseases, 3(1). https://doi.org/10.1186/1750-1172-3-5 Links to an external site. 

Absorption Disorder
Nutrients are absorbed by the gastrointestinal (GI) system, especially the small intestines. Malabsorption is a dietary absorption limitation. Disease, GI tract damage, genetics, infection, and compromised blood flow can cause this deficit. Malabsorption Syndrome can occur when nutrients are impaired or all nutrients are impaired (Zuvarox & Belletieri, 2020). The small intestine’s villi and microvilli and pancreatic enzymes chymotrypsin and trypsin break down protein. Protein is digested into dipeptides and amino acids for absorption in the small intestine’s duodenum and proximal jejunum. 

Genetics and Malabsorption
Malabsorption can be caused by genetics. Nutritional deficits can come from the congenital intestinal membrane or small bowel changes. Genetics can potentially predispose one to Crohn’s disease or other causes that restrict absorption surface area (Zuvarox & Belletieri, 2020).Malnutrition results from malabsorption. Age and lack of dentures cause malnutrition. The patient cannot chew food well without teeth, reducing nutrient absorption. Gastric motility, intestinal absorption, blood flow, and protein absorption decline with age.  link decreased albumin levels to poorer nutrition in the elderly. High IL-6 and TNF-alpha levels delay gastric emptying and impair stomach motility in hypoalbuminemia. Lack of nutrition and malabsorption syndrome increase protein deficit risk.

Displaying Symptoms
The 83-year-old patient had generalized extremity and abdominal edema. The patient is likely low in necessary nutrients for normal body system function due to malabsorption syndrome, protein malnutrition, and dentures. If the patient’s dentures fit poorly, they may eat less, worsening malnutrition. Diseases caused by severe protein deficiency impact blood vessel wall fluid balance and pressure. Chemical and hormonal changes result from low albumin levels. All of these things cause edema (Benjamin &Lappin, 2020). Age and lack of dentures cause malnutrition. The patient cannot chew food well without teeth, reducing nutrient absorption. Gastric motility, intestinal absorption, blood flow, and protein absorption decline with age.

Stimulus Reaction
Starvation can produce edema. Albumin helps maintain fluid balance in vascular walls. The patient’s protein deficiency may produce intravascular depletion due to low albumin levels. To treat hypovolemia, antidiuretic hormones are released, causing edema (Benjamin & Lappin, 2020).

Cell Involvement
This patient’s edema may have resulted from cellular responses to dietary imbalances, which increased capillary permeability and allowed fluid to pass through vascular walls, or from antidiuretic hormone production. Another theory is that the cells allowed water to enter due to changes in the fluid’s osmolality, causing edema (Medical Dictionary, n. d.).

Gender or Genetic
Due to the non-gender-specific symptoms, I don’t think gender would influence my response. Genetics may cause malnutrition in this patient due to digestive system congenital abnormalities. Protein shortage appears to cause edema regardless of gender or heredity. Malabsorption syndrome may be hereditary. Genetic susceptibility and diagnosis can be determined through HLA-typing. Chronic pancreatitis, celiac disease, cystic fibrosis, and Crohn’s disease have unique weaknesses. 

            References 

Benjamin, O., & Lappin, S. (2020). Kwashiorkor – StatPearls – NCBI bookshelf.

(2020, July 19). National Center for Biotechnology

Information. https://www.ncbi.nlm.nih.gov/books/NBK507876/#article-23961.s5Links to an external site.

Malcolm G. Coulthard (2015) Oedema in kwashiorkor is caused by hypoalbuminemia, Paediatrics and International Child Health, 35:2, 83-89, DOI: 10.1179/2046905514Y.0000000154Links to an external site.

Medical Dictionary. (n.d.). Cellular edema. TheFreeDictionary.com.

     https://medicaldictionary.thefreedictionary.com/cellular+edemaLinks to an external site.

Zuvarox, T., & Belletieri, C. (2020). Malabsorption Syndromes. In StatPearls. StatPearls

Publishing. https://pubmed-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/31971746/Links to an external site.

The nutrition we put in our bodies is paramount to our ability to function on a daily basis. Cells need macro and micronutrients to sustain life. An 83-year-old patient who presents with edema from malabsorption of nutrients due to the lack of dentures should simply have a soft diet until the patient is properly fit with dentures, or until another suitable option is found. Malabsorption syndrome has many causes, both genetic and not; though, genetics plays a role in every disease and how it manifests in the body. When not enough protein is circulating in the bloodstream for the body to utilize, the cells in the body cannot function properly and eventually malnutrition occurs (Keller, 2014; Zuvarox & Belletieri, 2022). In short, the cells and rest of the body, including the organs will not get the nutrients needed to thrive, or even survive.

McCance (2018) explains that it is important for fat, starch, and protein to pass through the intestines to complete cellular growth and regeneration. Otherwise, the process of catabolism does not take place as it should. In cellular metabolism, there are two processes: anabolism and catabolism. Catabolism happens when the body breaks down complex molecules into simple ones for the purpose of transferring energy to the cell to produce more cells and alter cell structures. In the third and final phase of catabolism, after intracellular breakdown of nutrients, waste products are excreted (McCance, et al., 2018). For this 83-year-old patient, that process is not occurring as it should, so edema builds up instead of excreting waste through urine and stool.

This patient may have a family history of diseases or disorders that would cause malabsorption syndrome, such as autoimmune disorders, gastrointestinal disorders, or Whipple’s disease (Patnayak, et al., 2016). However, with the information that the patient has not been eating because of the lack of dentures, it is highly likely that this is the route cause. There may still be a genetic link as to why this patient has malabsorption syndrome, but the medical staff would need to inquire further with family and follow up with more diagnostic tests if they wanted to know if there was any genetic link in this case.

When patients experience malabsorption, other symptoms may arise, such as neurological changes (Patnayak, et al., 2016). Neurological changes in an 83-year-old patient may not be taken as seriously as if they were occurring in a younger individual, which could further delay care. A proper diet and semi-frequent labs are more than adequate to manage elderly nutrition. The Mini-Nutritional Assessment (MNA) is a quick and reliable test to assess nutrition in elderly patients, but early diagnosis and treatment is crucial (Nagaratnam, 2019). Understanding patients’ history is also important, as well as managing their everyday dietary intake.

In “Maldigestion versus malabsorption in the elderly,” Schiller (2020) discusses the difference between maldigestion/malabsorption verses malnourishment in older adults. He offers suggestions that it may not be lack of or poor food intake that results in malabsorption. Rather, poor diet combined with other underlying illnesses. He found that elderly individuals with malabsorption had previous surgeries, or were taking medicines that blocked nutrient absorption, or had underlying illnesses or diseases (Schiller).

Zuvarox and Belletieri (2022) differentiates between malabsorption and maldigestion stating malabsorption is, “impaired nutrient absorption at any point where nutrients are absorbed… [whereas,] maldigestion refers to impaired nutrient digestion within the intestinal lumen or at the brush border” (para. 3). These authors argue that malabsorption is rarely from malnutrition and almost always occurs when there is a disfunction with the small intestines. The patient in this case had edema in the extremities and abdomen, so malabsorption is a possibility since those are side effects when waste is not excreted. However, the edema may have been due to other causes, as well. In short, a diagnosis of malabsorption may be premature, but starting with this diagnosis and exploring further into other options makes sense with what is known at this time. Understanding the patient’s history and more of the symptoms would be helpful in further diagnosis or agreeing with the current diagnosis. If the patient has a history of Crohn’s disease, previous issues with the small intestine, or other illnesses or surgeries, it makes more sense to diagnosis this patient with malabsorption. No matter what the current diagnosis is, though, rehydrating and nourishing the patient is paramount, as the cells need the building blocks of fats, starches, and proteins to survive and thrive.

References

Keller, J. & Layer, P. (2014). The pathophysiology of malabsorption. Visceral Medicine, 30(3), 150-154.

McCance, K. L., & Huether, S. E. (2018). Pathophysiology (8th ed.). Elsevier Health Sciences (US). https://bookshelf.vitalsource.com/books/9780323413206Links to an external site.

Nagaratnam, N. (2019). Malnutrition and Malabsorption in the Elderly. Advanced Age Geriatric Care, 225-233.

Patnayak, R., Suresh, V., Jena, A., Madhu, K., Phaneendra, B. V., & Reddy, V. (2016). The maladies of malabsorption. Journal of Pediatric Neurosciences, 11(1), 74.

Schiller, L. R. (2020). Maldigestion versus malabsorption in the elderly. Current Gastroenterology Reports, 22(7), 1-8.

Zuvarox T. & Belletieri C. (2022). Malabsorption Syndromes. National Library of Medicine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553106/

The Role Genetics Plays in the Disease

Malnutrition is complex and multifactorial and the development in the elderly population is mainly facilitated by the ageing process. Older adults are at risk of nutritional problems and eventually malnutrition through various mechanisms. According to Mathewson et al., (2021), old people are specifically at risk of disease related weight loss, loss of muscle strength and mass. Any change in nutrient intake potentially results in malnutrition.

Reasons the Patient Presents the Specific Symptoms Described

When the normal functioning of the body is altered, it causes development of signs and symptoms. Malabsorption syndrome leads to impaired uptake of nutrients at any point where nutrients are absorbed. When there is protein deficiency due to malabsorption, patients present with generalized oedema of the abdomen and extremities. The patient also reports of difficulty in feeding due to lack of dentures which can greatly affect nutrition. According to Volkert et al., (2019), dentition and oral health have been shown to substantially affect food intake and mostly declines with ageing.

Physiologic Response, the Reasons for Occurring, and the Cells Involved

The physiologic response evident include generalized oedema of the extremities and abdomen. In people with protein malnutrition, there is decreased synthesis of visceral proteins (Thaxton et al., 2018). The resulting hypoalbuminemia causes extravascular fluid accumulation leading to the clinical presentation of generalized oedema.

How Age Would Change my Response

Age influences the risk of getting protein malnutrition.  Thus, some diseases are more common in the young population whereas others are more prevalent in the elderly population. Protein energy malnutrition is prevalent in infants and children especially in developing countries than the elderly. According To WHO 45.4 million children are affected by malnutrition.

References

Mathewson, S. L., Azevedo, P. S., Gordon, A. L., Phillips, B. E., & Greig, C. A. (2021). Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Research Reviews, 70, 101401. https://doi.org/10.1016/j.arr.2021.101401

Thaxton, G. E., Melby, P. C., Manary, M. J., & Preidis, G. A. (2018). New Insights into the Pathogenesis and Treatment of Malnutrition. Gastroenterology Clinics of North America, 47(4), 813–827. https://doi.org/10.1016/j.gtc.2018.07.007

‌ Volkert, D., Beck, A. M., Cederholm, T., Cereda, E., Cruz-Jentoft, A., Goisser, S., de Groot, L., Großhauser, F., Kiesswetter, E., Norman, K., Pourhassan, M., Reinders, I., Roberts, H. C., Rolland, Y., Schneider, S. M., Sieber, C. C., Thiem, U., Visser, M., Wijnhoven, H. A. H., & Wirth, R. (2019). Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions. Journal of Clinical Medicine, 8(7), 974. https://doi.org/10.3390/jcm8070974

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Case Study Analysis

Malabsorption syndrome is a disorder that prevents an individual’s acquisition of essential nutrients from food (McCance & Huether, 2019). When people consume healthy food, it benefits the individual with vitamins and minerals for life-sustaining growth. However, disorders in the small intestines and other organs involved in absorption hinder the body from absorbing essential nutrients and minerals, leading to malnutrition and other secondary diseases such as edema (Nyborg & Molberg, 2021). This discussion will analyze malabsorption syndrome, the role of genetics in disease development, and patient symptoms. In the case study, the 83-year-old man has malabsorption syndrome that leads to edema and protein malnutrition.

Role Genetics Play in the Disease

Malabsorption syndrome interferes with nutrient absorption in the small intestine. The cause of this condition is influenced by several factors, including infections, genetics, and the effects of medication (Clark & Johnson,2018). However, the situation in this case study can be linked to genetic factors due to a condition known as hereditary folate malabsorption (HFM). According to McCance and Huether (2018), The loss-of-function mutations in the Proton-coupled folate transporter (PCFT) are the cause of the uncommon autosomal recessive condition known as hereditary folate malabsorption (HFM). This condition leads to systemic folate shortage and poor delivery to the brain. HFM is inherited and controlled by the systematic central nervous system (McCance & Huether, 2018). In other cases, genetic links to malnutrition of a pregnant mother throughout the pregnancy directly affect the infant (Clark & Johnson, 2018). Unfortunately, it is challenging to link a specific gene that causes the diseases in the case study. In most cases, a patient’s genetic history plays a vital role in the development of diseases.

  Why did the Patient present with specific symptoms

In the case study, the Patient had generalized edema of the extremities and abdomen. Edema involves the build-up of excess fluid in the interstitial space caused by a lack of protein in the bloodstream (Nyborg, & Molberg, 2021). Protein in the body is essential for hemoglobin, tissues, muscles, and bone formation (McCance & Huether, 2019). Malabsorption syndrome destroys small intestine cells hindering nutrient absorption and leading to malnutrition. Lack of proteins causes salt retention and fluid leak into interstitial spaces, causing edema.

Physiological Responses

Several factors contributed to the physiological stimuli of the Patient in the case study. Patient lack of enough nutrient absorption, especially protein, caused morbidity and edema (Jo et al., 2018). Lower protein in the blood causes salt retention in cells, leading to water being filtered in cell spaces and tissues. As a result, hyperproteinemia causes the body to struggle to absorb water and protein in the cells, which accumulate in cell spaces (McCance & Huether, 2019). Lack of protein also leads to emaciation, and muscles wear out and cannot develop

  Cells Involved in the Process

The process of nutrient absorption begins in the mouth through mechanical food breakdown and enzymatic digestion of nutrients in the oral cavity (McCance & Huether, 2018). The lack of dentures has limited the Patient’s ability to break food down into digestible components (Jo et al., 2018). The primary cells involved in nutrient absorption are the epithelial cells (McCance & Huether, 2018). Other cells include microvilli, Plicae circulares, and villi. Usually, all cells have proteins that help them in repair and regeneration. Protein help maintains fluid balance, regulate pH, and is involved in protein synthesis and energy production (McCance & Huether, 2018).

Other Characteristics

Age, gender, race, and genes all influence the development of malabsorption syndrome; however, age was a significant factor in this case. Older patients are at higher risk of developing malabsorption due to decreased stomach acid secretions resulting in a reduced ability to extract vitamin B (McCance & Huether, 2018). Additionally, older persons may not eat easily digestible meals or consume them insufficiently. Older adults who drink excessive alcohol are also at risk of malabsorption syndrome (Nyborg & Molberg, 2021).

References

Clark, R., & Johnson, R. (2018). Malabsorption syndromes. Nursing Clinics of North America, 53(3), 361–374. https://doi.org/10.1016/j.cnur.2018.05.001Links to an external site.

Jo, S., Lee, C.-H., Jung, W.-J., Kim, S.-W., & Hwang, Y.-H. (2018). Common features of atopic dermatitis with hypoproteinemia. Korean Journal of Pediatrics, 61(11), 348–354. https://doi.org/10.3345/kjp.2018.06324Links to an external site.

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.

Nyborg, G., & Molberg, Ø. (2021). Small intestinal biopsy findings consistent with celiac disease in patients with idiopathic inflammatory myopathy: Review of existing literature. Seminars in Arthritis and Rheumatism, 51(5), 1033–1044. https://doi.org/10.1016/j.semarthrit.2021.07.012Links to an external site.

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of the extremities and abdomen. History obtained from the staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition. 

Malabsorption is a disorder that occurs when a person is unable to absorb nutrients from dietary intake. This included proteins, carbohydrates fats, minerals, and vitamins. (Luo and Nall 2018) Problems with the digestive process may cause malabsorption thus causing malnutrition. Malabsorption can occur if there is not enough production of enzymes to break down the food. Enzymes are a necessary component needed to break down food as they go through the digestive system.  

Genetics can play a key role in the development of malabsorption if the patient has an autoimmune condition or familial history of conditions such as celiacs disease, Crohn’s disease, and cystic fibrosis  

The patient is presenting with generalized edema of the extremities and abdomen because of the altered protein levels in her body. If there is evidence of protein deficiency it will cause swelling and accumulation of fluid(edema) throughout the body. Edema is a result of the development of excess fluid in the interstitial space due to decreased protein levels. Decreased oncotic attraction of fluid within the capillary causes fluid to move into the interstitial space. (McCance and Huether2019) 

The physiologic response to the stimulus is the scenario is:  

The resident has difficulty eating with dentures. Without dentures they are unable to chew properly. This will affect the digestive process as the primary stages. 

The cells that are involved in this process are in the small intestine. The villi and microvilli. Proteins and amino acids. 

Other characteristics that would change my response would be the age of the patient. Such as a child with a diagnosis of failure to thrive.  

Reference: 

McCance,K.L &Huether,S.E.(2019) Pathophysiology: The basis for disease in adults and children(8thed.). St. Louise, MO: Mosby/Elsevier. 

Malabsorption (Syndrome).(n.d). Cleavland Clinic. 

https://myclevelandclinic.org/health/diseases/22722-malabsorption 

Repost due to lack of reference:

• The role genetics plays in the disease.

Malabsorption syndrome is an impairment of nutrient absorption caused by any disruption and alterations of intestinal mucosa, such as Crohn disease, Celiac disease, lactose intolerance, small intestine resection, pernicious anemia (Clark & Johnson, 2018). The digested nutrient are unable to be absorbed by the intestinal mucosa due to deficiencies of enzymes, such s pancreatic lipase, or inadequate secretion of bile salts, or inadequate reabsorption of bile (McCance & Huether, 2019). However, there is not enough information about what type of malabsorption, thus it is unable to determine if genetics are the cause. If the malabsorption syndrome is caused by Celiac Disease which is an  autoimmune disease that damages the small intestinal villous epithelium when people digest of gluten. Celiac Disease is a strong genetic predisposition.  The resident is a genetically susceptible individual and was born with it. 

• Why the patient is presenting with the specific symptoms described.

        Celiac Disease is autoimmune disease, that means immune system attack its own tissue and cause injury to the small intestinal epithelial cells (McCance & Huether, 2019). The tissues in the small intestine are damaged by own immune system and fail to transmit the digested nutrients and electrolytes. However, there are no evidence or other manifestation to point out that the resident has celiac disease or other disease that cause malabsorption. The resident has generalized edema possibly due to lack of sufficient plasma proteins secondary to protein malnutrition. Generalized edema is a serious condition and is caused by a variety of clinical conditions such as heart failure, renal failure, liver failure, or lymphatic system (Kattua, Avula, & Varadhi, 2022). 

• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

         The resident’s autoimmune system attack own tissues of the small instill epithelial cells. Villus of the epithelial cells get injured and become atrophy which cause decease surface area and decrease digestive enzymes. Even epithelial cell production increase to compensate for the tissue lost, the increased cell production is not sufficient, and the cells are not mature enough to maintain absorptive function. Thus, the small intestine decrease carbohydrate absorption, protein absorption, and fat absorption. Damage of mucosal cells causes inflammation which  lead to diarrhea that causes electrolytes and protein lost. At the same time, due to damage of mucosal cells, the body decrease intestinal hormones such as secretive and cholecystokinin, there fore, it decreases pancreatic function.  Hypoalbuminemia and hyponatremia may contribute the generalized edema. 

• The cells that are involved in this process.

       The cells that are involved in this process are epithelial cells in the small intestinal. CD4+ T-cell-mediated autoimmune, antibody and complement activation attack and injury the villi of the epithelial cells. 

• How another characteristic (e.g., gender, genetics) would change your response.

          The age, cognitive function, mobility function, difficulty in swallowing, mental illness, competencies of the caregivers are factors to contribute the malnutrition. This resident is 83 years old and possibly is unable to take care himself. He might need assistant in feeding. He might have difficulty in swallowing. He might have some mental illnesses such as depression or schizophrenia, which may have problems in thought process. He might be neglect by his caregivers. There are so many factors that may cause malnutrition. In addition, heart failure, kidney injury, cirrhosis, or drugs might contribute generalized edema. 

Reference

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. 

Clark, R., & Johnson, R. (2018). Malabsorption Sundromes. Nursing Clinics of North America, 53(3), 361-374. http://doi.org/10.1016/j.cnur.2018.05.001

Kattula, . R., Avula, A., & Baradhi, K. (2022). Anasarca. https://www.ncbi.nlm.nih.gov/books/NBK519013/