- Increased stool volume with increased fecal fat contents (due to malabsorption)
- Causes:
- Zollinger-Ellison syndrome
- increased production of gastric acid inactivates the pH-sensitive pancreatic lipases
- Drug-Induced Diarrhea
- Orlistat (Xenical)
- Acarbose
- Diseases affecting proximal small intestines
- Carbohydrate malabsorption
- Lactose Intolerance
- Fructose Intolerance
- celiac disease
- tropical sprue
- giardiasis
- Whipple disease
- Caused by Tropheryma whipplei bacteria (diarrhea, steatorrhea, abdominal pain, weight loss, migratory arthropathy(large joints), fever, and neurological symptom)
- Lymphoma (Lymphatic injury)
- Amyloidosis
- SIBO
- HIV enteropathy
- exocrine pancreatic insufficiency
- chronic pancreatitis
- cystic fibrosis (CF)
- pancreatic duct obstruction or resection of the pancreas (e.g., pancreatic tumors)
- Bile acid deficiency
- Cholestasis
- primary biliary cirrhosis/primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- inability to absorb bile acids in the distal ileum resulting in diminished bile acid pool
- e.g. ileal resection or Crohn disease of the ileum
- deconjugation of bile acids
- e.g., small intestinal bacterial overgrowth (SIBO)
- Symptoms
- Pale, bulky stools
- Frothy or greasy stools
- Foul odor to stool
- Weight loss with nutritional deficiency
- Resolves within 1-2 days of not eating
- Excessive Flatus
- Evaluation
- fecal elastase
- celiac screen
- stool chymotrypsin level
- Complications
- Weight loss in adults and other consequences of malnutrition such as increased susceptibility to infections, and increased morbidity and mortality from various disease states. Additionally, in children, malnutrition results in growth failure and poor neurological development
- Deficiencies of fat-soluble vitamins (A, D, E, and K)
- Poor bone health resulting in osteopenia, osteoporosis, and fractures (CF, celiac disease)
- Iron deficiency anemia, zinc deficiency (celiac disease)
- Dermatitis herpetiformis, non-Hodgkin lymphoma, adenocarcinoma of the upper gastrointestinal tract (celiac disease)
- Megaloblastic anemia due to B12 deficiency (in terminal ileum disease and SIBO)
- Pancreatic pseudocyst, ascites, splenic vein thrombosis, diabetes, pancreatic cancer (chronic pancreatitis)
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