STEATORRHEA
STEATORRHEA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is the patient a child or an adult? Children with steatorrhea may have celiac disease, cystic fibrosis, or tropical sprue.
- Are there associated respiratory symptoms? The presence of respiratory symptoms should suggest cystic fibrosis, regardless of whether the patient is an adult or a child.
- Is there jaundice? The presence of jaundice would suggest obstructive jaundice such as that due to biliary cirrhosis and other disorders.
- Is there pallor and anemia? The presence of pallor or anemia suggests malabsorption syndrome, blind loop syndrome, intestinal parasites such as
Diphyllobothrium latum
, scleroderma, amyloidosis, and chronic obstructive jaundice.
- Are there signs of systemic disease? If there are signs of systemic disease, scleroderma, amyloidosis, and cystic fibrosis should be considered.
- Is there an abdominal mass? The presence of an abdominal mass should suggest obstructive jaundice, pancreatic carcinoma, and hemochromatosis. Chronic pancreatitis may also present with an abdominal mass if there is a pseudocyst of the pancreas.
DIAGNOSTIC WORKUP
The basic workup includes a CBC, a blood smear for cell morphology, sedimentation rate, urinalysis, chemistry panel, serum B
12
and folic acid, serum amylase and lipase, stool for occult blood, ovum and parasites, fat and trypsin, and urine for 5-HIAA.
A sweat test should be done if cystic fibrosis is suspected. A
d
-xylose absorption test will help differentiate primary diseases of the small intestines. An abnormal yield of labeled carbon dioxide after ingestion of a meal with radioactive
14
C-glycocholate will help diagnose bacterial overgrowth. An upper GI series and small bowel follow-through may be helpful. Intubation and analysis of pancreatic secretion of enzymes after pancreozymin or secretin injection will help differentiate pancreatic disorders. A CT scan of the abdomen and endoscopy may be useful. Intestinal biopsy with a Crosby capsule may help differentiate primary intestinal diseases also. Consult a gastroenterologist before ordering many of these expensive diagnostic tests.
A therapeutic trial with pancreatic enzymes, antibiotics, or even a gluten-free diet may also assist in the diagnosis.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
More About Steatorrhea
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Medical Books Excerpts
- Steatorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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