STEATORRHEA

Ask the Following Questions:

1. Is the patient a child or an adult? Children with steatorrhea may have celiac disease, cystic fibrosis, or tropical sprue.
2. 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.
3. Is there jaundice? The presence of jaundice would suggest obstructive jaundice such as that due to biliary cirrhosis and other disorders.
4. 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.
5. Are there signs of systemic disease? If there are signs of systemic disease, scleroderma, amyloidosis, and cystic fibrosis should be considered.
6. 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.

Other Book Chapters Related to Steatorrhea

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Steatorrhea

• Back to symptom: Steatorrhea: Introduction (review 25 causes)
• Next Book Extract About Steatorrhea: Gastrointestinal Bleeding (A Pocket Manual of Differential Diagnosis)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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