Concluded Case

Malabsorption

26 Y/M C/O : Foamy and oily stool for more than 1 Yr. H/O : 1. Stool is foul smelling. Complete evacuation occurs after at least 3 defecations. Food particles remain in present though patient can't say the type of the food present. 2. Increased acidity with sour feeling inside the mouth. 3. Increased thirst. 4. Appetite and food intake are normal. 5. Weight loss present (patient couldn't say how much weight he lost.) 6. Patient can't understand in which type of food he faces such problems. 7. Joint pain, fever, constipation, pain abdomen are absent. No blood in stool seen. 8. Already taken treatment for IBS-D with no result. What is your provisional diagnosis and ddx? Discuss the cost effective approach and treatment. Prognosis?

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Concluded answer
A patient presenting with chronic fatty diarrhea can have small bowel pathology or pancreatic pathology. What is the volume of stool. Do a CBC, RFT, LFT with albumin, INR. Presence of anemia, hypoproteinemia, voluminous diarrhea are more in favor of small bowel pathology. Then patient can be planned for an UGI endoscopy with duodenal biopsy. If inconclusive, can go for a CT enterography. And plan accordingly. Better to refer this patient to a gastroenterologist.
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SINCE... 1. SYMPTOMS. ARE. LONG. STANDING..... CHRONIC.....ALMOST. ...FOR. THE. LAST..... ONE. YEAR... 2. NO.....FEVER.... ABDOMEN. PAIN ... BLEEDING. ...JOINT. PAIN....AND NO. CONSTIPATION... 3. ONLY. PROBLEM. IS..... FOAMY....OILY. STOOL...WITH. FOUL. SMELL.... AND. TAKES.... 3. DEFECATIONS.......TO. CLEAR... INCREASED. ACIDITY...WITH. SOUR. FEELING......WEIGHT. LOSS... SO.... ... SUGGESTIVE OF.... STEATORRHOEA... POSSIBLE.....REASONS.... 1. INDIGESTION 2. MALABSORPTION 3. GLUTEN. SENSITIVITY 4. LACTOSE. INTOLERANCE 5. HEAVY. FATTY.... FIBROUS. DIET.... 5. HEAVY. NON. VEG. AND. ALCOHOL...AND. NUTS.. 6. WORRISOME. INTOLERANT.. ...NATURE../.PERSONALITY..... ADVISABLE... 1. ALL. ROUTINE. INVESTIGATION 2. ENDOSCOPIC. EXAMINATION 3. SYMPTOMATIC MANAGEMENT. .. ..TO. IMPROVE... DIGESTION. AND. ABSORPTION 4. CULTURE. AND. SENSITIVITY. TESTS
A patient presenting with chronic fatty diarrhea can have small bowel pathology or pancreatic pathology. What is the volume of stool. Do a CBC, RFT, LFT with albumin, INR. Presence of anemia, hypoproteinemia, voluminous diarrhea are more in favor of small bowel pathology. Then patient can be planned for an UGI endoscopy with duodenal biopsy. If inconclusive, can go for a CT enterography. And plan accordingly. Better to refer this patient to a gastroenterologist.
Very nicely explained sir. I already suggested him to consult an gastroenterologist. Posted just for knowledge enhancing. SIR, TODAY HE IS SAYING HE FACES TROUBLE LIKE HEAVYNESS OF ABDOMEN AND THE CALLED SYMPTOMS AFTER MILK INTAKE. FOR FEW DAYS STOOL COLOUR IS LITTLE REDDISH BUT HE IS NOT SURE WHETHER IT'S BLOOD OR ANYTHING ELSE.
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* IBD ** Gastric juice,pancreatic juice or liver functions disturbed not working properly Needs further investigation and evaluation to conclude and line of treatment. Reassurance and counciling required. Good nutritious balanced diet liquid frequently to avoid wt loss etc.
Thanks Dr Salim Marchent
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DD..IBD,Gluten enteropathy,Tropical sprue, Whipple'disease, ulcerative colitis,investment.routine stool examination to rule out fat in stool,colonoscopy.rx.drugs like Rifagut,panreoflat.anxiolytic helpful
Fat intolerance To confirm ,stool fat can be checked for fat globules. To rule out Chronic pancreatitis Tropical sprue Suggest Pancreatic enzyme replacement orally ( Panlipase ) Low fat diet
Thank you, Friends
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Stool routine and microscopy with culture and sensitivity needed Crowns disease Chronic Gastritis IBS Peptic ulcer Endoscopy is also useful, liver enzymes needed
Sirvduodenal biopsy, Tropical sprue higher in card,do HIV, other dd MAC INFECTED BACTEC CULTURE, TB WORK UP
UGI endoscopy with duodenal biopsy Further investigation and evaluation to conclude line of treatment.
D/D 1.Tropical sprue 2.Gluten enteropathy 3.Ulcerative colitis 4.Whipple's disease. 5.IBS .
Sir, he doesn't have any problem with wheat products so I excluded Gluten enteropathy. No fever, pain abdomen and blood in stool so UC excluded. No joint pains so didn't consider Whipple's disease. No pain abdomen so IBS also ruled out. Today he is saying he faces problem with milk. I have confusions between.... 1. Exocrine pancreatic insufficiency. 2. Tropical sprue. 3. Lactose intolerance. Can't understand how to differentiate them.
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IBD
No blood in stool, No fever, No pain abdomen.
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