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A 54-year-old male presents with 1 month of diarrhea


A 54-year-old male presents with 1 month of diarrhea


حالة سريرية

الوصف الكامل Background
A 54-year-old male presents with 1 month of diarrhea. He states that he has 8 to 10 loose bowel movements a day. He has lost 8 lb during this time. Vital signs and physical examination are normal. Serum laboratory studies are normal. A 24-h stool collection reveals 500 g of stool with a measured stool osmolality of 200 mosmol/L and a calculated stool osmolarity of 210 mosmol/L. Based on these findings, what is the most likely cause of this patient's diarrhea?

A. Celiac sprue
B. Chronic pancreatitis
C. Lactase deficiency
D. Vasoactive intestinal peptide tumor
E. Whipple's disease

explain ur answer...

by

ok ,all what we have :
chronic diarrhea in such a pt (old)does not go with lactase deficiency
..
Celiac Disease ..i think old enough that he should discover his illness decades before ..
Whipple's disease ..i don't know ,but i guess it is infectious so i think sth else would be presented..
Chronic pancreatitis ,i think the usual presenting symptom is the postprandial pain ,rather than the diarrhea .
i guess it is D.the VIPOMA ,it cause such a diarrhea ..Chronic+with such osmotic gap (less than 50) which make it far from most of the other choices mentioned above ..
Green Wave's picture
Green Wave


A 24-h stool collection reveals 500 g of stool with a measured stool osmolality of 200 mosmol/L and a calculated stool osmolarity of 210 mosmol/L.

What's the normal values supposed 2 be ??

pearls-2's picture
pearls-2
السنة السادسة


diarrhea is defined when when the stool exceeds 200 grams

about osmolality....less than 50 indicates secretory diarrhea
a larger than 50 gap indicates an osmotic one

Vince Carter


celiac sprue ,chronic pancreatitis and whipples are probably with steatorrhea....
leave us with lactase deficiency and vipoma...
in lactase deficiency the osmotic gap is more than 50 and no history support it ...
so it is vipoma

mbs2380's picture
mbs2380
بعد التخرج


right....

Quote:

celiac sprue ,chronic pancreatitis and whipples are probably with steatorrhea....
leave us with lactase deficiency and vipoma...
in lactase deficiency the osmotic gap is more than 50 and no history support it ...
so it is vipom

. Celiac sprue, chronic pancreatitis, lactase deficiency, and Whipple's disease all cause an osmotic diarrhea(gap greater than 50).

whereas our patient has a gap less than 50...so indicates a secretory diarrhea

Vince Carter


up...
managements of vipoma is?

Buzz_LightYear
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