Question

An 18 -year-old man complains of spending a small fortune on bathroom air fresheners over the past year. His main complaint however is a low volume but chronic, foul smelling diarrhea and increased gas for the past year. He has lost 10 pounds and no nausea or vomiting is present. On physical examination there is vague mild abdominal pain to palpation but no masses. Bowel sounds are active. His stool is negative for occult blood. Laboratory studies include a quantitative stool fat of 10 g/day.

1. What does this mean?

2. What is it called?

3. What do these findings suggest?

4. Why is this important?

5.What is his general diagnosis?

6. What could you do next to nail down his specific diagnosis?

7.What is his most likely diagnosis?

8.Which of the following therapies would likely be most useful to this man? Why?

Answer 1

The patient likely has chronic pancreatitis.Chronic pancreatitis is a condition characterized by inflammation of the pancreas that persists over time, leading to impaired digestion and absorption of nutrients.

Step-by-step explanation:

Chronic pancreatitis is a condition characterized by inflammation of the pancreas that persists over time, leading to impaired digestion and absorption of nutrients. The elevated stool fat of 10 g/day, known as steatorrhea, indicates malabsorption of fats. This occurs because the pancreas is not producing sufficient enzymes, such as lipase, needed for fat digestion. The foul-smelling diarrhea and increased gas are consistent with malabsorption, and the unintentional weight loss of 10 pounds further supports a malabsorptive state.

Chronic pancreatitis often presents with vague abdominal pain, as noted in the physical examination. The absence of occult blood in the stool rules out gastrointestinal bleeding. The key diagnostic finding is the elevated stool fat, confirming malabsorption. This is crucial as it directs further investigation and management. Chronic pancreatitis can have various etiologies, including alcohol consumption, and it is essential to identify the underlying cause to tailor appropriate treatment.

To confirm the diagnosis and determine the cause, imaging studies such as abdominal CT scans or MRI may be conducted. Additionally, blood tests measuring pancreatic enzymes and function may provide further insights. An endoscopic ultrasound might also be considered. The most likely diagnosis at this point is chronic pancreatitis, given the constellation of symptoms, physical findings, and laboratory results.

Therapeutically, pancreatic enzyme replacement therapy (PERT) would likely be beneficial. PERT supplements the deficient enzymes, aiding in fat digestion and alleviating symptoms. Lifestyle modifications, such as dietary changes and abstinence from alcohol if relevant, are also crucial components of management. Early intervention is essential to prevent complications and improve the patient's quality of life.