Malabsorption

1. Pancreatic dysfunction. Leads to fat malabsorption and steatorrhea, with large, greasy, foul-smelling stools; growth failure; and deficiencies of fat-soluble vitamins. Causes include cystic fibrosis, Schwachman syndrome, and chronic pancreatitis.

2. Bacterial overgrowth. Consider in postsurgical patients. Leads to bile salt deconjugation, which typically promotes watery diarrhea.

3. Celiac disease. Allergic response to gluten, characterized by proximal small bowel mucosal damage and subsequent malabsorption. Can occur at any time after gluten is introduced into the diet, from about 6 months to adulthood. Symptoms include diarrhea, abdominal distention and discomfort, lactose intolerance, poor growth, vitamin deficiencies, and iron-deficiency anemia.

4. Eosinophilic gastroenteritis. Typically presents with signs and symptoms of malabsorption, hypoalbuminemia, and anemia.

J. Irritable Bowel Syndrome. Intermittent diarrhea may alternate with constipation. Abdominal pain and flatulence may be present. Symptoms are aggravated by stress. Physical exam and routine laboratory tests are normal.

K. Anatomic Abnormalities. Short-bowel syndrome or intestinal lymphangiectasia.

Endocrine Disorders. Hyperthyroidism, diabetes, or Addison disease.

Immunodeficiency. HIV infection, isolated IgA deficiency, combined immune deficiency.

Tumor. Familial polyposis coli, functional tumors (eg, VIPoma, somatostatinoma, gastrinoma), or lymphoma involving the bowel. Inborn Metabolic Errors. Familial chloride diarrhea, Wolman disease, abetalipoproteinemia, or hypobetalipoproteinemia.

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