Maldigestion

(fatty; ↑ fecal fat, ↑ osmotic gap, ↓ diarrhea w/ fasting) Fatty diarrhea with increased fecal fat, increased osmotic gap, and decreased diarrhea with fasting - A type of diarrhea characterized by fatty, greasy stools with a high concentration of fat, indicated by an increased fecal fat level. The osmotic gap (the concentration of substances in the stool that can cause water retention) is also increased. This type of diarrhea tends to decrease with fasting, meaning that symptoms become less frequent or severe when the patient doesn’t eat.

This pattern of symptoms suggests that the cause of the diarrhea may be due to factors such as malabsorption (inability to properly absorb nutrients), exocrine pancreatic insufficiency (a condition where the pancreas doesn’t produce enough digestive enzymes), or certain medical conditions, such as cystic fibrosis or celiac diseas

• Defective intraluminal hydrolysis of nutrients, typ. 2/2 pancreatic/hepatobiliary pathology

• pancreatic insufficiency: most commonly from chronic pancreatitis or pancreatic cancer. Test w/ stool elastase, chymotrypsin levels, fecal fat, or empiric pancreatic enzyme Rx.

• ↓ bile acids due to ↓ synthesis (cirrhosis), cholestasis (PBC), or s/p ileal resection. Test w/ empiric bile acid replacement therapy.