darkhorse
Forum Elite
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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
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| bax
Forum Senior
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D
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| dr.wad
Forum Senior
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Serum laboratory studies are normal. A 24-h stool collection reveals 500 g of stool
is this sentence complete ?????
however .....stool osmlar gap is used to diagnose lacatse deficiency.
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| aaroho
Forum Junior
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?d
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| dr penicillin
Forum Junior
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i am agree with bax
gap is less than 50 so its not osmolar diarrhea
so its D
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| doc_clotaire
Forum Guru
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yes D ---------also called Verner-Morrison syndrome
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| darkhorse
Forum Elite
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The answer is D.
This patient has a stool osmolality gap (measured stool osmolality – calculated stool osmolality)
of <50 mosmol/L, suggesting a secretory rather than an osmotic cause for diarrhea. Secretory
causes of diarrhea include toxin-mediated diarrhea (cholera, enterotoxigenic Escherichia coli)
and intestinal peptide–mediated diarrhea in which the major pathophysiology is a luminal or
circulating secretagogue. The distinction between secretory diarrhea and osmotic diarrhea aids
in forming a differential diagnosis. Secretory diarrhea will not decrease substantially during a
fast and has a low osmolality gap. Osmotic diarrhea will generally decrease during a fast and
has a high (>50 mosmol/L) osmolality gap. Celiac sprue, chronic pancreatitis, lactase
deficiency, and Whipple's disease all cause an osmotic diarrhea.
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