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Malabsorption
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Author17 Posts
  #1

45 y/o man with diarrhea for 8 months, lost 15 lbs for the last 8 months, no blood in the stool

24 hour stool collection shows reveal fecal fat of 10 mg/d

D xylose test, less than 2gramx xylose in urine in 5 hours, after treatment of antibiotics, D xylose test have the same result

Most likely diagnosis ?

A. Lactulose intolerance

B. Bacterial overgrowth

C. Pancreatic insufficiency

D. Whipple

E. Terminal ileal disease

  #2

Are you sure the question is correct ?

Fecal fat = shows no malabsorption (normal < 6gm /day while it is only 10mg/day in the question)

D-Xylose test shows = malabsorption


  #3

e

  #4

e...terminal ileum disease ( crohns ) ...

d-xylose absorption depends on intact mucosa only ...it doesnt need any ezymatic digestion.

but ..i guess that in whipple there is mucosal affection....isnt???

to eagle .....in malabsorpion there is increased fecal fat ....i guess u need just to reread the q.


  #5

dr.wad wrote:
e...terminal ileum disease ( crohns ) ...

d-xylose absorption depends on intact mucosa only ...it doesnt need any ezymatic digestion.

but ..i guess that in whipple there is mucosal affection....isnt???

to eagle .....in malabsorpion there is increased fecal fat ....i guess u need just to reread the q.


The stem question says:

24 hour stool collection shows reveal fecal fat of 10 mg/d

The quantity of fecal fat is so low that it practically rules out malabsorption.

Is not so ?


  #6

ddd
if normal is <6 then 10 is high......
D-xylose= malabsorption
I'd go for Whipple d/s....

  #7

D
I took 10mg as 10g and assume increased fecal fat.

  #8

fat >6 MA synd give antibiotics normal D Xilosa overgrow
abnormal D xilosa WIPPle

  #9

nyimalay wrote:
D
I took 10mg as 10g and assume increased fecal fat.

How can you assume on your own that it is 10g instead of clear 10mg when the author did not correct it


  #10

doc649 wrote:
ddd
if normal is <6 then 10 is high......
D-xylose= malabsorption
I'd go for Whipple d/s....


Please put the units with 6 and 10 so that we should what are your talking about.


  #11

For your reference.

D-xylose absorption test:

This test measures the intestine's ability to absorb the simple sugar, D-xylose. This is an indicator for whether or not nutrients are being absorbed properly in the intestine. This test is often used to evaluate persistent diarrhoea, weight loss, malnutrition and cases of suspected malabsorption. Abnormal results may be seen in the following conditions: Crohn's disease, Giardiasis, hookworm infestation, radiation enteritis, celiac sprue, viral gastroenteritis and Whipple's disease.



___________________
Nothing is impossible.

  #12

i smell an A oops that says lactulose ...?!
hmmm

then E


  #13

if after treatment of antibiotics, D xylose test have the same result - it's not Whipple, so - E



  #14

please PAT u know the answer whts the correct answer?

  #15

hopefor wrote:
please PAT u know the answer whts the correct answer?

this is from UW and ans is Whipple's. Can't figure it out why not Crohn's

  #16

sometimes its just a badly made question


  #17

don't you think that it might be fat malabsorbtion with normal sugars absorbtion in Crohn's, and fat and sugars mal in Whipple's? Or it's analysis paralysis?







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