By Brad Steiger
Paperback ebook relates eye witness alien conferences through a variety of humans.
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A 72-hr fecal fat study should be done. The sample is collected after 3 days of a 100-gm fat diet that is continued throughout the collection. More than 7 gm/day is abnormal, but mild increases of up to 14 gm are very common in any cause of diarrhea. In steatorrhea (fat malabsorption), there is typically Ͼ14 gm of fat/24 hr in the stool (GE 1999;116:1464). If steatorrhea is not present, then the dx might not be malabsorption. If the pt is reluctant to do a 72-hr collection, a qualitative fecal fat on a single sample can be a helpful positive but is not a reliable negative.
Sx/Si: Pts with malabsorption typically present with weight loss and diarrhea. The stool is of high fat content so it might look greasy or oily, or be difficult to flush. There may be bloating, excessive flatus, and borborygmi. In very advanced cases, there may be a syndrome associated with specific nutrient deficiencies such as anemia associated with folate or B12 deficiency, bleeding with vitamin K deficiency, or metabolic bone disease from vitamin D deficiency. However, it is now uncommon for pts to present with these advanced findings.
Rectal gas is a combination of swallowed air (rich in nitrogen) and gas produced from colonic bacterial metabolism that produces hydrogen, methane, and malodorous sulfur gases (Gut 1998;43:100). Some pts will complain of frequent passage of flatus because of poor sphincter tone. A small number of pts will have excess gas from serious malabsorptive diseases (p 19) such as celiac disease, small bowel bacterial overgrowth, and pancreatic insufficiency. The remainder have an anatomically normal gut and have excessive flatus either from air swallowing or from gas produced by bacterial fermentation of carbohydrates.