A patient with Crohn's disease complains of extreme muscle weakness, fatigue, diarrhea, bruising, 10-pound weight loss over the last few weeks, and dypnea on exertion
On physical examination, the patient is afebrile, pulse 110, resps 20/min, and BP 100/ 50. BMI is 15. The patient is pale and frail looking, with bilateral ankle edema and bruises noted on cachetic thighs. Which of the following diagnostic tests is most helpful in the diagnosis of intestinal malabsorption?
A. Liver enzymes
B. Vitamin B12 assay
C. Stool for fat
D. INR
ANS: C
The signs and symptoms vary according to the underlying problem, but common symptoms include weight loss, flatulence, abdominal bloating, edema in the lower extremities resulting from protein deficiency, muscle weakness, possibly diarrhea or steatorrhea, dehydration, glossitis, and bruising. A variety of abnormal findings can be associated with malabsorption syndromes, including iron, folic acid, or B12 deficiency anemia; calcium deficiency; vitamins A, B, C, and D deficiencies; and niacin deficiency. A combination of weight loss, diarrhea, and anemia should raise the possibility of malabsorption. A variety of abnormal findings can be associated with malabsorption syndromes, including iron, folic acid, or B12 deficiency anemia; calcium deficiency; vitamins A, B, C, and D deficiencies; and niacin deficiency. There are as many diagnostics as there are causes of malabsorption. Measurement of fat in the stool is the most valuable diagnostic for diagnosing malabsorption, and a 3- to 4-day stool collection is advised. Stool specimens for ova, parasites and culture, and sensitivity will help to rule out infectious causes. Absorption tests, flat plate of the abdomen, upper GI with small bowel follow-through, endoscopy, and small bowel biopsy may be necessary for definitive diagnosis.
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