What Is Steatorrhea?

Fatty diarrhea refers to the clinical syndromes of the small intestine that have reduced digestive and absorptive functions caused by various reasons, so that nutrients cannot be completely absorbed, and are excreted from the feces, causing nutritional deficiency. Because the patient discharges too much fat in the stool, it is also called small bowel malabsorption, also known as oily diarrhea. There are many reasons, such as malabsorption syndrome, bile salt and pancreatic digestive enzyme deficiency, enteritis or diverticulosis, intestinal-derived fat metabolism disorders, gastrinoma or chyle ducts cannot absorb fat. Typical fatty diarrhea stools are pale in color, large in amount, greasy or foamy, often floating on the water surface, and often have a foul odor.

Basic Information

nickname

Dyspepsia syndrome, small intestinal malabsorption, oily diarrhea

English name

steatorrhea

Visiting department

Traditional Chinese Medicine

Common locations

Small intestine

Common causes

Hepatobiliary diseases, intestinal diseases, pancreatic diseases, endocrine diseases, etc.

Common symptoms

Fatty diarrhea, light stools, large amounts, greasy or foamy, more than foul odor, weight loss, fatigue, convulsions of hands and feet, night blindness, edema, etc.

Causes of steatosis

Hepatobiliary disease

It is more common in extrahepatic biliary obstruction or intrahepatic biliary obstruction in biliary obstruction lesions. Biliary obstruction is the most likely cause of bile retention and changes in bile components, which significantly reduce the bile acid concentration in the intestinal cavity, which affects fat hydrolysis and fatty acids Decomposed digestion forces fat to be excreted from the stool, resulting in steatosis.

2. Intestinal diseases

Various intestinal infections, extensive resection of the small intestine, primary small bowel lymphoma, small bowel ischemia due to arteriosclerosis, intestinal lipid metabolism syndrome, eosinophilic gastroenteritis, food allergies, etc. are all possible Fatty diarrhea occurs when the digestive function of small intestinal mucosal epithelial cells is damaged.

3. Pancreatic disease

Chronic Pancreatitis and Pancreatic Cancer in Pancreatic Lesions. Mainly because the pancreatic lipase secreted by the pancreas decreased significantly, resulting in fat indigestion, which caused a large amount of fatty substances to be excreted from the stool.

4. Endocrine diseases

Adrenal insufficiency, hypothyroidism in endocrine diseases, and steatosis can occur even in a few patients with hyperthyroidism. This is because endocrine disorders can easily lead to lipid metabolism disorders, and then steatosis occurs.

5. Other

Beta lipoproteinemia, gamma globulinemia, gastric resection, and scleroderma also easily lead to reduced fat metabolism and steatosis.

Clinical manifestations of steatosis

Local symptoms

80% to 97% of patients have diarrhea, typically with fatty diarrhea, light stools, large amounts, greasy or foamy, and many stench, stool frequency ranging from several to more than ten times, and sometimes intermittent diarrhea. May have abdominal fullness, loss of appetite, etc., but abdominal pain is rare.

2. Systemic symptoms

Wasting, weakness, convulsions of hands and feet, paresthesia, stomatitis, dry cornea, night blindness, edema and other malnutrition symptoms. Children with long-term fatty diarrhea can cause developmental delay, thin body and so on.

3. Signs

There may be signs of weight loss, mild tenderness in the abdomen, paresthesia in the extremities of the extremities, glossitis or ulcers, pellagra, edema, concave nails, muscle tenderness, clubbing fingers (toes) and other signs.

Steatosis test

Fecal examination

Including appearance, microscopy and culture. Look for red blood cells, white blood cells, eggs, and protozoa on the microscopy. Sudan III staining can check for fat drops. Fecal fungal examination and bacterial spectrum analysis are helpful for the etiology diagnosis of diarrhea.

2. Examination of fecal fat under a microscope

(1) Put a small amount of faeces on a glass slide and mix with 1 or 2 drops of Sudan III saturated solution for microscopic examination. It can be seen that the neutral fat is in the shape of scarlet round oil droplets; the free fatty acids are in the shape of dark yellow-red bunches, or short. Curved needle-shaped crystals; while the bound fatty acids are not colored, they are pile-shaped or arranged in a fan shape.

(2) Take one drop of a saturated saline solution of normal saline and scarlet dye, add a little feces and mix on a glass slide, and cover with a cover glass for microscopy. Visible neutral fats and crystalline fatty acids. If more than 1/4 of the specimen is stained red, it is strongly positive (ten or ten ten), and it is severe steatosis.

3. Quantitative determination of fecal fat

The Vandekamer test method is generally used. The test method is to continuously eat a standard meal (containing 60 to 100 g / day of fat) for 3 days, while measuring its fecal fat content for 3 days. Take the daily average, if the amount of fecal fat is> 6g per day, or the fat absorption rate is <95%, it can be considered that there is fat malabsorption.

4. Absorptive function check

D-xylose absorption test, vitamin B ₁₂ absorption test, pancreatic function test, etc.

5. Other auxiliary inspections

Blood routine, ESR, electrolytes, urea nitrogen, carbon dioxide binding capacity, etc. If gastric diarrhea is suspected, gastric fluid analysis should be performed. For patients with suspected hyperthyroidism, relevant tests such as basal metabolic rate and thyroid iodine absorption rate can be done. Pancreatic function tests, imaging studies, and endoscopy can help diagnose the primary diseases of the pancreas and gastrointestinal tract that cause fatty diarrhea.

Diagnosis of steatosis

Patients with steatosis often have large cell anemia, serum electrolytes, plasma albumin, cholesterol, and even folic acid. Vitamin B ₁₂ levels are lowered. Fecal fat content is> 6 g / d. D-xylose absorption test <3 g. Test <8% 10%.

Steatorrhea treatment

Substitute treatment

It is best to choose intravenous hypertrophic therapy to supplement the lost water electrolytes and various nutrients and vitamins. Intravenous albumin or blood transfusion if necessary.

2. Etiology treatment

If pancreatic function is insufficient, trypsin tablets (containing trypsin, pancreatic lipase, and pancreatic amylase) can be given; in addition to treating bile salt deficiency, medium chain triglycerides should be added to the diet to improve patients Nutritional status, medium chain fat can be directly absorbed by the small intestine without bile salts. For patients with malnutrition caused by malnutrition, intravenous nutrition can be used first. After the situation improves, diet should be gradually increased. Celiac disease should be restricted from eating cereals. Some fat malabsorption is related to bacterial effects, such as excessive reproduction of bacteria in the upper small intestine, which can decompose bile salts and affect fat absorption. Need to be treated with appropriate antibiotics.

3. Adjuvant therapy

Give a high-calorie, high-protein, low-fat diet. Because monosaccharides are easier to absorb, they can give bananas and other foods containing a lot of monosaccharides.

Steatosis prognosis

The prognosis of steatosis caused by different diseases is different, and most patients can be relieved after eliminating the cause.

Steatorrhea prevention

1. Prevent the occurrence of primary disease

Such as dietary hygiene can prevent fatty diarrhea caused by intestinal bacterial infections. Prevention of steatosis caused by endocrine diseases such as hypothyroidism is to treat and prevent the primary disease.

2. Avoid excessive consumption of fatty foods.