steatorrhea

Introduction

Steatorrhea is the presence of undigested fat in stools.

Etiology

• malabsorption
  • inflammatory bowel disease
  • celiac disease*
  • tropical sprue
  • abetalipoproteinemia
• exocrine pancreatic insufficiency*
  • pancreatitis
• obstruction of the bile duct
  • choledocholithiasis (gallstones)
  • pancreatic cancer
  • primary sclerosing cholangitis
• small intestinal bacterial overgrowth*
• short bowel syndrome*
• cystic fibrosis
• Zollinger-Ellison syndrome
• giardiasis
• Graves' disease / hyperthyroidism
• pharmaceutical agents
  • Orlistat
  • octreotide
  • lanreotide
• whole nuts, especially cashews
• oilfish (butterfish)
• jojoba oil

* 4 most common causes

Clinical manifestations

• by inspection, the stools are frothy, greasy & foul-smelling
• microscopically, fat globules may be seen with Sudan III stain
• abdominal pain or cramping
• diarrhea
• flatulence
• nausea with or without vomiting
• red flags
  • bloody stool
  • high fever
  • severe abdominal pain or sudden onset of sharp pain

Laboratory

• serum carotene: < 60 ug/dL with the patient on a diet of 100g fat/day for 72 hours
• fecal fat in 24 hour stool collection: > 7 g daily

Management

• correct underlying cause
• pancreatic enzyme supplementation if indicated
• adequate amounts of fat-soluble vitamins

More general terms

• malabsorption

Additional terms

• fat in feces