DDSEP® 8 Quick Quiz

Question 1

Publish date: March 31, 2022

A 65-year-old male with no significant past medical history presents with significant diarrhea. He reports that for the past 3 months, he has had four to five bowel movements a day. He characterizes them as greasy and foul smelling, but not entirely watery. He notices no blood or mucous in the stool. Over the same time period, he has also noticed increased swelling in both of his ankles. The physician sends a broad work-up.
Stool testing results include the following:
Clostridioides difficile - Negative.
Stool Ova and Parasite - Negative.
Stool Culture - Negative.
Stool Elastase - within normal limits.
Fecal Fat (spot test) - within normal limits.
Stool Alpha-1 Antitrypsin - Elevated.

Which of the following diagnoses best explains the patient's symptoms?

Amyloidosis involving the small intestine

Celiac disease

Ulcerative Colitis

Small bowel dysmotility

Correct answer: A. Amyloidosis involving the small intestine

Rationale
This patient has a protein-losing enteropathy as indicated by his diarrhea, peripheral edema, and positive stool alpha-1 antitrypsin test. Multiple diseases, particularly in their later stages, can be associated with a protein-losing enteropathy including primary intestinal lymphangectasia, Crohn's disease of the small intestine, small intestinal bacterial overgrowth (SIBO), and amyloidosis of the small intestine (A). Celiac disease (B) is not associated with protein-losing enteropathy. While Crohn's disease can be associated with protein-losing enteropathy, ulcerative colitis (C) is not usually associated with it. Small bowel dysmotility (D) does not impact absorption or secretion unless associated with SIBO, making this a wrong answer.

Next Article:

First-year fellows guide to gastroenterology