Thursday, November 16, 2006

Steatorrhea

Steatorrhea
From Wikipedia, the free encyclopedia

Classification and external resources
ICD-10 K90.
ICD-9 579.8
MeSH D045602

Steatorrhea is the presence of excess fat in faeces. Stools may also float due to excess lipid, have an oily appearance and be especially foul smelling. An oily anal leakage or some level of fecal incontinence may occur. There is increased fat excretion, which can be measured by determining the fecal fat level. While definitions have not been standardised, fat excretion in feces in excess of 0.3 (g/kg)/day[citation needed] is considered indicative of steatorrhea.

Possible biological causes
Possible biological causes can be lack of bile acids (due to liver damage or hypolipidemic drugs), defects in pancreatic juices (enzymes), and defective mucosal cells. The absence of bile acids will cause the feces to turn gray or pale. Another cause of steatorrhea is due to the adverse effect of Octreotide which is an analog of somatostatin used clinically to treat acromegaly.

  • Seen in
    1. malabsorption, e.g. in inflammatory bowel disease, celiac disease, and
      abetalipoproteinaemia
    2. exocrine pancreatic insufficiency
    3. pancreatitis
    4. choledocholithiasis - (obstruction of the bile duct by a gallstone)
    5. pancreatic cancer - (if it obstructs biliary outflow)
    6. primary sclerosing cholangitis
    7. bacterial overgrowth
    8. short bowel syndrome
    9. cystic fibrosis
    10. Zollinger-Ellison syndrome
    11. Giardiasis - a protozoan parasite infection
    12. Abuse or misuse of certain prescribed slimming pills.
  • As a side effect
    • Steatorrhea can also be due to eating non-digestible oils or fats such as
      Olestra, and a side-effect of medicines that prevent the absorption of dietary
      fats such as Orlistat.[1][2][3][4]
  • Artificial fats
    • The fat substitute Olestra, used in some reduced-fat foods, has been proven to
      cause leakage in some consumers. The United States Food and Drug Administration
      warning indicated that excessive consumption of Olestra could result in "loose stools"; this warning has not been required since
      2003.[2][4]
  • Medications
    • Orlistat (Xenical) is a diet pill that works by blocking the enzymes that digest
      fat. As a result fat cannot be absorbed from the gut and some fat is excreted in
      the feces instead of being metabolically digested, sometimes causing oily anal
      leakage.[1][3]
  • Natural fats
    • Consuming jojoba oil has been documented to cause steatorrhea and anal leakage
      because it is indigestible.[5]
  • Consuming escolar and oilfish (sometimes called butterfish) will often cause steatorrhea.
    • The fish is commonly used in party catering due to its delicate flavor and the
      fact that it is cheap and readily available.

Treatment
Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.[6]


References
^ a b "Weighing a Pill For Weight Loss". Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2006/01/23/AR2006012301270.html. Retrieved on 2007-07-06. "While the Food and Drug Administration (FDA) still must approve the switch, the agency often follows the advice of its experts. If it does, Orlistat (xenical) -- currently sold only by prescription -- could be available over-the-counter (OTC) later this year. But it's important to know that the weight loss that's typical for users of the drug -- 5 to 10 percent of total weight -- will be less than many dieters expect. And many consumers may be put off by the drug's significant gastrointestinal side effects, including flatulence, diarrhea and anal leakage."
^ a b "Frito-Lay Study: Olestra Causes "Anal Oil Leakage"". Center for Science in the Public Interest. February 13, 1997. http://www.cspinet.org/new/flaynal.html. Retrieved on 2007-07-07. "The Frito-Lay report states: "The anal oil leakage symptoms were observed in this study (3 to 9% incidence range above background), as well as other changes in elimination. ... Underwear spotting was statistically significant in one of two low level consumer groups at a 5% incidence above background." Despite those problems, the authors of the report concluded that olestra-containing snacks "should have a high potential for acceptance in the marketplace.""
^ a b "The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug.". Newsweek. June 25, 2007. http://www.msnbc.msn.com/id/19263093/site/newsweek/. Retrieved on 2007-06-21. "GlaxoSmithKline has a tip for people who decide to try Alli, the over-the-counter weight-loss drug it is launching with a multimillion-dollar advertising blitz—keep an extra pair of pants handy. That's because Alli, a lower-dose version of the prescription drug Xenical, could (cue the late-night talk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be good for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accident is worth it."
^ a b "Reported medical side-effects of Olestra according to Procter and Gamble studies". Center for Science in the Public Interest. http://www.cspinet.org/olestra/11cons.html. Retrieved on 2007-06-21. "Olestra sometimes causes underwear staining associated with "anal leakage." Olestra sometimes causes underwear staining. That phenomenon may be caused most commonly by greasy, hard-to-wipe-off fecal matter, but occasionally also from anal leakage (leakage of liquid olestra through the anal sphincter)."
^ Comparative aspects of lipid digestion and absorption: physiological correlates of wax ester digestion
^ WrongDiagnosis >Treatments for Steatorrhea Retrieved on 20 Mars, 2009

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