Samiksha Jaiswal (Editor)

Steatorrhea

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Covid-19
ICD-10  K90
MeSH  D045602
ICD-9-CM  579.8
Specialty  Gastroenterology, general surgery

Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance and can 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. The definition of how much fecal fat constitutes steatorrhea has not been standardized.

Contents

Causes

Impaired digestion or absorption can result in fatty stools. Possible causes include exocrine pancreatic insufficiency, with poor digestion from lack of lipases, loss of bile salts, which reduces micelle formation, and small intestinal disease producing malabsorption. Various other causes include certain medicines that block fat absorption, or indigestible or excess oil/fat in diet.

The absence of bile secretion can cause the feces to turn gray or pale. Other features of fat malabsorption may also occur such as reduced bone density, difficulty with vision under low light levels, bleeding, bruising and slow blood clotting times.

Associated diseases

  • Conditions affecting the pancreas. Exocrine pancreatic insufficiency can be caused by chronic pancreatitis, cystic fibrosis and pancreatic cancer (if it obstructs biliary outflow).
  • Conditions affecting bile salts. Obstruction of the bile ducts by gallstones (choledocholithiasis), primary sclerosing cholangitis, liver damage (intrahepatic cholestasis), hypolipidemic drugs, or changes following gallbladder removal (cholecystectomy).
  • Conditions producing intestinal malabsorption. These include celiac disease, bacterial overgrowth, tropical sprue, Giardiasis (a protozoan parasite infection), Zollinger-Ellison syndrome, short bowel syndrome, inflammatory bowel disease and abetalipoproteinemia.
  • Other causes. Drugs that can produce steatorrhea include Orlistat, a slimming pill, or as adverse effect of octreotide or lanreotide, used to treat acromegaly. It can be found in Graves' disease / hyperthyroidism.
  • Medications

    Orlistat (also known by trade names Xenical and Alli) is a diet pill that works by blocking the enzymes that digest fat. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically digested, sometimes causing oily anal leakage. Vytorin (ezetimibe/simvastatin) tablets can cause steatorrhea in some people.

    Excess whole nuts in diet

    There are anecdotal reports on the internet describing oily droplets in feces after eating large amounts of cashews or other whole nuts. They agree with studies showing that stool lipids are greatest when whole nuts are eaten, compared to their nut butters, oils or flour and that lipids from whole nuts are significantly less well absorbed.

    Natural fats

    Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.

    Consuming escolar and oilfish (sometimes called butterfish) will often cause steatorrhea, also referred to as Gempylotoxism or Gempylid Fish Poisoning or keriorrhea. The fish is commonly used in party catering due to its delicate flavor and because it is cheap and readily available.

    Artificial fats

    The fat substitute Olestra, used to reduce digestible fat in some foods, was reported to cause leakage in some consumers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenated form that is not liquid at physiologic temperature. The U.S. Food and Drug Administration warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.

    Treatment

    Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.

    References

    Steatorrhea Wikipedia


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