ASE STUDY: A 26 year old woman appeared in the outpatient clinic with the complaint of abdominal discomfort, diarrhea, and an 18lb, unintentional weight loss during the past 2-3 years. She related a similar period of 5-6 years of abdominal distress and diarrhea in childhood, but this essentially disappeared when she was about 12-13 years old. She was now having three to five bowel movements daily, which were described as bulky, malodorous, and floating. She weighed 106lb and was 67 in tall. She never had surgical procedures. Physical examination revealed poor skin turgor, general pallor, and a protuberant abdomen. Abnormal clinical laboratory values included those in Case Study table 28.5.1 Fecal examination revealed no ova or parasites, and bacteriologic culture revealed no pathogens. CASE STUDY TABLE 28.5.1 Analyte Result Hemoglobin 8.1 g/dL Hematocrit 30% RBC count 4.1 X 10^6/uL Serum sodium 134 mmol/L Potassium 3.4 mmol/L Serum caotenoids 14ug/dL Fecal Fat 22 g/24h d-xylose absorptiontest (25-g dose) 5-h excretion of 1.3g and blood level at 2h of 8mg/dL Prothrombin time 15.8 s (12-14 s) Activated partial thromboplastin time 56 s (30-45 s) Questions: 1) What is the disease process? 2) What is the probable etiology in this case? 3) What is the cause of the abnormal coagulation tests? 4) What is the probable major cause for the anemia, and what are the other possible contributing causes?
CASE STUDY:
A 26 year old woman appeared in the outpatient clinic with the complaint of abdominal discomfort, diarrhea, and an 18lb, unintentional weight loss during the past 2-3 years. She related a similar period of 5-6 years of abdominal distress and diarrhea in childhood, but this essentially disappeared when she was about 12-13 years old. She was now having three to five bowel movements daily, which were described as bulky, malodorous, and floating. She weighed 106lb and was 67 in tall. She never had surgical procedures. Physical examination revealed poor skin turgor, general pallor, and a protuberant abdomen. Abnormal clinical laboratory values included those in Case Study table 28.5.1
Fecal examination revealed no ova or
CASE STUDY TABLE 28.5.1
Analyte Result
Hemoglobin 8.1 g/dL
Hematocrit 30%
RBC count 4.1 X 10^6/uL
Serum sodium 134 mmol/L
Potassium 3.4 mmol/L
Serum caotenoids 14ug/dL
Fecal Fat 22 g/24h
d-xylose absorptiontest (25-g dose) 5-h excretion of 1.3g and blood level at 2h of 8mg/dL
Prothrombin time 15.8 s (12-14 s)
Activated partial thromboplastin time 56 s (30-45 s)
Questions:
1) What is the disease process?
2) What is the probable etiology in this case?
3) What is the cause of the abnormal coagulation tests?
4) What is the probable major cause for the anemia, and what are the other possible contributing causes?
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