Fat absorption Tests

Dr. Anisha Mathew

A 56-year-old man who is an alcoholic presents with a 2-week
history of mid abdominal pain. He also describes clay-colored stools,
mild icterus, nausea, vomiting, and a 10-lb weight loss. Laboratory
findings are shown in Case Study Table 27-2.1.
  Steatorrhea

What is Fat  Fatty, bulky stools that are difficult to

Malabsorption? flush away
 Typically after a fat containing diet
  Major clinical sign in uncontrolled disease, &
higher dietary fat concentration (Intolerance)
Effects of Fat
Malabsorption  Substrate for bacterial hydroxylation
How is fat
absorbed?
 Causes of
Steatorrhea
Malabsorption
  Important, often overlooked, cause
of chronic diarrhoea
 Due to active secretion of water and
electrolytes into the bowel, which is
Laxative abuse described as secretory diarrhoea
 Diagnosis is a high index of clinical
suspicion
 urine laxative screen
  History and Physical Examination
Diagnosing Fat  Laboratory testing
Malabsorption  Ultrasound/ CT
  Pertaining to abdominal complaints
 Liver disease

History  Pancreatic insufficiency

 Dietary habits
 Past and Family history
  Foul-smelling feces
 Bulky stool
 Pale stools
Description of
steatorrhea  Loose stools
 Greasy stools
  Cachexic
 Signs of liver failure

Examination  Abdominal tenderness

 Spider nevi
 Scratch marks
  Pancreatic cause
 Abdominal X-ray (calcification),
ultrasound, CT scan, or ERCP.
Radiological  Liver Disease
tests  Ultrasound, CT-scan
 Intestinal Cause
 Biopsy via endoscopy
  Complete Blood Count
 Liver Function Test
 Serum Electrolytes
Laboratory Tests  Iron studies
 Tests for antibodies in celiac disease
(celiac serology)
 Fat Malabsorption tests
  Bile salt malabsorption
 The 75selenohomocholyltaurine
(75SeHCA ) test
 Measurement of serum 7α-hydroxy-
Laboratory Tests 4-cholesten-3-one
 Pancreatic function tests
 Pancreatic elastase-1 in faeces
 Sweat Electrolyte Determination
  D-Xylose Test
 Schilling test (obsolete)
Intestinal
Malabsorption  Endoscopic Biopsy of intestinal
Tests lumen- Atrophy of villi
 Hydrogen Breath test
  Faecal lipids are derived from four
sources:
 unabsorbed ingested lipids
 lipids excreted into the intestine
Faecal Fat  cells shed into the intestine
 metabolism of intestinal bacteria
 Faecal fat does not normally exceed
about 7 g in a 24-hour period
  Normal faecal lipid is composed of
 60% fatty acids
 30% sterols, higher alcohols, and
Faecal Fat carotenoids
 10% triglycerides
 Small amounts of cholesterol and
phospholipids
  Faecal fat Analysis
 Sudan stain of a random sample of
homogenized stool
 Normal ≤20/hpf, 1 to 4 micrometer in
Biochemical size
Tests for  Slightly increased >20/hpf, 1 to 8
steatorrhea micrometer in size
 Definitely increased >20/hpf, 6 to 75
micrometer in size
 Steatocrit (Spot test); Normal <10%
  Quantitative Faecal Fat Analysis
 A 72 hour stool collection
 Traditional methods are gravimetric
Biochemical
and titrimetric methods
Tests for
 Reference range :1–7g/24 hour
steatorrhea