What is Steatorrhea?

Steatorrhea is a medical condition in which there is an excessive amount of fat deposit in the fecal matter. One tell that the stool has fat because it floats, it is greasy or oily in appearance and it has a foul smell. The reason why fat deposits can be seen in a person’s fecal matter is usually due to the digestive tract having problems with absorbing fats. Steatorrhea is commonly found in syndromes that deal with malabsorption problems.

Pic 1- Steatorrhea showing Fatty Stool

Steatorrhea Symptoms

Steatorrhea is suspected when a person has stools that are foul smelling, greasy and large. Other symptoms and signs that are associated with Steatorrhea are as follows:

• Stools that are loose in nature
• Stools that are pale
• Stools that are bulky or heavy

Aside from these common symptoms, Steatorrhea may also accompany other known signs and symptoms that are associated with digestive tract problems such as:

• Gas
• Diarrhea
• Nausea
• Vomiting
• Stools that are either tarry or black or red
• Abdominal bloating
• Abdominal cramping

Some patients will complain of the following symptoms, which may be associated with other problems that occur in other systems throughout the body, which include:

• Urine that is dark in hue
• Itchy skin
• Unexplained weight-loss
• Jaundice or skin turning yellow in hue
• Infections that occur frequently
• Cough
• Fever
• Level of consciousness changes
• Having difficulty in breathing
• Palpitations
• Chest pain
• Stool having pus

What causes Steatorrhea?

Steatorrhea may be experienced by a person either temporarily or persistently. Temporary Steatorrhea may be due to changes made in diet of the patients or because of presence of infections in the intestinal region. Steatorrhea that is experienced in a persistent manner may be due to a disease that affects the pancreas, biliary tract or perhaps a problem in the intestinal region. Other reasons for Steatorrhea are as follows:

• Idiopathic

Idiopathic is a medical term that means no known cause. There has been research conducted that links idiopathic Steatorrhea to nontropical sprue, celiac disease and tropical sprue as each of these have the same pathological process. Another study suggests that there to be no connection of familial cases associated with Steatorrhea.

• Pancreatic

Normally, the pancreas help in the absorption of fat through the digestive enzyme called lipase.

• Cystic Fibrosis

However, when a person is known to have cystic fibrosis, the fat absorption is affected and does not function appropriately. Cystic fibrosis is known to interfere with the person’s pancreas particularly in its ability to secrete the digestive enzyme. And inability to do so results in pancreatic insufficiency.

• Pancreatitis

This is a medical term that means the pancreas is inflamed. When such happens, the lipase can’t function properly which results in Steatorrhea.

• Pancreatic cancer

Those with pancreatic cancer have a tumor that grows in the pancreas and when it grows it stretches the pancreas and will lead to the disruption of the digestive enzyme production, which then leads to Steatorrhea.

• Congenital pancreatic lipase deficiency

This congenital pancreatic lipase deficiency usually happens at birth. When such happens, it also disturbs the normal lipase function, which leads to an inability in the pancreas to absorb fats.

• Biliary tract

Steatorrhea may also be brought about by problems that affect the biliary tract such as:

• Gallstone formation
• Cancer of the gallbladder or biliary tract
• Stricture in the biliary tract
• Atresia of the biliary tract

• Intestinal

Lastly, Steatorrhea may also be associated with problems associated in the intestinal region like:

• Short bowel syndrome
• Inflammatory bowel disease
• Intolerance to food
• Celiac disease
• Infection that involves bacterial, viral or parasitic kind
• Whipple’s disease

Aside from the ones mentioned above, medicine and excess of consumption of alcoholic beverages also leads to Steatorrhea.

Steatorrhea Diagnosis

When suspected to have Steatorrhea, the physician will base the diagnosis on the tests conducted, such tests include:

• Physical examination
• Medical historical examination
• Abdominal x-ray
• CT scan
• ERCP
• Schilling tests
• Biopsy
• Duodenal aspiration
• Three day fecal fat
• Ultrasound
• D-xylose absorption
• Fecal fat concentration
• Sudan III stain

Steatorrhea Differential Diagnosis

The differential diagnosis of persons with Steatorrhea includes:

• Cholangitis
• Pre eclampsia, which is related to liver disease
• Choledocholithiasis
• Autoimmune hepatitis
• Primary biliary cirrhosis
• Viral hepatitis

These are some of the differential diagnoses that are associated in those having Steatorrhea.

Steatorrhea Treatment

Depending on various etiological factors, treatment for those suffering from Steatorrhea vary. The treatment also depends on the symptoms experienced by the person as well as their age. The following treatment may be done:

• Healthy lifestyle

One should follow a healthy lifestyle when one has Steatorrhea. One example of adapting to a healthy lifestyle is by eating a diet rich in vegetables and fish.

• Eating a balanced diet

Balanced diet can be achieved when one consumes foods that are normally low in fat, such as fruits, whole grains, vegetables and the like. Aside from that, the persons with Steatorrhea are encouraged to digest foods that are rich in fiber.

• Reduction of the consumption of alcohol

Another thing that one should adopt in their lifestyle is to reduce the alcohol consumption, as alcohol can exacerbate an already poor-functioning liver.

• Management of weight

This is another important thing to consider when one has Steatorrhea, which is the management of weight. In managing weight, one must have lesser consumption of fat and must do exercise.

• Medical treatment

• Pancreatic enzyme supplements

Usually physicians will prescribe supplements, particularly pancreatic enzyme supplements, which are known to decompose in the person’s small intestines. These types of supplements also have the ability to restore the body to normal function. Other medications prescribed are:

• Antihistamines–which are used to cure itchy episodes
• Cholestyramine–which is a known bile acid sequestrant that functions to bind the bile in the person’s gastrointestinal tract.
• H2 blockers–which are known to block histamine 2, which reduces the acid amount found in the person’s stomach.
• Analgesics–which are known to relieve pain episodes

These are the common treatments that are effective for the treatment of Steatorrhea. However if the symptoms get far worse, the person with Steatorrhea may be advised to undergo surgical procedure depending on the assessment done by the physician.

Steatorrhea Pictures

Picture 2 – The mechanism of fat mixture in the GIT leading to Steatorrhea

Picture 3 – Fatty Deposits on the Stool

Picture 4 – Steatorrhea may also be brought about by problems that affect the biliary tract

What is Cardiomegaly?

It is a medical condition, which in layman’s terms, is an enlarged heart wherein the heart’s width is more than the half of the thorax’s total width. In addition to that, it has a characteristic of having a ratio of cardiothoracic of above 0.50.  It is associated with heart conditions such as high blood pressure, congestive heart failure, long term anemia and the like.  Hence, it is important that you have important facts pertaining to this kind of disease and also to attend regular health consultations for early detection and management.

Picture 1 – Image Showing the Difference of a Normal Heart to an Enlarged Heart

Cardiomegaly Symptoms

The symptoms that are associated with Cardiomegaly will greatly depend on the severity and etiological factors that are linked with this kind of disease condition. If in such case, the person suffers a mild to moderate case of Cardiomegaly, he or she may or may not exhibit symptoms associated with the disease. However, if a person suffers a severe and chronic kind of Cardiomegaly, the symptoms may manifest as:

• Experiencing shortness of breath
• Dizziness
• Arrhythmia
• Heart palpitations
• Fainting
• Pain in the chest region
• Dyspnea or difficulty breathing
• Edema in the limbs
• Tenderness in the region of the upper right quadrant
• Ascites

Cardiomegaly Causes

The etiological factors, which lead to acquiring or experiencing this kind of disease condition may be due to either one of the following:

1. Right ventricular hypertrophy

With right ventricular hypertrophy, what happens is that the right ventricular part of the heart hypertrophies or abnormally enlarges.  When this happens, the right ventricular portion of the heart thickens, which leads to a decrease in the blood circulation to the lungs, which leads to enlargement of the heart, if management is prolonged or if the person is not responding well to the therapy given.

2. Left ventricular hypertrophy

It may also be due to the hypertrophy or the enlargement of the left ventricular portion of the person’s heart, which will lead to having stenosis, systemic hypertension, and irregular heartbeat or worse, heart attack.

Picture 3 – Left Ventricular Hypertrophy

3. Dilation

When dilation is the primary etiological reason as to why a person suffers Cardiomegaly, it is then medically labeled as congestive cardiomyopathy or DCM, otherwise known as dilated Cardiomegaly. When this happens, the heart will become enlarged and weak, eventually problems delivering oxygenated blood to all the part of the human body will result to a far bigger complications. This kind of etiological cause happens most often in men.

4. Hypertension

Hypertension occurs when there is high blood pressure, causing the heart difficulty pumping blood throughout the body, making the heart muscle thicker and eventually leading to a hypertensive kind of Cardiomegaly.

5. Anemia

When a person has anemia, he or she has insufficient or lack of RBC or red blood cells (iron), which, if not treated can result in Cardiomegaly. When there is a lack of iron, the heart has to compensate by beating faster than its normal beat. If left untreated it can lead to further complications.

6. Valvular heart disease

Conditions causing valvular heart disease include, rheumatic fever, endocarditis, connective tissue disorder among others.  Cancer related therapies and medications can also cause problems in the heart valves.

7. Thyroid disorders

Hypothyroidism and hyperthyroidism leads to Cardiomegaly.

8. Dwarfism

A particular kind of dwarfism called morquio syndrome or otherwise known as mucopolysaccharidosis IV can result in Cardiomegaly.

9. Hemochromatosis

This is a metabolic disorder, particularly one where a person has improper iron metabolism, which leads to accumulation of too many iron stores.  This can weaken the heart muscles and lead to the enlargement of the left ventricular portion of the person’s heart.

10. Amyloidosis

It is the excess or abnormal protein, which leads to the enlargement of the person’s heart.

11. Other Etiological Reasons or Causes

Other reasons why Cardiomegaly is experienced can be due to a known side-effect of a particular pharmacological medication prescribed by a physician, infection, toxication of the person’s blood because of drug abuse and alcohol abuse and if a person is deficient in certain nutrients. Sometimes, it may be due to congenital reasons, which are common in newborns.

Cardiomegaly Pathophysiology

Normally, the heart pumps blood from the heart and back. The heart is made up of four chambers: the right ventricle, right atrium, left ventricle, and left atrium. The left atrium and ventricles are where the deoxygenated or the waste material of the blood or the carbon dioxide rich blood is absorbed and passed through. The lungs expel the carbon dioxide through exhalation. While the right atrium and ventricles are where the oxygenated or the clean blood is absorbed and distributed to every parts of the human body.

What happens in Cardiomegaly is that there is an abnormal enlargement of either the left or right ventricles or atrium  that will cause a blockage of the passageways for the blood to travel, which will result in a compilation of the waste material produced by the blood or perhaps block the passageway for the oxygenated blood.

Cardiomegaly Types (based on severity)

• Mild

When the patient has a mild case of Cardiomegaly, it simply means that there is a slight form of heart enlargement. Despite the condition being mild, it still needs to be treated because it has the possibility to get worse.

• Moderate

 A moderate type of Cardiomegaly may or may not manifest symptoms mentioned above. Still, like the mild type of Cardiomegaly there is a need for the person to be treated before reaching damaging effects.

• Severe

With the severe case of Cardiomegaly, the symptoms are clearly manifested and there is a greater risk and need for further evaluation, as well as treatment.

Cardiomegaly Diagnosis

The physician will be the one who will diagnose this disease condition. When diagnosing, the physician will order tests or examinations, which will include:

• Medical historical examination
• Physical examination
• X-ray examination
• Electrocardiogram or ECG or EKG
• Echocardiogram
• MRI or CT scan
• Stress Test
• Cardiac Catheterization
• Biopsy

Picture 4 – X-ray Showing Enlargement of the Heart

Cardiomegaly Treatment

The treatment for this kind of disease condition will rely on two treatment therapies or management, such as:

1. Pharmacological therapy

The medications often prescribed for persons with Cardiomegaly are the medications under the classification of ARBS, diuretics, beta blockers, digoxin and anticoagulants.

2. Surgical therapy and medical devices

It may include pacemaker implantation, and other implantation devices such as LVAD or left ventricular assist device, and ICD or Implantable Cardioverter Defibrilator.

Also, surgeries may be conducted depending on the assessment made by the physician and especially when the person suffers atrial fibrillation.

In addition to the treatment mentioned, the person will recover faster if the treatment is accompanied with measures to prevent further complications and permanent changes in the lifestyle, such as giving up alcohol or smoking, eating a low salt diet, physical exercise, a proper amount of sleep among other modifications.  By doing such activities, there is a bigger chance that the dangers associated with this kind of condition will be averted.