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35yo female. diarrhea for 5 months Diarrhea=inc stool frequency/liquidity…

- - - - Pancreatic exocrine insufficiency
        ~chronic pancreatitis - epigastric pain (radiates to back, a/w N/V partially relived by sitting upright/leaning forward)
        ~duct obstruction (e.g. stones, CF)
        ~Insufficient functional reserves (carcinoma, resection)
      - Gastrinoma (gut too alkaline for lipase to act)
      - Drug - orlistat
- - - - Gastrinoma/Zollinger-Ellison - abdo pain, erosive esophagitis, GERD, enlarged gastric folds, duodenal ulcers
      - Carcinoid - episodic flushing (30sec-30min) of face neck upper chest, venous telangiectasia, enlarged nodular liver from metastases, bronchospasm
      - VIPoma - diarrhea persists with fasting, tea-colored odorless stool, hypokalemia, dehydration, achlorhydria, lethargy, N/V, muscle weakness, muscle cramps
      - Somatostatinoma - DM, cholelithiasis, hypochlorhydria
        ~abdo pain & weight loss
      - Glucagonoma - DM, DVT, depression, necrolytic migratory erythema (erythematous papules/plaques involving face, perineum, extremities. it enlarge and coalesce -> central clearing -> bronze-colored, indurated centrally w blistering, crusting, scaling at borders. pruritic and painful)