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35yo female shop assistant presents with “diarrhoea for five months” …

- - - - No Δ in Stool volume
        Fecal osmotic gap <50 mmol/L
        
        Secretory
        Net secretion of ions (Cl-, HCO3-)
        Inhibition of net Na+ absorption
        
        Infection
        
        Peptide-secreting endocrine tumors
        (e.g. carcinoid, gastrinoma)
        Enlarged nodular liver, skin flushing, wheezing
        
        Inflammatory Bowel Disease
        Crohn Disease, Ulcerative Colitis
        
        Bile Acid Malabsorption
        
        Non-osmotic Laxatives
        
        Disordered Regulation
        Post vagatomy, DM neuropathy, Hyperthyroidism
        
        Neoplasia
        Colon carcinoma, Lymphoma, Villous adenoma
      - ↓Stool volume with fasting
        Fecal osmotic gap >50 mmol/L
        
        Osmotic
        Ingestion of poorly absorbed cations (Mg2+), anions (e.g. Phosphate, Sulfate), sugars (e.g. lactose intolerance)
        --> Measure Stool pH to differentiate
  - - - Pancreatic Insufficiency
        Chronic Pancreatitis
      - ↓Duodenal Bile Concentration
        Small Intestine Bacterial Overgrowth (Predisposing factor: Intestinal Stasis, Achlorhydria, Pancreatic Insufficiency, Immune deficiency), Cirrhosis
    - - Celiac Disease
        Chronic malabsorptive diarrhea, fatigue, iron deficiency anemia, weight loss, dermatitis herpetiformis, family history