What is Steatorrhea?
The term Steatorrhea means that there are fatty components present in the stool. Once the stool has fatty particles, it leads to a stool that is bulky and floats, greasy in appearance, and has a foul smell. The occurrence of fat in the stool is due to the fact that the digestive tract was not able to absorb all the fatty components from the food.
Steatorrhea can be temporary or persistent. The former is believed to be the result from changes in the diet or the presence of infection in the intestine. On the other hand, persistent steatorrhea occurs as a result from diseases of the biliary tract, pancreas, as well the intestines.
To fully understand the mechanism of digestion, here is a simple rundown on how the digestive system works. The absorption of fats is made possible by the actions of bile, pancreatic enzymes called lipases, and normal functions of the intestines. The bile, which is produced in the liver and is stored in the gallbladder, is important in the emulsification of fats. If the need arises, the bile from the gallbladder will be secreted in instances when the body needs it. The enzyme lipase is responsible for the breakdown of these fat components.
Now, what are the instances that may disrupt the normal actions of these three important events? First, the production of bile can be interrupted by any abnormality in the flow of bile by any blockage of the biliary tract. Second, although the absence of pancreatic enzymes is uncommon, there are still instances that would lead someone to this unfortunate event such as the occurrence of diseases in the pancreas, cystic fibrosis, or other congenital disorders. Third, inflammation of the lining of the intestines can happen as a result to certain conditions of the intestine such as ulcerative colitis, Crohn’s disease, celiac disease, etc.
The symptoms of steatorrhea actually vary, depending on the underlying cause. The following are the typical symptoms of the condition based on the area affected.
Digestive tract symptoms:
- Pain and cramping in the abdomen
- Abdominal bloating
- Foul-smelling stool
- Black and tarry stool
- Nausea with or without vomiting
- Pale feces
- Dark urine
- Itchy skin
- Sudden weight loss
- Jaundice or yellowing of the skin and sclera of the eyes
Symptoms that may indicate life-threatening conditions:
- Bloody stool
- Change in the level of consciousness such as being unresponsive
- Pain on the chest as well as pressure and palpitations
- High fever (more than 101°F)
- Decreased urine output
- Shortness of breath or difficulty in breathing
- Abdomen becomes rigid
- Sudden and severe abdominal pain
As mentioned, steatorrhea can be temporary or persistent. Temporary cases result from dietary changes while persistent cases are associated with diseases affecting the organs in the digestive system.
Intestinal causes of Steatorrhea
- Infections of the intestine due to bacteria, parasites, or viruses.
- Celiac disease – the body is extremely sensitive to gluten found in wheat and other grains and will lead to intestinal damage.
- Food allergies
- Inflammatory bowel diseases (IBS) such as Crohn’s disease and ulcerative colitis. IBD are conditions affecting the intestines, which are of unknown causes. There seems to be an autoimmune dysfunction happening and the body’s immune system attacks its own.
- Short bowel syndrome – this happens when there is surgical resection of the intestines.
Biliary tract causes of Steatorrhea
- Biliary atresia – congenital disorder wherein there is failure of the biliary ducts to completely develop.
- Biliary stricture or narrowing of the common bile ducts. If this happens, not enough amount of bile will be delivered from the gallbladder to the intestine in case bile is needed in the emulsification of fats.
- Malignancies of the biliary tracts or the gallbladder.
- Presence of gallstones
Pancreatic causes of Steatorrhea
- Congenital lipase deficiency disorder – if the supply of enzyme lipase is decreased, then fats would not be broken down efficiently.
- Cystic fibrosis – this is an autosomal recessive genetic disorder that affects the lungs, pancreas liver, and the intestine. In this condition, there is an abnormal transport of chloride and sodium resulting to thick and viscous secretions.
- Pancreatitis or inflammation of the pancreas
- Pancreatic cancer
The main goal of treatment of steatorrhea is to treat the underlying cause; therefore, steatorrhea has different courses of treatment from one person to another. Once the cause has been established, then lifestyle modifications and medical management can be done immediately. Included in the recommended management are the following: treatment of the primary disease, limitation of the intake of fats, maintaining a balanced and nutritious diet, and pancreatic enzyme replacement therapy, which is of course dependent on the course of the disease.
For pancreatic causes of steatorrhea such as pancreatitis, it would result to decreased level of pancreatic enzymes, which are important in the breakdown of fats. In this case, the first goal of management is to ingest potent enzymes. The recommended level of lipase to be consumed each meal is about 30,000 units. To protect the enzymes from the strong effects of gastric juices, it is important to take in a few mouthfuls of meal before ingesting any enzyme.
There are cases wherein therapy with potent pancreatic enzymes is not effective, and the best way to do is to protect these pancreatic enzymes from gastric acids, which can be done by maintaining the secretion of hydrogen ions at a minimum level through the use of H2 blockers and taking in pH-sensitive enteric-sensitive pancreatic enzymes.
If the pancreatic enzyme therapy coupled with the use of H2 blocker or enteric-coated pancreatic enzymes are still found ineffective, then the next step to do is to reduce the intake of dietary fat to 50gm per day and substitute the use of medium-chain triglycerides.
Aside from the medical treatment given to patients, treatment regimen for steatorrhea can also be done at home by doing lifestyle modifications such as changes in the diet and reducing the intake of alcoholic beverages.
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