Originally Posted by XpaezX
I dont understand.. I may sound stupid.. for what I see the stool osmolal gap is less than 50 .. (it is 10 to be exact).. no history is given that specific meals cause the symptoms.. and the patient is losing weight.. I will pick VIPoma as the answer..
Exactly u r correct......Great.....
The answer is D.
This patient has a stool osmolality gap (measured stool osmolality - calculated stool osmolality) of less than 50 mosmol/L, suggesting a secre-tory rather than an osmotic cause for diarrhea. Secretory causes of diarrhea include toxin-mediated diarrhea (cholera, enterotoxigenic Escherichia coli) and intestinal peptide–mediated diarrhea in which the major pathophysiology is a luminal or circulating secretagogue. The distinction between secretory diarrhea and osmotic diarrhea aids in forming a differential diagnosis. Secretory diarrhea will not decrease substantially during a fast and has a low osmolality gap. Osmotic diarrhea will generally decrease during a fast and has a high (>50 mosmol/L) osmolality gap. Celiac sprue, chronic pancreatitis, lactase deficiency, and Whipple’s disease all cause an osmotic diarrhea.