12-15-2007, 02:08 AM
A 48-year-old male seeks evaluation for diarrhea and malabsorptive symptoms. Approximately
5 years ago the patient underwent partial gastrectomy with gastrojejunostomy for a perforated
duodenal ulcer. He had done well since that time until 5 months ago, when he developed
abdominal pain and bloating after eating. In addition, the patient has had profound diarrhea
that occurs after eating and is worse after he eats fatty foods. He notes that the diarrhea is
foul-smelling and often leaves a greasy film in the toilet. On physical examination the patient is
thin with a body mass index of 19. The examination is unremarkable. His stool is
hemoccult-negative. Laboratory studies are remarkable except for an albumin of 3.1 g/dL. He is
noted to have a hemoglobin of 9.6 mg/dL and a mean corpuscular volume (MCV) of 106. What
is the most likely diagnosis?
A. Dumping syndrome
B. Bile reflux gastropathy
C. Afferent loop syndrome
D. Postvagotomy diarrhea
E. Zollinger-Ellison syndrome
5 years ago the patient underwent partial gastrectomy with gastrojejunostomy for a perforated
duodenal ulcer. He had done well since that time until 5 months ago, when he developed
abdominal pain and bloating after eating. In addition, the patient has had profound diarrhea
that occurs after eating and is worse after he eats fatty foods. He notes that the diarrhea is
foul-smelling and often leaves a greasy film in the toilet. On physical examination the patient is
thin with a body mass index of 19. The examination is unremarkable. His stool is
hemoccult-negative. Laboratory studies are remarkable except for an albumin of 3.1 g/dL. He is
noted to have a hemoglobin of 9.6 mg/dL and a mean corpuscular volume (MCV) of 106. What
is the most likely diagnosis?
A. Dumping syndrome
B. Bile reflux gastropathy
C. Afferent loop syndrome
D. Postvagotomy diarrhea
E. Zollinger-Ellison syndrome