Snapshot A 60-year-old man presents to his primary care physician for pale, foul-smelling stools. He has a history of alcoholism, though he has not had a drink in a few months. He also has a history of recurrent pancreatitis, requiring multiple admissions. Each episode was treated conservatively. He is scheduled for an abdominal computed tomography (CT), which shows inflammation and calcium deposits in the pancreas, suggesting chronic pancreatitis. He is started on enzyme replacement therapy for pancreatic insufficiency. Introduction Overview login to view 4 more bullets Epidemiology login to view 11 more bullets Pathogenesis login to view 10 more bullets Presentation History login to view 1 more bullet Symptoms login to view 8 more bullets Vitamin Deficiencies Vitamin A Deficiency Vitamin D Deficiency Vitamin E Deficiency Vitamin K Deficiency Night blindness Xeroderma Osteomalacia Rickets Hemolytic anemia Muscle weakness Paresthesias Bleeding Easy bruising Imaging Abdominal computed tomography login to view 2 more bullets Studies Serum labs login to view 6 more bullets Invasive studies login to view 25 more bullets Differential Fat Malabsorption Syndromes Celiac Disease Whipple Disease Pancreatic Insufficiency Tropical Sprue Fat malabsorption Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Unique clinical features Positive autoantibodies Dermatitis herpetiformis Triad cardiac symptoms arthralgia neurologic symptoms Caused by Tropheryma whipplei, a gram-positive rod History of alcoholism History of previous episodes of pancreatitis History of being in tropical regions Negative autoantibodies Megaloblastic anemia due to folate and vitamin B12 deficiences Diagnostic testing Small bowel biopsy Abnormal D-xylose test Autoantibodies Small bowel biopsy Polymerase chain reaction of stool showing T. whipplei Abnormal D-xylose test Abdominal CT scan Secretin stimulation testing Small bowel biopsy Abnormal D-xylose test Treatment Dietary restrictions avoid gluten Ceftriaxone Trimethoprim/sulfamethoxazole Tetracycline Enzyme replacement therapy Doxycycline Trimethoprim/sulfamethoxazole Treatment Lifestyle login to view 5 more bullets Medical login to view 17 more bullets Surgical login to view 1 more bullet Complications Malnutrition