Approach to diarrhea (chronic) Quiz: Ace Your Exams
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A 48-year-old man presents to the clinic with 3-months of greasy, foul-smelling stools that are difficult to flush and constant epigastric pain. He has had increased gas and abdominal and a 10-pound weight loss since the symptoms started. He has not had any recent travel, new medications, or dietary changes. Temperature is 37.0°C (98.6°F), pulse is 72/min, respiratory rate is 18/min, and blood pressure is 124/82 mmHg. Physical examination reveals epigastric tenderness and hyperactive bowel sounds. Fecal pancreatic elastase-1 is 180 mcg/g (reference range: >500 mcg/g). Which of the following additional features is most likely to be present in this patient?
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