Approach to diarrhea (chronic) Quiz: Ace Your Exams
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A 27-year-old woman presents to the primary care clinic with 3-months of chronic diarrhea, characterized by frequent, watery stools that decrease in volume when she fasts. She has not had abdominal pain, blood in the stool, or significant weight loss. She has no recent travel history, new medication, or dietary changes. Her diet consists mostly of whole foods, including grains, vegetables, and low-fat protein. She works at a nightclub as a server. Temperature is 37.0°C (98.6°F), pulse is 82/min, respiratory rate is 16/min, and blood pressure is 128/84 mmHg. Cardiopulmonary examination is within normal limits. The abdomen is soft and non-tender, with normal bowel sounds. Laboratory results are shown below. Which of the following is the most likely diagnosis?
| Laboratory test | Result |
| Hemoglobin | 13.5 g/dL |
| White blood cell (WBC) count | 7,500 /µL |
| Platelets | 250,000 /µL |
| C-reactive protein (CRP) | 2 mg/L |
| Erythrocyte sedimentation rate (ESR) | 15 mm/hr |
| Sodium | 140 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 105 mEq/L |
| Bicarbonate | 23 mEq/L |
| Tissue transglutaminase IgA antibodies | Negative |
| Stool Studies | |
| Fecal calprotectin | 40 µg/g (normal range <50 µg/g) |
| Stool sodium | 40 mEq/L |
| Stool potassium | 10 mEq/L |
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