Which of the following factors is a common cause of fatty diarrhoea?

RIMS Nursing Officer - 2022

Medical & Surgical Nursing

Easy

Appeared in: RIMS Nursing Officer - 2022

Explanation

Celiac disease is an autoimmune disorder triggered by gluten, which damages the villi of the small intestine.
This damage, known as villous atrophy, severely reduces the surface area available for nutrient absorption.
Impaired absorption of dietary fat is a primary consequence, leading to excess fat being excreted in the stool, a condition known as steatorrhea (fatty diarrhea).
The characteristic stools in steatorrhea are bulky, pale, greasy, foul-smelling, and may float.

Option A: Lactose intolerance is due to a deficiency in the lactase enzyme, leading to carbohydrate malabsorption. This causes an osmotic effect, drawing water into the bowel and resulting in watery diarrhea, not fatty diarrhea.
Option C: Common bacterial and viral infections typically cause acute secretory or inflammatory diarrhea. This results in watery stools, sometimes with mucus or blood, due to intestinal fluid secretion or inflammation, not fat malabsorption.
Option D: Similar to lactose intolerance, sucrose intolerance is a carbohydrate malabsorption issue. Undigested sucrose leads to an osmotic pull of water into the intestines, causing watery diarrhea.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and causes of fatty diarrhea (steatorrhea) as background academic context rather than a clinical decision trigger.
Nurses must perform thorough assessments of stool characteristics. The report of greasy, floating, or foul-smelling stools is a key indicator of fat malabsorption and should prompt further investigation.
Patient education is a cornerstone of care for Celiac disease. The nurse must teach the importance of a strict, lifelong gluten-free diet to allow the intestinal lining to heal and prevent complications.
Patients with steatorrhea are at high risk for deficiencies of fat-soluble vitamins (A, D, E, K) and other nutrients. Nurses should monitor for clinical signs of these deficiencies (e.g., bruising, bone pain, night blindness) and ensure appropriate supplementation is provided.

How to Approach the Question

First, identify the key concept in the question stem: "fatty diarrhoea." This is a specific type of diarrhea, also known as steatorrhea, which points to a problem with fat digestion or absorption.
Next, evaluate the underlying mechanism of each option provided.
Consider Lactose and Sucrose intolerance. Recognize that these are issues with carbohydrate (sugar) digestion, which classically cause osmotic (watery) diarrhea, not fatty diarrhea.
Consider Bacterial and viral infection. Recall that common gastroenteritis causes acute secretory or inflammatory diarrhea, which is also watery in nature.
Analyze Celiac disease. Remember that this condition damages the lining of the small intestine, directly impairing the absorption of nutrients, especially fats.
Conclude that Celiac disease is the only option that directly causes fat malabsorption, leading to fatty diarrhea.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 318-320