A 52-year-old man has suffered with chronic diarrhea for several years, but has refused to see a doctor. He finally comes because he is having trouble driving at night, because of difficulty seeing. Physical examination reveals a slender, pale, unwell-looking man. He has a microcytic anemia, slight elevation in the INR, low ionized calcium, and albumin levels. Which of the following is the most likely cause for his diarrhea?
malabsorption
osmotic diarrhea
secretory diarrhea
inflammatory bowel disease
His night blindness suggests vitamin A deficiency, which is more likely to occur with malabsorption. His anemia and general appearance are compatible with chronic inflammatory bowel disease as well, but the clinical and biochemical features of fat-soluble vitamin deficiency (in this case vitamin A, D, and K) suggest malabsorption.
G.I.T.