American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT typically associated with steatorrhea?

1. Celiac disease

2. SIBO

3. Cholera

4. Pancreatic insufficiency

The correct answer is: Cholera

C. Cholera is indeed not typically associated with steatorrhea. Steatorrhea refers to the presence of excess fat in the stool, which often occurs due to malabsorption syndromes. Celiac disease, for instance, is characterized by an autoimmune response to gluten leading to villous atrophy in the intestines, which results in malabsorption of fats and carbohydrates, often manifesting as steatorrhea. Small Intestinal Bacterial Overgrowth (SIBO) can also lead to steatorrhea because the overgrowth of bacteria can disrupt normal digestion and absorption processes in the intestines, leading to fat malabsorption. Pancreatic insufficiency, such as in chronic pancreatitis or cystic fibrosis, is another condition where steatorrhea is common. The pancreas produces enzymes necessary for digesting fats, and when these enzymes are deficient, fat is not properly digested and ends up in the stool. In contrast, cholera primarily leads to secretory diarrhea, which is a result of an enterotoxin that stimulates the secretion of electrolytes and water into the intestinal lumen, rather than causing fat malabsorption. Hence, steatorrhea is not a common feature of cholera.