A 24-year-old Caucasian female presents with a 6-month history of diarrhea. She reports three to four watery stools a day. She has not noticed any blood in her stools. She also reports decreased appetite and a 5-lb weight loss. She sometimes takes Imodium (loperamide), which partially controls her symptoms

A 24-year-old Caucasian female presents with a 6-month history of diarrhea. She reports three to four watery stools a day. She has not noticed any blood in her stools. She also reports decreased appetite and a 5-lb weight loss. She sometimes takes Imodium (loperamide), which partially controls her symptoms. She tried a trial of lactose avoidance, which failed to control her symptoms. She has not taken any other medications or been hospitalized in the past year. She does not have any other medical problems. Physical examination and vital signs are normal. > What initial workup is indicated for this patient with chronic diarrhea? > The only significant laboratory abnormalities are mild iron deficiency anemia and a mildly decreased total protein and albumin. What is the next step in the evaluation? > What stool analysis findings are associated with the different categories of diarrhea? > Positive findings on stool analysis are osmotic gap 120, steatorrhea, and guaiac-positive stool. Fecal leukocytes are not elevated. Laxative screen is negative. What is the next step in management? > What are the next steps in management? > What are possible extraintestinal manifestations of celiac sprue? > The patient asks about her long-term prognosis. What should you tell her?