Mr. Ellison is a 19 year old college student who complains of having an "embarrassing bowel problem." Specifically, he has three to four bowel movements per day. The stool is described as being "usually mushy" but at times, well formed. He sees no blood but indicates that the mushy stool is often pale or "tan" and "fills up the toilet bowl." Sometimes the stool floats in the toilet bowl. Surprisingly, he states that he has had this problem "off and on for as long as I can remember. "He is seeking help now out of desperation. He lives in a university dormitory and has become the focus of many jokes because of the malodorous odor in the community washroom after he moves his bowels. The frequent passage of stools is accompanied by an inordinately frequent passage of equally offensive flatus. He also feels bloated.

He denies any change in quantity or quality of dietary intake. Although he just returned from a semester break vacation in 'Mexico, he states that "I was careful not to drink the water." He occasionally chews gum and drinks 2-4 glasses of milk per day.

Mr. Ellison tearfully expressed how embarrassed he feels about his problem and doesn't see how he can go on in school. He is confused because his family never complained but the dormitory students make him feel like an outcast.

PAST MEDICAL HISTORY includes an appendectomy at age 11, cystic fibrosis and frequent pulmonary infections. He presently takes no prescribed or over‑the‑counter medicines. He has no allergies.

PHYSICAL EXAMINATION: The patient is a tall, thin man who appears drawn and somewhat anxious. Vital signs: Blood Pressure: right arm 118/72, left arm 122/74; Heart Rate: 76/minute and regular; Respiratory Rate 12/minute; Temperature 98.4' F. Height 6'1", Weight 152 lbs.

 HEENT: Cheeks are scaphoid with prominent maxillary bones.

CHEST: The chest appears more prominent than one would expect for the patient's age. Percussion is normal. Auscultation reveals slightly diminished breath sounds in both bases. There are a few scattered bilateral expiratory wheezes which clear with coughing.