Derangements in fluid and electrolyte transport across entero colonic mucosa Watery,large volume fecal output,painless and persits with fasting 1)medications—ethanol,laxatives 2)bowel resection,mucosal d/s,enterocolic resection—idiopathic secretory diarrhoea
3)hormones-serotonin,prostaglandins,kinins 4)congenital defects in Fe absorption
Osmotically active solutes 1)osmotic laxatives—Mg2+,(po4)3-,(so4)2- 2)carbohydrate malabsorption—lactase deficiency
15% of unexplained diarrhoea Eg:munchausen syndrome,eating disorders(psychiatric illness)
Proper history and physical examination very important HISTORY—onset,duration,pattern,aggrevating and relieving factors etc wt.loss,pain,exposures(travel,medications etc). FAMILY HISTORY—ibd,sprue
PHYSICAL EXAMINATION -- anemia,edema,clubbing(features of malabsorption,IBD) --muco cutaneous manifestations of systemic d/s(dermatitis herpetiformis,erythema nodosum,oral ulcers etc) --abdominal mass or tenderness --abnormalities of rectal mucosa,rectal defects
Diagnostic evaluation directed by a careful history and physical examination If not revealing triage tests required to direct the choice of complex investigations
Curative,suppressive,empirical1)curative—antibiotic for whipples d/s,discontinuation of drug2)suppressive—elimination of dietry lactose,PPI for gastrinoma,pancreatic enzyme replacement3)emperical—mild opiates(loperamide),clonidine,fluid and electrolyte replition
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