AN APPROACH TO A
PATIENT WITH CHRONIC
Dr Basharat Hussain
DIARRHEA: passage of abnormally liquid/
unformed stools at an increased frequency
Stool wt > 200g 1day
ACUTE DIARRHEA: If duration is < 2 wk.
PERSISTENT DIARRHEA: duration is < 2-4
CHRONIC DIARRHEA: diarrhea lasting > 4
PSEUDO DIARRHEA: frequent passage of
small volumes of stool and is often associated
with urgency and accompanies irritable bowl
It is involuntary discharge of rectal contents and most
often caused by neuromuscular disorders or
structural anorectal sphincter problem.
CLASSIFICATION OF CHRONIC
According to patho physiological mechanism.
It is due to derangement of fluid & electrolyte
transport across mucosa.
It is characterized by
Large volume fecal output > 1 Ltr per day.
Persists with fasting
No fecal osmotic gap
It occurs when ingested, poorly absorbable,
osmotically active solutes draw enough fluid
It ceases with fasting.
Steatorrhea is define as stool fat exceeding >
7gm per day.
Fat malabsorption may lead to greasy foul
smelling, difficult to flush diarrhea.
It is offten associated with weight loss &
nutritional deficiency due to malabsorption of
A.A & vitamins.
History, Physical Examination and routine blood
studies should attempt to characterize the
mechanism of diarrhea.
Assess the patient fluid and electrolyte and
HISTROY & EXAMINATION
Pt. should be questioned about on set duration,
pattern, aggravating and relieving factors,
stool characteristics and extra intestinal
manifestation like skin changes, arthralgia.
GENERAL & SYSTEMIC EXAMINATION
TO DONE THOROUGLY.
Increased Urea (Dehydration)
Raised ALP (Liver Mets).
STOOL CULTURE AND MICROSCOPY FOR
OVA AND CYST
All pts shold have a sigmoidoscopy and
rectalbiopsy. It may show a pigmented mucosa
(Melanosis coli).Rectalbiopsy show pigment laden
All pts with chronic diarrhea and
hematochezia should be evaluated stool
microbiologic studies and colonoscopy &
Serum Vasoactive Intestinal peptide
Duodenal and jajunal biopsy
Small bowl eneamia