Chronic diarrhoea

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Chronic diarrhoea

  1. 1.  Diarrhoea lasting for more than 4 weeks Mainly non infections causes
  2. 2. 1. Secretory causes2. Osmotic causes3. Steatorrheal causes4. Inflamatory causes5. Dysmotility causes6. Factitial causes
  3. 3.  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
  4. 4. 3)hormones-serotonin,prostaglandins,kinins 4)congenital defects in Fe absorption
  5. 5.  Osmotically active solutes 1)osmotic laxatives—Mg2+,(po4)3-,(so4)2- 2)carbohydrate malabsorption—lactase deficiency
  6. 6. 1) intraluminal maldigestion—c/c pancreatitis,fibrosis,pancreatic duct obstruction 2)mucosal malabsorption—celiac d/s,tropical spure,whipples d/s 3)post mucosal lymphatic obstruction— congenital intestinal lymphangiectasia,acquired lymphatic obstruction(trauma,tumour)
  7. 7.  Pain,fever,bleeding,other manifestations ofinflamation eg:IBD,immunodeficiencies,eosinophilic gastrits,c/cGVH
  8. 8.  Hyper motility Diabetic diarrhoea—peripheral andgeneralised autonomic neuropathy
  9. 9.  15% of unexplained diarrhoea Eg:munchausen syndrome,eating disorders(psychiatric illness)
  10. 10.  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
  11. 11. 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
  12. 12.  Diagnostic evaluation directed by a careful history and physical examination If not revealing triage tests required to direct the choice of complex investigations
  13. 13. 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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