Chronic Diarrhea

1. Chronic diarrhea
DINA MAKLAD
471
ALEXANDRIA FACULTY OF
MEDICINE

2. Definition
Its diarrhea that begins acutely as watery or
bloody diarrhea and persists for 14 days or
more .
N.B: The major causes and the prevalence of persistent
diarrhea differ between resource-limited and resource-rich
countries.
In resource-limited usually follows an acute episode and
typically is associated with serial enteric infections without
sufficient time to recover between episodes
In resource-rich countries more likely to be caused by
underlying disease, such as celiac disease or other
autoimmune inflammatory bowel disease.

3. Risk factors
1. Low birth weight.
2. Malnutrition.
3. Absence of breast feeding.
4. Recent introduction of animal milk.
5. Recent/recurrent acute diarrhea in very young infant.
6. Immunological; impairment due to measles, malnutrition, and AIDS.
7. Mismanagement of acute diarrhea as antibiotic use and prolonged starvation.

4. Diagnosis of chronic Diarrhea
History
 Onset of diarrhea.
 Number , Character and
volume of the stool .
 Presence of blood in stool,
fever and weight loss .
 Recent travel .
 Medications recently used.
Physical
examination
 Abdominal distention or
Tenderness.
 Presence of a large fecal
mass on rectal
examination.
 Anal sphincter tone.
Laboratory testing
 Stool culture.
 CBC if bacterial enteritis is suspected.
 If diarrhea occurs after a course of antibiotics, a
clostridium difficile toxin assay
 Fecal fat content or fecal elastase to test for
pancreatic insufficiency.
 Specific test:
o serum antibody tests for celiac disease.
o Colonscopy for suspected ulcerative colitis
o A trial for lactose restriction for several days in
evaluating of lactose intolerance.

5. Management
1. Persistent diarrhea should be treated in hospital.
2. Correction of fluids, electrolytes and acid base balance.
3. Apprropriate antibiotics or antiparasitic agents.
4. Nutritional therapy.
o Temporary reduction of animal milk in diet.
o Sufficient nutrients for mucosal repair.
o Avoid hyperosmolar food.
o Avoid low energy food.

6. General Guidelines for feeding
 For exclusively breastfed : more frequent breast feeds day and night.
 For infants less than 6 months fed on adapted milk formula:
o Lactose free milk.
o Soya bean based formula.
o Special protein hydrolysate formula.
 For older infant and children fed on breast milk or formula +
complementery foods:
• Breast milk more frequent.
• Replace animal milk with yoghurt.
• Frequent small amount of food .
• Vitamins and minerals ( vit A, folate , iron , magnesium , zinc and copper ) .

7. Thank You !