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2.  Diarrhoea lasting for more than 4 weeks
 Mainly non infections causes

3. 1. Secretory causes
2. Osmotic causes
3. Steatorrheal causes
4. Inflamatory causes
5. Dysmotility causes
6. Factitial causes

4.  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

5. 3)hormones-
serotonin,prostaglandins,kinins
4)congenital defects in Fe absorption

6.  Osmotically active solutes
1)osmotic laxatives—Mg2+,(po4)3-,(so4)2-
2)carbohydrate malabsorption—lactase
deficiency

7. 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)

8.  Pain,fever,bleeding,other manifestations
ofinflamation
eg:IBD,immunodeficiencies,eosinophilic
gastrits,c/cGVH

9.  Hyper motility
 Diabetic diarrhoea—peripheral andgeneralised
autonomic neuropathy

10.  15% of unexplained diarrhoea
 Eg:munchausen syndrome,eating
disorders(psychiatric illness)

11.  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

12. 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

13.  Diagnostic evaluation directed by a careful
history and physical examination
 If not revealing triage tests required to direct
the choice of complex investigations

16. Curative,suppressive,empirical
1)curative—antibiotic for whipples
d/s,discontinuation of drug
2)suppressive—elimination of dietry lactose,PPI
for gastrinoma,pancreatic enzyme replacement
3)emperical—mild
opiates(loperamide),clonidine,fluid and
electrolyte replition