Diarrhea

Description

Chronic diarrhea is defined as the frequent passage of loose stools greater than 200 grams per day for more than 3 weeks.

Causes

Inflammatory diarrhea can be caused by: inflammatory bowel disease (ulcerative colitis and CrohnÕs disease); radiation enterocolitis; eosinophilic gastroenteritis; and AIDS. Risk factors include: infections, and radiation.

Osmotic diarrhea can be caused by: pancreatic insufficiency; bacterial overgrowth; Celiac disease; Lactase deficiency; WhippleÕs disease; abetalipoproteinemia; short bowel syndrome; drugs (colchicine, neomycin, and para-aminosalicylic acid - nondigestible intraluminal solute that exerts an osmotic force increasing the intraluminal fluid overwhelming the colonic mucosal absorptive capacities). Risk factors include: bacterial infections, abdominal surgery (cholecystectomy, gastric and small bowel resection), vagotomy, chronic alcohol abuse, Sorbitol, fructose, and gluten.

Secretory diarrhea can be caused by: carcinoid syndrome; Zollinger-Ellison syndrome; vasoactive intestinal peptide-secreting pancreatic adenomas; medullary carcinoma of thyroid; villous adenoma of rectum; microscopic colitis; choleraic diarrhea (excessive secretion of electrolytes). Risk factors include distal ileal surgery. Altered intestinal motility can be caused by: irritable bowel syndrome; fecal impaction; neurologic diseases; diabetes (increased transit and possible bacterial overgrowth) Factitious diarrhea can be caused by: laxative abuse; or self induced (patient may add water or urine to stool).

Conventional Labs

Standard lab tests include: Stool ova and parasites; Stool leukocytes; Stool fat and osmolality, and occult blood; Serum electrolytes and blood count; serum Iron studies, vitamin B12, folate, vitamin D, PT, blood chemistry for albumin and cholesterol, serum carotene; D-xylose absorption test A barium enema and KUB are usually ordered. A colonoscopy and esophagogastroduodenoscopy (EGD) may be ordered, usually with biopsy.

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