Chronic diarrhea laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
===Blood Tests=== | ===Blood Tests=== | ||
Initial laboratory tests should include a complete blood count to evaluate for anemia and an abnormal white blood cell count, as well as electrolytes, thyroid tests, and serological tests for celiac disease. | Initial laboratory tests should include a complete blood count to evaluate for anemia and an abnormal white blood cell count, as well as electrolytes, thyroid tests, and serological tests for celiac disease. <ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602 }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778 }} </ref> | ||
===Stool Analysis=== | ===Stool Analysis=== | ||
*Fecal leukocytes; the presence of white blood cells in the stool has a sensitivity of 70% and a specificity of 50% for detecting inflammation in studies of infectious diarrhea. Fecal white blood cells can be present in both infectious colitis and inflammatory bowel diseases such as ulcerative colitis, Crohn’s disease, and microscopic colitis. | |||
*Fecal lactoferrin; this is an iron-binding glycoprotein that is a major component of the secondary granules of polymorphonuclear neutrophils and is secreted by most mucosal membranes. Fecal lactoferrin levels have never been evaluated in the workup of chronic diarrhea. | |||
*Fecal occult blood; the sensitivity and specificity of stool guaiac cards for detecting inflammatory or neoplastic causes of diarrhea have not been studied. | |||
*Stool electrolytes | |||
by most mucosal membranes. Fecal lactoferrin levels have never been evaluated in the workup of chronic diarrhea. | |||
Measuring stool potassium and sodium concentrations can determine the stool osmotic gap. For secretory diarrhea, the osmotic gap is less than 50 mOsm/kg. In osmotic diarrhea, the osmotic gap is greater than 50 mOsm/kg. | Measuring stool potassium and sodium concentrations can determine the stool osmotic gap. For secretory diarrhea, the osmotic gap is less than 50 mOsm/kg. In osmotic diarrhea, the osmotic gap is greater than 50 mOsm/kg. | ||
===Endoscopy=== | ===Endoscopy=== | ||
Revision as of 12:55, 6 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Laboratory Findings
Blood Tests
Initial laboratory tests should include a complete blood count to evaluate for anemia and an abnormal white blood cell count, as well as electrolytes, thyroid tests, and serological tests for celiac disease. [1][2][3][4]
Stool Analysis
- Fecal leukocytes; the presence of white blood cells in the stool has a sensitivity of 70% and a specificity of 50% for detecting inflammation in studies of infectious diarrhea. Fecal white blood cells can be present in both infectious colitis and inflammatory bowel diseases such as ulcerative colitis, Crohn’s disease, and microscopic colitis.
- Fecal lactoferrin; this is an iron-binding glycoprotein that is a major component of the secondary granules of polymorphonuclear neutrophils and is secreted by most mucosal membranes. Fecal lactoferrin levels have never been evaluated in the workup of chronic diarrhea.
- Fecal occult blood; the sensitivity and specificity of stool guaiac cards for detecting inflammatory or neoplastic causes of diarrhea have not been studied.
- Stool electrolytes
Measuring stool potassium and sodium concentrations can determine the stool osmotic gap. For secretory diarrhea, the osmotic gap is less than 50 mOsm/kg. In osmotic diarrhea, the osmotic gap is greater than 50 mOsm/kg.
Endoscopy
There has been much debate over the appropriate endoscopic method for evaluating chronic diarrhea. Flexible sigmoidoscopy is less expensive, less invasive, with fewer complications than colonoscopy. However some cases might be missed if biopsy samples are only taken from the distal segment of the colon.
References
- ↑ Fine, K; Schiller, L (1999). "AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆". Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.
- ↑ "American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆". Gastroenterology. 116 (6): 1461–1463. 1999. doi:10.1016/S0016-5085(99)70512-3. ISSN 0016-5085.
- ↑ Camilleri M (2004). "Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist". Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
- ↑ Fine KD, Seidel RH, Do K (2000). "The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea". Gastrointest Endosc. 51 (3): 318–26. PMID 10699778.