Chronic diarrhea classification: Difference between revisions
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==Overview== | ==Overview== | ||
Chronic diarrhea may be classified into 3 basic categories: [[Watery diarrhea|watery]], [[Steatorrhea|fatty]]([[malabsorption]]) and [[inflammatory]] (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up. | [[Chronic diarrhea causes|Chronic diarrhea]] may be classified into 3 basic categories: [[Watery diarrhea|watery]], [[Steatorrhea|fatty]]([[malabsorption]]) and [[inflammatory]] (with [[blood]] and [[pus]]). It is important to note that not all chronic diarrhea falls into one category alone. The [[differential diagnosis]] for [[chronic diarrhea]] is enormous, with a large number of [[Diagnostic test|diagnostic tests]] available that can be used to evaluate these patients. Classifying the patient with [[chronic diarrhea]] into a subcategory helps to direct the diagnostic work-up. | ||
==Classification== | ==Classification== | ||
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===Inflammatory diarrhea=== | ===Inflammatory diarrhea=== | ||
Diarrhea is said to be due to an [[inflammatory]] cause when stool analysis such as stool cultures, [[flexible sigmoidoscopy]] or [[colonoscopy]] with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include | [[Diarrhea (patient information)|Diarrhea]] is said to be due to an [[inflammatory]] cause when [[Stool examination|stool analysis]] such as [[Stool culture|stool cultures]], [[flexible sigmoidoscopy]] or [[colonoscopy]] with [[biopsies]] show evidence of the presence of [[Fecal occult blood|fecal leukocytes]]. Causes of [[Inflammatory|inflammatory diarrhea]] include: | ||
*[[Idiopathic]] [[inflammatory bowel disease]] such as [[Crohn’s disease]] or [[ulcerative colitis]] | *[[Idiopathic]] [[inflammatory bowel disease]] such as [[Crohn’s disease]] or [[ulcerative colitis]] | ||
*[[Infectious disease|Infectious diseases]] such as [[cytomegalovirus]], [[herpes simplex]], [[tuberculosis]], [[strongyloidiasis]], [[Aeromonas]] or [[Plesiomonas shigelloides|Plesiomonas]] | *[[Infectious disease|Infectious diseases]] such as [[cytomegalovirus]], [[herpes simplex]], [[tuberculosis]], [[strongyloidiasis]], [[Aeromonas]] or [[Plesiomonas shigelloides|Plesiomonas]] | ||
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*[[Neoplasia]] | *[[Neoplasia]] | ||
===Watery diarhea=== | ===Watery diarhea=== | ||
Watery diarrhea can be classified as | Watery diarrhea can be classified as: | ||
*Osmotic diarrhea | *Osmotic diarrhea ([[Stools]] with high osmotic gap >100 mosm/kg). Causes of osmotic diarrhea include: | ||
**[[Celiac sprue]] | **[[Celiac sprue]] | ||
**[[Chronic pancreatitis]] | **[[Chronic pancreatitis]] | ||
**[[Lactase deficiency]] | **[[Lactase deficiency]] | ||
**[[Lactulose]] | **[[Lactulose]] | ||
**[[Laxative abuse|Laxative use/abuse]] | **[[Laxative abuse|Laxative use/abuse]] | ||
**[[Whipple's disease]] | **[[Whipple's disease]] | ||
*Secretory diarrhea | *Secretory diarrhea (Stools with low osmotic gap <50 mosm/kg) causes of secretory diarrhea include: | ||
**[[Cholera]] | **[[Cholera]] | ||
**[[ETEC|Enterotoxigenic strains of E. coli]] | **[[ETEC|Enterotoxigenic strains of E. coli]] | ||
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**[[Cryptosporidium]], | **[[Cryptosporidium]], | ||
* Structural and [[Endocrine system|Endocrine]] [[diseases]] should also be considered | * Structural and [[Endocrine system|Endocrine]] [[diseases]] should also be considered, these [[diseases]] include the following: | ||
** [[Diabetes]] | ** [[Diabetes]] | ||
** [[Hyperthyroidism]] | ** [[Hyperthyroidism]] | ||
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===Fatty diarrhea=== | ===Fatty diarrhea=== | ||
Fatty diarrhea can be described either due to [[malabsorption]] or [[maldigestion]] problems | Fatty diarrhea can be described either due to [[malabsorption]] or [[maldigestion]] problems: | ||
* | *The most common causes of [[malabsorption]] are: | ||
**[[Celiac sprue]] | **[[Celiac sprue]] | ||
**[[Pancreatic insufficiency]] | **[[Pancreatic insufficiency]] | ||
**[[Bacterial overgrowth]] | **[[Bacterial overgrowth]] | ||
*[[Maldigestion]] | *[[Maldigestion]] results from [[Pancreatic insufficiency|pancreatic exocrine insufficiency]]. | ||
==References== | ==References== | ||
Revision as of 15:37, 25 July 2017
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Chronic diarrhea Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Chronic diarrhea may be classified into 3 basic categories: watery, fatty(malabsorption) and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up.
Classification
Chronic diarrhea may be classified into:[1][2][3][4]
Inflammatory diarrhea
Diarrhea is said to be due to an inflammatory cause when stool analysis such as stool cultures, flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include:
- Idiopathic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
- Infectious diseases such as cytomegalovirus, herpes simplex, tuberculosis, strongyloidiasis, Aeromonas or Plesiomonas
- Ischemic colitis
- Radiation colitis
- Neoplasia
Watery diarhea
Watery diarrhea can be classified as:
- Osmotic diarrhea (Stools with high osmotic gap >100 mosm/kg). Causes of osmotic diarrhea include:
- Secretory diarrhea (Stools with low osmotic gap <50 mosm/kg) causes of secretory diarrhea include:
A normal gap is between 50 and 100 mosm/kg.[6]
Fatty diarrhea
Fatty diarrhea can be described either due to malabsorption or maldigestion problems:
- The most common causes of malabsorption are:
- Maldigestion results from pancreatic exocrine insufficiency.
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.
- ↑ Oster JR, Materson BJ, Rogers AI (1980). "Laxative abuse syndrome". Am J Gastroenterol. 74 (5): 451–8. PMID 7234824.
- ↑ Shiau, Yih-Fu (1985). "Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders". Annals of Internal Medicine. 102 (6): 773. doi:10.7326/0003-4819-102-6-773. ISSN 0003-4819.