Chronic diarrhea overview
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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 is a common symptom of many conditions with an estimated prevalence of 5%. Although chronic diarrhea has multiple definitions, a current working definition is the production of loose stools for longer than 4 weeks’ duration. Frequent defecation with normal consistency is termed psuedodiarrhea.
Historical Perspective
Classification
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.
Pathophysiology
The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the lumen either because of a reduced rate of net water absorption (related to impaired electrolyte absorption or excessive electrolyte secretion) or because of osmotic retention of water intraluminally.[1] The causes of chronic diarrhea include inflammatory, osmotic, secretory, iatrogenic, motility, and functional diseases. In general, no single cause of chronic diarrhea is truly unifactorial from a perspective of pathophysiology. For example, cholera is caused by secretion and altered motility[2] whereas pseudomembranous colitis is said to be associated with secretion, inflammation, and motility[3]. Thus, diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiologic mechanisms of diarrhea include osmotic, secretory, inflammatory, altered motility or iatrogenic.
Causes
Depending on the socio economic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic bacteria include; mycobacterial and parasitic infections and less likely to include functional disorders such as malabsorption and inflammatory bowel diseases. In a developed nation however, the most likely cause of diarrhea include; irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised).
Differentiating Chronic Diarrhea fron other Conditions
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.
Epidemiology and Demographics
Risk Factors
Natural History, Complication and Prognosis
Daignosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT Scan
Other Imaging Findings
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Sweetser S (2012). "Evaluating the patient with diarrhea: a case-based approach". Mayo Clin Proc. 87 (6): 596–602. doi:10.1016/j.mayocp.2012.02.015. PMC 3538472. PMID 22677080.
- ↑ Goyal RK, Hirano I (1996). "The enteric nervous system". N Engl J Med. 334 (17): 1106–15. doi:10.1056/NEJM199604253341707. PMID 8598871.
- ↑ Kurose I, Pothoulakis C, LaMont JT, Anderson DC, Paulson JC, Miyasaka M; et al. (1994). "Clostridium difficile toxin A-induced microvascular dysfunction. Role of histamine". J Clin Invest. 94 (5): 1919–26. doi:10.1172/JCI117542. PMC 294602. PMID 7962537.