Chronic diarrhea is a general but v...

Chronic diarrhea is a general but vexing problem for physicians and patients. Defined as diarrhea that continues for more than four weeks, chronic diarrhea come into one's heads in 1 to 5 percent of the population. Patients many times present late, after other symptoms as it is as weight loss, rectal bleeding, and abdominal pain have perform the operations indicated ined Schiller reviewed the management of chronic diarrhea.

Diarrhea outcomes from incomplete absorption of water from the bowel lumen because of a reduc rate of water absorption or osmotically induced luminal retention of water. steady mild changes in absorption can cause untie stools. The three available management strategies are trial and treat; categorize, test, and treat; and empiric therapy. After a ended history and physical examination, a diagnosis could be made which could then be confirmed at appropriate testing. This "test and treat "plan is useful when the history and physical examination yield a high probability of a specific diagnosis, When the evaluation is les clear, it is impractical to criterion for every possible etiology. A "categorize, standard and treat "plan is useful because the presentation of ten is nonspecific. Diarrhea can be categorized as watery, fatty, or inflammatory based upon gross stool examination or microscopic analysis (see accompanying table). one time the diarrhea is categorized, further testing becomes more specific. An "empiric therapy "plan avoids determining a diagnosis and simply treats the symptoms. This is a reasonable approach, assuming serious causes for the diarrhea have been exclud Patients must be monitored closely when this plan is followed.

Calculation of the fecal osmotic gap may be useful to differentiate chronic osmotic diarrhea and chronic secretor y diarrhea when fatty and inflammatory bowel question s are excluded. In secretory diarrhea, water is held within the bowel lumen at incompletely absorbed electrolytes, whereas in osmotic diarrhea, electrolyte absorption is normal still water is held in the bowel lumen from some other osmotically active substance. This means that secretory diarrhea will have a high electrolyte contented while osmotic diarrhea will have a depressed electrolyte content. Stool electrolyte quantitation is determined by the agency of doubling the total of the stool sodium and potassium concentrations and subtracting that amount from 290 mOsm by kg, which is the normal osmolality of bowel stool. This fecal osmotic gap clarifies the diagnosis :values of les than 50 mOsm by means of kg indicate a secretory diarrhea, and values of greater than 50 mOsm by kg indicate an osmotic diarrhea.

The author gather s that methods for managing diarrhea should hang on the specific presentation of each patient.

proofs to Categorize Chronic Diarrhea

Stool electrolyte concentrations

Fecal mystic blood test

Fecal leukocyte or lactoferrin levels

Stool fat quantitation

RICHARD SADOVSKY, MD

Schiller LR Chronic diarrhea. Gastroenterology July 2004;127:287-93

COPYRIGHT 2005 American Academy of Family Physicians

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