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Chronic Diarrhea

by Carlo Raj, MD

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    00:01 Chronic diarrhea. Another definition, greater than three weeks.

    00:05 Steatorrhea, this then means, steato means lipid.

    00:10 For example you've heard of steatohepatitis or steatosis in the liver and there would be accumulation of lipid.

    00:19 So, steato, the prefix means lipid. In this case, steatorrhea is defined as 70 g per day of fat.

    00:28 That's a lot of fat that you're losing. Why? Because of malabsorption.

    00:33 Why? Well, maybe gastronoma, maybe celiac disease in which there is going to be destruction of the microvilli.

    00:41 And when such an event takes place, there'll be malabsorption.

    00:46 And so therefore the stool that your -- that is being evacuated is going to be highly rich in lipid, you know, so therefore is going to be extremely uncomfortable for the patient.

    01:00 Abdominal pain and cramps with diarrhea chronically.

    01:04 Systemic symptoms such as fever, weight loss, arthritis, uveitis could be seen with the chronic diarrhea and signs of nutritional deficiencies because over a long period of time with a chronic diarrhea, you can only imagine that you're losing quite a bit of nutrients.

    01:21 Let's take a look at evaluating your chronic diarrhea.

    01:26 If it's acute diarrhea does it require evaluation? Let's associate with pretty massive dehydration.

    01:32 Remember, diarrhea in adult for the most part would be loss of isotonic fluid.

    01:36 Then blood pressure may not necessarily be -- well, it could be decreased, but not significantly if it's acute.

    01:42 Stool studies: culture, O and P stands for ova and parasites.

    01:48 And C. diff assay perhaps if you're suspecting the patient being at hospital antibiotics.

    01:54 And for clearing everything out, C. diff wins the battle, end up having diarrhea secondary to C.diff, fecal leukocytes and osmolar gap.

    02:03 Let's take a look at that osmolar gap.

    02:06 The equation in 290 which is approximately your plasma osmolarity.

    02:11 From that, you subtract your cations which include sodium plus potassium, multiply that by two.

    02:17 If you find the osmolar gap to be greater than 40 and this would then suggest osmotic diarrhea.

    02:24 For example; you've heard of lactose intolerance.

    02:28 A 72 hours stool collection for volume and fat would be often times the go standard if you worry about malabsorption.

    02:36 In stool phenolphthalein for laxative abuse; though taken off the market by FDA.

    02:45 Let's note that as being a historic fact.

    02:47 Let's go into malabsorption. Now, the evaluation that you wanna conduct with mild absorption.

    02:55 D-xylose test. Hydrogen breath test.

    03:00 Serum vitamin, iron and ferritin measurements with malabsorption. Endoscopy.

    03:06 You wanna check to see as to whether or not, is everything okay in the intestine? There's something called the wireless capsule endoscopy for small bowel.

    03:17 Radiologic studies (small bowel series) is very important for you especially radiologically and maybe perhaps your CT enterography.

    03:27 So either your evaluation for carbohydrates, maybe you're looking for organisms.

    03:32 Obviously you're looking for issues where maybe your patient is iron deficient maybe because of a blood loss and vitamins and such; fat-soluble, water-soluble vitamins or it depends.


    About the Lecture

    The lecture Chronic Diarrhea by Carlo Raj, MD is from the course Small and Large Intestine Diseases.


    Included Quiz Questions

    1. More than 3 weeks
    2. More than 2 weeks
    3. More than 5 weeks
    4. More than 6 weeks
    5. More than 1 week
    1. More than 7 grams per day
    2. More than 6 grams per day
    3. More than 5 grams per day
    4. More than 4 grams per day
    5. More than 2 grams per day
    1. Babesia microti
    2. Ascariasis
    3. Strongyloides stercoralis
    4. Trichurus trichura
    5. Diphyllobothrium latum
    1. Osmolar gap = 290 - (Na K) 2
    2. Osmolar gap = 290 - (Na Ca) 2
    3. Osmolar gap = 290 - (Cl K) 2
    4. Osmolar gap = 290 - (Na HCO3) 2
    5. Osmolar gap = 280 - (Na K) /2
    1. 30
    2. 40
    3. 35
    4. 45
    5. 25

    Author of lecture Chronic Diarrhea

     Carlo Raj, MD

    Carlo Raj, MD


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