Chronic Diarrhea

by Carlo Raj, MD

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides Small and large bowel.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 Chronic diarrhea. Another definition, greater than four 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.

    01:24 Stool studies: culture, O and P stands for ova and parasites.

    01:31 And C. diff assay perhaps if you're suspecting the patient being at hospital antibiotics.

    01:37 And for clearing everything out, C. diff wins the battle, end up having diarrhea secondary to C.diff, fecal leukocytes and osmolar gap.

    01:46 Let's take a look at that osmolar gap.

    01:48 The equation in 290 which is approximately your plasma osmolarity.

    01:53 From that, you subtract your cations which include sodium plus potassium, multiply that by two.

    01:59 A 72 hours stool collection for volume and fat would be often times the go standard if you worry about malabsorption.

    02:08 In stool phenolphthalein for laxative abuse; though taken off the market by FDA.

    02:15 Let's note that as being a historic fact.

    02:18 Let's go into malabsorption. Now, the evaluation that you wanna conduct with mild absorption.

    02:24 D-xylose test. Hydrogen breath test.

    02:29 Serum vitamin, iron and ferritin measurements with malabsorption. Endoscopy.

    02:35 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.

    02:46 Radiologic studies (small bowel series) is very important for you especially radiologically and maybe perhaps your CT enterography.

    02:56 So either your evaluation for carbohydrates, maybe you're looking for organisms.

    03:01 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: Basic Principles with Carlo Raj.

    Included Quiz Questions

    1. More than 4 weeks
    2. More than 2 days
    3. More than 5 months
    4. More than 6 hours
    5. More than 3 hours
    1. More than 7 grams per day over the normal daily expectation
    2. More than 6 grams per day over the normal daily expectation
    3. More than 5 grams per day over the normal daily expectation
    4. More than 4 grams per day over the normal daily expectation
    5. More than 2 grams per day over the normal daily expectation
    1. H. pylori test
    2. D-xylose test
    3. Hydrogen breath test
    4. Serum vitamin, iron, and ferritin measurements
    5. CT enterography
    1. Osmolar gap = 290 - 2(Na+ + K+)
    2. Osmolar gap = 290 - 2(Na+ + Ca2+)
    3. Osmolar gap = 290 - 2(Cl- + K+)
    4. Osmolar gap = 290 - 2(Na+ + HCO3-)
    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

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star
    Good lecture on the topic
    By S C. on 06. August 2021 for Chronic Diarrhea

    Thank you for such a good lectue. This has clarified things in my head and organize the topc.