Chronic Diarrhea

by Carlo Raj, MD

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    00:01 Chronic Diarrhea. There´s the definition: Greater than 3 weeks.

    00:05 Steatorrhea, does that means, steato means lipid.

    00:10 For example, you have heard of steatohepatitis or steatosis in the liver and that would be accumulation of lipid, so steato, the prefix means lipid.

    00:21 In this case, steatorrhea is defined as 7 g/day of fat.

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

    00:33 Why? Maybe gastronoma, maybe Celiac disease in which there is going to be destruction of the microvilli and when such an event takes place, there´ll be malabsorption so therefore the stool that is being evacuated is going to be highly rich in lipid and so therefore is going to be extremely uncomfortable for the patient. Abdominal pain and cramps with diarrhea chronically, systemic symptoms such as fever, weight loss, arthritis, uveitis can be seen with chronic diarrhea and signs of nutritional deficiencies because over a long period of time with chronic diarrhea, you can imagine that you are losing quite a bit of nutrients.

    01:20 Acute diarrhea does not require evaluation unless associated with dehydration.

    01:26 Stool studies, what you´re looking for? You might be looking for bacteria, so therefore culture or maybe you might be looking for certain worms.

    01:38 Worms, ovum, parasites. Remember, the fish tapeworm that likes to consume B12 will be something like your Diphyllobothrium latum or if you´re thinking about important nematodes and such then you might think about Ascaris lumbricoides, Trichuris trichiura, and Strongyloides stercoralis, alright? So O and P.

    02:02 If you´re in a hospital setting and the patient is receiving high doses of antibiotic, there is a possibility that you kill off all of the competitors for C. diff and all the competitors are dead, C. diff wins this battle and may result to in what´s known as well, talk about pseudomembranous colitis.

    02:22 What else much you'd be looking for in your stool? If you notice that there might be an infection and it´s exudative and you´re thinking about your leukocytes in your feces.

    02:34 It doesn´t have to be every diarrhea, huh? Like for example, for osmotic diarrhea due to lactase deficiency, why would you find leukocytes in your feces? That´s makes no sense.

    02:45 You would find it there. Osmolar gap, yes.

    02:49 Osmotic diarrhea especially you would find an increase in osmolar gap.

    02:53 So allow the name to speak to you.

    02:55 Of all the diarrheas, the osmolar gap is the most significant in osmotic diarrhea osmotic, osmolar. As far as osmotic gap and the secretory diarrhea, not as significant.

    03:05 What is the osmolar gap? If I were you, I would memorize this formula just like what you´ve done for acid-base in which you´ve memorized the anion gap. This is the osmolar gap.

    03:19 So here we have approximately 290 as being the normal plasma osmolarity.

    03:24 From this you would subtract your cations and these include your sodium plus your potassium and a gap greater than 40 will suggest once again an osmotic diarrhea will exhibit an osmolar gap.

    03:39 Same with 2-hour stool collection for volume and fat.

    03:43 You wanna see how much volume is being passed and how much fat? Steatorrhea.

    03:48 Stool which is known as phenolphthalein for laxative abuse, even though it´s taken off the market by the FDA, if a patient wishes to lose weight, sometimes things get a little interesting, don´t they? Amazing as to what people would do, due to pressures of their environment.

    04:15 Let it be sports, let it be certain industries so therefore even though something´s been taken off the market, doesn´t mean that the patients aren´t still using things, huh? Let´s go to malabsorption.

    04:30 Now, the evaluation that you wanna conduct with malabsorption: D-xylose test, hydrogen breath test, serum vitamin, iron and ferritin measurements with malabsorption. Endoscopy, you wanna check to see as to whether or not, is everything okay in the intestine.

    04:51 Some to call the wireless capsule endoscopy for small bowel, radiological studies (small bowel series) is very important for you especially radiologically and maybe perhaps your CT enterography.

    05:05 Either all evaluation for carbohydrates, maybe you`re looking for organisms.

    05:11 Obviously, you´re looking for ratios where maybe your patient is iron deficient, maybe because of blood loss and vitamins as such fat soluble, water soluble vitamins all 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 4 weeks
    2. More than 2 weeks
    3. More than 5 weeks
    4. More than 3 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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