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.
The lecture Chronic Diarrhea by Carlo Raj, MD is from the course Small and Large Intestine Diseases.
According to the definition, how many weeks must diarrhea be persistent to qualify as chronic diarrhea?
According to the definition, how much fat is excreted per day in a patient with steatorrhea?
Which of the following would NOT be a part of the evaluation for malabsorption?
Which of the following is the formula to calculate the osmolar gap?
A 26-year-old woman presents with chronic diarrhea that she has had for 5 weeks. Her stool studies show a sodium level of 35 mmol/L, a potassium of 95 mmol/L, and a chloride of 10 mmol/L. What is the osmolar gap?
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Thank you for such a good lectue. This has clarified things in my head and organize the topc.