Liver & GIT
A patient is said to have chronic diarrhea if it is occurring for more than.. weeks?
Definition-It is defined according to symptoms as increase in liquidity, frequency and volume of stools; and according to sign as increase in stool weight of more than 200gm/day.
Pseudo diarrhea-it is the frequent passage of small volume of stools. It is seen in irritable bowel syndrome and proctitis.
Classification-It is classified according to duration as
Acute-Duration less than 2 weeks.
Persistent-Duration of 2-4 weeks.
Chronic-Duration of more than 4 weeks.
Acute Diarrhea-90% cases of acute diarrhea are due to infectious causes, rest 10% are due to noninfectious cause.
1. Infectious causes-
A. Toxin producer-
i. Preformed toxin-Staphylococcus aureus, Bacillus cereus, Clostridium perfringens.Q
ii. Enterotoxin-Vibrio cholerae, ETEC, Klebsiella pneumoniae, Aeromonas sp.Q
v. Cytotoxin producers-
Clostridium difficile, hemorrhagic E. coli.
vi. Invasive organisms-
a. Minimal inflammation- Rotavirus, Norwalk virus
b. Moderate inflammation- Salmonella, Campylobacter, Yersinia, Vibrio parahaemolyticus
c. Severe inflammation- Shigella, enteroinvasive E. coli, Entamoeba histolytica. Q
2. Non-infectious causes-
i. Drug- Antibiotics, antiarrhythmic, laxatives, NSAIDs, antihypertensives, chemotherapeutic agents, antacids, Theophylline.
ii. Toxins-organophosphate insecticides, amanita mushroom, arsenic.
iii. Ischemia-Ischemic colitis.
iv. Diverticulitis-colonic diverticulitis.
v. Graft vs host reaction.
Investigations-The most cases of acute diarrhea are self limiting and do not require detailed investigations. The indications for evaluation are-
1. Profuse diarrhea with dehydration.
2. Grossly bloody stools.
3. Fever>38.5 C.
4. Duration >48 hrs without improvement.
5. Age>50 years with severe abdominal pain .
6. Immunocompromised pt.
7. New community outbreak
Examination of the stools-
1. Presence of WBCs in stools-bacteria, toxin, ischemic colitis.
2. Occult blood in stools-colonic neoplasm, ischemia, ameobiasis, severe mucosal inflammation causing bacteria.
3. Ova and cyst –for helminths
4. Viral antigen-Rota virus
5. Immunoassay for toxins-Clostridium difficile Q
6. Protozoal antigen-Giardia, E. histolytica. Q
Endoscopy-If stool studies are unrevealing, flexible sigmoidoscopy with biopsy and upper GI endoscopy with duodenal aspirate and biopsy are indicated.
1. Fluid and electrolyte replacement.
2. Antimotility agents should be avoided in infectious diarrhea. They can be given in moderately severe nonfebrile, non bloody diarrhea.
3. Antibiotics-The indications for the use of antibiotics are-
a. Fever>38.5 C b. Bloody stools
c. Increased in fecal WBCs d. Immunocompromised pt.