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Chronic diarrhoea

Diarrhoea of long duration (more than, 2 wks) mainly non infection and associate with malabsorption syndrome chronic diarrhoea can be categorized pathophysiologically as-   

  1. Inflammatory
  2. Osmotic
  3. Secretory
  4. Altered intestine motility 
  1. Inflammatory
     
    Mucosal and submucosal inflammation Damage epithelium

    C/f – fever, abdominal pain, blood and/or WBC in stool.
     
    Causes.   
  • Ulcerative colitis
  • Crohn’s disease
  • Radiation enterocolitis
  • Eosinophilic gastroenteritis
  • AIDS
  1. Osmotic
    1. Non absorbed or non digested intraluminal solute
    2. Diarrhoea improve with fasting
    3. Bulky greasy stool
    4. Stool pH <: 5
    5. Reducing substance in stool (+)
    6. Osmotic gap in fecal water 

Causes

  1. Pancreatic insufficiency        
  2. Bacterial over growth
  3. Lactase del                    
  4. Celiac disease      
  5. Excessive intake of non absorbable solutes 
  1. Secretory
    1. Excessive secretion of electrolytes        
    2. Watery diarrhoea
    3. Persists with fasting                              
    4. Stool pH > 6
    5. Reducing substance – ve                      
    6. Absence of osmotic gap in fecal water. 

Causes

  1. Carcinoid syndrome                    
  2. Zollinger Ellison syndrome
  3. Medullary carcinoma of thyroid              
  4. VIP secreting adenoma
  1. Altered intestine motility

Rapid transient in some cases associated with bacterial over growth.

  

Causes

  1. Irritable bowel syndrome                      
  2. Neurologic disease




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