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.