Chronic Diarrhea

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.