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Chronic Diarrheal Diseases
Mohammed al-matrafi
Diarrhea more than 2 weeks
CHRONIC DIARRHEA
Pathogenesis Digestion lactase , C.F., Bile Absorption celiac, glucose -galactose malabsorption Food intolerance Cows milk allergy Loss Lemphangectasia Na pump, cl diarrhea Unknown Toddlers diarrhea Intractable diarrhea of infancy Inflammation Ulcerative Colitis Immune def./Drugs HIV, Laxatives, Ab
Malabsorption = Steatorrhea = Stool fat
Chronic Non specific diarrhea (Toddlers diarrhea/Peas & carrots Syndrome)
Cause is unknown. Juice sugars ?. Between 6 months - 3years Diarrhea is the only symptom growth & activity not affected Dx history R+ juices ( if applicable) reassure parents Loperamide??
Lactose intolerance.
Congenital or post infectious. Diarrhea , bloating, cramps , flatus & excoriation at diaper area. Dx Stool reducing substance Lactose free formula Intestinal biopsy & enzyme assessment R+ lactose free diet
Glucose-Galactose Malabsorption
Inherited disease Diarrhea with feeding Stopping feeding stops diarrhea Dx History & intestinal biopsy R+ Glucose & Galactose free formula
(Galaktamine19)
Celiac Disease
Glutine sensitive entropathy
Celiac Disease
Glutine??
Celiac DiseaseGlutine
WheatOat BarleyRye
Celiac Disease
Glutine sensitive entropathy Vellus atrophy + Crypts Hyperplasia Chronic diarrhea (Steatorrhea)
Starts at introduction of cereals (< 2years) Typical appearance Dx intestinal biopsy + serology R+ Gluten free diet for life
Normal
mucosa
Mucosa of a patient suffering from coeliac disease
normalCoeliac disease
Milk Protein allergy
Immune mediated in about 1-7% 50% allergic to soy protein Over diagnosed Diarrhea (bloody), poor growth, urticaria&wheeze Dx - CBC esoinophils Hgb
-Protein serum stool - challenge test
R+ Replace cows milk
Intractable diarrhea of infancy
Affects infants around 3-6 months.Secretary diarrhea (explosive& watery)May start with fever & vomiting Babe will be cachectic & marasmic with
abdominal distentionStopping feeding dose not stops diarrheaNo etiology defined mortality
Cystic fibrosis
Autosomal recessive Lung diseaseHx of meconium plug or rectal prolepsesPancreatic enzyme def. SteatorrheaFecal fat (qualitative & quantitative)Dx sweat chloride R+ Antibiotic & enzymes replacement
Protein losing interopathy
Intestinal loss of protein & diarrhea. Etiology - intestinal permeability e.g. post infection - lymphangectasia * Primary * Secondary -Allergic Dx -History -Stool Protein (Fecal alpha 1-antitrypsin) -Serum Protein (albumin & TP) Isotope scan R+ as per etiology
Other Causes
Small bowel bacterial over growthBile salt deficiencyAbetalipoprotienemiaAcrodermatitis enteropathica
Inflammatory Bowel Disease (IBD)
Crohn’s Disease
Ulcerative colitis
Chronic Diarrhea
Approach
Good detailed HistoryPhysical Examination -nutritional status
-specific signs
Proper Investigations -general
-specific