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