diarrhea cha cha cha

############################# Video Source: www.youtube.com/watch?v=L-hRZpuENo4

medskl.com is a free, global medical education site (FOAMEd) covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations. • Gastroenterology – Chronic Diarrhea: A Practical Approach to Chronic Diarrhea • Whiteboard Animation Transcript • with Sylvain Coderre, MD • https://medskl.com/Module/Index/chron... • There are several definitions for diarrhea. The most “scientific” approach is a stool weight over 300g, or stool volume over 300ml, in a 24-hour period. The more practical definition is a stool frequency over 3 times per day, with a loose stool consistency. • There are several approaches to categorizing chronic diarrhea: physiological (osmotic vs secretory), anatomical (small bowel vs large bowel). • However, my preference is to look at this problem in terms of the four most common causes: lactose intolerance, celiac disease, inflammatory bowel disease, and by default irritable bowel syndrome. • Therefore, a very practical approach to this problem is as follows. • • First, exclude chronic infections (most notably Giardia in campers/well water drinkers and clostridium difficile with antibiotics), and medications (especially new ones, metformin being a good example). • • Second, while formal laboratory tests do exist for lactose intolerance, one way to exclude it is a dairy-free trial for 14 days. • • Next, if the patient is still symptomatic, then consider celiac disease by sending a tissue trans-glutaminase level and/or the gold standard test, a gastroscopy with • duodenal biopsy. • • Inflammatory bowel disease is next to be excluded. This requires a history of prototypical symptoms (for ulcerative colitis, bloody diarrhea, for Crohn’s right lower quadrant pain), laboratory work such as findings of anemia, low albumin, elevated c-reactive protein, and finally if it is still considered, a colonoscopy with view of terminal ileum. • • Having excluded the above, most patients (especially without warning symptoms such as bleeding or weight loss) will have diarrhea-predominant irritable bowel syndrome, an entity which may also be accompanied by bloating, abdominal pain relieved by defecation, constipation, and mucus in the stools. • One caveat to the above approach: in older patients, consideration must be given to colon cancer (especially with iron deficiency anemia) and microscopic colitis (especially with use of NSAIDS).

#############################

New on site