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Chronic DiarrhoeaChronic DiarrhoeaDr Katie AllenDr Katie Allen
Department of Gastroenterology Department of Gastroenterology and Clinical Nutritionand Clinical Nutrition
OverviewOverview
Physiology of GI absorptionPhysiology of GI absorptionDefinition of chronic diarrhoeaDefinition of chronic diarrhoeaCategories of causesCategories of causesAlgorithm for diagnosisAlgorithm for diagnosisSpecific diseases Specific diseases Practical tipsPractical tips
Review GI physiology in Review GI physiology in GanongGanong
Gastrointestinal absorptionGastrointestinal absorption
Fat digestion and absorptionFat digestion and absorption
Mechanism of Mechanism of abetalipoproteinaemiaabetalipoproteinaemia
Protein digestion and absorptionProtein digestion and absorption
Digestion of carbohydratesDigestion of carbohydrates
What is diarrhoea ?What is diarrhoea ?
It is an increase in the frequency, It is an increase in the frequency, volume and fluid content of stoolvolume and fluid content of stoolWhat is normal ? What is normal ?
Breast fedBreast fed babies can pass 1 stool q babies can pass 1 stool q 10/7 or 10 stools/day, 10/7 or 10 stools/day,
bottle fedbottle fed infants pass 2infants pass 2--3 pasty stools 3 pasty stools per day and per day and
older childrenolder children 11--2 formed stools /day 2 formed stools /day or 1 stool q 2/7 or 1 stool q 2/7
NORMAL STOOLS IN INFANTSNORMAL STOOLS IN INFANTS
1st week 8-28 days 1-12 mth 13-24 mth
No. / 24 hr Range
4.0 1-12
2.2 0-6
1.8 0-5
1.7 0-3
Mean wt Range (g)
4.3 0.5-48
11 0.3-40
17 2-98
35 4-180
Stool water 73% 73% 75% 74%
Lemoh and Brooke
Arch Dis Childh
1979, 54:719
Definition of Chronic DiarrhoeaDefinition of Chronic Diarrhoea
History of diarrhoea >2/52History of diarrhoea >2/52Aetiology is based on physiological Aetiology is based on physiological principles and include osmotic, secretory, principles and include osmotic, secretory, inflammatory or GI inflammatory or GI dysmotilitydysmotilityCan result in electrolyte and nutritional Can result in electrolyte and nutritional deficienciesdeficienciesToddlers Diarrhoea and Overflow Toddlers Diarrhoea and Overflow constipation are the commonest causes constipation are the commonest causes
Bloody diarrhoeaBloody diarrhoea
Infectious colitisInfectious colitisInflammatory bowel diseaseInflammatory bowel diseaseEosinophillicEosinophillic gastroenteritisgastroenteritisCow milk protein colitisCow milk protein colitis
Fat globules implies impaired Fat globules implies impaired digestiondigestion
Impaired Impaired intraluminalintraluminal digestion Idigestion I
Affecting Affecting allall nutrientsnutrientsCYSTIC FIBROSISCYSTIC FIBROSIS
ShwachmanShwachman syndrome (syndrome (pancpanc hypoplasiahypoplasia, , neutropenianeutropenia and and metaphysialmetaphysial chondrodysplasiachondrodysplasia))
JohansonJohanson--Blizzard syndromeBlizzard syndromePearson syndromePearson syndromeCystinosisCystinosis
Impaired Impaired intraluminalintraluminal digestion IIdigestion II
Affecting Affecting fatfat absorptionabsorptionBiliaryBiliary atresiaatresiaImpaired Impaired enterohepaticenterohepatic circ circ •• ((egeg ilealileal resection or resection or Crohn’sCrohn’s disease)disease)
Blind loopBlind loop
Isolated lipase or Isolated lipase or colipasecolipase defydefyImpaired bile acid synthesisImpaired bile acid synthesis
Impaired Impaired intraluminalintraluminal digestion IIIdigestion III
Affecting Affecting proteinsproteinsCongenital Congenital trypsinogentrypsinogen defydefyCongenital Congenital enterokinaseenterokinase defydefy
Fatty acid crystals implies impaired Fatty acid crystals implies impaired absorption absorption –– capable of partial hydrolysiscapable of partial hydrolysis