Diarrhoea -an overview 

• What is diarrhoea? 
• What the types of diarrhoea? 
• What are the causes of acute watery
• What are the infectious causes of diarrhoea? 
• What is chronic diarrhoea?
• causes of chronic diarrhoea

What is Diarrhoea? 

Defination of Diarrhoea: according to WHO,Passage of loose stool more than three times a day is called diarrhoea.

Types of diarrhoea:

A) Types of Diarrhoea According to duration:

1. Acute diarrhoea: Diarrhoea persisting less than 14 days.
2. Persistent diarrhoea: Diarrhoea persisting from 14 days to 6 weeks.
3. Chronic diarrhoea: Diarrhoea persisting more than 6 weeks.

B) According to nature:

1. High volume diarrhoea: (>200 gm stool/day or > IL per day) Secretory diarrhoea: Due to intestinal inflammation e.K. viral or bacterial infections,ulcerative colitis or Crohn’s disease .  Osmotic diarrhoea: Due to malabsorption, drugs or motility disorders,
2. Low volume diarrhoea: (<200 gm stool/day).

Acute Watery Diarrhea 

What are the Causes of acute watery diarrhoea?

Cause of acute watery Diarrhea are below:

Infectious causes:

• Gastroenteritis
• C. difficile infection
• Acute diverticulitis
• Sepsis
• Pelvic inflammatory disease
• Meningococcaemia
• Malaria
• Pneumonia (specially atypical disease)

Non-infectious causes:

1. Gastrointestinal:

• Inflammatory bowel disease
• Bowel malignancy
• Overflow from constipation
• Enteral tube feeding

2. Metabolie:

• Diabetic ketoacidosis
• Thyrotoxicosis
• Uraemia
• Neuroendocrine tumour releasing VIP or 5-HT

3. Drugs and toxins:

• NSAIDs
• Cytotoxic agents
• Antibiotics
• Ciguatera fish poisoning
• Dinoflagellates
• Plant toxins
• Heavy metals
• Ciguatera fish poisoning
• Scombrotoxic fish poisoning

Chronic diarrhoea

Chronic diarrhoea: Diarrhoea persisting more than 4 weeks is called chronic diarrhoca.

Causes of chronic diarrhoea:

• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD)
• Giardiasis
• Chronic pancreatitis
• Thyrotoxicosis.
• Intestinal tuberculosis.
• Addison’s disease.
• Colonic carcinoma
• Pancreatic cancer
• Lymphoma
• Coeliac disease
• Tropical sprue
• VIPoma
• Colonic ischaemia
• Drug induced: NSAIDs, Aminosalicylates, Selective serotonin re-uptake inhibitor (SSRI)

clinical case of chronic diarrhoea 

A young man has come to you with complaints of persistent diarrhoea for the last 6 month.How will you proceed to diagnosis of the case of chronic diarrhoea?

Or 

A 40 years old male presented with chronic diarrhoea with remarkable weight loss for last 3
months. How will you investigate the patients?

My Diagnosis of these case of chronic diarrhoea:
Clinical features of chronic diarrhoea is present such-

Colonic causes:

• Blood and mucus in stool
• Cramping lower abdominal pain

Malabsorption:

• Steatorrhoea.
• Undigested food in the stool
• Weight loss and nutritional disturbances

Small bowel causes:

• Large-volume, watery stool
• Abdomoinal bloating
• Cramping mid abdominal pain

Investigations of chronic diarrhoea:

Colonic causes:

• Colonoscopy with biopsies.
• Faecal calpotectin

Malabsorption:

• Ultrasound, CT and MRCP.
• Small bowel biopsy
• Barium follow-through.
• Faecal elastase

Small bowel causes:

• Barium follow-through
• Stool volume.
• Gut hormone profile.

What is normal stool frequency?
Normal stool frequency is 3 times a day to 3 times a week.
of Tinidazole 2 gm.