Chronic diarrhea

Diarrhea is a clinical syndrome of

diverse etiology associated with
many influencing factors

According to (WHO) Diarrhea is

characterized by:
3 or more loose or liquid stools per day due
to Abnormally high fluid content of stool.
 Mechanisms of diarrhea
Osmotic

Secretory

Mucosal inflammation (invasion)

Motality
 Mechanisms of Diarrhea
Secretory
Defect
Increased secretion
Decreased absorption
Example
Cholera
Toxinogenic E.coli
Comment
Persists during fasting
No stool leukocytes
 Mechanisms of Diarrhea
Invasion
Defect
Inflammation
Decreased colonic reabsorption
Increased motility

Example
Bacterial enteritis

Comment
Blood, mucus and WBCs in stool
 Mechanisms of Diarrhea
Increased motility

Defect
Decreased transit time

Example:
Irritable bowel syndrome
 Clinical manifestation
Gastrointestinal symptom
Systemic symptom
Dehydration and electrolyte
disturbances
Dehydration

Hypokalemia

Metabolic Acidosis

Hypocalcemia /Hypomagnesemia
 Dehydration

Excessive loss of water,

especially loss of extracellular fluid
 Investigation
Take history
Full blood count
Spot fecal analysis
Quatitative analysis
Urinalysis
Imaging
 Treatment
Primarily supportive
Fluid therapy
Rehydration
Correcting acidosis
Potassium supplement
Correcting ongoing loss
Managing secondary complication resulting
from mucosa injury
Antibiotic treatment
for only some bacterial and parasitic causes of
diarrhea
Start food as soon as possilble
 Antibiotic Therapy
Organisms Antibiotic
Campylobacter erythromycin
Jejuni azithromycin
E. Coli EPEC: Indicated for infants younger than 3
months old with
ETEC: Usually none if endemic
TMP-SMZ or ciprofloxacin for traveler's
diarrhea
EIEC: Third-generation cephalosporin
TMP-SMZ
Ampicillin
EHEC: not recommend
EAEC: TMP-SMZ
 Antibiotic Therapy

Organisms Antibiotic
Shigella Third-generation cephalosporin
species Ampicillin, TMP-SMZ,
Salmonella Usually none (if 3 months old) for non
typhoid;
ampicillin, cefotaxime for S. typhi or
S.paratyphy
Yersinia None for uncomplicated diarrhea; TMP-SMZ;
enterocolitica gentamicin or cefotaxime for extraintestinal
disease
C. difficile metronidazole,
vancomycin
 Antibiotic Therapy

Organisms Antibiotic
E. histocolytica metronidazole followed by a luminal agent,
such as iodoquinol

G. lamblia Albendazole
Metronidazole
Furazolidone
Quinacrine
Cryptospodium Non specific treatment
Complication of diarrhea

Hypovolemic shock
Tetany & Convulsions
Hypoglycemia
Renal failure