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