Chronic Diarrhoea (female) (Steatorrhoea: greasy, foul-smelling, bulky…
Chronic Diarrhoea (female)
Steatorrhoea: greasy, foul-smelling, bulky stools that float in water – due to fat malabsorption
Pancreas: chronic pancreatitis, duct obstruction
(e.g. stones, cystic fibrosis), insufficient functional
reserve (carcinoma, resection).
Gastrinoma: gut too alkaline for lipase to act.
Drug: lipase inhibitors e.g. Orlistat
Bile salt insufficiency
Liver insufficiency or cirrhosis
Bile duct: obstructive jaundice preventing bile salt
short gut syndrome after resection, inflammation (e.g. Crohn’s), celiac dx.
Inflammatory Diarrhea: painful,bloodystools± systemic symptoms e.g. fever – due to colitis.
Inflammatory bowel disease
Crohn’s, ulcerative colitis. There is typically a gradual onset of bloody diarrhoea, abdominal pain, weight loss, and fever. Symptoms are intermittant but with flares.
chronic infection with particular
Others: ischemic, radiation injury, etc. Elicit risk fx for atherosclerotic dx, and PMHx of abdominal radiation.
Watery or partially-formed stool
large volume, watery stools, usually painless and unrelated to food intake.
Chronic infection: especially consider in patients
with risk factors like travel, immunosuppression
(including HIV), antibiotic use, and contaminated
drinking water. Assess C. diff risk (e.g. recent
hospital stay, institutionalization); do C. diff toxin.
Drugs: as a side effect
Osmotically active agent: e.g. laxative ingestion,
lactose intolerance (lactase deficiency), ↑ bile acids
in colon due to cholecystectomy
Short gut syndrome: post-resection, or fistula
Mucosal disease e.g. celiac disease
Endocrine tumors: secretion of vasoactive
substances from carcinoid (diarrhoea, flushing) and
watery stools occuring on intake of non-absorbable, osmotically active solutes, ceasing when intake of the culprit is stopped.
Colorectal CA: presenting as a change in bowel
habits. Ask abt blood in stools, change in stool
calibre, weight loss etc – but their absence do not
rule out CA colon. See approach to constipation.
Neurologic: Autonomic neuropathy e.g. diabetes –
see approach to constipation
Fecal incontinence: neuromuscular disorders or
anorectal anatomical problems.
Overflow (spurious) diarrhoea: fecal impaction
with only fluid matter able to pass the impacted
feces. Often due to constipating drugs in the
elderly, but may also be secondary to a obstructing
tumor. Do per rectal for impacted feces.