DR Medhat MRCP

Diarrhea
• Def :
- Abnormal passage of ≥ 3 times/day loose or liquid stools &/or
- Daily stool weight in adult > 200 grams due to excess water loss in stool (normally
stool weight 100 gm).
• Classification of diarrhea :
Acute diarrhea :
Persistent diarrhea :
< 2 weeks duration , usually resolve spontaneously.
2-4 weeks duration.
Chronic diarrhea : > 4 weeks duration.
Acute diarrhea
• Causes :
1) Infective diarrhea : (> 90% of cases).
‣ Diarrhea whilst at home.
‣ Travellers' diarrhea.
2) Drug-induced diarrhea :
‣ Laxitives.
‣ Antibiotics (clostridium difficile →pseudomembranous colitis) :
[Cephalosporins, clindamycin , amoxicillin ,neomycin]
‣ Colchicine.
‣ Digoxin.
‣ NSAIDS, cimitidine ,ticlopidine,omeprazole ( → microscopic colitis)
‣ Immunosuppressives (MMF).
3) Acute surgical conditions :
‣ Acute appendicitis.
‣ Intussusception.
‣ Ischemic colitis.
سؤال : colitis Microscopic
Def : 2 medical conditions which cause diarrhea (collagenous colitis and
lymphocytic colitis)
Features :
1) Chronic large volume watery diarrhea
2) Normal colonoscopy in old age
3) Characteristic histopathology (inflamm. Lymphocytes).
TTT : 1 st choice : Budesonide
Alternative : oral prednisolone.
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