Chronic diarrhea natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, patients with chronic diarrhea may progress to develop symptoms of altered sensorium due to electrolyte imbalance, dehydration, and malnutrition. Common complications of chronic diarrhea include confusion, perforated bowels, sepsis and death. Prognosis is generally good when the underlying cause is identified and treated early. | If left untreated, patients with chronic diarrhea may progress to develop symptoms of [[Altered mental status|altered sensorium]] due to [[electrolyte imbalance]], [[dehydration]], and [[malnutrition]]. Common [[complications]] of chronic diarrhea include [[confusion]], perforated bowels, [[sepsis]] and death. Prognosis is generally good when the underlying cause is identified and treated early. | ||
==Natural History== | ==Natural History== | ||
The symptoms of chronic diarrhea usually develop within 4 weeks and start with symptoms such as abdominal pain, voluminous [[watery diarrhea]] due to disorders of the colon, fatty or [[Bloody diarrhea|bloody]] loose bowel movement, alteration of diarrhea and constipation as seen in irritable bowel disease. The symptoms of chronic diarrhea are usually as a result of medications, genetic disorders, and rarely due to viral, bacterial or parasitic infections. It is important to ask for risk factors such as recent travel history, occurence of diarrhea during fasting or at night, weight loss, family history of [[Inflammatory bowel disease|IBD]], use of medications (including over-the-counter drugs and supplements), presence of systemic symptoms, which may indicate [[IBD]] (such as [[fevers]], joint pains, [[mouth ulcers]], | The [[symptoms]] of chronic diarrhea usually develop within 4 weeks and start with [[symptoms]] such as [[abdominal pain]], voluminous [[watery diarrhea]] due to disorders of the [[Colon (anatomy)|colon]], fatty or [[Bloody diarrhea|bloody]] loose bowel movement, alteration of [[diarrhea]] and [[constipation]] as seen in [[irritable bowel disease]]. The symptoms of chronic diarrhea are usually as a result of [[medications]], [[genetic disorders]], and rarely due to [[viral]], [[bacterial]] or [[parasitic]] [[infections]]. It is important to ask for [[risk factors]] such as recent [[Travel diarrhea|travel]] history, occurence of [[diarrhea]] during fasting or at night, [[weight loss]], [[family history]] of [[Inflammatory bowel disease|IBD]], use of [[medications]] (including [[over-the-counter drugs]] and [[supplements]]), presence of [[Systemic Constellations|systemic symptoms]], which may indicate [[IBD]] (such as [[fevers]], [[joint pains]], [[mouth ulcers]], [[conjunctivitis]]) and promiscuous sexual activity is a risk factor associated with [[HIV]] infection. Without treatment, the patient will develop symptoms of [[dehydration]], [[malnutrition]], [[altered mental status]], [[sepsis]] and eventually [[coma]] or death. | ||
==Complications== | ==Complications== | ||
Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to dehydration and malnutrition. It is important to keep patients hydrated by taking fluids. patients who are unable to tolerate fluids orally should be given | Depending on the underlying cause, [[Chronic (medical)|chronic]] or [[Diarrhea|severe diarrhea]] can lead to potentially serious complications some of which include but are not limited to [[dehydration]] and [[malnutrition]]. It is important to keep patients hydrated by taking fluids. patients who are unable to tolerate fluids orally should be given IV [[Oral rehydration salt|oral rehydration solution]] to replace the [[Intravenous fluids|fluids]] and [[Electrolyte|electrolytes]] ([[salts]]) lost in [[diarrhea]]. | ||
==Prognosis== | ==Prognosis== | ||
The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated. There are certain features which if present in a patient complaining of diarrhea for over 4 weeks may indicate poor prognosis; | The [[prognosis]] of chronic diarrhea is good especially when the underlying cause is identified early and treated. There are certain features which if present in a patient complaining of diarrhea for over 4 weeks may indicate poor prognosis; | ||
*[[Rectal bleeding]]<ref name="pmid16973955">{{cite journal| author=Halfdanarson TR, Litzow MR, Murray JA| title=Hematologic manifestations of celiac disease. | journal=Blood | year= 2007 | volume= 109 | issue= 2 | pages= 412-21 | pmid=16973955 | doi=10.1182/blood-2006-07-031104 | pmc=1785098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16973955 }} </ref> | *[[Rectal bleeding]]<ref name="pmid16973955">{{cite journal| author=Halfdanarson TR, Litzow MR, Murray JA| title=Hematologic manifestations of celiac disease. | journal=Blood | year= 2007 | volume= 109 | issue= 2 | pages= 412-21 | pmid=16973955 | doi=10.1182/blood-2006-07-031104 | pmc=1785098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16973955 }} </ref> | ||
*[[Weight loss]] | *[[Weight loss]] | ||
Revision as of 15:44, 24 July 2017
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Chronic diarrhea Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
If left untreated, patients with chronic diarrhea may progress to develop symptoms of altered sensorium due to electrolyte imbalance, dehydration, and malnutrition. Common complications of chronic diarrhea include confusion, perforated bowels, sepsis and death. Prognosis is generally good when the underlying cause is identified and treated early.
Natural History
The symptoms of chronic diarrhea usually develop within 4 weeks and start with symptoms such as abdominal pain, voluminous watery diarrhea due to disorders of the colon, fatty or bloody loose bowel movement, alteration of diarrhea and constipation as seen in irritable bowel disease. The symptoms of chronic diarrhea are usually as a result of medications, genetic disorders, and rarely due to viral, bacterial or parasitic infections. It is important to ask for risk factors such as recent travel history, occurence of diarrhea during fasting or at night, weight loss, family history of IBD, use of medications (including over-the-counter drugs and supplements), presence of systemic symptoms, which may indicate IBD (such as fevers, joint pains, mouth ulcers, conjunctivitis) and promiscuous sexual activity is a risk factor associated with HIV infection. Without treatment, the patient will develop symptoms of dehydration, malnutrition, altered mental status, sepsis and eventually coma or death.
Complications
Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to dehydration and malnutrition. It is important to keep patients hydrated by taking fluids. patients who are unable to tolerate fluids orally should be given IV oral rehydration solution to replace the fluids and electrolytes (salts) lost in diarrhea.
Prognosis
The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated. There are certain features which if present in a patient complaining of diarrhea for over 4 weeks may indicate poor prognosis;
- Rectal bleeding[1]
- Weight loss
- Age > 50 years[2]
- Pain[3]
- Associated psychological factors
- Somatization[4]
- Dietary causes of diarrhea[5]
References
- ↑ Halfdanarson TR, Litzow MR, Murray JA (2007). "Hematologic manifestations of celiac disease". Blood. 109 (2): 412–21. doi:10.1182/blood-2006-07-031104. PMC 1785098. PMID 16973955.
- ↑ Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004). "Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998". Gut. 53 (3): 346–50. PMC 1773978. PMID 14960513.
- ↑ Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA; et al. (2005). "Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome". Am J Gastroenterol. 100 (4): 896–904. doi:10.1111/j.1572-0241.2005.41211.x. PMID 15784038.
- ↑ . doi:10.1016/j.cgh.2006.11.024 showArticle Info Check
|doi=value (help). Missing or empty|title=(help) - ↑ Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS (1990). "Carbohydrate malabsorption. Its measurement and its contribution to diarrhea". J Clin Invest. 86 (6): 1936–44. doi:10.1172/JCI114927. PMC 329829. PMID 2254453.