Chronic Diarrheal Diseases Mohammed al-matrafi. Diarrhea more than 2 weeks.
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Transcript of Chronic Diarrheal Diseases Mohammed al-matrafi. Diarrhea more than 2 weeks.
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Chronic Diarrheal Diseases
Mohammed al-matrafi
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Diarrhea more than 2 weeks
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CHRONIC DIARRHEA
Pathogenesis Digestion lactase , C.F., Bile Absorption celiac, glucose -galactose malabsorption Food intolerance Cows milk allergy Loss Lemphangectasia Na pump, cl diarrhea Unknown Toddlers diarrhea Intractable diarrhea of infancy Inflammation Ulcerative Colitis Immune def./Drugs HIV, Laxatives, Ab
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Malabsorption = Steatorrhea = Stool fat
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Chronic Non specific diarrhea (Toddlers diarrhea/Peas & carrots Syndrome)
Cause is unknown. Juice sugars ?. Between 6 months - 3years Diarrhea is the only symptom growth & activity not affected Dx history R+ juices ( if applicable) reassure parents Loperamide??
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Lactose intolerance.
Congenital or post infectious. Diarrhea , bloating, cramps , flatus & excoriation at diaper area. Dx Stool reducing substance Lactose free formula Intestinal biopsy & enzyme assessment R+ lactose free diet
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Glucose-Galactose Malabsorption
Inherited disease Diarrhea with feeding Stopping feeding stops diarrhea Dx History & intestinal biopsy R+ Glucose & Galactose free formula
(Galaktamine19)
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Celiac Disease
Glutine sensitive entropathy
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Celiac Disease
Glutine??
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Celiac DiseaseGlutine
WheatOat BarleyRye
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Celiac Disease
Glutine sensitive entropathy Vellus atrophy + Crypts Hyperplasia Chronic diarrhea (Steatorrhea)
Starts at introduction of cereals (< 2years) Typical appearance Dx intestinal biopsy + serology R+ Gluten free diet for life
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Normal
mucosa
Mucosa of a patient suffering from coeliac disease
normalCoeliac disease
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Milk Protein allergy
Immune mediated in about 1-7% 50% allergic to soy protein Over diagnosed Diarrhea (bloody), poor growth, urticaria&wheeze Dx - CBC esoinophils Hgb
-Protein serum stool - challenge test
R+ Replace cows milk
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Intractable diarrhea of infancy
Affects infants around 3-6 months.Secretary diarrhea (explosive& watery)May start with fever & vomiting Babe will be cachectic & marasmic with
abdominal distentionStopping feeding dose not stops diarrheaNo etiology defined mortality
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Cystic fibrosis
Autosomal recessive Lung diseaseHx of meconium plug or rectal prolepsesPancreatic enzyme def. SteatorrheaFecal fat (qualitative & quantitative)Dx sweat chloride R+ Antibiotic & enzymes replacement
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Protein losing interopathy
Intestinal loss of protein & diarrhea. Etiology - intestinal permeability e.g. post infection - lymphangectasia * Primary * Secondary -Allergic Dx -History -Stool Protein (Fecal alpha 1-antitrypsin) -Serum Protein (albumin & TP) Isotope scan R+ as per etiology
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Other Causes
Small bowel bacterial over growthBile salt deficiencyAbetalipoprotienemiaAcrodermatitis enteropathica
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Inflammatory Bowel Disease (IBD)
Crohn’s Disease
Ulcerative colitis
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Chronic Diarrhea
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Approach
Good detailed HistoryPhysical Examination -nutritional status
-specific signs
Proper Investigations -general
-specific