Gastroenterology Book

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Chronic Watery DiarrheaAka: Secretory Diarrhea, Osmotic Diarrhea

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  1. See Also
    1. Diarrhea
    2. Chronic Fatty Diarrhea (Diarrhea due to Malabsorption)
    3. Chronic Inflammatory Diarrhea
    4. Infectious Diarrhea
    5. Drug-Induced Diarrhea
    6. Diarrhea in Cancer
    7. Diarrhea in Children
    8. Diarrhea in Pregnancy
    9. Diarrhea in HIV
  2. Causes: Osmotic Diarrhea
    1. Malabsorption
      1. Lactose malabsorption (Lactose Intolerance)
      2. Glucose malabsorption
      3. Galactose malabsorption
      4. Gluten-sensitive enteropathy (Celiac Sprue)
    2. Magnesium
      1. Magnesium Sulfate (Epsom salts)
      2. Magnesium antacids
    3. Excessive High sugar juice intake
      1. Apple juice
      2. Pear juice
    4. Mannitol ingestion
    5. Sorbitol ingestion (chewing gum Diarrhea)
    6. Lactulose therapy
    7. Sodium Sulfate (Glauber's Salt)
    8. Sodium phosphate
    9. Sodium citrate
  3. Causes: Secretory Diarrhea
    1. Drug-Induced Diarrhea
    2. Secretory villous adenoma of rectum
    3. Small bowel total villous atrophy
    4. Intestinal Lymphoma
    5. Chronic infections (granulomatous)
    6. Pseudopancreatic Cholera Syndrome
    7. Ileocolic resection
    8. Inflammatory Bowel Disease
      1. Usually inflammatory Diarrhea
      2. Crohn's Disease
      3. Ulcerative Colitis
      4. Microscopic colitis (e.g. Lymphocytic Colitis)
      5. Diverticulitis
    9. Endocrine Causes
      1. Hyperthyroidism
      2. Medullary Thyroid Carcinoma
      3. Islet Cell Tumor
        1. Gastrinoma (Zollinger-Ellison Syndrome)
        2. Vipoma (Watery Diarrhea, Hypokalemia, achlorhydria)
      4. Malignant Carcinoid syndrome
      5. Mastocytosis
      6. Pheochromocytoma
    10. Collagen Vascular Disease
      1. Systemic Lupus Erythematosus
      2. Scleroderma
      3. Mixed connective tissue disease
  4. Labs
    1. Fecal electrolytes (fecal sodium, fecal potassium)
      1. Electrolytes increased in Secretory Diarrhea
        1. Electrolytes negligible in Osmotic Diarrhea
      2. Small osmotic gap <50 mOsm/kg in Secretory Diarrhea
    2. Stool pH
      1. pH <6 in carbohydrate malabsorption
  5. References
    1. Schiller in Feldman (2002) Sleisenger GI, p. 136

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