CAUSES :
- ULCERATIVE COLITIS
- CROHNS DISEASE
- CHR DYSENTERY , DUE TO BACTERIAL, VIRAL OR PROTOZOAL INFECTIONS
- COELIAC DISEASE
- FAT MALABSORPTION OR STEATORRHEA
- EOSINOPHILIC GASTROENTERITIS
- DERMATITIS HERPETIFORMIS
- TROPICAL MALABSORPTION
- WHIPPLES DISEASE
- RADIATION DAMAGE TO SMALL INTESTINE
- LYMPHOMA
- TUBERCULOSIS
- DRUG INDUCED DAMAGE TO SMALL INTESTINE LIKE NEOMYCIN, PAS, ANTIBIOTICS, LAXATIVES, ALCOHOL , MAGNESIUM CONTAING ANTACIDS, ARSENIC, COLCHICINE, MEFANAMIC ACID
- VASCULAR ABNORMALITY OF SMALL INTESTINE, VASCULAR INSUFFICIENCY
- GANGRENE
- ABNORMALITIES OF INTESTINAL LYMPHATICS, LYMPHANGIECTASIA
- INTESTINAL RESECTION
- ENDOCRINE ABNORMALITIES LIKE HYPERTHYROIDISM, HYPOTHYROIDISM, DIABETES MALLITUS
- IMMUNODEFICIENCY SYNDROME
- BACTERIAL OVER-GROWTH
- PROGRESSIVE SYSTEMIC SCLEROSIS
- SHORT BOWEL SYNDROME
- ENTERO-COLIC FISTULA
- STRICTURES OR PRESENCE OF JEJUNAL DIVERTICULOSIS
- DISACCHARIDASE DEFICIENCY LIKE LACTASE DEFICIENCY
- GASTRIC CAUSES LIKE GASTRIC RESECTION, GASTROENTEROSTOMY & TOTAL VAGOTOMY
- PANCREATIC CAUSES LIKE CHR PANCREATITIS, CARCINOMA, CYSTIC FIBROSIS OF PANCREAS, RESECTION, HYPOPLASIA ( SCHWACHMANS SYNDROME ), CONGENITAL ENZYME DEFECTS
- TUMORS OF SMALL OR LARGE BOWELS LIKE CARCINOMA COLON OR LYMPHOMAS
- CHR LIVER DISEASE
- CHOLERRHEIC DIARRHOEA - DUE TO INCREASED EXCRETION OF BILE ACIDS AS IN CROHNS DISEASE & IN TUMORS
- IDEOPATHIC SECRETARY DIARRHEA
- DIVERTICULAR DISEASE OF COLON
- IRRITABLE BOWEL SYNDROME
- TUMORS ASSOCIATED WITH ABNORMAL PRODUCTION OF HORMONES LIKE CARCINOID SYNDROME, VIPOMAS, GASTRIN PRODUCING TUMORS ( ZOLLINGER ELLISON SYNDROME) , GASTRINOMA, MEDULLARY CARCINOMA OF THYROID, SYSTEMIC MASTOCYTOSIS, COLORECTAL VILLOUS ADENOMAS
- CHR GRAFT VERSUS HOST REACTION
- BEHCETS SYNDROME
- CRONKITE- CANADA SYNDROME
- CONGENITAL DEFECTS IN ION ABSORPTION LIKE IN CONGENITAL CHLORIDORRHEA
- FACTITIAL CAUSES LIKE DECEPTION OR SELF INJURY OR BULIMIA
* JEJUNAL BIOPSY
* DISACCHARIDASE ASSAY
* SMALL BOWEL ENEMA
* STUDIES OF BACTERIAL STATUS OF SMALL BOWEL WITH COLLECTION & CULTURE OF ASPIRATE
* H2 BREATH TEST
* PANCREATIC FUNCTION TEST
β’ Stool ova and parasites
β’ Stool leukocytes
β’ Stool fat, osmolality, and occult blood
β’ Stool for C. difficile toxin
β’ Serum electrolytes and CBC
β’ Serum iron studies, vitamin B12, folate, vitamin D, PT, blood chemistry for albumin and cholesterol, serum carotene
β’ D-Xylose absorption test
β’ Inflammatory diarrhea: blood or leukocytes in stool, hypoproteinemia (hypoalbuminemia and hypoglobulinemia)
β’ Factitious: hypokalemia
SPECIAL TESTS :
β’ Inflammatory: colonic biopsies
β’ Biopsies with esophagogastroduodenoscopy (EGD) or colonoscopy when performed
β’ Fecal fat stool collections: 48-72 hours
β’ Breath test for labeled CO2 to assess fat, carbohydrate, and bile salt malabsorption
β’ Blood and urine hormone levels in endocrine diseases
β’ Malabsorption - small bowel biopsies
β’ Capsule endoscopy - small bowel visualization
IMAGING : Barium enema, KUB
DIAGNOSTIC PROCEDURES :
β’ Thorough history and physical exam helpful
β’ Colonoscopy for infl ammatory lesions and associated occult blood in stool or with iron deficiency
β’ If barium enema is negative and diarrhea persists, biopsies are required (to rule out microscopic colitis in which the mucosa may appear normal). UGI evaluation with small bowel biopsies for malabsorption evaluation
β’ Melanosis coli suggests cathartic abuse Diarrhea, chronic