1. chronic diarrhea
SOEPLE – 3
AHMAD MHD AL-DHLAWIY

2. Contents…
SOEPEL
Definetion
Epideiology
Physiology
patohphysiology
Classification
Causes
Clinical features
Diagnosis
Treatment

3. SOEPEL
Subject:
A 3 years old child came with abdominal pain, and diarrhea since 3 weeks.
Analysis of pain:
1.
Site: diffuse
2.
Onset: gradually
3.
Character: --
4.
Associated factors: --
5.
Time/duration: 2 week.
6.
Exaggerated and relieving factors: --
7.
Severity: moderate

4. SOEPEL
Object: General examination & Abdominal examination
Evaluation (DD): Celiac disease, Crohn’s disease.
Plan: CBC, stool examination, and Antibody test.
Elaboration: Diet management.
Learning goals: chronic diarrhea.

5. Epidemiology …
- According to ( WHO ) there are more than 700 million episodes of
diarrhea annuallyin children 5 years of age in developing countries.
- more than two to four weeks occurs in up to 3 to 5 percent of the
population worldwide.
- more frequent in men.

6. Physiology …

7. Physiology

8. Pathophysiology …
Osmotic diarrhea.
Secretory diarrhea.
Mutations in apical membrane transport proteins.
Reduction in anatomic surface area.
And alteration in intestinal motility.

10. Osmotic diarrhea
It’s caused by the presence of nonabsorbable solutes in the
gastrointestinal tract.
e.g. lactose intolerance

11. Secretory diarrhea …
Activation of intracellular mediators (cAMP, cGMP and intracellular
calcium)
This stimulates active chloride secretions from the crypt and prevent
the neutral coupled sodium chloride absorption.
Thus the intraluminal electrolyte content will be high and this leads to
diarrhea.
e.g. cholrea, E.coli.

12. Mutations in apical membrane
transport proteins …
Congenital defects in:
1.
Sodium-hydrogen exchange.
2.
Chloride-bicarbonate exchange.
3.
And sodium-bile acid transport protein

13. CON’T …
Reduction in anatomic surface area:
This is called short bowel syndrome and can occur after surgical
indications.
And alteration in intestinal motility:
This can result duo to malnutrition, scleroderma, and diabetes mellitus.

14. Causes …
1- Noninfectious Causes of Chronic Diarrhea :
A. Antibiotic Therapy
B. Extraintestinal Infections
C. Malnutrition
D. Diet and Medications
E. Allergic Diarrhea
F. Chronic Nonspecific Diarrhea
G. Secretory Diarrhea
H.Inflammatory bowel disease

15. CON’T …
2- Infectious Causes of Chronic Diarrhea:
e.g. salmonella, Giardia lamblia
common in immune deficiency
states, especially IgA deficiency and T-cell abnormalities.

16. Clinical features …
Cramping
Abdominal pain
Nausea
Fever
Bloody stools
Dehydration
Incontinence

17. Investigation …
History
Physical examination
General examination:

18. CON’T …

19. CON’T …

20. Treatment …

21. References …
- Nelson textbook of pediatrics.
- CURRENT diagnosis and treatment pediatrics.
- Some figures from websites.