Chronic Diarrhea - Workup

Osmotic:

 • Consider food diary and trial avoiding certain foods or meds, Consider diagnostic fast, Stool osmotic gap > 125mOsm/kg, Lactose hydrogen breath test if lactose intolerance suspected, Colonoscopy unnecessary, but if performed, may show melanosis coli in laxative abuse

Secretory:

 • Consider diagnostic fast, Stool osmotic gap < 50mOsm/kg, Consider CT A/P, Consider testing of specific hormones

Malabsorptive:

 • Assessment of stool fat (Sudan stain of stool, 72 hr stool collection on gm fat/day diet), Endoscopy (EGD +/- ERCP +/- colonoscopy), Abdominal imaging (CT, ultrasound, or MRCP), Consider serologic testing for celiac and/or testing for fecal elastase-1

Hypermotility:

 • TSH, Consider testing for celiac disease

Inflammatory:

 • Colonoscopy, Fecal calprotectin, Stool testing for C.diff (particularly if recent hospitalization or antibiotics)



- Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/



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