Functional diarrhoea

Gastroenterology

Clinicals - History

Fact Explanation
Loose, mushy or watery stools The symptom of loose, mushy or watery stools was the most frequent symptom of functional diarrhea. In fact, most people apply the term diarrhea to loose or watery stools. It was indicated that stool form, not frequency, defined diarrhea, and how often a symptom must occur to be significant depends on its troublesomeness.. Loose, mushy or watery stools
The symptom of loose, mushy or watery stools was the most frequent symptom of functional diarrhea. In fact, most people apply the term diarrhea to loose or watery stools. It was indicated that stool form, not frequency, defined diarrhea, and how often a symptom must occur to be significant depends on its troublesomeness..
Frequent bowel movements without abdominal pain More than three bowel movements a day can be identified.Functional diarrhea was defined in accordance with the Rome II criteria as loose, mushy, or watery stools, present more than three quarters of the time and no abdominal pain in the last 3 months.. Frequent bowel movements without abdominal pain
More than three bowel movements a day can be identified.Functional diarrhea was defined in accordance with the Rome II criteria as loose, mushy, or watery stools, present more than three quarters of the time and no abdominal pain in the last 3 months..
Having to rush to the toilet Having to rush to the toilet to have a bowel movement is one of the most common symptom of functional diarrhea.. Having to rush to the toilet
Having to rush to the toilet to have a bowel movement is one of the most common symptom of functional diarrhea..
Feeling of Incomplete emptying Feeling of incomplete emptying after a bowel movement is another reported symptom.. Feeling of Incomplete emptying
Feeling of incomplete emptying after a bowel movement is another reported symptom..
Abdominal fullness Another presenting symptom of functional diarrhea.. Abdominal fullness
Another presenting symptom of functional diarrhea..
Bloating or swelling Functional diarrhea may also present with bloating and swelling. But not a frequent complaint.. Bloating or swelling
Functional diarrhea may also present with bloating and swelling. But not a frequent complaint..
Food intolerance Food intolerance, especially to wheat, corn, and dairy products, seems to be a common cause of functional diarrhea in some patients.. Food intolerance
Food intolerance, especially to wheat, corn, and dairy products, seems to be a common cause of functional diarrhea in some patients..
History of male sex and high BMI Some studies showed that the prevalence of functional diarrhea was slightly higher in men than in women.It might be that men had a faster colonic transit time than women, and women had delayed gastric emptying of liquids and solids compared to that in men. Studies also found that BMI was positively associated with functional diarrhea.This may be that BMI is correlated inversely with colonic transit time and overweight/obese patients have more severe symptoms of urgency, loose stools and more stools per day.. History of male sex and high BMI
Some studies showed that the prevalence of functional diarrhea was slightly higher in men than in women.It might be that men had a faster colonic transit time than women, and women had delayed gastric emptying of liquids and solids compared to that in men. Studies also found that BMI was positively associated with functional diarrhea.This may be that BMI is correlated inversely with colonic transit time and overweight/obese patients have more severe symptoms of urgency, loose stools and more stools per day..
Family history of gastrointestinal diseases Some studies found that functional diarrhea was significantly associated with a family history of gastrointestinal diseases. Common demographic risk factors and a genetic predisposition may play a role in this relationship.. Family history of gastrointestinal diseases
Some studies found that functional diarrhea was significantly associated with a family history of gastrointestinal diseases. Common demographic risk factors and a genetic predisposition may play a role in this relationship..

Clinicals - Examination

Fact Explanation
Mucus containing stool Passing mucus (slime) during a bowel movement also observed in patients with functional diarrhea.. Mucus containing stool
Passing mucus (slime) during a bowel movement also observed in patients with functional diarrhea..
Features of dehydration Have to look for the features of dehydration. If there is no dehydration, but diarrhea,It is corresponds to <5% loss of total body weight. In moderate dehydration patient feels thirsty, dry mouth/tongue, no tears, sunken eyes, skin pinch slow to retract and it is corresponds to 5%–10% loss of total body weight. In severe dehydration,patient is unconscious, lethargic or floppy, weak pulse, unable to drink and corresponds to >10% loss of total body weight. Those patients who are hemodinamically unstable, may need immediate fluid resuscitation.. Features of dehydration
Have to look for the features of dehydration. If there is no dehydration, but diarrhea,It is corresponds to <5% loss of total body weight. In moderate dehydration patient feels thirsty, dry mouth/tongue, no tears, sunken eyes, skin pinch slow to retract and it is corresponds to 5%–10% loss of total body weight. In severe dehydration,patient is unconscious, lethargic or floppy, weak pulse, unable to drink and corresponds to >10% loss of total body weight. Those patients who are hemodinamically unstable, may need immediate fluid resuscitation..
Abdominal examination findings Even functional diarrhea itself not produced any specific abdominal finding, abdominal examination is performed to exclude other associated pathologies such as colorectal cancers that sometimes give rise to palpable masses.. Abdominal examination findings
Even functional diarrhea itself not produced any specific abdominal finding, abdominal examination is performed to exclude other associated pathologies such as colorectal cancers that sometimes give rise to palpable masses..
Pallor Right sided colorectal tumors were associated with anemia. So that examination of pallor should be performed to detect clinical presence of anemia.. Pallor
Right sided colorectal tumors were associated with anemia. So that examination of pallor should be performed to detect clinical presence of anemia..
DRE findings Digital rectal examtion can perform, not in all cases but in suspected cases of malignancy such as colorectal cancer in elderly patients. It has the ability to identify low rectal cancers but not high rectal cancers.. DRE findings
Digital rectal examtion can perform, not in all cases but in suspected cases of malignancy such as colorectal cancer in elderly patients. It has the ability to identify low rectal cancers but not high rectal cancers..
Gynecological examination for women In women, gynecological causes (endometriosis, adnexitis, ovarian cysts, ovarian carcinoma) should be ruled out through an examination by a gynecologist.. Gynecological examination for women
In women, gynecological causes (endometriosis, adnexitis, ovarian cysts, ovarian carcinoma) should be ruled out through an examination by a gynecologist..

Investigations - Diagnosis

Fact Explanation
Complete blood count FBC is suggested to look for anemia and signs of inflammation. They were taken as red flag signs.The absence of red flags, a normal physical examination, and the presence of yellow flags support the diagnosis of a functional bowel disorder.. Complete blood count
FBC is suggested to look for anemia and signs of inflammation. They were taken as red flag signs.The absence of red flags, a normal physical examination, and the presence of yellow flags support the diagnosis of a functional bowel disorder..
Erythrocyte sedimentation rate (ESR) Carried out to rule out other inflammatory causes.. Erythrocyte sedimentation rate (ESR)
Carried out to rule out other inflammatory causes..
C-reactive protein (CRP) Also carried out to rule out other inflammatory causes.. C-reactive protein (CRP)
Also carried out to rule out other inflammatory causes..
Urinalysis Also perform as a basic investigation to exclude other pathological conditions.. Urinalysis
Also perform as a basic investigation to exclude other pathological conditions..
Abdominal ultrasonography Ultrasonography is part of the basic diagnostic assessment of abdominal symptoms. Carried out in functional diarrhea to exclude other abdominal pathology.. Endoluminal ultrasound can used to identify intraluminal tumour masses in rectum.. Transabdominal ultrasound also can detect bowel wall thickening, enlarged lymph nodes, abdominal tuberculosis, , pneumatosis and complications such as amoebic liver abscesses.. Abdominal ultrasonography
Ultrasonography is part of the basic diagnostic assessment of abdominal symptoms. Carried out in functional diarrhea to exclude other abdominal pathology.. Endoluminal ultrasound can used to identify intraluminal tumour masses in rectum.. Transabdominal ultrasound also can detect bowel wall thickening, enlarged lymph nodes, abdominal tuberculosis, , pneumatosis and complications such as amoebic liver abscesses..
Sigmoidoscopy with biopsy/ Ileocolonoscopy Chronic diarrhea without pain is caused by many diseases. So that to rule out other serious pathology sigmoidoscopy with biopsy is performed..No investigations except sigmoidoscopy and rectal biopsy are needed when the patient is under
40, has had diarrhea off and on for many years, when his symptoms are closely related to stress and anxiety, and when his weight is steady and his stool is free of occult blood. . Ileocolonoscopy can be carried out in individual basis, for patients over age 50, for patients over age 45 with a family history of colon cancer, and for patients of any age with elevated levels of calprotectin A / lactoferrin in the stool)..
Sigmoidoscopy with biopsy/ Ileocolonoscopy
Chronic diarrhea without pain is caused by many diseases. So that to rule out other serious pathology sigmoidoscopy with biopsy is performed..No investigations except sigmoidoscopy and rectal biopsy are needed when the patient is under
40, has had diarrhea off and on for many years, when his symptoms are closely related to stress and anxiety, and when his weight is steady and his stool is free of occult blood. . Ileocolonoscopy can be carried out in individual basis, for patients over age 50, for patients over age 45 with a family history of colon cancer, and for patients of any age with elevated levels of calprotectin A / lactoferrin in the stool)..
Stool tests Basic evaluation of functional diarrhea includes routine blood and stool tests plus sigmoidoscopy with biopsy.. Calprotectin A / lactoferrin in the stool can be performed for further evaluation on individual basis.. Stool tests
Basic evaluation of functional diarrhea includes routine blood and stool tests plus sigmoidoscopy with biopsy.. Calprotectin A / lactoferrin in the stool can be performed for further evaluation on individual basis..
Selenium-75-homotaurocholic acid test (SEHCAT) A special diagnostic test, that performed depending on the main symptoms.. SEHCAT, a radiolabelled bile acid analogue which emits gamma rays and so can be counted easily with little or no handling of stools.SEHCAT can be use to confirm bile acid malabsorption in patients with chronic diarrhoea.. Selenium-75-homotaurocholic acid test (SEHCAT)
A special diagnostic test, that performed depending on the main symptoms.. SEHCAT, a radiolabelled bile acid analogue which emits gamma rays and so can be counted easily with little or no handling of stools.SEHCAT can be use to confirm bile acid malabsorption in patients with chronic diarrhoea..

Investigations - Management

Fact Explanation
Blood urea and serum creatinine Acute renal failure a common manifestation secondary to diarrheal diseases due to dehydration.. So to detect those conditions these test are performed.. Blood urea and serum creatinine
Acute renal failure a common manifestation secondary to diarrheal diseases due to dehydration.. So to detect those conditions these test are performed..
Serum electrolytes Use for Further diagnostic evaluation.It is important to inform the patient that these tests are very unlikely to reveal a serious illness, and that they are simply being performed to rule such illnesses out..Usually Patients with functional diarrhoea do not get dehydrated or hypokalaemic.. Serum electrolytes
Use for Further diagnostic evaluation.It is important to inform the patient that these tests are very unlikely to reveal a serious illness, and that they are simply being performed to rule such illnesses out..Usually Patients with functional diarrhoea do not get dehydrated or hypokalaemic..
Psychosocial screening Functional diarrhea itself can cause psychological disturbances. And on the other hand psycosocial factors as well as somatic factors also contribute for this.Impairment can be assess by asking few questions. The affect to the day today life can assess by asking “How do the symptoms affect your everyday life/your performance?” and emotional state can be assess by asking“Have you often felt depressed in the past month? Have you often felt anxious or nervous in the past month?” like questions. Symptoms get worse when disease get progressed.. Psychosocial screening
Functional diarrhea itself can cause psychological disturbances. And on the other hand psycosocial factors as well as somatic factors also contribute for this.Impairment can be assess by asking few questions. The affect to the day today life can assess by asking “How do the symptoms affect your everyday life/your performance?” and emotional state can be assess by asking“Have you often felt depressed in the past month? Have you often felt anxious or nervous in the past month?” like questions. Symptoms get worse when disease get progressed..

Management - Supportive

Fact Explanation
Symptom explanation, and reassurance Discussion should be include disease symptoms and signs, contributory factors including psychological factors and reassurance of the patient.. They should be assure that they have normal life expectancy. Explain them about stress or vicious-circle model of the disease. Then asked them to do regular physical exercise, engage in their hobbies and social contact to overcome the stress.Educate them that those measures will cause improvement of the disease but not fully curative.. Symptom explanation, and reassurance
Discussion should be include disease symptoms and signs, contributory factors including psychological factors and reassurance of the patient.. They should be assure that they have normal life expectancy. Explain them about stress or vicious-circle model of the disease. Then asked them to do regular physical exercise, engage in their hobbies and social contact to overcome the stress.Educate them that those measures will cause improvement of the disease but not fully curative..
Dietary measures Restriction of foods seems to be help..If the clinical history suggest that the symptoms related to a certain food, these measures can be taken. The patient should asked to keep a diary of food intake and symptoms for a limited period of time. Those measures can be continue only if they clearly improved the patient’s symptoms.. Dietary measures
Restriction of foods seems to be help..If the clinical history suggest that the symptoms related to a certain food, these measures can be taken. The patient should asked to keep a diary of food intake and symptoms for a limited period of time. Those measures can be continue only if they clearly improved the patient’s symptoms..

Management - Specific

Fact Explanation
Loperamide and diphenoxylate Diphenoxylate or loperimide like empiric antidiarrheal therapy found to be effective. Specially if taken those drugs prophylactically, before meals .. Loperamide and a diphenoxylate-atropine combination act by increasing intestinal transit time and enhancing the potential for reabsorption of fluid and electrolytes. They have some effect on reducing faecal losses and loperamide also found to have some antisecretory activity .. Loperamide can be used over long term because it is not systemically bioavailable. Treatment causes improvement of quality of life and improvement of symptoms but not elimination.. Loperamide found to be efficacious even in low doses such as 0.1–0.25 mg/kg/day. So that the lowest efficacious dose should be used reduce the risk of overdose.. Loperamide and diphenoxylate
Diphenoxylate or loperimide like empiric antidiarrheal therapy found to be effective. Specially if taken those drugs prophylactically, before meals .. Loperamide and a diphenoxylate-atropine combination act by increasing intestinal transit time and enhancing the potential for reabsorption of fluid and electrolytes. They have some effect on reducing faecal losses and loperamide also found to have some antisecretory activity .. Loperamide can be used over long term because it is not systemically bioavailable. Treatment causes improvement of quality of life and improvement of symptoms but not elimination.. Loperamide found to be efficacious even in low doses such as 0.1–0.25 mg/kg/day. So that the lowest efficacious dose should be used reduce the risk of overdose..
Cholestyramine The occasional patient responds to cholestyramine..Colestyramine is an anion exchange resin. It forms complexes with organic anions such as bile acids with high affinity.It is mainly helpful to control bile acid diarrhea. This drug is generally well tolerated but has an unpleasant taste. Constipation is the main side effect of the drug. Other Side effects include nausea, , flatulence, bloating, borborygmi and abdominal pain.. Cholestyramine
The occasional patient responds to cholestyramine..Colestyramine is an anion exchange resin. It forms complexes with organic anions such as bile acids with high affinity.It is mainly helpful to control bile acid diarrhea. This drug is generally well tolerated but has an unpleasant taste. Constipation is the main side effect of the drug. Other Side effects include nausea, , flatulence, bloating, borborygmi and abdominal pain..

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