Essay on Chronic Diarrhoea in South Africa

Essay on Chronic Diarrhoea in South Africa

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DEFINITION
The definition of chronic diarrhoea varies in the different references. The generally accepted definition is the frequent passage of stools (> 3 times per day) that are loose in consistency for a minimum duration of 4 weeks or more. The minimum duration of 4 weeks is set in order to exclude common infective causes of diarrhoea. The commonly accepted reference value for diarrhoea for the amount of stools passed per day is more than 200 g. it is important to note that it is just a rough guide as pathology in the distal colon may not increase the stool weight above 200 g / day. [clinical approach and management of CD] [evaluation of chronic diarrhoea] [guideline for the investigation of chronic diarrhoea, 2nd ed]
It is important to determine whether or not the patient has faecal incontinence. If faecal incontinence is present, refer the patient to the surgery department.
[clinical approach and management of CD]
INCIDENCE
There are no figures available for the incidence of chronic diarrhoea in the South African population. International figures suggest that the incidence is between 3 and 5 percent. [evaluation of chronic diarrhoea]
CLASSIFICATION [what is the ebst approach for chronic diarrhoea] [evaluation of chronic diarrhoea] [guideline for the investigation of chronic diarrhoea, 2nd ed]
PATHOLOGICAL FUNCTIONAL
Urgency and cramping Urgency and cramping
Nocturnal bowel movements – pathognomonic of pathological No awakening at night due to bowel movements
Continuous diarrhoea Intermittent diarrhoea
Significant weight loss Normal physical examination
Fever
Bleeding per rectum
Greater stool volumes Smaller stool volumes
Abnormal laboratory results No gross abnormalities on laboratory results
New onset Known diarrhoea or sy...


... middle of paper ...


...e entails treating the symptoms and treating the cause. [clinical approach and management of CD]
Empiric therapy is for chronic diarrhoea is warranted when one has a specific diagnosis in mind. It may only be given if the patient can be followed-up. [evaluation of chronic diarrhoea]
NUTRITION
The link between gastrointestinal disorders, especially pathological chronic diarrhoea, is strong. In cases of severe malnutrition chronic diarrhoea may persist due to impaired immune function and poor mucosal recovery. Thus it is of the utmost importance to address the nutrition as a part of the holistic management of the patient. Specialised nutritional support via enteral or parenteral routes may be required to boost caloric and / or micronutrient intake. It is important to refer the patient to a dietician as early as possible. [nutritional consequences of chronic diarrhoea]

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