Diarrhea and Constipation

Basic Principles Diarrhea and Constipation

Classification Diarrhea and Constipation: acute or chronic; infectious; secondary to organic disease

Principal signs and symptoms Diarrhea and Constipation:
Diarrhea:
- more than four bowel movements per day
– stool weight i 250g/day
– soft or liquid consistency
Constipation:
- two or fewer bowel movements per week
– stool volume significantly below the normal range of approximately
80–150 g/day
– hard consistency
x The passage of stool may or may not cause discomfort. Stool may be mucuscovered, bloody, watery, or granular and may contain grossly visible food residues.

Diagnosis:

The history is of key importance, as bowel habits are interpreted differently by different examiners. A stool examination may be helpful.
All patients with diarrhea should be evaluated for the presence of an infection and for organic disease. Blood work should be done and may include tests for infectious organisms (blood culture, complement binding reaction). The stool may also be examined for bacteriologic testing and antibody detection (e.g.,clostridium antibody).

All true cases of chronic constipation are presumed to be caused by a stenosing lesion.

Only a few causes of diarrhea and constipation can be diagnosed with ultrasound. Most cases should be investigated by endoscopy with tissue sampling and histologic evaluation.
The differential diagnosis is reviewed in Table, where the possible diagnoses are listed in order of their frequency in the general hospital setting.