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/EricsMedi #Chronic #Diarrhea #Workup #diagnosis #differential #testing #evaluation
