![]() The colon absorbs much of the remaining fluid, leaving approximately 100 to 150 cc of slightly hypertonic stool to be excreted. As this chyme is passed along the small intestine, the osmolality is adjusted so that, at the distal ileum, the bowel contents are isotonic with plasma and total only 1 to 2 liters. By the time this food material has reached the proximal duodenum, another 7 liters of digestive secretions from the stomach, liver, pancreas, intestine, and salivary glands have been added. Approximately 2 liters are ingested daily in the normal diet. ![]() To understand better what causes diarrhea and how to treat it, one must first have an understanding of the normal digestive system. Any recent travel, a history of possible exposure to tainted foods or diarrheal illness in the family, and a sexual history are also important.Īsk about associated symptoms, both those related to the gastrointestinal tract (e.g., abdominal pain, cramping, nausea, vomiting, rectal urgency, incontinence, bloating, increased flatus or jaundice), and more constitutional symptoms (e.g., fever, chills, malaise, anorexia, or weight loss).įinally, a review of systems may point out some important related involvement that can serve as a clue to diagnosis, for example, arthritis or skin rash associated with inflammatory bowel disease or anxiety associated with irritable bowel disease. Next, inquire about any medications that might cause diarrhea, such as antacids, laxatives, antibiotics, or colchicine. Are the symptoms acute, that is, of less than 7 to 10 days" duration or chronic?Īttempt to elicit a description of the stool: What are your abnormal bowel movements like? Are the stools formed, soft or watery? Is any blood or mucus present? Is there ever any undigested food or fat in the stool? Is the quantity or character of the stool affected by fasting or certain foods? The color of the stool is rarely helpful diagnostically unless melena is present or the stools are acholic. ![]() Do the symptoms interrupt normal sleeping patterns? The absence of nocturnal diarrhea is suggestive of functional bowel disease. Small and frequent bowel movements often indicate left colon or rectal disease, whereas voluminous stools usually indicate small bowel or right colon disease. The frequency and size of each bowel movement are important.
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