Differential Diagnosis of Chronic Watery Diarrhea

Chronic Watery Diarrhea can be subdivided in: osmotic, secretory and functional.

Secretory Diarrhea::
  • bowel secretes too much fluid 
  • VERY HIGH volume stools (>1L)
  • Stool Osmolar Gap less than 50.
  • No changes on Fasting.
  • Caused by enterotoxins, bile acids(when ileal resection), carcinoid sx, VIPoma.

Osmotic Diarrhea::  
  • Non absorbable solutes that stay in bowel and drag water in
  • its SMALLER volume stools. (<1L)
  • Stool Osmolar Gap more than 50.
  • Stops on fasting.
  • ex. lactose intolerance and celiac disease

Functional Diarrhea::  
  • IBS, where hallmark is hypermotility, 
  • has smaller volume and symptoms disappear at night.

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