The clinical assessment of chronic diarrhoea

Key points

A wide number of possibilities need to be considered
Classic steatorrhea is not common in malabsorption
A systematic history usually identifies the likely cause or mechanism
Basic screening tests of the stool and blood tests looking for causes and complications
Confirmatory testing usually requires imaging or endoscopic (+/- specific tests for malabsorption)
Empiric treatment for protozoan infection is reasonable before expensive testing

Standard history taking

SOCRATES method (site, origin/onset, character/chronology. relieving, aggrating/alleviating/associated, time course, exacerbating, severity)

PHx - GIT surgery, liver or bililary disease, pancreatic disease, thyroid disorders

FHx - Coeliac disase, IBD, lactose intolerance, cystic fibrosis

Meds / Drugs - alcohol, laxative, IVDU, transfusion history

Sexual history - unsafe sex practices, anal sex

By syndrome

By complication

 By anatomy


by physiological process

by pathological sieve / aetiology

Initial tests

Advanced tests