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Secretory diarrhoea clinical features

  • Stool volume > 1 litre/day
  • Stool is watery in consistency
  • Stool does not contain pus or blood
  • Diarrhoea continuous, even when patient fasts for 24-48 hours but stops when agents causing fatty acid malabsorption or laxatives are not ingested.
  • Osmotic gap < 50 milliosm/ L. In mixture of osmotic and secretary diarrhoea the osmotic gap will be between 50 and 125.
Causes of secretory diarrhea
  • Infections due to enterotoxigenic bacteria, chronic mycobacterial fungal or parasitic infections. 
  • Intestinal resections
  • Inflammatory bowel diseases
  • Coeliac sprue
  • Lymphoma of small intestine
  • Zollinger-Ellison syndrome, VIPoma, glucagonoma
  • Malignant carcinoid syndrome
  • Hyperthyroidism
  • Collagen vascular diseases (SLE, scleroderma, MCTD)
  • Following use or abuse of stimulant laxatives.