Extreme weight loss, vomiting, diarrhea would need following work up, if not done;
1) Contrast enhanced CT scan of abdomen
2) Liver function tests
3) Pancreatic function tests
4) Kidney function tests
5) Stool exam and culture.
6) Thyroid function tests
6) Adrenal function tests
7) Tests for diabetes like glycosylated hemoglobin, serum insulin.
No harm in getting a nuclear medicine GI study which tells about the motility disorders of the intestines.
The initial evaluation of diarrhea is on these characteristic;
a) stool volume,
c) consistency, and
d) gross appearance.
Stool volume can give an idea of disease location and underlying mechanism.
a) Large-volume stools (more than one liter per day) would point to small bowel disease and secretory diarrhea.
b) Small-volume stools (less than 300 ml per day) suggest large intestine diseases and functional gastrointestinal disorders like IBS.
Stool consistency can be varied ranging from formed to watery, and correlates with the rate of intestinal transit.
a) Secretory diarrheas are liquid.
b) Functional diarrheas are soft or semi-solid.
c) Stool floating will be indicative of if being filled with gas from fermentation of mal absorbed carbohydrates.
d) Mucus can point to both inflammatory and noninflammatory diarrheas, such as ulcerative colitis and IBS.
She should be investigated for IBD, chronic infections or for secretory diarrhea (by estimating total amount of stools per 24 hours). Looking for the carcinoid tumor also may be considered. Gastrinoma and VIPoma also should be considered for prolonged secretory diarrhea and an high index of suspicion is required. Secretory diarrhea characteristically continues despite fasting, is associated with stool volumes more than 1 liter/day. Selective testing for plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin, as well as urine excretion of 5-hydroxyindole acetic acid, metanephrine, or histamine and other tests of endocrine function, such as measurement of thyroid-stimulating hormone and serum thyroxine levels or an adrenocorticotropin-
stimulation test for adrenal insufficiency, can be considered by your physician. An aspirate of small bowel contents for quantitative culture or breath tests with glucose or isotopically labeled xylose can be used to establish the presence of small bowel bacterial overgrowth.
The causes of nausea and vomiting are iatrogenic (doctor induced like medicines), toxic, or infectious causes; gastrointestinal disorders; and central nervous system or psychiatric conditions. Following are the main causes;
A. Central nervous system
2) Space occupying lesion in brain (Mass lesion)
4) Ménière's disease
5) Pseudotumor cerebri
B. Gastrointestinal symptoms;
2) Irritable bowel syndrome
3) Non ulcer dyspepsia
4) Peptic ulcer disease
5) Hepatitis (liver inflammation)
1) Thyroid disorders
3) Adrenal disorders
D. Psychiatry disorders
3) Conversion disorders
Chronic nausea and vomiting are usually a pathologic response to any of a variety of conditions. Gastrointestinal etiologies include obstruction, functional disorders, and organic diseases. Central nervous system etiologies are primarily related to conditions that increase intracranial pressure, and typically cause other neurologic signs. Numerous metabolic abnormalities and psychiatric diagnoses also may cause nausea and vomiting. Evaluation should then turn to identifying the underlying cause and providing specific therapies.
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