Approach To Chronic Diarrhea Patient – Mnemonic

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Here is a quick mnemonic “CHRONIC DIARRHEA PATIENt“ to remember about Approach To Chronic Diarrhea Patient

This can be valuable for patients as well as medical doctors, nurses & students doing their clinical rounds. You can also find it very useful for med exams like USMLE, NExT Medical Step 1&2, MBBS, NEET PG, INI-CET, FMGE,MCAT & NCLEX exams

Approach To Chronic Diarrhea Patient : How To Remember Easily ?

  • C – Clinical history and physical examination: Start with a careful history and physical examination to gather essential information, including medications and other relevant factors.
  • H – History, Onset, Duration, and Characteristics of Diarrhea: Question the patient about the onset, duration, pattern, and characteristics of their diarrhea, including aggravating and relieving factors.
  • R – Routine Blood Studies: Conduct routine blood studies to assess fluid/electrolyte and nutritional status and identify any abnormalities.
  • O – Other Findings: Pay attention to other physical findings that might provide clues about the underlying condition, such as thyroid mass, edema, or hepatomegaly.
  • N – Notable Symptoms and Exposures: Take note of other symptoms like fever, weight loss, pain, and possible exposures (travel, medications, contacts with diarrhea).
  • I – IBD or Celiac Disease: Consider a family history of inflammatory bowel disease (IBD) or celiac disease as potential indications.
  • C – Chemistries: Check blood chemistries to assess electrolyte, hepatic, or other metabolic disturbances.
  • D – Detect Celiac Disease: Measure IgA tissue transglutaminase antibodies to help detect celiac disease.
  • I – Initial Therapeutic Trial: Consider a therapeutic trial based on the specific diagnosis suggested during the initial encounter with the physician.
  • A – Additional Investigation: Perform further investigations for persistent symptoms and unclear causes of chronic diarrhea.
  • R – Quantitative Stool Collection and Analyses: Utilize quantitative stool collection and analyses to obtain objective data for diagnosis or further studies.
  • R – Rule Out Secretory Diarrheas: Reconsider medication-related side effects or surreptitious laxative use for secretory diarrhea.
  • H – Microbiologic Studies: Conduct microbiologic studies, including fecal bacterial cultures and assays for parasites and infections.
  • E – Evaluate Malabsorption: Further evaluate osmotic diarrhea for lactose intolerance and magnesium ingestion.
  • A – Assess Fatty Diarrhea: Investigate proven fatty diarrhea with endoscopy and small-bowel biopsy.
  • P – Pancreatic Disease: Exclude pancreatic exocrine insufficiency with direct tests if suspected.
  • A – Avoid Indirect Tests: Don’t rely on indirect tests for pancreatic disease due to low sensitivity and specificity.
  • T – Toxin Assay and Imaging: For inflammatory-type diarrhea, perform stool cultures, C. difficile toxin assay, colonoscopy with biopsies, and small-bowel imaging studies.
  • I – Imaging Studies: Use imaging studies like small-bowel radiograph when appropriate.
  • E – Endoscopic Tests: Consider endoscopic tests, such as secretin-cholecystokinin stimulation test, for pancreatic exocrine insufficiency.
  • N – Noteworthy Investigations: Inspect for notable investigations like fecal elastase or chymotrypsin activity.
  • T – (blank)

Mnemonic :  CHRONIC DIARRHEA PATIENt

Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER working in govt.health department
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