The following are causes of secretory diarrhoea except-
Correct Answer: Inflammatory bowel disease
Description: Clinical features of Ulcerative colitis The cardinal symptoms are rectal bleeding with passage of mucus and bloody diarrhoea. The presentation varies, depending on the site and severity of the disease , as well as the presence of extra-intestinal manifestations. The first attack is usually the most severe and is followed by relapses and remissions. Emotional stress, intercurrent infection, gastroenteritis, antibiotics or NSAID therapy may all provoke a relapse. Proctitis causes rectal bleeding and mucus discharge, accompanied by tenesmus. Some patients pass frequent, small-volume fluid stools, while others pass pellety stools due to constipation upstream of the inflamed rectum. Constitutional symptoms do not occur. Left-sided and extensive colitis causes bloody diarrhoea with mucus, often with abdominal cramps. In severe cases, anorexia, malaise, weight loss and abdominal pain occur and the patient is toxic, with fever, tachycardia and signs of peritoneal inflammation . Clinical features of Crohn's disease The major symptoms are abdominal pain, diarrhoea and weight loss. Ileal Crohn's disease subacute or even acute intestinal obstruction. The pain is often associated with diarrhoea, which is usually watery and does not contain blood or mucus. Almost all patients lose weight because they avoid food, since eating provokes pain. Weight loss may also be due to malabsorption and some patients present with features of fat, protein or vitamin deficiencies. Crohn's colitis presents in an identical manner to ulcerative colitis but rectal sparing and the presence of perianal disease are features that our a diagnosis of Crohn's disease. Many patients present with symptoms of both small bowel and colonic disease. A few patients present with isolated perianal disease, vomiting from jejunal strictures or severe oral ulceration. Physical examination often reveals evidence of weight loss, anaemia with glossitis and angular stomatitis. There is abdominal tenderness, most marked over the inflamed area. An abdominal mass may be palpable and is due to matted loops of thickened bowel or an intra-abdominal abscess. Perianal skin tags, fissures or fistulae are found in at least 50% of patients Ref Davidson edition23rd pg 816,817
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