Groll A
Can Med Assoc J. 1977 Apr 9;116(7):742-4.
The practical approach to the investigation of diarrhea must be logical and based on anatomic considerations. The site of the underlying disorder may be determined by the clinical picture, and the logic of investigation will be influenced by the history. Important specific investigation in a case of colonic diarrhea include a careful rectal examination, stool inspection, sigmoidoscopy, rectal biopsy and barium enema study. Colonoscopy has been used, but its role has yet to be defined. In a case of small-bowel steatorrhea or diarrhea quantitative chemical estimation of the daily output of stool fat is useful, and to this investigation is added a small-bowel radiograph series and, if the radiographic findings are abnormal, small-bowel biopsy. Other investigations for small-bowel disease may include the breath test with carbon-14-labelled glycocholic acid, the lactose tolerance test, duodenal aspiration for giardiasis, analysis of serum immunoglobulins and, on occasion, isolation of vasoactive intestinal polypeptide hormone (which may aid the diagnosis of functioning tumours of the pancreas or small bowel). Investigations for pancreatic steatorrhea include abdominal radiography, performance of the secretin test and testing of the response to pancreatic replacement therapy. In some patients it may be useful to use endoscopic retrograde cholangiopancreatography to differentiate pancreatic carcinoma and chronic pancreatitis.
腹泻的实际调查方法必须符合逻辑，并基于解剖学考虑。潜在疾病的部位可通过临床表现来确定，调查的逻辑将受病史影响。结肠性腹泻病例的重要特异性检查包括仔细的直肠检查、粪便检查、乙状结肠镜检查、直肠活检和钡灌肠检查。已有人使用结肠镜检查，但它的作用尚未明确。对于小肠脂肪泻或腹泻病例，对粪便脂肪日排出量进行定量化学测定很有用，此外还需进行一系列小肠X光检查，如果X光检查结果异常，则需进行小肠活检。小肠疾病的其他检查可能包括用碳-14标记的甘氨胆酸进行呼气试验、乳糖耐量试验、十二指肠抽吸检查贾第虫病、血清免疫球蛋白分析，偶尔还需分离血管活性肠多肽激素（这可能有助于诊断胰腺或小肠的功能性肿瘤）。胰腺性脂肪泻的检查包括腹部X光检查、进行促胰液素试验以及测试对胰腺替代疗法的反应。在一些患者中，使用内镜逆行胰胆管造影来区分胰腺癌和慢性胰腺炎可能有用。
