diarrhea

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Diarrhea

 

Definition

To most individuals, diarrhea means an increased frequency or decreased consistency of bowel movements; however, the medical definition is more exact than this. In many developed countries, the average number of bowel movements is three per day. However, researchers have found that diarrhea best correlates with an increase in stool weight; stool weights above 10oz (300 gs) per day generally indicates diarrhea. This is mainly due to excess water, which normally makes up 60-85% of fecal matter. In this way, true diarrhea is distinguished from diseases that cause only an increase in the number of bowel movements (hyperdefecation) or incontinence (involuntary loss of bowel contents).
Diarrhea is also classified by physicians into acute, which lasts one or two weeks, and chronic, which continues for longer than 2 or 3 weeks. Viral and bacterial infections are the most common causes of acute diarrhea.

Description

In many cases, acute infectious diarrhea is a mild, limited annoyance. However, worldwide acute infectious diarrhea has a huge impact, causing over five million deaths per year. While most deaths are among children under five years of age in developing nations, the impact, even in developed countries, is considerable. For example, over 250,000 individuals are admitted to hospitals in the United States each year because of one of these episodes. Rapid diagnosis and proper treatment can prevent much of the suffering associated with these devastating illnesses.
Chronic diarrhea also has a considerable effect on health, as well as on social and economic well being. Patients with celiac disease, inflammatory bowel disease, and other prolonged diarrheal illnesses develop nutritional deficiencies that diminish growth and immunity. They affect social interaction and result in the loss of many working hours.

Causes and symptoms

Diarrhea occurs because more fluid passes through the large intestine (colon) than that organ can absorb. As a rule, the colon can absorb several times more fluid than is required on a daily basis. However, when this reserve capacity is overwhelmed, diarrhea occurs.
Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent absorption of fluids. Also, certain substances in the colon, such as fats and bile acids, can interfere with water absorption and cause diarrhea. In addition, rapid passage of material through the colon can also do the same.
Symptoms related to any diarrheal illness are often those associated with any injury to the gastrointestinal tract, such as fever, nausea, vomiting, and abdominal pain. All or none of these may be present depending on the disease causing the diarrhea. The number of bowel movements can vary—up to 20 or more per day. In some patients, blood or pus is present in the stool. Bowel movements may be difficult to flush (float) or contain undigested food material.
The most common causes of acute diarrhea are infections (the cause of traveler's diarrhea), food poisoning, and medications. Medications are a frequent and often over-looked cause, especially antibiotics and antacids. Less often, various sugar free foods, which sometimes contain poorly absorbable materials, cause diarrhea.
Chronic diarrhea is frequently due to many of the same things that cause the shorter episodes (infections, medications, etc.); symptoms just last longer. Some infections can become chronic. This occurs mainly with parasitic infections (such as Giardia) or when patients have altered immunity (AIDS).
The following are the more usual causes of chronic diarrhea:
  • AIDS
  • colon cancer and other bowel tumors
  • endocrine or hormonal abnormalities (thyroid, diabetes mellitus, etc.)
  • food allergy
  • inflammatory bowel disease (Crohn's disease and ulcerative colitis)
  • lactose intolerance
  • malabsorption syndromes (celiac and Whipple's disease)
  • other (alcohol, microscopic colitis, radiation, surgery)

Complications

The major effects of diarrhea are dehydration, malnutrition, and weight loss. Signs of dehydration can be hard to notice, but increasing thirst, dry mouth, weakness or lightheadedness (particularly if worsening on standing), or a darkening/decrease in urination are suggestive. Severe dehydration leads to changes in the body's chemistry and could become life-threatening. Dehydration from diarrhea can result in kidney failure, neurological symptoms, arthritis, and skin problems.

Diagnosis

Most cases of acute diarrhea never need diagnosis or treatment, as many are mild and produce few problems. But patients with fever over 102 °F (38.9 °C), signs of dehydration, bloody bowel movements, severe abdominal pain, known immune disease, or prior use of antibiotics need prompt medical evaluation.
When diagnostic studies are needed, the most useful are stool culture and examination for parasites; however these are often negative and a cause cannot be found in a large number of patients. The earlier cultures are performed, the greater the chance of obtaining a positive result. For those with a history of antibiotic use in the preceding two months, stool samples need to be examined for the toxins that cause antibiotic-associated colitis. Tests are also available to check stool samples for microscopic amounts of blood and for cells that indicate severe inflammation of the colon. Examination with an endoscope is sometimes helpful in determining severity and extent of inflammation. Tests to check changes in blood chemistry (potassium, magnesium, etc.) and a complete blood count (CBC) are also often performed.
Chronic diarrhea is quite different, and most patients with this condition will receive some degree of testing. Many exams are the same as for an acute episode, as some infections and parasites cause both types of diarrhea. A careful history to evaluate medication use, dietary changes, family history of illnesses, and other symptoms is necessary. Key points in determining the seriousness of symptoms are weight loss of over 10 lb (4.5 kg), blood in the stool, and nocturnal diarrhea (symptoms that awaken the patient from sleep).
Both prescription and over-the-counter medications can contain additives, such as lactose and sorbitol, that will produce diarrhea in sensitive individuals. Review of allergies or skin changes may also point to a cause. Social history may indicate if stress is playing a role or identify activities which can be associated with diarrhea (for example, diarrhea that occurs in runners).
A combination of stool, blood, and urine tests may be needed in the evaluation of chronic diarrhea; in addition a number of endoscopic and x-ray studies are frequently required.

Treatment

Treatment is ideally directed toward correcting the cause; however, the first aim should be to prevent or treat dehydration and nutritional deficiencies. The type of fluid and nutrient replacement will depend on whether oral feedings can be taken and the severity of fluid losses. Oral rehydration solution (ORS) or intravenous fluids are the choices; ORS is preferred if possible.
A physician should be notified if the patient is dehydrated, and if oral replacement is suggested then commercial (Pedialyte and others) or homemade preparations can be used. The World Health Organization (WHO) has provided this easy recipe for home preparation, which can be taken in small frequent sips:
  • Table salt—3/4 tsp
  • Baking powder—1 tsp
  • Orange juice—1 c
  • Water—1 qt (1l)
When feasible, food intake should be continued even in those with acute diarrhea. A physician should be consulted as to what type and how much food is permitted.
Anti-motility agents (loperamide, diphenoxylate) are useful for those with chronic symptoms; their use is limited or even contraindicated in most individuals with acute diarrhea, especially in those with high fever or bloody bowel movements. They should not be taken without the advice of a physician.
Other treatments are available, depending on the cause of symptoms. For example, the bulk agent psyllium helps some patients by absorbing excess fluid and solidifying stools; cholestyramine, which binds bile acids, is effective in treating bile salt induced diarrhea. Low fat diets or more easily digestible fat is useful in some patients. New antidiarrheal drugs that decrease excessive secretion of fluid by the intestinal tract is another approach for some diseases. Avoidance of medications or other products that are known to cause diarrhea (such as lactose) is curative in some, but should be discussed with a physician.

Alternative treatment

It is especially important to find the cause of diarrhea, since stopping diarrhea when it is the body's way of eliminating something foreign is not helpful and can be harmful in the long run.
One effective alternative approach to preventing and treating diarrhea involves oral supplementation of aspects of the normal flora in the colon with the yeasts Lactobacillus acidophilus, L. bifidus, or Saccharomyces boulardii. In clinical settings, these "biotherapeutic" agents have repeatedly been helpful in the resolution of diarrhea, especially antibiotic-associated diarrhea. Their effectiveness is also supported by the results of a research study published in the Journal of the American Medical Association in 1996.
Nutrient replacement also plays a role in preventing and treating episodes of diarrhea. Zinc especially appears to have an effect on the immune system, and deficiency of this mineral can lead to chronic diarrhea. Also, zinc replacement improves growth in young patients. Plenty of fluids, especially water, should be taken by individuals suffering from diarrhea to prevent dehydration. The BRAT diet also can be useful in helping to resolve diarrhea. This diet limits food intake to bananas, rice, applesauce, and toast. These foods provide soluble and insoluble fiber without irritation. If the toast is slightly burnt, the charcoal can help sequester toxins and pull them from the body.
Acute homeopathic remedies can be very effective for treating diarrhea especially in infants and young children.

Prognosis

Prognosis is related to the cause of the diarrhea; for most individuals in developed countries, a bout of acute, infectious diarrhea is at best uncomfortable. However, in both industrialized and developing areas, serious complications and death can occur.
For those with chronic symptoms, an extensive number of tests are usually necessary to make a proper diagnosis and begin treatment; a specific diagnosis is found in 90% of patients. In some, however, no specific cause is found and only treatment with bulk agents or anti-motility agents is indicated.

Prevention

Proper hygiene and food handling techniques will prevent many cases. Traveler's diarrhea can be avoided by use of Pepto-Bismol and/or antibiotics, if necessary. The most important action is to prevent the complications of dehydration.

Resources

Organizations

World Health Organization, Division of Emerging and Other Communicable Diseases Surveillance and Control. Avenue Appia 20, 1211 Geneva 27, Switzerland. (+00 41 22) 791 21 11. http://www.who.int.

Other

"Directory of Digestive Diseases Organizations for Patients." National Institute of Diabetes and Digestive and Kidney Disease. http://www.niddk.nih.gov.
"A Neglected Modality for the Treatment and Prevention of Selected Intestinal and Vaginal Infections." JAMA. http://pubs.ama-assn.org.
Selected publications and documents on diarrhoeal diseases (including cholera). World Health Organization (WHO). http://www.who.ch/chd/pub/cdd/cddpub.htm.

Key terms

Anti-motiltiy medications — Medications such as loperamide (Imodium), diphenoxylate (Lomotil), or medications containing codeine or narcotics that decrease the ability of the intestine to contract. These can worsen the condition of a patient with dysentery or colitis.
Colitis — Inflammation of the colon.
Endoscope — An endoscope, as used in the field of gastroenterology, is a thin flexible tube that uses a lens or miniature camera to view various areas of the gastrointestinal tract. Both diagnosis, through biopsies or other means, and therapeutic procedures can be done with this instrument.
Endoscopy — The performance of an exam using an endoscope is known generally as endoscopy.
Lactose intolerance — An inability to properly digest milk and dairy products.
Oral rehydration solution (ORS) — A liquid preparation developed by the World Health Organization that can decrease fluid loss in persons with diarrhea. Originally developed to be prepared with materials available in the home, commercial preparations have recently come into use.
Steatorrhea — Excessive amounts of fat in the feces.

diarrhea

 [di″ah-re´ah]
rapid movement of fecal matter through the intestines resulting in poor absorption of water, nutritive elements, and electrolytes and producing abnormally frequent evacuation of watery stools. adj., adj diarrhe´ic, diarrhe´al.

Diarrhea is a nursing diagnosis accepted by the North American Nursing Diagnosis Association, who defined it as “the state in which an individual experiences a change in normal bowel habits characterized by the frequent passage of loose, unformed stools.” It can be caused by intestinal mucosal defects produced by infectious or chemical agents, toxins, which cause hypersecretion with no mucosal damage, osmotic agents, functional loss of intestinal segments, or emotional disorders which bring about increased peristalsis and increased secretion of mucus in the colon (psychogenic diarrhea or irritable colon); chronic recurrent diarrhea is a major symptom of crohn's disease and of ulcerative colitis. Concentrated tube feedings can cause diarrhea if adequate water is not given after each feeding.

In all types of diarrhea there is rapid evacuation of water and electrolytes resulting in a loss of these essential substances. Potassium supply especially is depleted by diarrhea, thus producing acidosis as well as deficient fluid volume.
Symptoms. Diarrhea is accompanied by frequent and liquid bowel movements, abdominal cramps, and general weakness. The stools often contain mucus and may be blood streaked. In chronic diarrhea the patient is likely to be anemic and suffering from malnutrition.
Treatment. Mild cases of diarrhea of short duration can be treated conservatively with a bland diet, increased intake of liquids, and the administration of kaolin-pectin compounds to relieve the symptoms. Medicines are sometimes used to decrease peristalsis and relieve cramps. More severe and chronic cases can be symptomatic of a wide variety of disorders including glandular disturbances, deficiency diseases, allergies, and tumors of the intestinal tract. Since diarrhea is a symptom rather than a disease, extensive diagnostic procedures and laboratory tests may be necessary to determine the underlying cause. In the meantime symptomatic treatment must be instituted to relieve the dehydration, nutritional deficiencies, and disturbances of acid-base balance produced by the loss of water, food elements, and electrolytes in the stools. Liquids and semisolids may be given orally at frequent intervals if they can be tolerated. In cases in which vomiting accompanies the diarrhea or the stools occur with serious frequency, fluids may be given intravenously.
weanling diarrhea a collection of diseases in the infant, described as a syndrome, associated with weaning from the breast. It is attributed to the introduction of other food and loss of the protective properties of breast milk.

di·ar·rhe·a

(dī'ă-rē'ă), This word denotes not merely abnormal looseness of stools but also an increase in the urgency and frequency of defecation.
An abnormally frequent discharge of semisolid or fluid fecal matter from the bowel.
[G. diarrhoia, fr. dia, through, + rhoia, a flow, a flux]

diarrhea

/di·ar·rhea/ (-re´ah) abnormally frequent evacuation of watery feces.diarrhe´aldiarrhe´ic
choleraic diarrhea  a type seen in cholera, with serous feces and circulatory collapse.
familial chloride diarrhea  a type of severe watery diarrhea that begins in early infancy with feces containing excessive chloride because of impairment of chloride-bicarbonate exchange in the lower colon. Affected infants have a distended abdomen, lethargy, and retarded growth and mental development.
lienteric diarrhea  a form in which feces contain undigested food.
osmotic diarrhea  that due to the presence of osmotically active nonabsorbable solutes in the intestine, e.g., magnesium sulfate.
parenteral diarrhea  diarrhea due to infections outside the gastrointestinal tract.
secretory diarrhea  watery voluminous diarrhea resulting from increased stimulation of ion and water secretion, inhibition of their absorption, or both; osmolality of the feces approximates that of plasma.
summer diarrhea  acute diarrhea in children during the intense heat of summer.
toxigenic diarrhea  the watery voluminous diarrhea caused by enterotoxins from enterotoxigenic bacteria such as Vibrio cholerae and enterotoxigenic strains of Escherichia coli .
traveler's diarrhea  diarrhea in travelers, especially those visiting tropical or subtropical areas where sanitation is poor; many different agents can cause it, the most common being enterotoxigenic Escherichia coli.
tropical diarrhea  see under sprue.
weanling diarrhea  diarrhea in an infant when put on food other than its mother's milk, usually due to inadequate sanitation and infection by enterotoxigenic Escherichia coli or rotaviruses.

diarrhea

(dī′ə-rē′ə)
n.
Excessive and frequent evacuation of watery feces.

di′ar·rhe′al, di′ar·rhe′ic (-ĭk)(-rĕt′ĭk), di′ar·rhet′ic (-rĕt′ĭk) adj.

diarrhea

[dī′ərē′ə]
Etymology: Gk, dia + rhein, to flow
the frequent passage of loose, watery stools. The stool may also contain mucus, pus, blood, or excessive amounts of fat. Diarrhea is usually a symptom of some underlying disorder. Conditions in which diarrhea is an important symptom are dysenteric disorders, malabsorption syndrome, lactose intolerance, irritable bowel syndrome, GI tumors, and inflammatory bowel disease. In addition to stool frequency, patients may complain of abdominal cramps and generalized weakness. Untreated, severe diarrhea may lead to rapid dehydration and electrolyte imbalance. It should be treated symptomatically until proper diagnosis can be made. Anti-diarrheal preparations, such as diphenoxylate and paregoric, are helpful. If diarrhea is accompanied by vomiting, IV fluids may be necessary to prevent fluid depletion. Also spelled diarrhoea. See also dehydration. diarrheal, diarrheic, adj.

diarrhea

An abnormal frequency of defecation accompanied by abnormal liquidity of the feces; a daily stool weight of > 200 g; acute diarrhea is < 4 wks; chronic diarrhea is > 4 wks in duration. See Antibiotic-associated diarrhea, Brainerd diarrhea, Chewing gum diarrhea, Chronic idiopathic diarrhea, Day care diarrhea, High-output diarrhea, Magnesium-induced diarrhea, Osmotic diarrhea, Overflow diarrhea, Toddler's diarrhea, Traveler's diarrhea, Trench diarrhea, Weaning diarrhea, White stool.

di·ar·rhe·a

(dī'ă-rē'ă)
An abnormally frequent discharge of semisolid or fluid fecal matter from the bowel.
Synonym(s): diarrhoea.
[G. diarrhoia, fr. dia, through, + rhoia, a flow, a flux]

diarrhea,

n frequent loosened, watery stools, often accompanied by abdominal cramping and strong urge to move bowels.

di·ar·rhe·a

(dī'ă-rē'ă)
Abnormally frequent discharge of semisolid or fluid fecal matter from the bowel.
Synonym(s): diarrhoea.
[G. diarrhoia, fr. dia, through, + rhoia, a flow, a flux]

diarrhea

(dī´ərē´ə),
n a condition with the frequent passage of loose, watery stools. The stool may also contain mucus, suppuration, blood, or excessive amounts of fat. It is usually a symptom of some underlying disorder. See antidiarrheals.

diarrhea

rapid movement of fecal matter through the intestine resulting in poor absorption of water, nutritive elements and electrolytes, and producing abnormally frequent evacuation of watery droppings. The major causes are local irritation of the intestinal mucosa by infectious or chemical agents (gastroenteritis). In all types of diarrhea there is rapid evacuation of water and electrolytes resulting in a loss of these essential substances. Base (bicarbonate) especially is depleted by diarrhea, thus producing acidosis as well as fluid volume deficit.

acute idiopathic diarrhea
acute diarrhea syndromes in horses which are not diagnosable, such as salmonellosis, strongylosis, cyathostomiasis, Potomac horse fever, colitis-X, antibiotic-induced diarrhea (above), intestinal clostridiosis.
acute undifferentiated diarrhea of the horse
severe, acute diarrhea likely to be fatal may be related to stress or antibiotic therapy. See also colitis-X, intestinal clostridiosis, salmonellosis.
antibiotic-associated diarrhea
results from disruption of the normal bowel flora as a result of antimicrobial therapy for any reason. May occur as moderate diarrhea or as a life threatening syndrome often with severe colitis or pseudo-membranous colitis. See also antibiotic-associated colitis.
bovine virus diarrhea
see bovine virus diarrhea.
campylobacter diarrhea
watery diarrhea without other obvious signs and without other obvious cause in yearling sheep, calves and foals. Campylobacter fetus subspp. jejuni and intestinalis have been suggested as causes. See also winter dysentery.
chronic undifferentiated diarrhea of the horse
chronic, very watery diarrhea for very long periods but the horse has normal appetite and loses weight only gradually. Esthetically very displeasing to pleasure horse owners. Irreversible but not usually fatal.
ciliate diarrhea
colitis caused by troglodytella in primates.
dietary diarrhea
a result of dietary indiscretion; occurs in all species. It is caused by the chemical or physical nature of the ingested material. The commonest occurrence of the syndrome is in newborn animals, especially those who ingest too much milk. There is often a history of access to an oversupply of milk or of a recent change of source to an over-rich milk replacer or indigestible components in replacer. It is also caused by too-rapid drinking. Affected animals are bright and alert and have a normal appetite but the feces are voluminous, soft to fluid and evil-smelling. Secondary bacterial enteritis may ensue but most cases recover spontaneously when the diet is adjusted. Scavenging dogs and cats ('garbage eaters') commonly ingest food that is spoiled or to which they are unaccustomed, resulting in various degrees of vomiting or diarrhea. Called also dietetic scours.
effusion diarrhea
caused by an increase in the transepithelial hydrostatic pressure gradient, such as occurs in congestive heart failure and hepatic portal hypertension.
epizootic porcine diarrhea
at least two types of epidemic diarrhea occur in pigs which are not transmissible gastroenteritis or due to other known cause.
large bowel diarrhea
in dogs and cats, signs referable to the site of enteric disease responsible for the diarrhea being the large intestine include tenesmus, mucus, hematochezia, and increased frequency of defecation.
malabsorptive diarrhea
villous atrophy, such as occurs with some viral infections, causes malabsorption diarrhea because of the reduction in area of absorptive intestinal epithelium.
nursery diarrhea
see nursery diarrhea.
osmotic diarrhea
an overload of unabsorbed osmotically active particles will attract and retain water, increasing fecal volume and causing diarrhea. Associated with maldigestion, malabsorption, overeating, excessive carbohydrates or fats. The basis for the laxative effect of magnesium sulfate, sodium sulfate or sodium phosphate.
psychogenic diarrhea
see irritable colon syndrome.
secretory diarrhea
derangement of normal secretory and absorptive functions of intestinal epithelium such as occurs with bacterial enterotoxins may result in excessive secretion and a resulting diarrhea. Escherichia coli is the prime example of an infection with this effect.
small bowel diarrhea
in dogs and cats, signs referable to the site of enteric disease responsible for the diarrhea being the small intestine include lack of tenesmus or mucus, increased fecal volume, melena and weight loss.
undifferentiated diarrhea of the newborn
the situation in which a newborn animal (less than 7 days old) has life-threatening acute diarrhea. There is insufficient time and it would cost too much to differentiate between all of the possible causes. Added to this is the common occurrence in which there are two or more agents present, often acting in concert. Because of the need to treat these cases urgently and effectively if their lives are to be saved it has become the practice to group them together for the purposes of treatment and prognosis.

Patient discussion about diarrhea

Q. what are the causes of diarrhea? I've been having constant diarrhea, stomach aches and loud noises from my bowel. could it be cancer?

A. I don't know about cancer, but you might consider "Irritable bowel syndrome". it is a common disorder that can occur and have those symptoms that you mentioned. here is a nice web site that gives information about it: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs_ez/#symptoms

Q. What Is Travelers' Diarrhea? I wanted to know- what exactly is travelers' diarrhea?

A. Travelers' diarrhea is the most common illness affecting travelers. Travelers' diarrhea is defined as three or more unformed stools in 24 hours, commonly accompanied by abdominal cramps, nausea and bloating. Each year 20%–50% of international travelers, an estimated 10 million people, develop diarrhea, usually within the first week of traveling. It can occur due to poor sanitary conditions, usually by bacterial infection. Escherichia coli, enteroaggregative E. coli, and Shigella are the most common bacteria involved. High-risk destinations are the developing countries of Latin America, Africa, the Middle East and Asia.

Q. I heard that the major risk in diarrhea is dehydration, why is that? How can I avoid that? Are there other dehydration causes I should beware of?

A. vomiting will also dehydrate you about as dangerously as diarrhea fye

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