diarrheal


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Related to diarrheal: diarrhoea, Diaria

di·ar·rhe·al

, diarrheic (dī'ă-rē'ăl, -rē'ik),
Relating to diarrhea.
Synonym(s): diarrhetic

di·ar·rhe·al

, diarrheic (dī'ă-rē'ăl, -ik)
Relating to diarrhea.
Synonym(s): diarrhetic, diarrhoeal.

diarrhea

(di-a-re'a) [ dia- + -rrhea]
The passage of fluid or unformed stools. In acute diarrhea, the frequency of bowel movements and the volume of fluid lost determine the severity of the illness. In tropical nations, infectious diarrheal illnesses are among the most common causes of disease and death, esp. in children, who become dehydrated easily. Diarrhea in the tropics is typically attributed to contaminated drinking water, inadequate sanitation, or poor hygiene. Worldwide, millions of children die from diarrhea each year. Diarrheal illnesses are common in Western nations as well but tend to be more benign and more effectively managed. cholera; oral rehydration therapy; viral gastroenteritisdiarrheal, adjective

Etiology

Five general mechanisms may cause diarrhea. Excessive secretion, or secretory diarrhea, is usually caused by infectious organisms (such as adenovirus, rotavirus, Vibrio cholerae, Cryptosporidium) or enterotoxins (such as Escherichia coli, Clostridium difficile), which produce excessive secretion of electrolytes and water. More than 500 ml of stool/day is excreted even during fasting. In inflammatory or exudative disorders, infectious organisms (such as, Salmonella, Shigella) damage the intestinal mucosa; the stools often contain blood or pus and can be of small volume (dysentery) or large. The diarrhea continues during fasting. Transmission of infectious organisms is most commonly person-to-person or through contaminated water or food. The incubation period and duration of illness vary, depending on the organism involved. The diarrhea may be bloody.

Osmotic diarrhea occurs when highly concentrated substances that cannot be absorbed (such as antacids, lactulose, lactose) pull water from the intestinal wall into the stool. More than 500 ml of stool/day is excreted, but the diarrhea subsides during a fasting state.

Malabsorption of nutrients results in steatorrhea with high osmolarity. The diarrhea is eliminated by fasting, and both osmotic and secretory components are involved. Abnormal intestinal motility resulting from surgical removal of sections of the bowel, diabetic neuropathy, or irritable bowel syndrome produces alternating patterns of diarrhea and constipation.

Symptoms

Frequent watery bowel movements or stools with pus, blood, oils, or mucus are characteristic of diarrhea, as are abdominal cramping, bloating, or rectal discomfort. When volume losses from diarrhea are large, symptoms of dehydration or electrolyte imbalance, such as dizziness, thirst, and prostration, are common.

Treatment

Fluid replacement is the key to successful management of acute diarrhea and the prevention of its complications. Oral rehydration therapies (ORTs) are inexpensive, safe, and effective tools for volume repletion. Intravenous fluids are more costly. Infectious causes of diarrhea are often managed with antibiotics (such as sulfa drugs or quinolones). Antidiarrheal agents include kaolin derivatives, loperamide, and paregorics. Alternative medicine practitioners advocate herbal remedies such as arrowroot. The management of chronic diarrhea depends on the underlying cause.

Patient care

The patient is assessed for signs and symptoms of dehydration and metabolic disarray or renal failure, such as headache, lethargy, orthostatic dizziness, decreasing level of consciousness, and compensatory hyperventilation. The frequency, consistency, color, and volume of stools are monitored, and bowel sounds auscultated for changes from normal patterns. Fluid balance, intake and output, and daily weights are also monitored. Prescribed oral or intravenous fluids and electrolyte and nutrient replacements are administered, and the patient's response is evaluated. The anal area is assessed for skin excoriation and gently but thoroughly washed and rinsed after each bowel movement, and protective ointment is applied. Standard precautions are observed for these interventions. Antidiarrheal medications are administered as prescribed. Whenever diarrhea or acute gastroenteritis of unknown cause is encountered, health professionals should consider the possibility of waterborne illness and obtain a drinking water history (such as water sources at home, school, and work, recreational water exposures, travel abroad, use of filtering system).

The spread of infectious diarrhea is prevented by practicing and teaching thorough handwashing and hygiene measures, by using standard precautions and measures of controlling infection in health care facilities, by correctly handling and refrigerating foods at risk for bacterial contamination, by appropriately filtering or treating water supplies, and by reporting diarrheal pathogens to appropriate public health authorities.

acute diarrhea

Diarrhea marked by sudden onset.

antibiotic-associated diarrhea

Mild to moderate diarrhea in individuals taking oral antibiotics. The antibiotics destroy the normal flora in the gastrointestinal tract. See: pseudomembranous colitis

dysenteric diarrhea

Dysentery.

emotional diarrhea

Diarrhea caused by emotional stress.

epidemic diarrhea in the newborn

Contagious diarrhea in a newborn caused by pathogenic strains of Escherichia coli, occurring in epidemics in hospitals.

factitious diarrhea

Self-induced diarrhea, as by self-medication with laxatives.
See: Munchausen syndrome

fatty diarrhea

Steatorrhea..

infantile diarrhea

Diarrhea in children under 2 years of age. Most commonly, it is caused by infectious enterocolitis due to rotavirus, Norwalk virus, or Escherichia coli. See: enterocolitis Synonym: toddler's diarrhea

Symptoms

Frequent watery stools, occasionally accompanied by evidence of dehydration, are the primary findings.

Treatment

Each year the deaths of thousands of children with diarrhea are prevented by the use of oral rehydration solutions consisting of clean (potable) water, salt, potassium, bicarbonate, and glucose. See: oral rehydration solution

lienteric diarrhea

Watery stools with undigested food particles.

membranous diarrhea

Diarrhea with pieces of intestinal mucosa.

mucous diarrhea

Diarrhea with mucus.

osmotic diarrhea

Diarrhea caused by the retention of osmotically active solutes in the small intestine. This causes fluid to be drawn into the intestinal lumen. The retained fluid is more than the colon can resorb. The solute may be the result of maldigestion, malabsorbed nutrients, or drugs.

purulent diarrhea

Diarrhea with pus, a result of intestinal ulceration.

secretory diarrhea

Diarrhea in which there is a large volume of fecal output caused by abnormalities of the movement of fluid and electrolytes into the intestinal lumen. This can be caused by hormonal abnormalities present in disorders such as carcinoid syndrome, Zollinger-Ellison syndrome, certain types of pancreatic adenomas, and medullary carcinomas of the thyroid.

simple diarrhea

Diarrhea in which stools contain only normal excreta.

summer diarrhea

Diarrhea occurring in children during months when rotavirus is not prevalent. Shigella, Campylobacter jejuni, and cryptosporidia are among the most common causes.

toddler's diarrhea

Infantile diarrhea..

travelers' diarrhea

Abbreviation: TD
Diarrhea experienced by visitors, esp. those who go to tropical countries. The most common causes are enterotoxigenic Escherichia coli, amebas, Giardia, Cyclospora, Cryptosporidium, Shigella, Salmonella, and Campylobacter. The disease is common, affecting as many as 40% of travelers to underdeveloped nations. There is no completely effective method of prevention, but avoidance of tap water, fresh fruits and vegetables, iced drinks, or inadequately cooked foods is helpful. Fish and shellfish may contain biotoxins even when well cooked; local residents can provide valuable advice concerning which fish to avoid. Loperamide with a quinolone antibiotic (such as ciprofloxacin) used after the passage of the first loose stool frequently aborts the illness, but children and pregnant women should not take quinolones. As with other forms of diarrhea, rehydration is crucial. Antidiarrheals are used for comfort.

weanling diarrhea

Severe gastroenteritis that sometimes occurs in infants who recently have been weaned.
References in periodicals archive ?
Handwashing with soap is one of the most cost-efficient and effective methods for preventing diarrheal disease, reducing incidence up to an estimated 40 percent.
Diarrheal disease is the most common cause of illness and the second leading cause of child death in the world, ~2 million each year.
Diarrheal diseases--cholera, rotavirus, shigellosis, and others--are the second leading killer of children under the age of five in the developing world.
Recently, questions have been raised about the role that diarrheal disease and infectious and inflammatory states play in the development of infantile MHG (3,4).
OneWorld Health recently completed a robust five year strategic plan to inform the future direction and expansion of the diarrheal disease portfolio and programs.
Analysis showed that higher gross national product was associated with lower diarrheal disease rates among all the nations studied, regardless of rainfall.
OneWorld Health is assembling a portfolio of product candidates to address various aspects of diarrheal diseases, with a special focus on treatments for infants and young children.
The data are undoubtedly "noisy" (indicated by the scattering of points in Figure 1), probably due to a combination of chance and the contribution of multiple nonclimate factors to the monthly incidence of diarrheal disease.
OneWorld Health's symposium "Current Trends in Diarrheal Diseases Research and Case Management: Progress in Zinc Supplementation Therapy" took place on January 18.
Address for correspondence: Christina Polyak, Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Mailstop A38, 1600 Clifton Road, Atlanta, GA 30333, USA; fax: 404-639-2205; e-mail: cpolyak@cdc.
The lower cost of the new product can help increase the possibility that more families will use oral electrolyte solutions to treat diarrheal illness, a surprisingly common ailment among all age levels in the United States and a growing cause of concern among many health professionals.
Product coverage: Indigestion and heartburn remedies, laxatives, diarrheal remedies, motion sickness remedies, child-specific digestive remedies