Diarrhea Causes Diagnosis Symptoms Treatment

Diarrhea Causes Diagnosis Symptoms Treatment

Diarrhea

 Diarrhea is passage of abnormally liquid or un­formed stools at an increased frequency.

  • The following definitions have been suggested according to the duration of diarrhea
  • AcuteHYPERSENSITIVITY PNEUMONITIS Clinical features Diagnosis and Treatment of Hypersensitivity. Read more ... » — ≤ 14 days in duration
  • Persistent diarrhea — more than 14 days in duration
  • Chronic — more than 30 days in duration
  • The weight of stool is more than 200 gm/day.
  • Acute diarrhea is diarrhea of <2 weeks.
  • Chronic diarrhea is of >4 weeks duration.
  • Persistent diarrhea is diarrhea for 2-4 weeks.
  • Pseudodiarrhea is frequent passage of small volume of stool as in irritable bowel syndrome and proctitis.
  • Fecal incontinence is the involuntary passage of stools due to neuromuscular disorders or structural abnor­malities.
  • Abnormal increase in stool frequency or liquidity in an otherwise healthy individual
  • Often self-limiting; <14 days duration
  • Acute viral diarrhea (50–70%):
  • Most common form; usually occurs for 1–3 days; self-limited
  • CausesHYPERSENSITIVITY PNEUMONITIS Clinical features Diagnosis and Treatment of Hypersensitivity. Read more ... » changes in small intestinal cell morphology, such as villous shortening and an increase in the number of crypt cells
  • 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.


ACUTE DIARRHEA

  • Acute diarrhepa is usually due to infections.
  • There is vomiting, fever and. abdominal pain.
  • Acute — ≤ 14 days in duration

 Causes of Acute Diarrhea

  • Infections
  • Medications or drug induced
  • Toxin ingestion
  • Ischemia.

Infections (which cause diarrheal

  • E. coli
  • Campylobacter
  • Shigella
  • Salmonella
  • Giardia
  • Staphylococcus aureus Hepatitis A and B
  • AIDS
  • Clostridium difficile.

Medications (which cause diarrhea)

Symptoms —

Physical Exam

  • Loose liquid stools ± blood or mucus
  • Fever
  • Abdominal pain and distension
  • Determine hydration status; look for decreased skin turgor, dry mucous membranes, hypotension, or decreased urination.
  • In children: absence of tears, depressed fontanelles, dry diapers.
  • Abdominal exam to rule out potential surgical causes of diarrhea such as appendicitis or pelvic abscess
  • 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.

ACUTE DIARRHEA Diagnosis

  • Passage of ≥ 6 unformed stools per 24 hours or a duration of illness >48 hours
  • · Gross examination of stool
  • · Microbiologic analysis of stool
  • · Culture for bacteria and virus
  • · Immunoassay
  • · Sigmoidoscopy
  • · Biopsy
  • · Upper GI endoscopy with – Biopsy, duodenal as­pirates
  • ·CT scan. :
  • Profuse watery diarrhea with signs of hypovolemia
  • Passage of many small volume stools containing blood and mucus
  • Bloody diarrhea
  • Temperature ≥ 38.5ºC (101.3ºF)
  • Systemic illness with diarrhea, especially in pregnant women (in which case listeriosis should be suspected)

ACUTE DIARRHEA Treatment

  • Fluid replacement
  • Oral sugar electrolyte solutions 7 IV rehydration
  • Loperamide – Antimotility, antisecretory agents v/ Bismuth subsalicylate
  • Antibiotics – QUinolonesGemifloxacin. Read more ... » like ciprofloxacin 500 mg BD for 5 days
  • Metronidazole 250 mg qid for 7 days.

CHRONIC DIARRHEA

  • Diarrhea lasting more than 4 weeksis chronic diar­rhea.
  • Usually the causes are non infectious.

Causes of Chronic Diarrhea

  • · Medications
  • · Infections
  • · Bowel resection
  • · Mucosal disease – Crohn’s disease and regional ileitis
  • · Idiopathic secretory diarrhea
  • · Metastatic gastrointestinal carcinoid tumors
  • · Primary bronchial carcinoids
  • · Pancreatic cholera
  • · VIP oma – Vasoactive intestinal peptide tumor
  • · Medullary carcinoma of thyroid
  • · Lactase deficiency – carbohydrate malabsorption
  • · Steatorrhea – stool fat exceeding – 7 g/day
  • · Celiac sprue – gluten-sensitive enteropathy
  • Tropical sprue .
  • Whipple’s disease – Treponema infection Mycobacterium avium Abetalipoproteinemia
  • Hyperthyroidism
  • ~ Irritable bowel syndrome
  • . y Munchausen syndrome – Made-up diarrhea, false diarrhea.

Chronic Diarrhea Diagnosis

  • History
  • General examination
  •  History of medications
  • Gross examination of stools
  • Microscopic examination
  • Screen for gastrin, VIP – vasoactive intestinal peptide, calcitonin
  • Diarrhea in the elderly (≥ 70 years of age) or the immunocompromised
  • Severe abdominal pain
  • Recent use of antibiotics or hospitalized patients
  • TSH
  • Upper endoscopy and colonoscopy
  • Small bowel barium x-ray
  • Test of lactose intolerance
  • Culture of stools
  • Biopsies by colonoscopy .

Chronic Diarrhea Treatment

  • Treatment of etiology
  • Avoid lactose in lactase deficiency Stop the offending medications
  • Diphenoxylate or loperamide to stop the diar­rhea
  • Tincture of opium, codein for severe diarrhea Clonidine in diabetic diarrhea
  • Fat soluble vitamins in chronic steatorrhoea.