Diarrhea Causes Diagnosis Symptoms Treatment
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
- Acute — ≤ 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
- Causes 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 diarrhepa is usually due to infections.
- There is vomiting, fever and. abdominal pain.
- Acute — ≤ 14 days in duration
Causes of Acute Diarrhea
- Medications or drug induced
- Toxin ingestion
Infections (which cause diarrheal
- E. coli
- Staphylococcus aureus Hepatitis A and B
- Clostridium difficile.
Medications (which cause diarrhea)
- Loose liquid stools ± blood or mucus
- 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.
- 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 – QUinolones like ciprofloxacin 500 mg BD for 5 days
- Metronidazole 250 mg qid for 7 days.
- 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
- ~ Irritable bowel syndrome
- . y Munchausen syndrome – Made-up diarrhea, false diarrhea.
Chronic Diarrhea Diagnosis
- 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
- 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.