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
• 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.

Diarrhea Causes Diagnosis Symptoms Treatment

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)

•  Antibiotics
• Antiarrhythmics
• Antihypertensives
• NSAIDS
• Anti-depressants
• Laxatives.

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 – QUinolones 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.