| Diarrhea |
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Name = Diarrhoea | ICD10 = A09, K58, K59.1 | ICD9 = 009.2-009.3, 558.9, 564.5 | }} Diarrhea ('' American English '') or '''diarrhoea''' ('' Commonwealth English '') is a condition in which the sufferer has frequent loose Bowel Movement s (from the ancient Greek word διαρροή = leakage; lit. "to run through"). In the Third World , diarrhea is the most common cause of death among infants, killing more than 1.5 million per year. Causes This condition can be a Symptom of anal trauma, Disease , Allergy , food intolerance ( Fructose , Lactose ), Foodborne Illness or extreme excesses of Vitamin C or magnesium and is usually accompanied by abdominal pain, and often Nausea and Vomiting . There are other conditions which involve some but not all of the symptoms of diarrhea, and so the formal medical definition of diarrhea involves defecation of more than 200 grams per day (though formal weighing of stools to determine a diagnosis is never actually carried out). It occurs when insufficient fluid is absorbed by the colon. As part of the Digestion process, or due to fluid intake, Food is mixed with large amounts of water. Thus, digested food is essentially liquid prior to reaching the colon. The colon absorbs water, leaving the remaining material as a semisolid stool. If the colon is damaged or inflamed, however, absorption is inhibited, and watery stools result. Diarrhea is most commonly caused by myriad Viral infections but is also often the result of Bacteria l toxins. In sanitary living conditions and with ample food and water available, an otherwise healthy patient typically recovers from the common viral infections in a few days and at most a week. However, for ill or malnourished individuals diarrhea can lead to severe Dehydration and can become life-threatening without treatment. It can also be a symptom of more serious diseases, such as Dysentery , Cholera , or Botulism and can also be indicative of a chronic syndrome such as Crohn's Disease . Though Appendicitis patients don't generally have diarrhea, it is a common symptom of a ruptured Appendix . It is also an effect of severe Radiation Sickness . Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with Electrolyte s to provide essential Salt s and some amount of Nutrient s. For many people, further treatment and formal medical advice is unnecessary. The following types of diarrhea generally indicate medical supervision is desirable:
Since most people will ignore very minor diarrhea, a patient who actually presents to a doctor is likely to have diarrhea that is more severe than usual. Mechanism To evacuate the contents of the lower digestive tract, the fluidity of the contents of the small and large intestines is increased. Active Transport of Na+ back into the gut initiates a reverse sodium transport. This causes both Cl- and HCO3 to follow passively, as well as water. Now in the intestines, the water dilutes toxins as well as triggers contractions of the intestine due to increase in intestinal distension. These contractions push the contents of the lower GI tract towards and out of the anal canal. Medication s such as Loperamide are designed to prevent such contractions in response to the distension, and should not be used to prevent diarrhea. Such inhibition actually prolongs the infection or irritation, and can cause a worsening over time because the evacuation of the bowel contents has been delayed. Acute diarrhea This may be defined as diarrhea that lasts less than 4 weeks, and is also called Enteritis . This can nearly always be presumed to be infective, although only in a minority of cases is this formally proven. It is often reasonable to reassure a patient, ensure adequate fluid intake, and wait and see. In more severe cases, or where it is important to find the cause of the illness, stool cultures are instituted. The most common organisms found are Campylobacter (an organism of animal origin), Salmonella (also often of animal origin), Cryptosporidiosis (animal origin), Giardia Lamblia (lives in drinking water). Shigella (dysentery) is less common, and usually human in origin. Cholera is rare in Western countries. It is more common in travelers and is usually related to contaminated water (its ultimate source is probably sea water). Escherichia Coli is probably a very common cause of diarrhea, especially in travelers, but it can be difficult to detect using current technology. The types of E. coli vary from area to area and country to country. Virus es, particularly Rotavirus , are common in children. (Viral diarrhea is probably over-diagnosed by non-doctors). The Norwalk Virus is rare. Toxins and food poisoning can cause diarrhea. These include Staphylococcal toxin (often milk products due to an infected wound in workers), and Bacillus cereus (eg rice in Chinese takeaways). Often "food poisoning" is really salmonella infection. Parasites and worms sometime cause diarrhea but often present with weight loss, irritability, Rash es or anal itching. The most common is Pinworm (mostly of nuisance value rather than a severe medical illness). Other worms, such as Hookworm , ascaria, and Tapeworm are more medically significant and may cause weight loss, anemia, general unwellness and allergy problems. Amoebic Dysentery due to '' Entamoeba Histolytica '' is an important cause of bloody diarrhea in travelers and also sometimes in western countries which requires appropriate and complete medical treatment. Chronic diarrhea Infective diarrhea It is not uncommon for diarrhea to persist. Diarrhea due to some organisms may persist for years without significant long term illness. More commonly a diarrhea will slowly ameliorate but the patient becomes a carrier (harbors the infection without illness). This is often an indication for treatment, especially in food workers or institution workers. Parasites (worms and amoeba) should always be treated. Salmonella is the most common persistent bacterial organism in humans. Malabsorption These tend to be more severe medical illnesses. Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas. Causes include Celiac Disease (intolerance to Gluten , a wheat product), Lactose Intolerance (Intolerance to milk sugar, common in non-Europeans), Fructose Malabsorption , Pernicious Anemia (impaired bowel function due to the inability to absorb Vitamin B12 ), loss of pancreatic secretions (may be due to cystic fibrosis or pancreatitis), short bowel syndrome (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs such as chemotherapy. Inflammatory bowel disease There are of unknown origin but are likely to be abnormal immune responses to infection. There is some overlap but the two types are Ulcerative Colitis and Crohn's Disease :
Irritable Bowel Syndrome Irritable Bowel Syndrome is of unknown origin but often results from an insult to the gut, and as such can overlap with infective diarrhea, celiac, and inflammatory bowel diseases. IBS is a brain-gut dysfunction that causes visceral hypersensitivity and results in chronic diarrhea (or constipation) in association with lower abdominal pain or discomfort. While there is no direct treatment for the underlying pathology of IBS, symptoms, including diarrhea, can be well managed through a combination of dietary changes, soluble fiber supplements, and/or medications. Gut-directed hypnotherapy is also a very promising avenue of treatment. Other important causes
Treatment of diarrhea #Keep hydrated with properly balanced Electrolytes . This is the most appropriate treatment in most cases of diarrhea, even dysentery. Consuming large amounts of water unbalanced by dietary electrolytes may result in a dangerous Electrolytic Imbalance which in rare cases can prove fatal (cf. Water Poisoning ). #Try eating more but smaller portions. Eat regularly. Don't eat or drink too quickly. # can be life-threatening and intravenous fluid may be required. # Oral Rehydration Therapy : Taking a sugar/salt solution, which can be absorbed by the body. # ( Diphenoxylate with Atropine ); Lonox ( Difenoxin with atropine); Codeine ; Paregoric (camphorated tincture of opium), Opium Tincture (laudanum); and Morphine . The most potent opioids are generally reserved for chronic diarrhea (e.g., from complications of AIDS ). #) require appropriate antibiotics. Antibiotics are not routinely used, as the cause is rarely bacterial and antibiotics may further upset intestinal flora and ''worsen'' rather than improve the diarrhea. '' Clostridium Difficile ''-associated diarrhea and Pseudomembranous Colitis is often caused by antibiotic use. #Dietary manipulation: in particular, patients with Celiac Disease should avoid wheat products. Patients with Irritable Bowel Syndrome can make dietary changes to prevent the over-reaction of their gastrocolic reflex that results in diarrhea. Having soluble fiber foods and supplements, substituting soy or rice products for dairy, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating regular small amounts can all help to lessen the symptoms of IBS (Van Vorous 2000). Foods and beverages to be avoided or minimized include red meat, oily or fatty (and fried) products, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages (especially those also containing sorbitol) and artificial sweeteners (Van Vorous 2000). Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats, insoluble fibers, and fructose (Caldarella, 2005; Whorwell, 1994; Choi, 2003). # Hygiene and isolation: Hygiene is important in limiting spread of the disease. #It is claimed that some fruit, such as Banana s, Mango es, Papaya and Pineapple may have positive effects on this condition. Bananas have the merits of being easily obtainable, and they are unlikely to have any other significant unwanted side effects. Bananas and mangoes are high in soluble fiber, which can help regulate water content in the bowel and alleviate diarrhea. Mucilage, which can be obtained in capsule form, may be helpful for the same reason. Mucilage can also be used as cereal for babies, as it is easily digested. The high acid content of pineapple may make this food a bad choice for people suffering from chronic diarrhea. See also References
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