Diarrhea

 What is Diarrhea

Diarrhea occurs because more fluid passes through the large intestine (colon) than that organ can absorb. As a rule, the colon can absorb several times more fluid than is required on a daily basis. However, when this reserve capacity is overwhelmed, diarrhea occurs.

Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent absorption of fluids. Also, certain substances in the colon, such as fats and bile acids, can interfere with water absorption and cause diarrhea. In addition, rapid passage of material through the colon can also do the same.

Symptoms related to any diarrheal illness are often those associated with any injury to the gastrointestinal tract, such as fever, nausea, vomiting, and abdominal pain. All or none of these may be present depending on the disease causing the diarrhea. The number of bowel movements can vary—up to 20 or more per day. In some patients, blood or pus is present in the stool. Bowel movements may be difficult to flush (float) or contain undigested food material.

The most common causes of acute diarrhea are infections (the cause of traveler's diarrhea), food poisoning, and medications. Medications are a frequent and often over-looked cause, especially antibiotics and antacids. Less often, various sugar free foods, which sometimes contain poorly absorbable materials, cause diarrhea.

Chronic diarrhea is frequently due to many of the same things that cause the shorter episodes (infections, medications, etc.); symptoms just last longer. Some infections can become chronic. This occurs mainly with parasitic infections (such as Giardia) or when patients have altered immunity (AIDS).

The following are the more usual causes of chronic diarrhea:

• AIDS
• colon cancer and other bowel tumors
• endocrine or hormonal abnormalities (thyroid, diabetes mellitus, etc.)
• food allergy
• inflammatory bowel disease (Crohn's disease and ulcerative colitis)
• lactose intolerance
• malabsorption syndromes (celiac and Whipple's disease)
• other (alcohol, microscopic colitis, radiation, surgery)

 

Acute & Chronic Diarrhea

Is the medical term given to the type of diarrhea that can last between three and five days. It is fairly common and as stated before is likely to occur at some stage in your life. It can be as a result of an infection or as a side affect of some kind of medication that you may have been prescribed. It is also scary to know that acute diarrhea is particularly lethal in developing countries around the world. it has been stated by the World Health Organization that three and a half million people die each year from diarrhea. Even more startling is the fact that eight per cent of those who die are actually children under the age of five. Reason that they are far more likely to be in danger then adults is because they do not have fully eve loped immune systems by that age.

This is the term used to describe a more severe case of diarrhea. It can often last more then a few days, sometimes weeks interrupting a person’s life leaving them at the mercy of their toilets for weeks.

The major effects of diarrhea are dehydration, malnutrition, and weight loss. Signs of dehydration can be hard to notice, but increasing thirst, dry mouth, weakness or lightheadedness (particularly if worsening on standing), or a darkening/decrease in urination are suggestive. Severe dehydration leads to changes in the body's chemistry and could become life-threatening. Dehydration from diarrhea can result in kidney failure, neurological symptoms, arthritis, and skin problems.

Acute: Treatment

Treatment is ideally directed toward correcting the cause; however, the first aim should be to prevent or treat dehydration and nutritional deficiencies. The type of fluid and nutrient replacement will depend on whether oral feedings can be taken and the severity of fluid losses. Oral dehydration solution (ORS) or intravenous fluids are the choices; ORS is preferred if possible.

The World Health Organization (WHO) has provided this easy recipe for home preparation, which can be taken in small frequent sips:

• Table salt—3/4 tsp
• Baking powder—1 tsp
• Orange juice—1 c
• Water—1 qt (1l)

• Treatment is generally supportive
• Fluid resuscitation (oral, if possible, or IV)
• Antimotility agents: Opiates (e.g., loperamide) and parasympathetic inhibitors (e.g., diphenoxylate plus atropine); former concerns that these agents may slow the clearance of pathogens have been disproved

Antibiotic therapy is reserved for severe disease
–Most authorities recommend empiric treatment with a fluoroquinolone or trimethoprin-sulfamethoxasole in patients with severe or bloody diarrhea, fever, or fecal leukocytes

If Giardia, C. difficile, or E. histolytica is suspected, treat empirically with metronidazole

Antibiotic therapy increases the risk of hemolytic-uremic syndrome in children with E. coli

There is no good evidence that antibiotics prolong the carrier state in Salmonella infections

Advise patient to hydrate with glucose-containing, caffeine-free beverages, and to avoid lactose, sorbitol-containing gum, and raw fruit until symptoms subside

Chronic: Treatment

• Fluid resuscitation: Oral, if possible, or IV (e.g., normal saline or lactated Ringer's)

Nonspecific anti diarrheal agents (e.g., loperamide, codeine, tincture of opium) and fiber supplementation may be attempted initially

• Diabetic neuropathy: Control blood sugar, metoclopramide may be used
• Irritable bowel syndrome: High-fiber diet, anticholinergics

Inflammatory bowel disease is treated with steroids for acute exacerbations and daily prophylactic therapy with 5-aminosalicyclic agents
–Bowel resection may be necessary

• Lactose intolerance: Lactose-free diet
• Diseases of malabsorption: Gluten-free diet, long-term antibiotics
• Intestinal neoplasm: Consultation with gastroenterology, oncology, and/or surgery

Eat small meals that are easy on your stomach

Eat small meals throughout the day, instead of 3 large meals.

Your doctor or nurse may suggest the BRAT foods. BRAT stands for:
Bananas
Rice
Applesauce
Toast

Caution

·        Don't eat spicy, greasy, or fried foods.

·        Don't have milk or dairy products such as cheese or ice cream. Check food     labels to see if milk products are listed.

·        Don't have drinks with caffeine or alcohol.

·          You may need to avoid or have less raw fruit, vegetables, and whole wheat   breads and cereals.