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14-September-2008 18:38:49 - Diarrhea December 2007 For other uses, see Diarrhea disambiguation. In medicine, diarrhea, also spelled diarrhoea see spelling differences, is frequent loose or liquid bowel movements. Acute diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. Diarrhea Classification and external resources ICD-10 A09., K59.1 ICD-9 787.91 DiseasesDB 3742 eMedicine ped/583 MeSH D003967 Contents 1 Causes 2 Types of diarrhea 2.1 Secretory diarrhea 2.2 Osmotic diarrhea 2.3 Motility-related diarrhea 2.4 Inflammatory diarrhea 2.5 Dysentery 3 Infectious diarrhea 4 Malabsorption 5 Inflammatory bowel disease 6 Irritable Bowel Syndrome 7 Other important causes 8 Alcohol 9 Treatment 10 See also 11 Footnotes 12 External links Causes Diagram of the human gastrointestinal tract. Diagram of the human gastrointestinal tract. Diarrhea commonly results from gastroenteritis caused by viral infections, parasites or bacterial toxins.1 In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy patient usually recovers from viral infections in a few days. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment.2 Diarrhea 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 or severe mushroom poisoning syndromes. Though appendicitis patients do not generally have violent diarrhea, it is a common symptom of a ruptured appendix. It is also an effect of severe radiation sickness. Diarrhea can also be caused by dairy intake in those who are lactose intolerant. Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary. The following types of diarrhea indicate medical supervision is required: Diarrhea in infants Moderate or severe diarrhea in young children; Diarrhea associated with blood Diarrhea that continues for more than two days; Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc; Diarrhea in travelers, since they are more likely to have exotic infections such as parasites; Diarrhea in food handlers, because of the potential to infect others; Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes. A severity score is used to aid diagnosis in children.3 Types of diarrhea There are at least four types of diarrhea: secretory diarrhea, osmotic diarrhea, motility-related diarrhea, and inflammatory diarrhea. Secretory diarrhea Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. Osmotic diarrhea Osmotic diarrhea occurs when too much water is drawn into the bowels. This can be the result of maldigestion e.g., pancreatic disease or Coeliac disease, in which the nutrients are left in the lumen to pull in water. Osmotic diarrhea can also be caused by osmotic laxatives which work to alleviate constipation by drawing water into the bowels. In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who does not have lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who do not have fructose malabsorption, excess fructose intake can still cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol often found in sugar-free foods are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. Motility-related diarrhea Motility-related diarrhea is caused by the rapid movement of food through the intestines hypermotility. If the food moves too quickly through the GI tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and occasionally real diarrhea. Diarrhea can be treated with antimotility agents such as loperamide. Inflammatory diarrhea Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. Dysentery Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is caused by an excess of water by a release of antidiuretic hormone from the posterior pituitary gland. Dysentery is a symptom of, among others, Shigella, Entamoeba Histolytica, and Salmonella. Infectious diarrhea Main article: Infectious diarrhea Infectious diarrhea is diarrhea caused by a microbe such as a bacterium, parasite, or virus. Malabsorption Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas. Causes include celiac disease intolerance to wheat, rye, and barley gluten, the protein of the grain, 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, including agents used in chemotherapy. Inflammatory bowel disease The two overlapping types here are of unknown origin: Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum. Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel. Irritable Bowel Syndrome Main article: Irritable Bowel Syndrome Another possible cause of diarrhea is Irritable Bowel Syndrome IBS. Symptoms defining IBS: abdominal discomfort or pain relieved by defecation and unusual stool diarrhea or constipation or both or stool frequency, for at least 3 days a week over the previous 3 months.4 IBS symptoms can be present in patients with a variety of conditions including food allergies, infective diarrhea, celiac, and inflammatory bowel diseases. Treating the underlying condition celiac disease, food allergy, bacterial dysbiosis, etc. usually resolves the diarrhea.5 IBS can cause visceral hypersensitivity. While there is no direct treatment for undifferentiated IBS, symptoms, including diarrhea, can sometimes be managed through a combination of dietary changes, soluble fiber supplements, and/or medications. It is important to note that IBS can often be confused with Giardiasis since false negative tests for giardia can result in a misdiagnoses of the actual cause, a parasitic infection.6 Other important causes Ischemic bowel disease. This usually affects older people and can be due to blocked arteries. Bowel cancer: Some but not all bowel cancers may have associated diarrhea. Cancer of the large intestine is most common. Hormone-secreting tumors: some hormones e.g. serotonin can cause diarrhea if excreted in excess usually from a tumor. Bile salt diarrhea: excess bile salt entering the colon rather than being absorbed at the end of the small intestine can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a bad side-effect of gallbladder removal. It is usually treated with cholestyramine, a bile acid sequestrant. Celiac Disease Intestinal Protozoa such as Giardiasis6 Alcohol Chronic diarrhea can be caused by chronic ethanol ingestion.7 Consumption of alcohol affects the body's capability to absorb water - this is often a symptom that accompanies a hangover after a heavy drinking session. The alcohol itself is absorbed in the intestines and as the intestinal cells absorb it, the toxicity causes these cells to lose their ability to absorb water. This leads to an outpouring of fluid from the intestinal lining, which is in turn poorly absorbed. The diarrhea usually lasts for several hours until the alcohol is detoxified and removed from the digestive system. Symptoms range from person to person and are influenced by both the amount consumed as well as physiological differences. Treatment In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. Medicines that are available without a doctor's prescription include loperamide Imodium and bismuth subsalicylate as found in Pepto Bismol and Kaopectate.8 See also Constipation Drinking water Feces Steatorrhea fatty diarrhea Traveler's diarrhea Wilderness diarrhea Food poisoning The Diarrhea Song Shigella Rotavirus ETEC Footnotes ^ Wilson ME 2005. Diarrhea in nontravelers: risk and etiology. Clin. Infect. Dis. 41 Suppl 8: S541-6. doi:10.1086/432949. PMID 16267716. ^ Alam NH, Ashraf H 2003. Treatment of infectious diarrhea in children. Paediatr Drugs 5 3: 151-65. PMID 12608880. ^ Ruuska T, Vesikari T 1990. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand. J. Infect. Dis. 22 3: 259-67. doi:10.3109/00365549009027046. PMID 2371542. ^ Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC 2006. Functional bowel disorders. Gastroenterology 130 5: 1480-91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561. ^ Wangen, S. The Irritable Bowel Syndrome Solution. page 113. 2006; Innate Health Publishing. ISBN 978-0-9768537-8-7. Excerpted with the author's permission at http://www.IBSTreatmentCenter.com ^ a b Intestinal Protozoa ^ Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1. ^ Schiller LR 2007. Management of diarrhea in clinical practice: strategies for primary care physicians. Rev Gastroenterol Disord 7 Suppl 3: S27-38. PMID 18192963. External links Look up diarrhea in Wiktionary, the free dictionary. Victora CG, Bryce J, Fontaine O, Monasch R 2000. Reducing deaths from diarrhoea through oral rehydration therapy. Bull. World Health Organ. 78 10: 1246-55. PMID 11100619. Parashar UD, Bresee JS, Glass RI 2003. The global burden of diarrhoeal disease in children. Bull. World Health Organ. 81 4: 236. doi:10.1590/S0042-96862003000400003. PMID 12764488. Travelers' Diarrhea Rehydration Project v d e Digestive system - Digestive disease - Gastroenterology primarily K20-K93, 530-579 Upper GI tract Esophagus Esophagitis Candidal - Boerhaave syndrome - UES Zenker's diverticulum - LES Barrett's esophagus, Mallory-Weiss syndrome - Esophageal motility disorder Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD - Esophageal stricture - Megaesophagus Stomach Gastritis Atrophic, Ménétrier's disease, Gastroenteritis - Peptic gastric ulcer/Dieulafoy's lesion - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome - Gastric volvulus Intestinal/ enteropathy Small intestine/ duodenum/jejunum/ileum Enteritis Duodenitis, Jejunitis, Ileitis Peptic duodenal ulcer Malabsorption: Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Large intestine appendix/colon Appendicitis - Colitis Pseudomembranous, Ulcerative, Ischemic Functional colonic disease IBS, Intestinal pseudoobstruction/Ogilvie syndrome Megacolon/Toxic megacolon - Diverticulitis/Diverticulosis Large and/or small Enterocolitis Necrotizing - IBD Crohn's disease vascular: Abdominal angina - Mesenteric ischemia - Angiodysplasia Bowel obstruction: Ileus - Intussusception - Volvulus - Fecal impaction Constipation - Diarrhea Rectum/anus Proctitis Radiation proctitis - Proctalgia fugax - Rectal prolapse - Anal fissure/Anal fistula - Anal abscess Accessory Liver Hepatitis Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis - Cirrhosis PBC - Fatty liver NASH - vascular Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver - Alcoholic liver disease - Liver failure Hepatic encephalopathy, Acute liver failure - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Cholecystitis - Gallstones/Cholecystolithiasis - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis PSC, Ascending - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia - Gallstones/Cholelithiasis common bile duct Choledocholithiasis, Biliary dyskinesia Pancreatic Pancreatitis Acute, Chronic, Herary - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal Indirect, Direct - Umbilical - Incisional - Femoral Obturator hernia - Spigelian hernia Peritoneal Peritonitis Spontaneous bacterial peritonitis - Hemoperitoneum - Pneumoperitoneum GI bleeding Upper Hematemesis, Melena - Lower Hematochezia See also congenital, neoplasia Retrieved from http://en..org/wiki/Diarrhea Categories: Gastroenterology | Water-borne diseases | Symptoms | Digestive disease symptoms | Conditions diagnosed by stool testHidden category: Articles needing additional references from December 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Anglo-Saxon العربية Asturianu Aymar বাংলা Català Česky Dansk Deutsch Español Esperanto Ù?ارسی Français Gà idhlig í•œêµì–´ Hrvatski Bahasa Indonesia Ã?slenska Italiano עברית Latina Lietuvių Magyar Bahasa Melayu Nederlands 日本語 ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Occitan Polski Português Română Runa Simi РуÑ?Ñ?кий Shqip Sicilianu Simple English SlovenÄ?ina SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Srpskohrvatski / СрпÑ?кохрватÑ?ки Basa Sunda Suomi Svenska తెలà±?à°—à±? Türkçe УкраїнÑ?ька ä¸æ–‡ This page was last modified on 9 September 2008, at 18:35
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