DIARRHEA

DIARRHEA

diarrhea

Diarrhea is defined as passage of abnormally liquid (watery) or unformed (loose) stools at an increased frequency. Diarrhea may be classified into two (2) as acute if less than two (2) weeks, persistent if two (2) to four (4) weeks and chronic if more than four (4) weeks in duration. Diarrhea is among of the most common health complaints. Worldwide, more than one billion people suffer one or more episodes of acute diarrhea each year. Most cases of diarrhea are caused by an infection in the gastrointestinal tract. The microbes responsible for this infection include:

• bacteria
• viruses
• parasitic organisms

ACUTE DIARRHEA

Acute diarrhea refers to  at least three (3) liquid stools per day for less than two (2) weeks. Acute diarrhea is acquired by oral fecal route and transmitted by direct (dirty hands) or indirect (ingestion of contaminated water or food) contact with the pathogens; these cases are often associated with fever, vomiting and abdominal cramps.

There are 2 clinical types of acute diarrhea:

1. Simple diarrhea without blood, caused by viruses in 60% of cases (rotavirus, enterovirus), bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, non-typhi Salmonella, Yersinia enterocolitica) or parasites (giardiasis). Diseases, such as malaria, acute otitis media, upper and lower respiratory tract infections, can be accompanied by this type of diarrhea.
2. Dysentery or bloody diarrhea, caused by bacteria (Shigella in 50 percent of cases, Campylobacterjejuni, enteroinvasive or enterohaemorrhagic Escherichia coli, Salmonella) or parasites (intestinal amoebiasis).

Symptoms of acute diarrhea, includes:

• Profuse diarrhea without dehydration
• Grossly bloody stools in Dysentery diarrhea
• Fever more than 38.5 degree Celsius
• Abdominal pain / cramps
• Bloating

High-risk groups for acute diarrhea, includes:

• Immunodeficient person
• Travelers
• Institutionalized personnel
• Consumers of certain food and drinks
• Daycare attendees and their family member

CHRONIC DIARRHEA

Chronic diarrhea refers to diarrhea lasting more than four (4) weeks, most of the cause of the chronic diarrhea are noninfectious compared to acute diarrhea. Chronic diarrhea is characterized by abdominal cramps, nausea and vomiting and bloating. Chronic diarrhea can be life threatening if remain untreated due to its complications like dehydration, warning signs for dehydration are dark urine, excessive thirst, dizziness, fatigue, vomiting and fever. please see your doctors if you show these signs.

chronic diarrhea

Causes of chronic diarrhea, includes:

• Microscopic colitis: refers as persistent diarrhea that usually affects aged people, usually during the night.
• Malabsorptive and maldigestive diarrhea (Celiac disease): caused by impaired nutrient absorption, the second by impaired digestive function. 
• Chronic infections of bacteria and long term use of antibiotics can cause chronic diarrhea
• Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
• Endocrine causes (Addison disease and carcinoid tumors): hormonal factors cause diarrhea.
• Cancer causes: Neoplastic diarrhea is associated with a number of gut cancers.
• Inflammatory bowel disease (IBD) (ulcerative colitis or Crohn’s disease.) is another cause of chronic diarrhea. 

TREATMENT FOR ACUTE DIARRHEA

Medications can reduce diarrhea output and zinc supplement is effective to reduce severity and duration of acute diarrhea in children under five years old.

re-hydration solution ORS

• Fluid replacement is very important in all form of acute diarrhea, in mild cases only oral solutions (Oral Rehydration Salts - ORS) are enough to prevent dehydration but for dehydrated patient especially infants and children they require intravenous rehydration in hospital setting.
• Anti-motility and anti-secretory agents such as loperamide or Imodium may be used to relief symptoms in moderately severe non febrile and non bloody diarrhea patients.
• Antibiotics such as quinolone group (ciprofloxacin 500 mg twice a day for three to five days for moderate to severe ill patient with febrile dysentery), for giardiasis (metronidazole 250 mg three times a day for seven days) is appropriate required for acute diarrhea to reduce severity and duration, for travelers and immunodeficient patients who are at risk of diarrhea ciproflaxacin, trimethoprim/sulfamethoxazole can be used as antibiotic prophylaxis. Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in adults and children but should be avoided for the immunodeficient patient. 

NB> (For dose prescription of these Drugs please see your Doctor).

TREATMENT OF CHRONIC DIARRHEA

Treatment of chronic diarrhea depend on the specific cause of origin and may be cured (cause is eradicated), suppressed or empirical. Anti Diarrhea can be to relieve the symptoms of watery / loose stool but these medications are not recommended for long term therapy so treating the cause of chronic diarrhea is necessary. Lifestyle and food such as high fiber food, alcohol drinking and drinking caffeine or beverages may be factors that contribute to the illness, avoiding those factors is essential on improvement of the illness.     

INVESTIGATIONS FOR PATIENT WITH DIARRHEA

• Full blood count: Anemia or a raised platelet count will indicate nature of infections
• Liver function tests: This will include testing albumin levels.
• Tests for malabsorption: These will check the absorption of calcium, vitaminB-12, and folate. They will also assess iron status and thyroid gland function.
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Raised levels may indicate gastrointestinal diseases such as inflammatory bowel disease (IBD).
• Testing for antibodies: This may detect celiac disease.

PREVENTION MEASURES FOR DIARRHEA

• clean and safe drinking water
• wash fruits and vegetables before consuming them.
• good sanitation systems, for example, waste water and sewage
• clean kitchen surfaces to prevent contamination.
• good hygiene practices, including hand washing with soap after defecation, a before preparing food, and before eating
• breastfeeding for the first 6 months of life
• provision of heath education on diarrhea
• wash your hands after using the bathroom, changing a diaper, or attending to a sick person.