Diarrhea Disease

BASICS

DESCRIPTION

Diarrhea of abrupt onset in a healthy individual is most often related to an infectious process. A variety of symptoms are often observed, including frequent passage of loose or watery stools, fever, chills, anorexia, vomiting and malaise.

Acute viral diarrhea - the most common form, usually occurs for 1-3 days, and is self-limited. It causes changes in the small intestine cell morphology such as villous shortening and an increase in the number of crypt cells.
Bacterial diarrhea - may be suspected if there is a history of a similar and simultaneous illness in individuals who have shared contaminated food with the patient. Diarrhea developing within 12 hours of the meal is most likely due to ingestion of a preformed toxin.
Protozoal infections - such as Giardia lamblia cause prolonged, watery diarrhea that often afflicts travelers returning from endemic areas where the water supply has been contaminated.
Traveler's diarrhea - typically begins three to seven days after arrival in a foreign location and is generally quite acute
System(s) affected: Gastrointestinal, Endocrine/Metabolic
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: All ages
Predominant sex: N/A

SIGNS AND SYMPTOMS

Loose liquid stools +/- blood or mucus
Fever
Abdominal pain and distension
Headache
Anorexia
Malaise
Vomiting
Myalgia
With Giardia - cramping, pale-greasy stools, fatigue, weight loss, chronicity

CAUSES

Bacterial
- E. coli
- Salmonella
- Shigella
- Campylobacter jejuni
- Vibrio parahaemolyticus
- Vibrio cholerae
- Yersinia enterocolitica
Viral
- Rotavirus
- Norwalk virus
Parasitic
- Giardia lamblia
- Cryptosporidium
- Entamoeba histolytica

RISK FACTORS

Individual from an industrialized country visiting a developing country
Immunocompromised host

DIAGNOSIS

LABORATORY

CBC - increased WBC with a left shift may indicate an infectious process; decreased hemoglobin/hematocrit may indicate anemia from blood loss
Serum electrolytes - increased sodium from dehydration, decreased potassium from diarrhea
BUN, creatinine - elevated in dehydration
pH - hyperchloremic acidosis
Stool sample - occult blood (present in IBD, bowel ischemia, bacterial infections), fecal leukocytes (present in diarrhea caused by Salmonella, Campylobacter, Yersinia), bacterial culture and sensitivity (for Salmonella, Yersinia, Shigella, Campylobacter), ova and parasites, C. difficile toxin, Ziehl-Neelsen stain (for Cryptosporidium)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Viral diarrhea - changes in small intestine cell morphology that include villous shortening, increased number of crypt cells and increased cellularity of the lamina propria
Bacterial diarrhea - bacterial invasion of colonic wall leads to mucosal hyperemia, edema and leukocytic infiltration

SPECIAL TESTS

N/A

IMAGING

Abdominal x-rays (flat plate and upright) are indicated in patients with abdominal pain or evidence of obstruction to rule out toxic megacolon and bowel ischemia

DIAGNOSTIC PROCEDURES

Sigmoidoscopy indicated in patients with bloody diarrhea or suspected pseudomembranous or ulcerative colitis

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient except for complicating emergencies (dehydration)

GENERAL MEASURES

Replacement of lost fluid and electrolytes
Clear liquids such as tea, broth, carbonated beverages (without caffeine) and rehydration fluids (e.g., Gatorade) to replace lost fluid
Packets of rehydration salts (one packet to be diluted in one quart of water); drink until thirst is quenched; will help in replacing lost electrolytes. Treatment of choice for pediatric patients.

SURGICAL MEASURES

N/A

ACTIVITY

Bedrest

DIET

During periods of active diarrhea, avoid coffee, alcohol, dairy products, most fruits, vegetables, red meats, and heavily seasoned foods
After 12 hours with no diarrhea, begin by eating clear soup, salted crackers, dry toast or bread, and sherbet
As stooling rate decreases, slowly add to diet, rice, baked potato, and chicken soup with rice or noodles
As stool begins to retain shape, add to diet baked fish, poultry, applesauce, and bananas

PATIENT EDUCATION

See guidelines in Prevention/Avoidance

FOLLOW UP

PREVENTION/AVOIDANCE

Frequent oversights during foreign travel include brushing teeth with contaminated water, ingesting ice cubes, or eating cold salads or meats
Avoid uncooked or undercooked seafood or meat, buffet meals left out for several hours, or food served by street vendors

POSSIBLE COMPLICATIONS

Dehydration
Sepsis
Shock
Anemia

EXPECTED COURSE AND PROGNOSIS

A common problem that is rarely life-threatening if attention is given to maintaining adequate hydration

MISCELLANEOUS

ASSOCIATED CONDITIONS

Diabetes mellitus
Ileal resection
Gastrectomy
Hyperthyroidism

AGE-RELATED FACTORS

Pediatric:

Rotavirus is a common cause of viral diarrhea in the winter months and is accompanied with vomiting
Other etiologies include overfeeding, medications, cystic fibrosis and malabsorption

Geriatric: Watery diarrhea in elderly patient with chronic constipation may be caused by fecal impaction or obstructing neoplasm
Others: N/A

PREGNANCY

Avoid dehydration since this may lead to preterm labor

OTHER NOTES

N/A

ABBREVIATIONS

IBD = inflammatory bowel disease

Clinical Investigations

ROLE OF HOMOEOPATHY

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