Diarrhea
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Campylobacter jejuni organism |
Digestive system |
Cryptosporidium, organism |
Alternative
names
Stools - watery; Frequent bowel
movements; Loose bowel movements Definition
The passage of an increased
amount of stool. This is frequently considered
to be 3 or more stools per day, or excessively watery
and unformed stool. Chronic diarrhea occurs
when loose or more frequent stools persist for longer
than two weeks. Considerations
The majority of diarrheal diseases result
from infection, and are generally short
lived, self-limiting conditions. Common forms of
diarrhea are grouped under terms such as "stomach
flu" and gastroenteritis. These conditions may include
vomiting, and often appear in mini-epidemics in
schools, neighborhoods, or families. Quite often
parents and local physicians are aware the stomach
flu is "going around".
Most diarrhea will stop without treatment in a few
days. Certain drugs, such as antibiotics, can
cause or worsen diarrhea. Common
causes
Diarrheal diseases can be grouped into several general
categories.
INFECTIOUS
- viruses
- rotavirus
- Norwalk agent
- cytomegalovirus
(CMV)
- adenovirus
- echovirus
- HIV virus (see
HIV disease)
- bacteria
- shigella
- salmonella
- Escherichia coli
(commonly called "E. coli")
- Campylobacter jejuni
- Yersinia enterocolitica
- Clostridium difficile
(commonly called "C. diff")
- cholera (less of
a problem in developed countries)
- Staphylococcus
aureus
- parasites
- Giardia Lamblia
- Cryptosporidium
parvum
- Entamoeba histolytica
- occasionally roundworm
(ascariasis) or tapeworm infestation
TOXIC
Often referred to as "food poisoning" Toxins may
be produced in foods as bacteria grow. These toxins
are responsible for the associated vomiting and
diarrhea. The most common toxin is an enterotoxin
produced by staphylococcus species.
MALABSORPTION
- lactose intolerance,
- celiac disease (sprue)
or gluten malabsorption
- cystic fibrosis
- cows milk protein intolerance
- intolerance to specific
foods (beans, fruit, etc.)
There are other less frequently encountered causes
of malabsorption.
INFLAMMATORY DISEASES OF THE BOWEL
- Crohn’s disease
- Ulcerative colitis
IMMUNE DEFICIENCY
- severe combined immunodeficiency
- hypogammaglobulinemia
- panhypogammaglobulinemia
(Bruton)
- chronic granulomatous
disease
- IgA deficiency
MEDICATIONS
- antibiotics
- laxatives (especially
those containing Magnesium)
- chemotherapy
CERTAIN TREATMENTS
- gastrectomy
- gastroenterostomy
- high-dose radiation
therapy
OTHER
- Zollinger-Ellison syndrome
- autonomic neuropathy
(diabetic neuropathy)
- Carcinoid syndrome
- Bacterial overgrowth
syndrome
Home
care
The risk of developing
diarrhea can be reduced by washing hands and avoiding
contaminated food, utensils, or other objects.
Children should be taught not to put objects in
their mouth. Wash hands before and after using
the bathroom and before meals.
Diarrhea that comes on
suddenly and ends in a day or two is usually caused
by an infection or food poisoning.
In general, don’t try
to stop diarrhea as soon as it develops. Diarrhea
is the body’s way of getting rid of whatever food,
virus, or bug is causing it.
Adults with diarrhea
In adults with diarrhea, it may help to drink plenty
of fluids to avoid becoming dehydrated.
In adults, non-prescription
medications such as Pepto-Bismol, Kaopectate,
Imodium, and Diasorb can help diarrhea. (Note:
Pepto-Bismol can discolor the stools dark black
and can cause the tongue to turn black. This is
a normal response to the medication and not something
to be concerned about).
Enteral (formula tube)
feedings often cause diarrhea. If you are experiencing
diarrhea related to enteral tube feedings, consult
your health care provider or dietician. The rate
of the feedings may need to be changed or bulk
agents may need to be added to the formula.
Adding bulk to the diet may thicken the stool
and decrease the frequency of stools. Certain
foods thicken the stools, including rice, bananas,
yogurt, and cheese. An increase in fiber from
whole-wheat grains and bran add bulk to the diet.
Additionally, psyllium containing products such
as Metamucil or similar products can be used to
add bulk to the stools.
Children with diarrhea
Children who are placed on antibiotics may experience
diarrhea. Recent studies suggest that children on
antibiotics are less likely to get diarrhea if they
eat yogurt with active live cultures.
In children with diarrhea,
it used to be recommended (but is no longer) to
have the child drink plenty of clear fluids and
avoid milk. Now, doctors recommend that children
with mild diarrhea should stay on their normal
diet -- children and infants with diarrhea should
continue getting their normal amount of milk.
It may help to switch these children to soy milk,
if they will take it, but that is not neccessary.
Pedialyte and similar
rehydration fluids do NOT treat diarrhea. They
are used for vomiting and cases of serious dehydration.
If a child has nausea
or vomiting, the liquids should be given in small
amounts but very frequently, often every 15 minutes.
(Give liquids as directed by a health care provider).
Home mixed electrolyte solutions should be avoided
-- mixing mistakes can cause significant problems.
Diarrhea medications,
even non-prescription ones, should NOT be used
in infants and children unless a doctor has approved
it. For example, Pepto-Bismol has aspirin-like
compounds that are not safe in children.
Traveler's diarrhea
- The best way to avoid
traveler’s diarrhea is to be careful about
what is consumed.
- "Boil it, peel it,
cook it, or don’t eat it," should apply to everything
on the menu of even the fanciest restaurant
in Latin American, Asian, or African countries.
Food eaten there should be prepared just prior
to serving.
- "Traveler’s diarrhea"
usually stops spontaneously.
- Drink lots of liquids
to replace the lost fluids.
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