DIARRHEA

 

INTRODUCTION:  Diarrhea is a condition defined by an increased frequency of bowel movements that is to say, more than three per day, increased amount of stool, and altered consistency which is usually referred to as liquid stool. It is usually associated with urgency, perianal discomfort, incontinence, or a combination of these factors. Diarrhea can result from any condition that causes increased intestinal secretions, decreased mucosal absorption, or altered motility.

TYPES OF DIARRHEA:  Types of diarrhea include secretory, osmotic, malabsorptive, infectious, and exudative. It can be acute where it can be self-limiting and often associated with infection, or chronic which persists for a long period and may return sporadically. It can be caused by certain medications, tube feeding formulas, metabolic and endocrine disorders, and viral and bacterial infections. Other causes are nutritional and malabsorptive disorders, anal sphincter deficit, Zollinger–Ellison syndrome, paralytic ileus, acquired immunodeficiency syndrome (AIDS), and intestinal obstruction. Intestinal obstruction:  AIDS

CLINICAL MANIFESTATIONS:  Increased frequency and fluid content of stool.  Abdominal cramps, distention, intestinal rumbling, anorexia, and thirst.  Painful spasmodic contractions of the anus and ineffectual straining (tenesmus) with each defecation.  Other symptoms, depending on the cause and severity and related to dehydration and fluid and electrolyte imbalances, include the following: Watery stools, which may indicate small bowel disease.  Inflammatory bowel disease  

Loose, semisolid stools, which are associated with disorders of the large bowel.  Voluminous greasy stools, which suggest intestinal malabsorption.  Blood, mucus, and pus in the stools, which denote inflammatory enteritis or colitis.  Oil droplets on the toilet water, which are diagnostic of pancreatic insufficiency.  Nocturnal diarrhea, which may be a manifestation of diabetic neuropathy.

COMPLICATIONS:  Complications of diarrhea include cardiac dysrhythmias due to fluid and electrolyte (potassium) imbalance, urinary output less than 30 mL/h, muscle weakness, paresthesia, hypotension, anorexia, drowsiness, skin care issues related to irritant dermatitis, and death if imbalances become severe.

ASSESSMENT AND DIAGNOSTIC FINDINGS:  When the cause is not obvious: complete blood cell count; serum chemistries; urinalysis; routine stool examination; and stool examinations for infectious or parasitic organisms, bacterial toxins, blood, fat, electrolytes, and white blood cells. Endoscopy or barium enema may assist in identifying the cause. 

MEDICAL MANAGEMENT:  Primary medical management is directed at controlling symptoms, preventing complications, and eliminating or treating the underlying disease.  Certain medications such as, antibiotics, anti-inflammatory agents and antidiarrheals like, loperamide, diphenoxylate may reduce the severity of diarrhea and the disease.  Increase oral fluids; oral glucose and electrolyte solution may be prescribed.  Antimicrobials are prescribed when the infectious agent has been identified or diarrhea is severe. IV therapy is used for rapid hydration in very young or elderly patients.

RELATED;

1.  CONSTIPATION

2.  ULCERATIVE COLITIS

3.  INFLAMMATORY BOWEL DISEASE

4.  PEPTIC ULCER DISEASE

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