Diarrhea- Definition, Type Of Diarrhea And Causes, Symptoms, Type Of Stool, Diagnosis, And Management

 

I.  Introduction

Diarrhea is a common disease that frequently occurs in developing countries more than developed counties due to their living conditions and the knowledge related to hygiene and also the environment surrounded them. Throughout the world, that kind of disease rate is much higher in young children.

II. Definition

Diarrhea is a symptom that is caused by many diseases responded by the intestinal tract that can make you have diarrhea all day. It is classified based on the duration of the symptom and other features. Diarrhea is defined as an increase in the number of stools (3 or more per 24h), the fluidity of stool or liquid poop ( clear liquid poor), or the presence of blood (bloody diarrhea) and mucus with increased neutrophil polymorphs in the stool that can provoke patient diarrhea and fever.

III. Type of diarrhea and causes

A clinical classification based on the duration of diarrhea and stool character is important to identify the exact diagnosis. Acute diarrhea can be treated by using home remedies or self-limited and lasts for less than 2 weeks. Acute diarrhea that persists for longer than 14 days is classified as persistent diarrhea and if the duration longer than a month is called chronic diarrhea.

1/. Acute infective diarrhea

The pathogens causal for acute infectious diarrhea is divided into 2 types: invasive and noninvasive organisms. Noninvasive organisms produce watery diarrhea, usually through enterotoxin(infection released by bacterial or virus) affecting the small intestine. In opposite, invasive organisms, primarily affect the large bowel, invade the top layer of the intestine which results in bloody diarrhea and produces fever through an inflammatory response. Epidemics of acute infectious diarrhea also occur frequently in tropical regions. The reason for this is caused by environmental contamination, inadequate water supply, and poor sanitation.
The causes of acute infective diarrhea are Escherichia coli, Campylobacter jejuni, Campylobacter-like organisms, Yersinia, Rotarviruses, Norwalk-like viruses, Cryptosporidium, and others.
 The most common cause of diarrhea in temperate climates among small children during winter months is Rotavirus which one of the major causes of noninvasive diarrhea throughout the world. In contrast, the most common cause of inflammatory diarrhea throughout the world is Campylobacter Jejuni, followed by Salmonella, Shigella, Shigella, and Yersinia. Parasitic causes of diarrhea such as Giardia lamblia, Entamoeba histolytica, and S.Stercoralis are well worth recognizing and treating.

Causative agents of Acute Diarrhea

Viruses: Rotaviruses, Norwalk-like viruses

Bacteria: Enterotoxigenic E.coli, Campylobacter, Shigella, Yersinia, Vibrio, C.difficile

Parasites: Cryptosporidium, Giardia, Strongyloides, E.histolytica

2/. persistent diarrhea

The definition of persistent diarrhea is defined as an episode of acute infectious diarrhea that lasts for 14 days or longer, mostly occurs in children below 3 years of age. A specific microbial etiology has not been found but it may associate with E.coli (Escherichia coli). Malnutrition, particularly of micronutrients may be risk factors. Specific nutritional deficiencies should be corrected. Giving water and dietary supplement is crucial.

3/.Chronic diarrhea

Diarrhea is longer than a month found in a wide variety of conditions. A common presentation of human immunodeficiency virus-infected individuals is with a variety of opportunistic infections. The commonest type of chronic diarrhea in tropical countries is malabsorption syndromes.
Tropical sprue defined as a primary malabsorption syndrome of residents or visitors in certain tropical countries.

IV.Symptoms

 There are 3 clinical issues in patients with diarrhea :
       1.Significant dehydration?
       2.Infection requiring antibiotic therapy?
      3. Complications of nutritional deficiency, associated infections, renal failure …?
In acute infective diarrhea can be watery ( loose stools ), or bloody (dysentery).
Further possible symptoms :

• Fever
• Abdominal pain( diarrhea cramps )
• Blood in stool
• Nausea and vomiting
• Dehydration
• Chronic cases: malnutrition and, in children, failure to thrive

High-risk symptoms and exposures in acute diarrheal disease
Symptoms	Exposures
Profuse dehydration Symptoms of hypovolemia Febrile Bloody diarrhea Increased frequency Increased quantity	Extremes of illness in immunocompromised patients   Travel/occupation history Sick contacts Pregnancy Raw/undercooked meat/seafood/dairy

V.Type of stools

Actually, we can know the exact location of bleeding from the anus by the color of blood passed through. Black stools or dark-colored stools are due to the presence of blood altered by the intestinal enzymes or juices. Hematochezia is often used to notice the bleeding coming from a lower gastrointestinal bleeding source, whereas melena is often used to determine the bleeding from upper gastrointestinal bleeding.
Fatty stool or loose stool or floating is classified in many diseases such as pancreatic insufficiency or malabsorption syndrome.
Green stool results from food that moves through the large intestine quickly so It cannot take some time to break down completely.The color of the green given by green leafy vegetables, green food coloring, etc.

VI.Diagnosis

We can know clearly the main leading causes of this kind of disease by doing laboratory tests including tests of blood or take a piece of feces to examine the type of germs in that. If the patients have bloody diarrhea, we run more tests like endoscopy or coloscopy the verify the injury site or any diseases that mimic the real one.

VII.Management

Many patients that have acute or chronic diarrhea always lack water in the body or have trouble in concentration and more severity they can lose consciousness or coma and leads to death. So the first thing we should do is to give water if they can drink or perfusion from vessels for patients who unable to ingest water. If they still have symptoms, we should give them some medications to inhibit the movement of the intestinal tract due to toxins releasing from bacteria or viruses. The medications we use like Loperamide or Smecta oral solution to correct water in the body and reducing the movement of the bowels. For the cause of the infection( diarrhea and fever and alteration of consciousness), we should give the patients antibiotics (Attapulgite or Bismuth) that are sensible.

VIII. Conclusion

Diarrhea is a symptom of the secretory response of the gastrointestinal mucosa to a wide variety of stimuli. Many factors including enteric infection ( infection of the intestinal tract ), alteration in diet and food absorption, a variety of hormone factors, or a response to parenteral infection can result in symptoms of diarrhea. The strategy of maintaining hydration by oral rehydration solutions has been used to the reduction of mortality caused by this common disease, and anti-diarrheal medications are indicated only under specified conditions. persistent diarrhea with prolonged symptoms increases in the rate of the severity of the patients. On the other hand, chronic diarrhea is often associated with loose stool due to malabsorption of nutrients or bile acid diseases ( primary malabsorption syndrome).

Some tips to do to avoid diarrhea

• Not drinking unpasteurized milk or foods made with it
• Cooking meat and seafood until we have done
• Washing hands, knives after they touch raw food
• Cooking eggs until the yolk is firm