Diarrhea-Types, Causes, Treatment, Diagnosis, and Diet

Introduction

Diarrhea can be defined as the passage of loose and watery stools, frequency >3 times per day. Diarrhea word has been driven by the Greek word ‘Diarrhea’. Dia means "through" and rheo means "flow".

Diarrhea can occur at any age but it is more common in children below 5 years of age.

Clinical Types

Three clinical types of diarrhea:

Acute Diarrhea: Passage of loose and watery stools without any traces of blood, can be associated with vomiting and fever. If it persists more than 14 days it is called Persistent Diarrhea.

Chronic Diarrhea: It is long-lasting and recurrent due to non-infectious cause.

Dysentery: Diarrhea with blood. It is caused by Shigella, Entamoeba histolytica and Salmonella. See the table chart below!

Diarrhea on the basis pathophysiology (mechanism) is divided into the following types:

Osmotic Diarrhea: Poor absorption of osmotically active solutes in the intestinal tract and these osmotically active solutes draw more water from the intestinal tract into the bowel lumen. Magnesium salts, potassium and sulfate salts, mannitol, sorbitol, etc are osmotically active solutes.

 Malabsorption of certain carbohydrates is the most common deficit.

Secretory Diarrhea: It is caused by cholera toxin where the active chloride secretion occurs into the bowel lumen, water follows the chloride ion as the morning follows night, leading to a net loss of water.

Exudative Diarrhea: It is associated with the release of mucus, blood, fluid, and plasma proteins from cells. This occurs in infections such as E.coli or food poisoning. Also occurs in Ulcerative colitis.

Inflammatory Diarrhea:  It is associated with damaged intestinal mucosa as a result of inflammation leading to loss of protein-rich fluids and decreased ability to absorb the fluid. It is caused by bacterial, viral infections and autoimmune problems.

Motility related Diarrhea: Rapid movement of food due to hypermotility of the intestine, not enough time for sufficient nutrient and water absorption, resulting in diarrhea. It is generally seen in vagotomy (vagus nerve cut off) and diabetic neuropathy.

Hyperthyroidism can also lead to motility related diarrhea called as Pseudo-diarrhea.

Motility related diarrhea can be treated with anti-motility agents (loperamide).

Causes of diarrhea

Diarrhea can be caused by:

• Infections
• Drugs
• Food
• Diseases

Chart showing the causes of diarrhea:

These factors can lead to the passage of unformed stools.

Clinical Presentation

The patient may present with;

• Dehydration/Hypotension
• Febrile
• With abdominal pain
• Bloody diarrhea
• Fever
• Prolong vomiting

Treatment and Management

Most cases will resolve spontaneously and will not need therapy.

During the first or second episode of diarrhea, you shouldn’t take medicine so as some toxins and bacteria present in the intestine could be flushed out.

Despite not knowing what the cause is if the patient presents with high volume stools admit him/her in the hospital, start IV fluid therapy to prevent dehydration and hypovolemia. Use antibiotics such as ciprofloxacin if there is abdominal pain, tenderness, blood in the stool, and fever for more than 7 days. Along with symptomatic treatment such as for vomiting give anti-emetics.

How can you manage diarrhea at home until you get to the hospital?

At home, your main purpose is to focus on Rehydration Therapy to save the patient from dehydration that could lead him/her to hypovolemic shock and adequate food/breastfeeding in the case of infants.

For rehydration therapy, you can use ORS (ORAL REHYDRATION SOLUTION) sachet, dissolve it 1 liter of water (for infants less than 2 months of age dissolve it in 1 ½ liter water as they have a poor renal function) Use the solution within 24hrs, can’t be kept overnight after preparation.

If ORS sachet isn’t available you can prepare by yourselves;

Take half level teaspoon of salt, 6 level teaspoon of sugar, and 1-liter water. Dissolve them and use them within 24hrs. Give ORS after every stool.

If diarrhea doesn’t improve in 24hrs rush to the hospital without wasting any time.

Diagnosis

Individual presentation > risk factors

For diarrhea, the most important is the management because this is the crucial time for saving the patient life if you wait for the determination of specific etiology the patient could die while waiting for the results to come back.

Immediately initiate the management (mentioned above) for diarrhea until the lab reports reach.

Stool culture is the best tool to diagnose the etiology.

Once the lab reports arrive treat the patient accordingly to etiology (cause). Your Physician knows better how to treat according to etiology.

Do not give antibiotics if diagnosed with bacteria E. coli 0157:H7, because the antibiotics precipitate the Hemolytic Uremic Syndrome (HUS)

Not every organism is best diagnosed by Stool culture, some exceptions are;

Diarrhea due to Giardia (protozoa) is best diagnosed with a stool antigen test.

Diarrhea due to Cryptosporidiosis (protozoa) requires a unique test, a modified Acid-Fast test.

Some people taking antibiotics for any other disease (pneumonia etc) can develop diarrhea, this is called Clostridium difficile-associated diarrhea. Metronidazole (Flagyl) is the drug of choice along with discontinuation of antibiotics and supportive therapy resolves diarrhea.

Diet

What food should be avoided in diarrhea?

• Coffee/tea
• Alcohol
• Milk and dairy products (cheese)
• Junk food, Spicy food, or oily food
• Raw vegetables

What type of food you should take in diarrhea?

• Plenty of water
• Starchy food such as plain cereals, rice, and boiled potato.
• Bananas
• Apple
• Toast or bread
• Coconut water

Have a great and healthy life ahead