Speciality
Spotlight

 




 


Family Practice


 

 







Diahorrhea

 



ACUTE
DIARRHEA


 

 

The most common cause of acute
diarrhea is an


 

Infections agent.  
It  is
also caused 
by ingested drugs or toxins, 
chemotherapy  and resumption of feeding following a prolonged fast.

 

Acute
diarrhea may represent the onset of a chronic
diarrhea.

 

Antibiotic
therapy is generally not necessary in acute
diarrhea. It is needed only in shigellosis,
traveler’s diarrhea, cholera, and parasitic
diseases.

 

More
than antibiotics acute diarrhea needs rest and
fluid replacement. Since death can occur due to
dehydration. I.V. fluid therapy is needed in
severely dehydrated individuals [infants and the
elderly].

 

3.     
Infections –

 


Diarrhea, nausea, vomiting, fever,
abdominal pain .

 

Laboratory
Tests

 

       
Treatment


 


      a.     
Bed rest,

       
b.     
Fluid replacement

        c.     
Oral sugar –electrolyte solution

        d.     
Antibiotics


Only
for
 
   
1.  
Shigellosis


               
2.  
Traveler’s diarrhea

                    
3.  .
Parasitic diseas


4.     
Drug induced

 


Laxatives,
ampicillin, NSAIDS

Treatment


Stop
the drug.


5.  
Toxin
induced



 

 Organophosphorus insecticides,
mushrooms, arsenic

 

Symptoms


 


Nausea and vomiting as prominent symptoms
but no high fever

6.     
Lactose intolerance


Diarrhea 
within 
several 
hours of   
ingesting


 Milk
or milk products. Associated with   



 cramps,
abdominal pain and flatus.

 



 

CHRONIC
DIARRHEA


 

 

Diarrhea
that persists for weeks or months. [either
constant or intermittent] 
In majority of cases it is due to
irritable bowel syndrome.

 

2.     
Osmotic :-

 


Results into  
malabsorption  
of  fats 
or carbohydrates.

 

3.     
Secretory
:-

 


[Watery diarrhea]

 

4.     
Altered
intestinal mobility :-

 


Due to irritable bowel syndrome.

 

 Self
induced by the use of laxatives. Usually an H/o
psychiatric diseases present.

 

CAUSES

 

           Crohn’s 
disease

           Radiation
entero colitis

           Eosinophilic
gastroenteritis

           Infection
associated with AIDS

 

2.     
Osmotic


 

Bulky, greasy, foul smelling stools.
weight loss

Nutrient deficiencies

Improvement with fasting

e.g. –   Pancreatic
insufficiency

             Bacterial
overgrowth

3.     
Secretory-

 

Watery diarrhea persists with fasting.
Dehydration present.

e.g. –  Microscopic
colitis

           Carcinoid
syndrome

4.     
Protein –losing enteropathy –

 

Peripheral edema, ascites

3.     
Altered intestinal motility –


Alternating diarrhea
and constipation urinary bladder symptoms

Neurologic 
symptoms

e.g.
  Irritable
bowel syndrome

         
Fecal impaction

         
Neurologic diseases

 


4.     
Factitious-


Self induced
due to laxative abuse. Watery diarrhea with
hypokalemia, weakness, edema.

 


5.     
Drug induced


Laxatives,
digitalis, beta blockers, ACE inhibitors,
diuretics, ampicillin, lovastatin, fluoxetine,
theophylline, NSAIDS

 


6.     
Malabsorption


Of specific
nutrients present as anemia, bleeding tendency,
amenorrhea

1.     
Bulky, greasy, foul smelling stools that      

are
difficult  to
flush

2.     
Flatulence

3.     
Weight loss

 


7.     
Diabetic diarrhea


Symptoms of
autonomic dysfunction such as postural
hypotension, impotence, disordered sweating.



 

Physical
examination


 

To
assess volume depletion as indicated by postural
hypotension, tachycardia, mental lethargy,
generalized weakness.

 

Laboratory tests

 


1.     
Complete blood count

2.     
Peripheral smear

3.     
Serum electrolytes

4.     
Decreased levels of irons, folate,
vitamin B12

        
and vitamin D suggest 
malabsorption.

5.     
Stool  
PH  
less  
than 5.3    
suggests

        
Carbohydrate  
malabsorption.

6.     
Assay for µ
2 antitrypsin, an endogenous  

        
protein confirms protein-losing
enteropathy.

7.     
Measurement of fecal fat confirms

       Malabsorption.

8.     
Small intestinal biopsy is a diagnostic
test

        
in malabsorption.

9.     
Presence of blood and leukocytes in stool   

      
suggests
inflammatory diarrhea.

 

 

Treatment


 


1.     
Diphenoxylate and loperamide in secretory  

       
diarrhea.

2.     
Clonidine [an alpha-adrenergic agonist]
for  

      
diabetic
diarrhea.

3.     
Cholestyramine in diarrhea caused by bile

        
salt malabsorption.

 




 

 

Speciality Spotlight

 

 

Diahorrhea
 

ACUTE DIARRHEA
 
 
The most common cause of acute diarrhea is an
 
Infections agent.   It  is also caused  by ingested drugs or toxins,  chemotherapy  and resumption of feeding following a prolonged fast.
 
Acute diarrhea may represent the onset of a chronic diarrhea.
 
Antibiotic therapy is generally not necessary in acute diarrhea. It is needed only in shigellosis, traveler’s diarrhea, cholera, and parasitic diseases.
 
More than antibiotics acute diarrhea needs rest and fluid replacement. Since death can occur due to dehydration. I.V. fluid therapy is needed in severely dehydrated individuals [infants and the elderly].
 
3.      Infections –
 
Diarrhea, nausea, vomiting, fever, abdominal pain .
 
Laboratory Tests
 
        Treatment
 
      a.      Bed rest,
        b.      Fluid replacement
        c.      Oral sugar –electrolyte solution
        d.      Antibiotics

Only for      1.   Shigellosis

                2.   Traveler’s diarrhea
                     3.  . Parasitic diseas

4.      Drug induced
 
Laxatives, ampicillin, NSAIDS
Treatment
Stop the drug.

5.   Toxin induced
 
 Organophosphorus insecticides, mushrooms, arsenic
 
Symptoms
 
Nausea and vomiting as prominent symptoms but no high fever

6.      Lactose intolerance

Diarrhea  within  several  hours of    ingesting

 Milk or milk products. Associated with   

 cramps, abdominal pain and flatus.

 


 

CHRONIC DIARRHEA
 
 
Diarrhea that persists for weeks or months. [either constant or intermittent]  In majority of cases it is due to irritable bowel syndrome.
 
2.      Osmotic :-
 
Results into   malabsorption   of  fats  or carbohydrates.
 
3.      Secretory :-
 
[Watery diarrhea]
 
4.      Altered intestinal mobility :-
 
Due to irritable bowel syndrome.
 
 Self induced by the use of laxatives. Usually an H/o psychiatric diseases present.
 
CAUSES
 
           Crohn’s  disease
           Radiation entero colitis
           Eosinophilic gastroenteritis
           Infection associated with AIDS
 
2.      Osmotic
 
Bulky, greasy, foul smelling stools. weight loss
Nutrient deficiencies
Improvement with fasting

e.g. –   Pancreatic insufficiency
             Bacterial overgrowth

3.      Secretory-
 
Watery diarrhea persists with fasting. Dehydration present.
e.g. –  Microscopic colitis
           Carcinoid syndrome

4.      Protein –losing enteropathy –
 
Peripheral edema, ascites

3.      Altered intestinal motility –

Alternating diarrhea and constipation urinary bladder symptoms

Neurologic  symptoms

e.g.   Irritable bowel syndrome

          Fecal impaction

          Neurologic diseases

 

4.      Factitious-

Self induced due to laxative abuse. Watery diarrhea with hypokalemia, weakness, edema.

 

5.      Drug induced

Laxatives, digitalis, beta blockers, ACE inhibitors, diuretics, ampicillin, lovastatin, fluoxetine, theophylline, NSAIDS

 

6.      Malabsorption

Of specific nutrients present as anemia, bleeding tendency, amenorrhea

1.      Bulky, greasy, foul smelling stools that      

are difficult  to flush

2.      Flatulence

3.      Weight loss

 

7.      Diabetic diarrhea

Symptoms of autonomic dysfunction such as postural hypotension, impotence, disordered sweating.


 
Physical examination
 
To assess volume depletion as indicated by postural hypotension, tachycardia, mental lethargy, generalized weakness.
 
Laboratory tests
 
1.      Complete blood count
2.      Peripheral smear
3.      Serum electrolytes
4.      Decreased levels of irons, folate, vitamin B12
         and vitamin D suggest  malabsorption.
5.      Stool   PH   less   than 5.3     suggests
         Carbohydrate   malabsorption.
6.      Assay for µ 2 antitrypsin, an endogenous  
        
protein confirms protein-losing enteropathy.
7.      Measurement of fecal fat confirms
       Malabsorption.
8.      Small intestinal biopsy is a diagnostic test
         in malabsorption.
9.      Presence of blood and leukocytes in stool   
       suggests inflammatory diarrhea.
 
 
Treatment
 
1.      Diphenoxylate and loperamide in secretory  
        diarrhea.
2.      Clonidine [an alpha-adrenergic agonist] for  
       diabetic diarrhea.
3.      Cholestyramine in diarrhea caused by bile
         salt malabsorption.

 

 

By |2022-07-20T16:43:20+00:00July 20, 2022|Uncategorized|Comments Off on Diarhhea

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