A Family Doctor's Tale - DIARRHEA

DOC I HAVE DIARRHEA

Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.

Diarrhea is a symptom of many gastrointestinal disorders:
1.Infections:
Bacterial infections such as:
a.Shigella
b.Salmonella and typhoid
c.cholera

Viral infections such as:
a,enterovirus
b.rotavirus

Protozoan infections such as:
a.amoebic
b.giardia

2.Toxins from bacteria in contaminated food:
a.E.coli food poisoning (enterotoxins)
b.staphaloccal food poisoning (preformed toxins)

3.Antibiotic usage:
pseudomembraous enterocolitis

4.Food Intolerance
a.Lactose or sugar intolerance
b.Gluten sensitive enteropathy:
celiac disease, nontropical sprue

5.Inflammatory diseases of the intestine:
a.crohn's disease or regional ileitis
b.ulcerative colitis

6.Malabsorption syndromes
a.malabsorption of bile acids
b.pancreatic steatorrhea
c.ileal resection

7.Cancers:
a.colon
b.rectal cancers

8.Tumors especially hormonal producing tumors:
a,gastrinoma
b.Zollinger-Ellison syndrome
c.glucaglonoma
d.carcinoid tumors

9.Drug induced:
a.excessive use of laxatives
b.magnesium antacids which absorbs water into intestine
c.stimulant cathartics

10.Rapid intestinal movement:
a.Irritable bowel syndrome
b.resection of bowels in tumors or fistula
c.vagotomy
d.other surgery of intestine
rhea with blood and mucus

Diarrhea is investigated by:
1.full investigation of the possible underlying causes

2.Macroscopic and microscopic examination of the stools:
e.g rice water is typical of cholera

3.culture and sensitivity to antibiotic of the stools

4.Full blood count and electrolytes

Treatment of Diarrhea is by:

1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.

Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.

The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or light headedness

Mild dehydration can be treated by drinking liquids.

Severe dehydration may require intravenous fluids and hospitalization.

Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

2.Specific treatment if available for underling conditions eg.antibiotic the choice of which depends on the sensitivity of bacteria to the antibiotic.

3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).

The following steps may help relieve the symptoms of Diarrhea.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.

Prognosis of diarrhea depends on the cause:

Usual outcome of acute diarrhea is excellent if treated early.

For chronic diarrhea, the underlying cause must be treated.

Outcome is usually excellent with appropriate treatment.

Prevention of Infections causing Diarrhea is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers


2.washing your hands thoroughly for 20 seconds before eating


3.disinfecting contaminated surfaces such as counter tops and baby changing stations


4.Avoid eating or drinking foods or liquids that might be contaminated