BRISTOL STOOL SCALE

[caption id="" align="alignright" width="300" caption="Image via Wikipedia"][/caption]

DOC HOW DO I KNOW WHETHER MY STOOL IS NORMAL

Actually many people do not know the definition of diarrhea.

They define the word diarrhea as watery stools where in fact the word diarrhea means any stools which are softer or more frequent than normal.

The researchers at the Bristol University have come out with a scale which is called the Bristol Stool Scale.

According to the Bristol Stool Scale, the seven types of stools
are:
1.Type 1: Separate hard lumps like nuts
2.Type 2: Sausage shaped but lumpy
3.Type 3: like a Sausage but with cracks on its surface
4.Type 4: like a Sausage or snake, smooth and soft
5.Type 5: soft blobs with clear cut edges
6.Type 6: Fluffy pieces with ragged edges, a mushy stool
7.Type 7: Watery, no solid pieces. Entirely liquid.

Type 1 and 2 indicate constipation while type 5-7 indicate diarrhea. Type 3 and 4 are considered ideal stools because they are the easiest to pass.

Avoidance of constipation include:

1. Increase in daily fiber intake to at least 15gm (eg. 1 bowl of bran cereal for breakfast),
fruits and vegetables).
Fibre increases the bulk of the stool allowing easy passage of stools through the large
intestine.

2. Drink at least 8 glasses of water a day (2 liters). Water reduces the hardness of stools.

3. Regular exercises at least 2-3 times a day especially after meals. Exercise will enhance
intestinal movement.

4. Allow a distraction free period of 15 min a day for bowel movement. The strongest
intestinal movement occurs after breakfast.

5. Do not ignore or suppress the urge to pass bowel movement. This may impair the
sensation to detect initiation of bowel movement leading to constipation.

Avoidance of  diarrhea include:

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

5.Avoid rapid intestinal movement from stress, irritable bowel syndrome

Please read my blogs on constipation and diarrhea

A Simple Guide to Diarrhea

A Simple Guide to Diarrhea
-------------------------------------
What is Diarrhea?
---------------------------
Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.
What are the causes of Diarrhea?
--------------------------------------------
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
How is Diarrhea investigated?
------------------------------------------
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
How is Diarrhea treated?
-------------------------------------
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 lightheadedness
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:
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.
How is Diarrhea prevented?
----------------------------------------
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

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

A Simple Guide to Crohn's Disease

A Simple Guide to Crohn's Disease
----------------------------------------------------

What is Crohn's Disease?
---------------------------------------

Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.

It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.

Who is affected by Crohn's Disease?
---------------------------------------------------

Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites

It occurs equally in men and women and can be found in families.

Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.

What is the Cause of Crohn's Disease?
-----------------------------------------------------

The exact cause of Crohn's Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.

A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.

Infectious causes has also been blamed.


What are the Symptoms and signs of Crohn's Disease?
-----------------------------------------------------------

Symptoms varies from mild to severe:

1.severe abdominal pain, especially in the right iliac fossa

2.diarrhea

3.Rectal Bleeding

4.fever

5.weight loss

6.loss of appetite

7.joint pain

Signs:

1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa

2.Rectal examination may show blood in the stool

3.pallor due to anemia

4.skin lesions


How do you make the Diagnosis of Crohn's Disease?
------------------------------------------------------------

1.A history of abdominal pain , diarrhea and bloody stools

2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass

b.digital rectal exam to detect blood.

3.stool may be tested for blood

4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.

5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine

6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.

7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.


What are the complications of Crohn's Disease?
---------------------------------------------------

Bowel complications:

1.Strictures of intestine leading to blockage

2.Fistula especially in the rectal region

3.Fissures in the anal region

4.hemorrhage

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.mouth ulcers

4.Skin: eczema

5.Nutrition: malabsorption and vitamin deficiency

What is the treatment of Ulcerative Colitis?
---------------------------------------------------

Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.

Medications:

1.Anti-diarheal and bulk forming agents

2.Anti-spasmotic medication for spasm of the colon

3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response

7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.

8.Correction of anemia and nutritional deficiencies is important to enhance the immune system

9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.

10.Regular hemoglobin, blood counts and liver function tests

Surgery:

Surgery is required:

1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.

Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.

In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.


What is the prognosis of Crohn's Disease?
-----------------------------------------

The prognosis depends on the severity of the disease

Three quarters of patients with Crohn's Disease will require surgery sooner or later.

There will be temporary relief of symptoms but recurrences are common.

In many cases with proper treatment, patients are able to lead a normal life.

What are preventive measures in Crohn's Disease?
-----------------------------------------------------

A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.

Stress can also trigger off episodes of Crohn's disease.

A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.

A Simple Guide to Ulcerative Colitis

A Simple Guide to Ulcerative Colitis
----------------------------------------------------


What is Ulcerative Colitis?
---------------------------------------

Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.


Who is affected by Ulcerative Colitis?
---------------------------------------------------

Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites

Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.

Those above the age of 60 years have more severe symptoms and signs.

It occurs equally in men and women and can be found in families.

What is the Cause of Ulcerative Colitis?
-----------------------------------------------------

The exact cause of Ulcerative Colitis is not known.

It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.

Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.


What are the Symptoms and signs of Ulcerative Colitis?
-----------------------------------------------------------

Symptoms:
The symptoms can range from mild to severe.

Mild cases (about 50%)usually have:

1.an insidious onset

2.lower abdominal pain

3.Slight blood stained diarrhea

4.malaise

In the more severe cases, the main symptoms may be:

1.abrupt onset

2.severe diffuse abdominal pain

3.Bloody diarrhea

4.fever

5.shock

6.fatigue

7.weight loss

8.loss of appetite

9.loss of body fluids and nutrients

10.joint pain

Signs:
1.Abdominal distension and tenderness

2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter

3.pallor due to anemia

4.Wasting of muscles

5.skin lesions

How do you make the Diagnosis of Ulcerative Colitis?
------------------------------------------------------------

1.A history of lower abdominal pain , bloating and bloody diarrhea

2.The physical exam consists of
a.palpation of the abdomen for tenderness

b.digital rectal exam to detect tenesmus or blood.

3.stool may be tested for blood

4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon

6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.

What are the complications of Ulcerative Colitis?
---------------------------------------------------

Bowel complications:

1.Strictures of colon

2.Fistula

3.Toxic dilatation(toxic megacolon)

4.Perforation of the colon

5.hemorrhage

6.shock

7.rarely carcinoma(5%)

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.Skin: eczema


What is the treatment of Ulcerative Colitis?
----------------------------------------------------------------

Mild Cases:
Medications:

1.Antidiarrheal and bulk forming agents

2.Antispasmotic medication for spasm of the colon

3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.

5.Correction of anemia

6.Regular hemoglobin, blood counts and liver function tests

Severe cases:

1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary

2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.

3.Sulphasalazine (immuno-suppressant) given indefinitely

4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

5.Antibiotics in toxic megacolon syndrome

5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.

In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.

Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.


What is the prognosis of Ulcerative Colitis?
-----------------------------------------

The prognosis depends on the severity of the disease

Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.

5% will die within the first year.

75% will have recurrence for the rest of their life.

Only 10% will have remissions lasting 15 years.

A Simple Guide to Gastroenteritis

A Simple Guide to Gastroenteritis
-------------------------------------

What is Gastroenteritis?
---------------------------

Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites resulting in leakage of fluid from the cell into the intestine(diarrhea),abdominal pain and vomiting.

What are the causes of Gastroenteritis?
--------------------------------------------

Viral Gastroenteritis:
The most common cause of Gastroenteritis is Viral.

Rota virus is the leading cause among children 3 to 15 months old and the most common cause of diarrhea in children under the age of 5 years.

Adenovirus occurs mainly in children under the age of 2 years.

Caliciviruses especially the norovirus cause infection in people of all ages.

Astrovirus also infects primarily infants, young children, and the elderly.

Bacterial Gastroenteritis:
The most common cause is the E. coli bacteria, usually mild with diarrhea, abdominal pain and occasional vomiting. It rarely cause fever.

Salmonella, Shigella ,Vibrio cholerae, are more serious bacterial infection causing diarrhea and high fever.

Parasitic Gastroenteritis:
Most common is amoebic dysentery,common in India and Africa.
Other parasitic infection are giardiasis and threadworms.

What are symptoms of Gastroenteritis?
----------------------------------------------

The main symptoms of gastroenteritis are
1. watery diarrhea
2. abdominal pain
3. vomiting
4. headache
5. fever.
6.loss of appetite and energy

Symptoms usually appear within 4 to 48 hours after exposure to the germ and last for 1 to 2 days, though symptoms can last as long as 10 days.

How is Gastroenteritis transmitted?
------------------------------------------

Gastroenteritis can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Noroviruses in particular, are typically spread to other people by contact with stool or vomit of infected people and through contaminated water or food—especially oysters, prawns, crabs, lobsters, cockleshells from contaminated breeding waters.

How is the diagnosis of Gastroenteritis made?
-----------------------------------------------------

Doctors generally diagnose gastroenteritis based on the symptoms and a physical examination. Your doctor may ask for a stool sample to test for rotavirus or to rule out bacteria or parasites as the cause of your symptoms.

How is Gastroenteritis treated?
-------------------------------------

Most cases of viral gastroenteritis resolve without specific treatment.
Antibiotics are not effective against viral infections.

The primary goal of treatment is to reduce the symptoms which may 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).

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, vomiting, 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 lightheadedness

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.

The following steps may help relieve the symptoms of gastroenteritis.
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.

How is Gastroenteritis prevented?
----------------------------------------

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