diarrhea

(redirected from parenteral diarrhea)

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Diarrhea

Definition
To most individuals, diarrhea means an increased frequency or decreased consistency of bowel moveme
nts; however,the medical definition is more exact than this. In many developed countries, the average nu
mber of bowel movements isthree per day. However, researchers have found that diarrhea best correlate
s with an increase in stool weight; stoolweights above 10oz (300 gs) per day generally indicates diarrhea.
This is mainly due to excess water, which normallymakes up 60-
85% of fecal matter. In this way, true diarrhea is distinguished from diseases that cause only an increase i
nthe number of bowel movements (hyperdefecation) or incontinence (involuntary loss of bowel contents).
Diarrhea is also classified by physicians into acute, which lasts one or two weeks, and chronic, which cont
inues for longerthan 2 or 3 weeks. Viral and bacterial infections are the most common causes of acute dia
rrhea.

Description
In many cases, acute infectious diarrhea is a mild, limited annoyance. However, worldwide acute infectiou
s diarrhea has ahuge impact, causing over five million deaths per year. While most deaths are among chil
dren under five years of age indeveloping nations, the impact, even in developed countries, is considerabl
e. For example, over 250,000 individuals areadmitted to hospitals in the United States each year because
of one of these episodes. Rapid diagnosis and propertreatment can prevent much of the suffering associ
ated with these devastating illnesses.
Chronic diarrhea also has a considerable effect on health, as well as on social and economic well being.
Patients withceliac
disease, inflammatory bowel disease, and other prolonged diarrheal illnesses develop nutritional deficien
cies thatdiminish growth and immunity. They affect social interaction and result in the loss of many workin
g hours.

Causes and symptoms

Diarrhea occurs because more fluid passes through the large intestine (colon) than that organ can absorb
. As a rule, thecolon can absorb several times more fluid than is required on a daily basis. However, when
this reserve capacity isoverwhelmed, diarrhea occurs.
Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent abso
rption of fluids.Also, certain substances in the colon, such as fats and bile acids, can interfere with water a
bsorption and cause diarrhea.In addition, rapid passage of material through the colon can also do the sa
me.
Symptoms related to any diarrheal illness are often those associated with any injury to the gastrointestinal
tract, such asfever, nausea, vomiting, and abdominal pain. All or none of these may be present dependi
ng on the disease causing thediarrhea. The number of bowel movements can vary—
up to 20 or more per day. In some patients, blood or pus is presentin the stool. Bowel movements may be
difficult to flush (float) or contain undigested food material.
The most common causes of acute diarrhea are infections (the cause of traveler's diarrhea), food poisoni
ng, andmedications. Medications are a frequent and often over-
looked cause, especially antibiotics and antacids. Less often,various sugar free foods, which sometimes
contain poorly absorbable materials, cause diarrhea.
Chronic diarrhea is frequently due to many of the same things that cause the shorter episodes (infections,
medications,etc.); symptoms just last longer. Some infections can become chronic. This occurs mainly wi
th parasitic infections (suchas Giardia) or when patients have altered immunity (AIDS).
The following are the more usual causes of chronic diarrhea:

 AIDS
 colon cancer and other bowel tumors
 endocrine or hormonal abnormalities (thyroid, diabetes mellitus, etc.)
 food allergy
 inflammatory bowel disease (Crohn's disease and ulcerative colitis)
 lactose intolerance
 malabsorption syndromes (celiac and Whipple's disease)
 other (alcohol, microscopic colitis, radiation, surgery)

Complications
The major effects of diarrhea are dehydration, malnutrition, and weight loss. Signs of dehydration can be
hard to notice,but increasing thirst, dry
mouth, weakness or lightheadedness (particularly if worsening on standing), or adarkening/decrease in u
rination are suggestive. Severe dehydration leads to changes in the body's chemistry and couldbecome lif
e-
threatening. Dehydration from diarrhea can result in kidney failure, neurological symptoms, arthritis, and s
kinproblems.

Diagnosis
Most cases of acute diarrhea never need diagnosis or treatment, as many are mild and produce few probl
ems. Butpatients with fever over 102 °F (38.9 °C), signs of dehydration, bloody bowel movements, severe
abdominal pain, knownimmune disease, or prior use of antibiotics need prompt medical evaluation.
When diagnostic studies are needed, the most useful are stool culture and examination for parasites; how
ever these areoften negative and a cause cannot be found in a large number of patients. The earlier cultu
res are performed, the greaterthe chance of obtaining a positive result. For those with a history of antibioti
c use in the preceding two months, stoolsamples need to be examined for the toxins that cause antibioti
c-associated
colitis. Tests are also available to checkstool samples for microscopic amounts of blood and for cells that
indicate severe inflammation of the colon. Examinationwith an endoscope is sometimes helpful in determ
ining severity and extent of inflammation. Tests to check changes inblood chemistry (potassium, magnesi
um, etc.) and a complete blood count (CBC) are also often performed.
Chronic diarrhea is quite different, and most patients with this condition will receive some degree of testin
g. Many examsare the same as for an acute episode, as some infections and parasites cause both types
of diarrhea. A careful history toevaluate medication use, dietary changes, family history of illnesses, and o
ther symptoms is necessary. Key points indetermining the seriousness of symptoms are weight loss of ov
er 10 lb (4.5 kg), blood in the stool, and nocturnal diarrhea(symptoms that awaken the patient from sleep).
Both prescription and over-the-
counter medications can contain additives, such as lactose and sorbitol, that will producediarrhea in sensi
tive individuals. Review of allergies or skin changes may also point to a cause. Social history mayindicat
e if stress is playing a role or identify activities which can be associated with diarrhea (for example, diarrh
ea thatoccurs in runners).
A combination of stool, blood, and urine tests may be needed in the evaluation of chronic diarrhea; in addi
tion a numberof endoscopic and x-ray studies are frequently required.

Treatment
Treatment is ideally directed toward correcting the cause; however, the first aim should be to prevent or tr
eat dehydrationand nutritional deficiencies. The type of fluid and nutrient replacement will depend on whet
her oral feedings can be takenand the severity of fluid losses. Oral rehydration solution (ORS) or intraven
ous fluids are the choices; ORS is preferred ifpossible.
A physician should be notified if the patient is dehydrated, and if oral replacement is suggested then com
mercial(Pedialyte and others) or homemade preparations can be used. The World Health Organization (
WHO) has provided thiseasy recipe for home preparation, which can be taken in small frequent sips:

 Table salt—3/4 tsp

 Baking powder—1 tsp
 Orange juice—1 c
 Water—1 qt (1l)

When feasible, food intake should be continued even in those with acute diarrhea. A physician should be
consulted as towhat type and how much food is permitted.
Anti-
motility agents (loperamide, diphenoxylate) are useful for those with chronic symptoms; their use is limited
or evencontraindicated in most individuals with acute diarrhea, especially in those with high fever or bloo
dy bowel movements.They should not be taken without the advice of a physician.
Other treatments are available, depending on the cause of symptoms. For example, the bulk agent psylliu
m helps somepatients by absorbing excess fluid and solidifying stools; cholestyramine, which binds bile a
cids, is effective in treating bilesalt induced diarrhea. Low fat diets or more easily digestible fat is useful in
some patients. New antidiarrheal drugs thatdecrease excessive secretion of fluid by the intestinal tract is
another approach for some diseases. Avoidance ofmedications or other products that are known to cause
diarrhea (such as lactose) is curative in some, but should bediscussed with a physician.

Alternative treatment
It is especially important to find the cause of diarrhea, since stopping diarrhea when it is the body's way of
eliminatingsomething foreign is not helpful and can be harmful in the long run.
One effective alternative approach to preventing and treating diarrhea involves oral supplementation of as
pects of thenormal flora in the colon with the yeasts Lactobacillus acidophilus, L. bifidus, or Saccharomyc
es boulardii. In clinicalsettings, these "biotherapeutic" agents have repeatedly been helpful in the resolutio
n of diarrhea, especially antibiotic-
associated diarrhea. Their effectiveness is also supported by the results of a research study published in t
he Journal ofthe American Medical Association in 1996.
Nutrient replacement also plays a role in preventing and treating episodes of diarrhea. Zinc especially app
ears to have aneffect on the immune system, and deficiency of this mineral can lead to chronic diarrhea.
Also, zinc replacement improvesgrowth in young patients. Plenty of fluids, especially water, should be tak
en by individuals suffering from diarrhea toprevent dehydration. The BRAT diet also can be useful in helpi
ng to resolve diarrhea. This diet limits food intake tobananas, rice, applesauce, and toast. These foods pr
ovide soluble and insoluble fiber without irritation. If the toast isslightly burnt, the charcoal can help seque
ster toxins and pull them from the body.
Acute homeopathic remedies can be very effective for treating diarrhea especially in infants and young ch
ildren.

Prognosis
Prognosis is related to the cause of the diarrhea; for most individuals in developed countries, a bout of ac
ute, infectiousdiarrhea is at best uncomfortable. However, in both industrialized and developing areas, ser
ious complications and deathcan occur.
For those with chronic symptoms, an extensive number of tests are usually necessary to make a proper di
agnosis andbegin treatment; a specific diagnosis is found in 90% of patients. In some, however, no specif
ic cause is found and onlytreatment with bulk agents or anti-motility agents is indicated.

Prevention
Proper hygiene and food handling techniques will prevent many cases. Traveler's diarrhea can be avoide
d by use ofPepto-
Bismol and/or antibiotics, if necessary. The most important action is to prevent the complications of dehyd
ration.
Resources
Organizations
World Health Organization, Division of Emerging and Other Communicable Diseases Surveillance and Co
ntrol. AvenueAppia 20, 1211 Geneva 27, Switzerland. (+00 41 22) 791 21 11. http://www.who.int.
Other
"Directory of Digestive Diseases Organizations for Patients." National Institute of Diabetes and Digestive
and KidneyDisease. http://www.niddk.nih.gov.
"A Neglected Modality for the Treatment and Prevention of Selected Intestinal and Vaginal Infections." JA
MA. http://pubs.ama-assn.org.
Selected publications and documents on diarrhoeal diseases (including cholera). World Health Organizati
on (WHO). http://www.who.ch/chd/pub/cdd/cddpub.htm.

Key terms
Anti-motiltiy
medications — Medications such as loperamide (Imodium), diphenoxylate (Lomotil), or medicationscont
aining codeine or narcotics that decrease the ability of the intestine to contract. These can worsen the con
dition of apatient with dysentery or colitis.
Colitis — Inflammation of the colon.
Endoscope — An endoscope, as used in the field of gastroenterology, is a thin flexible tube that uses a l
ens or miniaturecamera to view various areas of the gastrointestinal tract. Both diagnosis, through biopsie
s or other means, andtherapeutic procedures can be done with this instrument.
Endoscopy — The performance of an exam using an endoscope is known generally as endoscopy.
Lactose intolerance — An inability to properly digest milk and dairy products.
Oral rehydration solution
(ORS) — A liquid preparation developed by the World Health Organization that can decreasefluid loss in
persons with diarrhea. Originally developed to be prepared with materials available in the home, commerc
ialpreparations have recently come into use.
Steatorrhea — Excessive amounts of fat in the feces.
diarrhea
(redirected from parenteral diarrhea)
Also found in: Dictionary, Thesaurus, Medical.

diarrhea
(dīərē`ə), frequent discharge of watery feces from the intestines, sometimes containing blood and mucus
. Itcan be caused by excessive indulgence in alcohol or other liquids or foods that prove irritating to the st
omach or intestine, byallergy to certain food products, by poisoning with heavy metals, by chemicals such
as are found in cathartics, byhyperactivity of the nervous system, and by infection with a virus (intestinal
grippe) or with bacteria or their toxins. Diarrhea isa concomitant of many infectious diseases, especially ty
phoid fever

, bacillary or amebic dysentery

, and cholera

. Persistentdiarrhea may result in severe dehydration and shock. It is therefore necessary to replace the fl
uid lost by the body. Treatmentis with a bland diet and drugs that will decrease the activity of the intestine
s, as well as with specific measures directed at theunderlying cause. The elderly are at especially high ris
k for diarrheal deaths caused by viruses. Ulcerative colitis is aninflamatory and ulcerative disease of the c
olon, properly described as "irritable bowl," and characterized by bloody diarrhea.Crohn's disease affects
the distal ileum and colon, but may occur in any part of the gastrointestinal tract, from the mouth tothe an
us and perianal area. The symptoms are chronic diarrhea associated with abdominal pain, fever, anorexia
, weight loss,and a mass or fullness in the right lower quadrant (of the abdomen).

The Columbia Electronic Encyclopedia™ Copyright © 2013, Columbia University Press. Licensed from
Columbia University Press. All rights reserved.

The following article is from The Great Soviet Encyclopedia (1979). It might be outdated or ideologically bi
ased.

Diarrhea

frequent excretion of liquid intestinal contents. Diarrhea is the main symptom of such acute bacterial and
viral intestinaldiseases as dysentery, food poisonings, and colienteritis, as well as of cholera, intestinal inv
asions, and other inflammatoryintestinal diseases. It can also be a symptom of chronic lesions of other di
gestive organs, for example, the stomach andpancreas; of general chronic diseases, such as tuberculosis
; and of acute and chronic poisonings of exogenous (as fromheavy metals) and endogenous (from renal i
nsufficiency) origin. Diarrhea may also result from metabolic disturbances, fromingestion of excessive or c
oarse food, or from neuroses. In addition, it occurs in infantile, fermentative, and putrefactivedyspepsia.
The development of diarrhea is related to the liquefaction of the intestinal contents owing to an inflammat
ory exudate or to anaccumulation of fluid in the intestinal lumen when the fluid’s absorption is hindered. T
he intestinal contents move morerapidly, stimulated by the prostaglandins, and there is a change in the tr
ansport of sodium and other electrolytes as well asosmotic shifts in the intestine. False, or constipation, di
arrhea is a secondary liquefaction of the intestinal contents duringprolonged constipation; a small quantity
of liquid feces is excreted frequently.
The diagnosis of diarrhea varies with the disease and is based on the medical history and on examination
of the feces.Therapy consists of treatment of the basic disease; special diets, antiinfectives, astringents,
and enzymes are prescribed forsymptomatic relief.
O. S. RADBIL’
The Great Soviet Encyclopedia, 3rd Edition (1970-1979). © 2010 The Gale Group, Inc. All rights
reserved.

diarrhea
[‚dī·ə′rē·ə]

(medicine)

The passage of loose or watery stools, usually at more frequent than normal intervals.

McGraw-Hill Dictionary of Scientific & Technical Terms, 6E, Copyright © 2003 by The McGraw-Hill
Companies, Inc.

diarrhoea
(esp US), diarrhea

frequent and copious discharge of abnormally liquid faeces

Collins Discovery Encyclopedia, 1st edition © HarperCollins Publishers 2005

DD • Other causes that can cause acute diahrea : • 1. Dietetic diarrhea: It may follow recent change in
the type of milk, concentrated formula or recent addition of new foods not suitable for the age of the
infant. • 2. Drug induced diarrhea: Most oral antibiotics especially ampicillin can cause acute diarrhea
(antibiotic-associated diarrhea). • 3. Parenteral diarrhea: It is a diarrhea that occurs secondary to
infections outside the gastrointestinal tract as respiratory and urinary tract infection. • 4.Spurious
diarrhoea; for example, in chronic constipation with overflow incontinence