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==Overview==
==Overview==
Diarrhea
 
==Historical Perspective==
==Historical Perspective==
The word "diarrhea" was coined by Hippocrates. Diarrhea is derived from the Greek term "to flow through." Diarrhea is a common manifestation of the gastrointestinal disease.


==Classification==
==Classification==
Diarrhea is defined as the passage of unformed or abnormally liquid [[Human feces|stools]] at an increased frequency. Acute diarrhea has a duration of <2 weeks and may be classified on the basis of [[etiology]] and presentation. On the basis of [[etiology]], acute diarrhea may be classified into [[Infection|infectious]] and non-infectious subtypes. Based on the type of presentation, acute diarrhea may be classified into [[Diarrhea|watery]] and inflammatory types. Watery diarrhea may further be classified into secretory and osmotic types of diarrhea.


==Pathophysiology==
==Pathophysiology==
[[Diarrhea]] is a condition of altered [[intestinal]] water and [[electrolyte]] transport. The pathophysiology of acute [[diarrhea]] includes [[osmotic]], secretory, [[inflammatory]] types, and diarrhea due to altered [[motility]]. Acute [[diarrhea]] due to an [[osmotic]] causes includes [[osmotic]] [[laxatives]] such as [[lactose intolerance]], [[Antacid|antacids]], [[fructose]], [[lactulose]], [[laxatives]] [[magnesium]], [[phosphate]], and [[sorbitol]], which induce a secretory state. [[Infection|Bacterial infection]] of the [[intestine]] leads to activation of epithelial ion channels with increased secretion of anions. Invasion of the [[epithelium]] by various [[Pathogen|pathogens]] lead to [[exotoxin]] production and enhancement of [[enterocyte]] secretion by [[Cytotoxicity|cytotoxins]] or intracellular signalling. In case of motility disorders of the gut, rapid transit time delivers [[fluid]] secreted during digestion to the distal [[small bowel]] or [[colon]]. This prevents reabsorption of normally secreted fluid in the [[small bowel]], overwhelming the reabsorptive capacity of the [[colon]].


==Causes==
==Causes==
Common causes of acute [[diarrhea]] in both developing and developed nations are infections. Infectious agents responsible for majority of cases include [[Norovirus]], [[Salmonella]], [[Shigella]], [[Clostridium perfringens]], [[Staphylococcus aureus]], Rotavirus, [[Shigella]], [[ETEC|Enterotoxigenic E.coli]] ([[ETEC]]), [[Campylobacter]] and [[Cryptosporidium parvum]]. Less commonly, acute diarrhea may be be caused by [[Norwalk virus|Norwalk viruses]] or may be associated with systemic infections including [[influenza]], [[Urinary tract infection|urinary tract infections]], and [[HIV AIDS|HIV infection]]. Other common causes of acute diarrhea include [[Food allergy|food allergies]] and drug side effects. Less commonly, acute [[diarrhea]] can be a symptom in the initial stages of systemic conditions including [[Ischemic colitis]], [[Hyperthyroidism]], [[Tropical sprue]] and with disorders of [[digestion]] and the [[absorption]] process.


==Differentiating Acute Diarrhea from Other Diseases==
==Differentiating Hereditary pancreatitis from Other Diseases==
The differentials of acute diarrhea include [[Ischemic colitis]], [[Lactose intolerance]], [[Tropical sprue]], [[Pseudomembranous enterocolitis]], [[Campylobacteriosis]], [[Salmonellosis]], [[Shigellosis]], [[Escherichia coli enteritis]], [[Yersinia enterocolitica]], [[Vibrio cholerae|Vibrio cholera]], [[Aeromonas]], [[Plesiomonas shigelloides|Plesiomonas]], [[Staphylococcus aureus]], [[Bacillus cereus]], [[Clostridium perfringens]], [[Rotavirus]], [[Norovirus]], [[Adenoviridae|Adenovirus]], [[Entamoeba histolytica]], [[Medication|medications]], [[Short bowel syndrome]], [[Organophosphate poisoning]], [[Radiation enteropathy|Radiation enteritis]] and [[Opium withdrawal]].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
In the US, the overall weighted [[prevalence]] for acute diarrheal illness corresponded to 0·6 episodes per person per year from 1996 to 2003. It has been found that approximately 179 million cases of acute [[gastroenteritis]] including 47.8 million cases of food-borne illness, occur each year in the US. The [[mortality rate]] due to acute diarrhea has been estimated for all ages to be 17.8 deaths per 100 000 of population. Global [[mortality rate]] for children (<5 years) is much higher, with a figure of 74·3 deaths per 100 000 of population. [[Morbidity]] and [[Mortality rate|mortality]] of diarrhea differs by location, with the highest rates of under-5 [[Mortality rate|mortality]] noted in sub-Saharan Africa and South Asia, in particular in Chad (594 deaths per 100 000) and Niger (485 deaths per 100 000).


==Risk Factors==
==Risk Factors==

Revision as of 16:49, 9 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hereditary pancreatitis from Other Diseases

Epidemiology and Demographics

Risk Factors

The risk factors of acute diarrhea may be assessed based on the epidemiologic associations and the patient exposure histories. Risk factors may be classified based on travel history, epidemics, outbreaks, food history, animal contact, hospitalization and immunosupression. The 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea lists the risk factors of diarrhea along with their causative pathogens.

Screening

There is insufficient evidence to recommend routine screening for acute diarrhea.

Natural History, Complications, and Prognosis

Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good when the underlying cause is identified and treated early.

Diagnosis

Diagnostic Criteria

There is no established diagnostic study of choice for acute diarrhea as it is generally self-limited. Specific diagnostic studies are performed if symptoms last >7 days, in moderate-to-severe cases, dysentery, and to determine etiology in order to enable directed pathogen-specific therapy.

History and Symptoms

Physical Examination

Laboratory Findings

Laboratory investigations performed in the evaluation of patients with acute diarrhea include spot stool analysis, detection of occult blood, white blood cells, stool culture, quantitative stool analysis, fecal weight, stool osmotic gap, fecal pH, fecal fat concentration and analysis for laxative abuse. According to the ACG guidelines, stool culture is done only in cases where the patient is at high risk of spreading the disease to others. Stool diagnostic studies are performed when symptoms last for >7 days, patient has dysentery or moderate-to-severe diarrhea and to determine etiology to enable directed pathogen-specific therapy. Antibiotic sensitivity testing for management of acute diarrhea is not advised.

Electrocardiogram

There are no ECG findings associated with acute diarrhea.

X-ray

An x-ray may be helpful in the diagnosis of some of the rare causes of acute diarrhea. Findings on an x-ray suggestive of organic causes acute diarrhea include intestinal dilation, irregular mucosal surface and increased luminal fluid.

Ultrasound

There are no ultrasound findings associated with acute diarrhea.

CT scan

CT scan is not routinely performed for cases of acute diarrhea. However, it may help in the detection of certain rare causes of acute diarrhea such as inflammatory bowel disease, intestinal lymphoma, carcinoid syndrome, and other neuroendocrine tumors.

MRI

There are no MRI findings associated with acute diarrhea.

Other Imaging Findings

There are no other imaging findings associated with acute diarrhea.

Other Diagnostic Studies

Sigmoidoscopy and colonoscopy may help in the diagnosis of conditions such as melanosis coli due to laxative abuse, amebiasis, polyps, ulceration, Crohn's disease, and ulcerative colitis. Upper GI endoscopy and biopsy help in the diagnosis of Crohn's disease, giardiasis, intestinal lymphoma, lymphangiectasia, eosinophilic gastroenteritis, Whipple's disease, mastocytosis, abetalipoproteinemia, fungal and protozoal infections.

Treatment

Medical Therapy

The majority of cases of acute diarrhea are self-limited and require only supportive care. Symptomatic treatment for diarrhea includes consumption of adequate amounts of water, mixed with electrolytes to replace water and salt depletion. According to the ACG Clinical Guideline, use of balanced electrolyte rehydration is recommended in patients with traveller’s diarrhea, excessively watery and severe diarrhea. Medical supervision is required in infants with diarrhea, moderate or severe diarrhea in young children, bloody diarrhea, diarrhea for more than two weeks and diarrhea associated with non-cramping abdominal pain, fever and weight loss. Empiric therapy is used as an initial treatment for diagnostic testing, after testing has failed to confirm a diagnosis, when there is no specific treatment or when specific treatment fails to effect a cure. Pharmacotherapy for acute diarrhea includes the use of antibiotics, anticholinergics, antimotility agents and other nonspecific antidiarrheal agents (probiotics).

Surgery

Surgical intervention is not recommended for the management of acute diarrhea.

Primary Prevention

Primary prevention of acute diarrhea includes measures such as counseling in patients and their close contacts. In addition, counseling prior to travel and hand washing using alcohol-based sanitizers are other recommended practices. Hand washing is particularly important for prevention of community-acquired diarrhea outbreaks in cruise ships or institutions.

Secondary Prevention

There are no established measures for the secondary prevention of acute diarrhea.

References


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