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Diarrhea
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Diarrhea?
Prevention
What to expect (Outlook/Prognosis)?
Diarrhea On the Web
Ongoing Trials at Clinical Trials.gov
Images of Diarrhea
Videos on Diarrhea
FDA on Diarrhea
CDC on Diarrhea
Diarrhea in the news
Blogs on Diarrhea
Directions to Hospitals Treating Diarrhea
Risk calculators and risk factors for Diarrhea

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Meagan E. Doherty

Overview

Diarrhea is loose, watery stools. A person with diarrhea typically passes stool more than three times a day. People with diarrhea may pass more than a quart of stool a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own without special treatment. Prolonged diarrhea persisting for more than 2 days may be a sign of a more serious problem and poses the risk of dehydration. Chronic diarrhea may be a feature of a chronic disease. Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and older people, and it must be treated promptly to avoid serious health problems. People of all ages can get diarrhea and the average adult has a bout of acute diarrhea about four times a year. In the United States, each child will have had seven to 15 episodes of diarrhea by age 5.

What are the symptoms of Diarrhea?

Diarrhea may be accompanied by cramping, abdominal pain, bloating, nausea, or an urgent need to use the bathroom. Depending on the cause, a person may have a fever or bloody stools.

What are the causes of Diarrhea?

Acute diarrhea is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea is usually related to functional disorders such as irritable bowel syndrome or inflammatory bowel disease.

A few of the more common causes of diarrhea include the following:

• Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli).
• Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
• Food intolerances. Some people are unable to digest food components such as artificial sweeteners and lactose—the sugar found in milk.
• Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Reaction to medicines. Antibiotics, blood pressure medications, cancer drugs, and antacids containing magnesium can all cause diarrhea.
• Intestinal diseases. Inflammatory bowel disease, colitis, Crohn’s disease, and celiac disease often lead to diarrhea.
• Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon after gallbladder surgery.

People who visit foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Traveler’s diarrhea can be a problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.

In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

Who is at risk for Diarrhea?

Anyone can get diarrhea. This common problem can last a day or two or for months or years, depending on the cause. Most people get better on their own, but diarrhea can be serious for babies and older people if lost fluids are not replaced. Many people throughout the world die from diarrhea because of the large volume of water lost and the accompanying loss of salts.

Diagnosis

Diagnostic tests to find the cause of diarrhea may include the following:

• Medical history and physical examination. The doctor will ask you about your eating habits and medication use and will examine you for signs of illness.
• Stool culture. A sample of stool is analyzed in a laboratory to check for bacteria, parasites, or other signs of disease and infection.
• Blood tests. Blood tests can be helpful in ruling out certain diseases.
• Fasting tests. To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask you to avoid lactose, carbohydrates, wheat, or other foods to see whether the diarrhea responds to a change in diet.
• Sigmoidoscopy. For this test, the doctor uses a special instrument to look at the inside of the rectum and lower part of the colon.
• Colonoscopy. This test is similar to a sigmoidoscopy, but it allows the doctor to view the entire colon.
• Imaging tests. These tests can rule out structural abnormalities as the cause of diarrhea.

When to seek urgent medical care

Diarrhea is not usually harmful, but it can become dangerous or signal a more serious problem. You should see the doctor if you experience any of the following:

• Diarrhea for more than 3 days
• Severe pain in the abdomen or rectum
• A fever of 102 degrees or higher
• Blood in your stool or black, tarry stools
• Signs of dehydration

Treatment options

In most cases of diarrhea, replacing lost fluid to prevent dehydration is the only treatment necessary. Medicines that stop diarrhea may be helpful, but they are not recommended for people whose diarrhea is caused by a bacterial infection or parasite. If you stop the diarrhea before having purged the bacteria or parasite, you will trap the organism in the intestines and prolong the problem. Rather, doctors usually prescribe antibiotics as a first-line treatment. Viral infections are either treated with medication or left to run their course, depending on the severity and type of virus.

Tips About Food

Until diarrhea subsides, try to avoid caffeine, milk products, and foods that are greasy, high in fiber, or very sweet. These foods tend to aggravate diarrhea.

As you improve, you can add soft, bland foods to your diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. For children, the pediatrician may also recommend a bland diet. Once the diarrhea has stopped, the pediatrician will likely encourage children to return to a normal and healthy diet if it can be tolerated.

Contraindicated medications

Patients diagnosed with Diarrhea should avoid using the following medications:

• Ethacrynic acid
  If you have been diagnosed with Diarrhea, consult your physician before starting or stopping any of these medications.

Where to find medical care for Diarrhea

Directions to Hospitals Treating Diarrhea

Prevention of Diarrhea

• Wash your hands often, especially after going to the bathroom and before eating.
• Teach children to not put objects in their mouth.
• When taking antibiotics, try eating food with Lactobacillus acidophilus, a healthy bacteria. This helps replenish the good bacteria that antibiotics can kill. Yogurt with active or live cultures is a good source of this healthy bacteria.
• Use alcohol-based hand gel frequently.

Traveler’s diarrhea happens when you consume food or water contaminated with bacteria, viruses, or parasites. You can take the following precautions to prevent traveler’s diarrhea when you travel outside of the United States:

• Do not drink tap water or use it to brush your teeth.
• Do not drink unpasteurized milk or dairy products.
• Do not use ice made from tap water.
• Avoid all raw fruits and vegetables, including lettuce and fruit salads, unless they can be peeled and you peel them yourself.
• Do not eat raw or rare meat and fish.
• Do not eat meat or shellfish that is not hot when served.
• Do not eat food from street vendors.

You can safely drink bottled water—if you are the one to break the seal—along with carbonated soft drinks, and hot drinks such as coffee or tea.

Depending on where you are going and how long you will stay, your doctor may recommend that you take antibiotics before leaving to protect you from possible infection.

What to expect (Outlook/Prognosis)

The Prognosis for diarrhea is usually good. Diarrhea is common and usually goes away on its own unless it is an underlying symptom of a chronic disease. It is important to replace lost fluid due to diarrhea because if you become severely dehydrated it can be fatal.

Sources

http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/

Pathophysiology Diarrhea

Normal fluid intake for an adult is about 2 L/d. The average amount of gastrointestinal secretions (composed of salivary glands, gastric, biliary, and pancreatic secretions) is 7-8 L/d, depending on the weight and age. The absorptive surface of the small intestine is formed by villis that reabsorb the majority of secreted water and electrolytes. The small intestine absorbs 75% of upper GI tract secretions. The rest of the secretions absorb in the large intestine. Colon absorbs 90% of its exposed volume, means that colon is the most effective absorbing organ in the GI system.
Decrease in the small intestine absorption, regardless of causes, may not cause diarrhea unless, there is a dysfunction in colon or the volume of the secretions exceeds the absorptive ability of the colon.

 

 

 

 

 

CNS dysregulation and psychosocial factors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Intrinsic gastrointestinal factors:
• Motor abnormalities
• Visceral hypersensitivity
• Immune activation and mucosal inflammation
• Altered gut microbiota
• Abnormal serotonin pathways

 

 

IRRITABLE BOWEL SYNDROME

 

 

 

Genetic factors:
• Twin concordance
• Familial aggregation
• Single nucleotide polymorphisms(SNPs)
• TNF polymorphism

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Environmental factors:
•Diet
•Infections

 

 

 

Differential Diagnosis of Diarrhea of other diseases

To review the differential diagnosis of diarrhea, click here.

To review the differential diagnosis of acute diarrhea, click here.

To review the differential diagnosis of chronic diarrhea, click here.

To review the differential diagnosis of traveler's diarrhea, click here.

To review the differential diagnosis of acute watery diarrhea, click here.

To review the differential diagnosis of acute bloody diarrhea, click here.

To review the differential diagnosis of acute fatty diarrhea, click here.

To review the differential diagnosis of chronic watery diarrhea, click here.

To review the differential diagnosis of chronic bloody diarrhea, click here.

To review the differential diagnosis of chronic fatty diarrhea, click here.

To review the differential diagnosis of acute diarrhea and fever, click here.

To review the differential diagnosis of chronic diarrhea and fever, click here.

To review the differential diagnosis of acute diarrhea and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea and weight loss, click here.

To review the differential diagnosis of chronic diarrhea and weight loss, click here.

To review the differential diagnosis of acute diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea, abdominal pain, and weight loss, click here.

To review the differential diagnosis of chronic diarrhea, abdominal pain, and weight loss, click here.

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief:

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case studies
Case #1
Sandbox:Cherry On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox:Cherry
CDC on Sandbox:Cherry
Sandbox:Cherry in the news
Blogs on Sandbox:Cherry
Directions to Hospitals Treating Cirrhosis
Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief:

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

History and Symptoms

• History should include:
  • Appearance of bowel movements
  • Travel history
  • Associated symptoms
  • Immune status
  • Woodland exposure

table causes

Causes

Population	Life threatening causes	Common causes	Less common causes
Children	Staphylococcus aureus (staphylococcal toxic shock syndrome [TSS]) Salmonella septicemia Hemolytic uraemic syndrome (Shiga toxin producing E. coli ETEC)	Infectious: Viral: Rota virus Noro virus Bacterial: Shigella species ( S.dysentriae, S.flexneri, S.sonneii, S.boydii) E.coli species ( Enterotoxigenic E.coli, Enterohemorrhagic E.coli, Enteroinvasive E.coli) Vibrio cholerae Non Typhoidal Salmonella: S.typhimurium, S.enterica Campylobacter jejuni Clostridium difficle Yersinia enterocolitica Protozoa: Entamoeba histolytica,Cryptosporidium parvum	Adeno virus Astro virus Calcivirus Aeromonas Systemic conditions associated with diarrhea: Influenza, measles, dengue fever, human immunodeficiency virus. Systemic infections associated with diarrhea include pneumonia,Otitis media, sepsis,urinary tract infection.
Adults	There are no life-threatening causes of Acute diarrhea; however, complications resulting from untreated Acute diarrhea are common.	Infections: Bacterial: Shigella species Non typhoidal Salmonella Clostridium difficile Campylobacter jejuni Escherichia coli : ETEC EPEC EHEC EIEC EAEC Yersinia enterocolitica Vibrio cholera Vibrio parahemolyticus Aeromonas Plesiomonas shigelloides Mycobacterium Avium complex Food poisoning: Staphylococcal aureus Bacillus cereus Clostridium perfringens Viral: Noro virus Rota virus Enteric Adeno virus HIV Infection CMV Astro virus Norwalk virus Protozoan and Parasitic: Entamoeba histolytica Giardia lamblia Microsporidia Isospora Medicatons: Antibiotics mostly with Cephalosporins Magnesium containing antacids Laxatives Anti retroviral agents Chemotherapeutic agents Antifungals ACE inhibitors Digoxin Statins Thiazide diuretics Lactulose Ingestion of plants (eg, hyacinths, daffodils, Amanita species mushrooms) Food allergies: Cow's milk protein allergy Soy protein allergy Tropical sprue (initial stages) Ischemic colitis(initial stages) Tumors: VIPoma Organophosphate poisoning Opium withdrawal Short bowel syndrome(initial stages) Radiation enteritis(initial stages)	Listeria monocytogenes (in immuno compromised) Hyperthyroidism Irritable bowel syndrome Disorders of digestive/absorptive processes: Glucose-galactose malabsorption Sucrase-isomaltase deficiency Late-onset (adult-type) hypolactasia, leads to lactose intolerance Intra abdominal emergencies including appendicitis, Intussusception.

References:

References

Other Imaging Findings

• Endoscopy
• Barium enema
• Colonoscopy
• Sigmoidoscopy

Other diagnostic studies

Other Diagnostic Studies

• Breath hydrogen test

• HIV testing for those patients suspected of having HIV

==

Overview

Medical Therapy

• Fluid resuscitation (oral, if not IV)
• Patients should be advised to do the following until symptoms subside:
  • Hydrate with liquids that are caffeine free and contain glucose
  • Avoid lactose
  • Chew gum that is free of sorbitol
  • Eat raw fruit
• For patients with lactose intolerance, a lactose-free diet is advised
• For patients with malabsorption diseases, a gluten free diet is advised
• Consultation with oncology, surgery and/or gastroenterology may be required for intestinal neoplasm
• Control blood sugar (diabetic neuropathy)

Empirical Therapy

Empirical therapy is used as an initial treatment before diagnostic testing or after diagnostic testing has failed to confirm a diagnosis or when there is no specific treatment or when specific treatment fails to effect a cure.

• Empirical trials of antimicrobial therapy like metronidazole for protozoal diarrhea or fluoroquinolone for enteric bacterial diarrhea if the prevalence of bacterial or protozoal infection is high in a specific community or situation.

• Most cases of diarrhea, except for high-volume secretory states, respond to a sufficiently high dose of opium or morphine. Codeine, synthetic opioids diphenoxylate and loperamide are less potent. However loperamide is generally used because of its less abuse potential.

• The somatostatin analogue octreotide has proven effectiveness in carcinoid tumors and other peptide-secreting tumors, dumping syndrome, and chemotherapy-induced diarrhea.

• Intraluminal agents include adsorbants, such as activated charcoal, and binding resins like bismuth and stool modifiers, such as medicinal fiber.

Pharmacotherapy

• Antibiotics (malabsorption diseases)
• Anticholinergics (IBS)
• Antimolality agents
• Antibiotic therapy (severe disease)
• Metoclopramide (diabetic neuropathy)
• Nonspecific antidiarrheal agents

Symptomatic Treatment

• Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary.
• The following types of diarrhea indicate medical supervision is required:
  • Diarrhea in infants;
  • Moderate or severe diarrhea in young children;
  • Diarrhea associated with blood;
  • Diarrhea that continues for more than two weeks;
  • Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
  • Diarrhea in travelers, since they are more likely to have exotic infections such as parasites;
  • Diarrhea in food handlers, because of the potential to infect others;
  • Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis.

Pathogen Specific

Immunocompetent

• Bacterial

• 1. Shigella species

• Preferred regimen (1):

• Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 3 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 3 days)
• Pediatric dose: TMP-SMZ, 5 and 25 mg/kg, respectively bid for 3 days

• Preferred regimen (2):

• Adult dose: Nalidixic acid 1 g/d for 5 days OR Ceftriaxone; Azithromycin
• Pediatric dose: Nalidixic acid, 55 mg/kg/d for 5 days

• 2. Non-typhi species of Salmonella

• Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 year old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 5 to 7 days; Ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

• 3. Campylobacter species

• Preferred regimen: Erythromycin 500 mg bid for 5 days

• 4. Escherichia coli species

• 4.1. Enterotoxigenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.2. Enteropathogenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.3. Enteroinvasive

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.4. Enterohemorrhagic

• Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

• 5. Aeromonas/Plesiomonas

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 6. Yersinia species

• Preferred regimen: Antibiotics are not usually required; Deferoxamine therapy should be withheld; for severe infections or associated bacteremia treat as for immunocompromised hosts, using combination therapy with Doxycycline, Aminoglycoside, TMP-SMZ, OR Fluoroquinolone

• 7. Vibrio cholerae O1 or O139

• Preferred regimen (1): Doxycycline 300-mg single dose
• Preferred regimen (2): Tetracycline 500 mg qid for 3 days
• Preferred regimen (3): TMP-SMZ 160 and 800 mg, respectively, bid for 3 days
• Preferred regimen (4): single-dose Fluoroquinolone

• 8. Toxigenic Clostridium difficile

• Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

• Parasites

• 1. Giardia

• Preferred regimen: Metronidazole 250-750 mg tid for 7-10 days

• 2. Cryptosporidium species

• Preferred regimen: If severe, consider Paromomycin, 500 mg tid for 7 days

• 3. Isospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 7 to 10 days

• 4. Cyclospora species

• Preferred regimen: TMP/SMZ, 160 and 800 mg, respectively, bid for 7 days

• 5. Microsporidium species

• Preferred regimen: Not determined

• 6. Entamoeba histolytica

• Preferred regimen (1): Metronidazole 750 mg tid for 5 to 10 days AND Diiodohydroxyquin 650 mg tid for 20 days
• Preferred regimen (2): Metronidazole 750 mg tid for 5 to 10 days AND Paromomycin 500 mg tid for 7 days

Immunocompromised

• Bacterial

• 1. Shigella species:

• Preferred regimen (1):

• Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 7 to 10 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 7 to 10 days)
• Pediatric dose:TMP-SMZ, 5 and 25 mg/kg, respectively bid for 7 to 10 days

• Preferred regimen (2):

• Adult dose: Nalidixic acid 1 g/d for 7 to 10 days OR Ceftriaxone; Azithromycin
• Pediatric dose: Nalidixic acid, 55 mg/kg/d for 7 to 10 days

• 2. Non-typhi species of Salmonella

• Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 14 days (or longer if relapsing); ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

• 3. Campylobacter species

• Preferred regimen: Erythromycin, 500 mg bid for 5 days (may require prolonged treatment)

• 4. Escherichia coli species

• 4.1. Enterotoxigenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days) (Consider fluoroquinolone as for enterotoxigenic E. coli)

• 4.2. Enteropathogenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.3. Enteroinvasive

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.4. Enterohemorrhagic

• Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

• 5. Aeromonas/Plesiomonas

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg ofloxacin, 400 mg norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 6. Yersinia species

• Preferred regimen: Doxycycline, Aminoglycoside (in combination) or TMP-SMZ or Fluoroquinolone

• 7. Vibrio cholerae O1 or O139

• Preferred regimen: Doxycycline, 300-mg single dose; or Tetracycline, 500 mg qid for 3 days; or TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days; or single-dose Fluoroquinolone

• 8. Toxigenic Clostridium difficile

• Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

• Parasites

• 1. Giardia

• Preferred regimen: Metronidazole, 250-750 mg tid for 7-10 days

• 2. Cryptosporidium species

• Preferred regimen: Paromomycin, 500 mg tid for 14 to 28 days, then bid if needed; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

• 3. Isospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly, or weekly Sulfadoxine (500 mg) and Pyrimethamine (25 mg) indefinitely for patients with AIDS

• 4. Cyclospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly indefinitely

• 5. Microsporidium species

• Preferred regimen: Albendazole, 400 mg bid for 3 weeks; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

• 6. Entamoeba histolytica

• Preferred regimen: Metronidazole, 750 mg tid for 5 to 10 days, plus either Diiodohydroxyquin, 650 mg tid for 20 days, or Paromomycin, 500 mg tid for 7 days

Contraindicated medications

Diarrhea is considered an absolute contraindication to the use of the following medications:

• Ethacrynic acid

References

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

Cirrhosis Microchapters
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Physical Examination
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Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
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Medical Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief:

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Normal versus Abnormal Barium study of esophagus with varices

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C. burnetii, the Q fever causing agent

Image and text to the right

<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.

Gallery

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  Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

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  Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

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  Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

References

REFERENCES