Diarrhea , also spelled diarrhea , is a condition of having at least three loose or liquid bowel movements each day. This often lasts for several days and may cause dehydration due to fluid loss. Signs of dehydration often begin with the loss of normal skin resilience and irritability. This may progress to decreased urination, loss of skin color, rapid heart rate, and decreased response power as it becomes more severe. Loose but non-aqueous stools in exclusively breastfed infants, however, are normal.
The most common cause is intestinal infection because of viruses, bacteria, or parasites - a condition also known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by feces, or directly from others infected. Three types of diarrhea are: short-duration watery diarrhea, short-term bloody diarrhea, and persistent diarrhea (lasting more than two weeks). Short-duration watery diarrhea may be due to infection by cholera, although this is rare in developed countries. If blood is present it is also known as dysentery. A number of non-contagious causes can cause diarrhea. These include lactose intolerance, irritable bowel syndrome, non-celiac gluten sensitivity, celiac disease, inflammatory bowel disease, hyperthyroidism, bile acid diarrhea, and a number of drugs. In most cases, stool culture to ascertain the exact cause is not necessary.
Diarrhea can be prevented with improved sanitation, clean drinking water, and hand washing with soap. Breastfeeding for at least six months and vaccination against rotavirus is also recommended. Oral rehydration solution (ORS) - clean water with a pinch of salt and sugar - is the treatment option. Zinc tablets are also recommended. This treatment is estimated to have saved 50 million children in the last 25 years. When people experience diarrhea, it is recommended that they continue to eat healthy foods and babies continue to be breastfed. If a commercial ORS is not available, a homemade solution can be used. In those with severe dehydration, intravenous fluids may be necessary. Most cases; However, it can be managed well with fluids through the mouth. Antibiotics, although rarely used, may be recommended in some cases such as bloody diarrhea and high fever, those with severe diarrhea after traveling, and those who grow certain bacteria or parasites in their feces. Loperamide can help reduce the amount of bowel movement but is not recommended in those with severe illness.
About 1.7 to 5 billion cases of diarrhea occur annually. This is most common in developing countries, where young children experience diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.26 million in 2013 - down from 2.58 million in 1990. In 2012, it was the second most common cause of death in children younger than five (0.76 million or 11% ). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years. Other long-term problems that can lead to stunted growth and poor intellectual development.
Video Diarrhea
Definitions
Diarrhea is defined by the World Health Organization because it has three or more loose or liquid stools per day, or has more stool than normal for the person.
Acute diarrhea is defined as the discharge of semisolid or fluid fluids from the abnormal gut, lasting less than 14 days, by the World Gastroenterology Organization.
Secretary
Diarrhea secretion means that there is an increase in active secretion, or there is inhibition of absorption. There is little or no structural damage. The most common cause of this type of diarrhea is cholera toxin that stimulates anion secretion, especially chloride ions. Therefore, to maintain a balance of charge in the gastrointestinal tract, sodium is brought with it, along with water. In this type of diarrhea the secretion of intestinal fluid is isotonic with plasma even during fasting. This continues even when there is no oral food intake.
Osmotic
Osmotic diarrhea occurs when too much water enters the intestine. If a person drinks a solution with excessive sugar or excessive salt, it can draw water from the body into the intestine and cause osmotic diarrhea. Osmotic diarrhea can also be caused by indigestion (eg pancreatic disease or celiac disease), where nutrients are left behind in the lumen to attract water. Or it may be caused by an osmotic laxative (which serves to relieve constipation by drawing water into the intestine). In healthy individuals, too much magnesium or vitamin C or undigested lactose can cause intestinal diarrhea and distention. A person who has lactose intolerance may have difficulty absorbing lactose after an unusually high dairy intake. In people who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have high glucose content are more readily absorbed and are less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large quantities, can cause osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the attacking agent (eg milk, sorbitol) is stopped.
Exudative
Exudative diarrhea occurs with the presence of blood and pus in the feces. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as E. coli or other forms of food poisoning.
Inflammation
Inflammatory diarrhea occurs when there is damage to the mucosal lining or border brush, leading to a passive loss of protein-rich fluid and a decrease in the ability to absorb the lost fluid. The third feature of the other types of diarrhea can be found in this type of diarrhea. This can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel disease. Can also be caused by tuberculosis, colon cancer, and enteritis.
Dysentery
If there is blood seen in the stool, it is also known as dysentery. Blood is a trace of intestinal tissue invasion. Dysentery is a symptom, among others, Shigella , Entamoeba histolytica , and Salmonella .
Maps Diarrhea
Health effects
Diarrheal disease may have a negative impact on physical fitness and mental development. "Malnutrition in children caused by any cause reduces physical fitness and work productivity in adults," and diarrhea is a major cause of child malnutrition. Furthermore, evidence suggests that diarrheal diseases have a significant impact on mental and health development; it has been shown that, even when controlling worm infections and early breastfeeding, children who have experienced severe diarrhea had significantly lower scores on a series of intelligence tests.
Diarrhea can cause electrolyte imbalances, renal impairment, dehydration, and immune system response. When oral medication is administered, the efficiency of the drug is to produce a therapeutic effect and this lack of effect may be due to the drug traveling too quickly through the digestive system, limiting the time it can be absorbed. Doctors try to treat diarrhea by reducing drug doses, changing dosing schedules, stopping drugs, and rehydration. Interventions to control diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the major factors for placing older adults in long-term care facilities (nursing home).
Differential diagnosis
Acute diarrhea is most commonly caused by viral gastroenteritis with rotavirus, which accounts for 40% of cases in toddlers. However, in transit, bacterial infections predominate. Various toxins like mushroom poisoning and drugs can also cause acute diarrhea.
Chronic diarrhea may be part of the presentation of a number of chronic medical conditions that affect the gut. Common causes include ulcerative colitis, Crohn's disease, microscopic colitis, celiac disease, irritable bowel syndrome and bile acid malabsorption.
Infection
There are many causes of infectious diarrhea, which include viruses, bacteria, and parasites. Infectious diarrhea is often referred to as gastroenteritis. Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years. Adenovirus types 40 and 41, and astroviruses cause a large number of infections.
Campylobacter spp. is a common cause of bacterial diarrhea, but infection by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also common causes.
In older people, especially those who have been treated with antibiotics for unrelated infections, toxins produced by Clostridium difficile often cause severe diarrhea.
Parasites, especially protozoa (eg, Cryptosporidium spp., Giardia spp., Entamoeba histolytica , Blastocystis spp. Cyclospora cayetanensis ), often a cause of diarrhea involving chronic infection. The spectrum of nitazoxanide antiparasitic agents has demonstrated efficacy against many diarrheal parasites.
Other infectious agents, such as parasites or bacterial toxins, may aggravate symptoms. In clean living conditions where there is plenty of food and water supplies, healthy people usually recover from viral infections within a few days. However, for sick or malnourished individuals, diarrhea can cause severe dehydration and can be life-threatening.
Malabsorption
Malabsorption is the inability to absorb food completely, mostly from disorders in the small intestine, but also because of indigestion from pancreatic disease.
Causes include:
- lack of enzymes or mucosal disorders , such as food allergies and food intolerance, eg. celiac disease (gluten intolerance), lactose intolerance (intolerance to milk sugar, common in non-Europeans), and fructose malabsorption.
- pernicious anemia , or impaired bowel function due to inability to absorb vitamin B 12 ,
- loss of pancreatic secretions , which may be caused by cystic fibrosis or pancreatitis,
- structural defects, such as short bowel syndrome (surgically removed intestines) and radiation fibrosis, usually follow cancer treatments and other drugs, including agents used in chemotherapy; and
- certain drugs , such as orlistat, that inhibit the absorption of fats.
Inflammatory bowel disease
The two types of overlap here are of unknown origin:
- Ulcerative colitis is characterized by chronic bleeding diarrhea and most inflammation affects distal colon near the rectum.
- Crohn's disease usually affects quite a limited segment of the intestine in the colon and often affects the tip of the small intestine.
Irritated bowel syndrome
Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort lost due to bowel movements and unusual stools (diarrhea or constipation) for at least 3 days a week for the previous 3 months. Symptoms of dominant diarrhea-IBS can be managed through a combination of dietary changes, soluble fiber supplements and drugs such as loperamide or codeine. Approximately 30% of patients with dominant diarrhea-IBS have bile acid malabsorption diagnosed with abnormal SeHCAT tests.
Other diseases
Diarrhea can be caused by diseases and other conditions, namely:
- Chronic ethanol intake
- Ischemic bowel disease: It usually affects the elderly and may be caused by blocked arteries.
- Microscopic colitis, a type of inflammatory bowel disease in which changes are seen only in histologic examination of colonic biopsy.
- malabsorption of bile salts (primary bile acid diarrhea) where excessive bile acids in the colon cause diarrhea secretion.
- Tumors that secrete hormones: some hormones (eg, serotonin) can cause diarrhea if excreted excessively (usually from a tumor).
- Chronic mild diarrhea in infants and toddlers can occur for no apparent and no other harmful cause; this condition is called infant diarrhea.
- Enteropathy environment
- Enteropathic radiation after treatment for pelvic and stomach cancers.
Cause
Sanitation
Open debris is the main cause of diarrhea that causes death.
Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not come from poverty itself, but from the conditions in which the poor live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, ground floors, lack of access to clean water or sewerage disposal (sanitation), cohabitation with domestic animals that can carry human pathogens, and lack of refrigerated storage for food, all of which increase the frequency of diarrhea. Poverty also limits the ability to provide age-appropriate, well-balanced or dietary diets when diarrhea develops so as to mitigate and improve nutritional loss, the impact is exacerbated by inadequate, available medical care, and affordable. "
Water
One of the most common causes of infectious diarrhea is lack of clean water. Often inappropriate waste disposal causes groundwater contamination. This can cause widespread infection among the population, especially in the absence of water filtration or purification. Human waste contains a variety of potentially harmful human pathogens.
Nutrition
Proper nutrition is important for health and function, including prevention of infectious diarrhea. This is especially important for children who do not have a fully developed immune system. Zinc deficiency, a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and functioning of the human immune system. Indeed, the relationship between zinc deficiency and decreased immune function is consistent with increasing severity of infectious diarrhea. Children who have low zinc levels have more instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can lead to increased severity of diarrheal episodes. However, there are some differences when it comes to the impact of vitamin A deficiency at the disease level. While some argue that there is no relationship between disease level and vitamin A status, others indicate an increase in rates associated with deficiency. Given that estimates suggest 127 million preschoolers worldwide are vitamin A deficiency, this population has a potential increased risk of contraction of the disease.
Drugs
Some drugs, such as penicillum can cause diarrhea. More than 700 drugs are known to cause diarrhea. The classes of drugs known to cause diarrhea are laxatives, antacids, ulcer medications, antibiotics, anti-neoplastic drugs, anti-inflammation as well as many dietary supplements.
Pathophysiology
Evolution
According to two researchers, Nesse and Williams, diarrhea can serve as an evolving evolutionary defense mechanism. As a result, if stopped, there may be a delay in recovery. They cite to support a research argument published in 1973 that found that treating Shigella with anti-diarrhea drugs (Co-phenotrope, Lomotil) caused people to remain febrile twice as long as those not treated. The researchers themselves observed that: "Lomotil may be contraindicated in shigellosis, and diarrhea may represent defense mechanisms".
Diagnostic approach
The following types of diarrhea may indicate further investigation is required:
- In baby
- Moderate or severe diarrhea in young children
- Associated with blood
- Continue for more than two days
- Related abdominal pain without cramping, fever, weight loss, etc.
- In the traveler
- In food handlers, because of the potential to infect others;
- In institutions such as hospitals, child care centers, or geriatric homes and detention centers.
Severity scores are used to help diagnose in children.
Prevention
Sanitation
Numerous studies have shown that improvements in drinking water and sanitation (WASH) lead to a reduced risk of diarrhea. Such improvements may include for example the use of water filters, piped water supply and high-quality sewer connections.
In institutions, communities, and households, interventions that promote handwashing with soap cause a significant reduction in the incidence of diarrhea. The same is true for preventing defecation at the community level and providing access to improved sanitation. This includes the use of toilets and the implementation of all sanitary chains connected to toilets (collection, transport, disposal or reuse of human waste).
Wash hands
Basic sanitation techniques can have a profound effect on the transmission of diarrheal diseases. Implementation of handwashing with soap and water, for example, has been experimentally proven to reduce the incidence of disease by around 42-48%. Handwashing in developing countries, however, is compromised by poverty as recognized by the CDC: "Handwashing is an integral part of disease prevention in all parts of the world, but access to soap and water is limited in a number of less developed countries. is one of many challenges for proper hygiene in developing countries. "The solution to this barrier requires the implementation of educational programs that encourage sanitation behavior.
Water
Given that water pollution is the primary means for transmission of diarrheal diseases, efforts to provide improved water supply and sanitation have the potential to dramatically reduce the incidence rate of the disease. In fact, it has been suggested that we may expect a 88% reduction in child mortality from diarrheal diseases as a result of improved water sanitation and hygiene. Similarly, meta-analyzes of various studies on increasing water supply and sanitation show a 22-27% decrease in disease incidence, and a 21-30% reduction in mortality rates associated with diarrheal diseases.
Processing of water chlorine, for example, has been shown to reduce both the risk of diarrheal disease, and the contamination of stored water with diarrheal pathogens.
Vaccinations
Immunization against pathogens that cause diarrheal diseases is a viable preventive strategy, but it is necessary to target certain pathogens for vaccination. In the case of Rotavirus, responsible for about 6% of diarrheal episodes and 20% of diarrheal deaths in children in developing countries, the use of the Rotavirus vaccine in trials in 1985 resulted in a slight (2-3%) decrease in incidence of total diarrheal diseases, while reducing overall mortality by 6-10%. Similarly, the Cholera vaccine shows a strong decrease in morbidity and mortality, although the overall impact of vaccination is minimal because Cholera is not one of the main causes of diarrheal disease. Since this time, more effective vaccines have been developed that could potentially save thousands of lives in developing countries, while reducing overall medical costs, and costs for communities.
The rotavirus vaccine lowers the rate of diarrhea in a population. New vaccines against rotavirus, Shigella , Enterotoxigenic Escherichia coli (ETEC), and cholera are under development, as well as other causes of infectious diarrhea.
Nutrition
Dietary shortages in developing countries can be resisted by promoting better eating practices. Zinc supplementation has been shown to show a significant decrease in the incidence of diarrheal disease compared with the control group. Much of the literature suggests that vitamin A supplementation is beneficial in reducing the incidence of disease. The development of supplementation strategies should take into account the fact that vitamin A supplementation is less effective in reducing the incidence of diarrhea when compared with vitamin A and zinc supplementation, and that the latter strategy is estimated to be significantly more cost-effective.
Breastfeeding
Breast-feeding practices have been shown to have a dramatic effect on the incidence of diarrheal diseases in poor populations. Studies in a number of developing countries show that those who receive exclusive breastfeeding during the first 6 months of life are more protected from diarrheal infections. One study in Brazil found that non-breastfed babies were 14 times more likely to die of diarrhea than exclusively breastfed babies. Exclusive breastfeeding is currently recommended for the first six months of life by WHO, with breastfeeding for at least two years.
More
Probiotics reduce the risk of diarrhea in those taking antibiotics.
Management
In many cases of diarrhea, replacing lost fluids and salt is the only necessary treatment. This is usually by mouth - oral rehydration therapy - or, in severe cases, intravenously. Dietary restrictions such as the BRAT diet are no longer recommended. Research does not support the restriction of breast milk in children because it has no effect on the duration of diarrhea. Instead, WHO recommends that children with diarrhea continue to eat because adequate nutrition is usually still absorbed to support growth and weight gain, and that continuing to eat also speeds up normal bowel function recovery. The CDC recommends that children and adults with cholera also continue to eat.
Drugs such as loperamide (Imodium) and bismuth subsalicylate may be beneficial; However they may be contraindicated in certain situations.
Fluid
Oral rehydration solutions (ORS) (water that is slightly sweet and salty) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yoghurt drink, vegetable soup and chicken with salt can be provided. Home remedies such as water where cereals have been cooked, soup tasteless, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juice can have from half a teaspoon to one teaspoon of salt (from one half to three grams) added per liter. Clean water can also be one of several liquids provided. There are commercial solutions such as Pedialyte, and aid agencies such as UNICEF widely distribute salt and sugar packets. WHO publications for doctors recommend homemade ORS consisting of one liter of water with one teaspoon of salt (3 grams) and two tablespoons of sugar (18 grams) added (approximately "tear"). The Rehydration Project recommends adding the same amount of sugar but only one and a half teaspoon of salt, stating that this dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse.
The right amount of zinc and potassium should be added if available. But this availability should not delay rehydration. As the WHO indicates, the most important thing is to start preventing dehydration as early as possible. In other instances of fast ORS expected to prevent dehydration, the CDC recommends for cholera treatment that continues to provide Oral Rehydration Solutions during a trip to medical care.
Vomiting often occurs during the first hour or two of treatment with ORS, especially if the child drinks the solution too quickly, but this rarely prevents successful rehydration because most of the fluid is still absorbed. WHO recommends that if a child vomits, wait five or ten minutes and then start giving the solution again more slowly.
Drinks especially those containing simple sugars, such as soft drinks and fruit juices, are not recommended in children under the age of 5 because they may increase dehydration. An overly rich solution in the intestine draws water from the rest of the body, as if the person is drinking sea water. Ordinary water can be used if more specific and effective ORT preparations are unavailable or unsuitable. In addition, the mixture of water and beverages may be too rich in sugar and salt can be given to the same person, in order to provide adequate amounts of sodium overall. A nasogastric tube can be used in young children to provide fluids if needed.
Eating
WHO recommends a child with diarrhea continues to be fed. Continued feeding speeds recovery of normal bowel function. Conversely, children whose food is restricted have longer-term diarrhea and restore bowel function more slowly. WHO states "The food should be never secret and the child's regular food should be not diluted." Breastfeeding should always continue. " And in specific examples of cholera, CDC also makes the same recommendations. Breastfed babies with diarrhea often choose to breastfeed more, and should be encouraged to do so. In young children who are not breastfed and living in the developed world, a lactose-free diet may be useful to speed recovery.
Drugs
While antibiotics are beneficial in some types of acute diarrhea, antibiotics are usually not used except in certain situations. There is concern that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157: H7. In resource-poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance, especially Shigella . Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with common antibiotics.
While bismuth compounds (Pepto-Bismol) decrease the amount of defecation in those who have diarrhea, they do not reduce the length of the disease. Anti-motility agents such as loperamide are also effective in reducing the amount of stool but not the duration of the disease. This agent should only be used if bloody diarrhea does not exist.
Sequic acid sequesters such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption. Therapeutic tests of these drugs are indicated in chronic diarrhea if bile acid malabsorption can not be diagnosed by specific tests, such as SeHCAT retention.
Alternative therapy
Zinc supplements can be beneficial for children over six months with diarrhea in areas with high levels of nutritional or zinc deficiency. It supports the World Health Organization's guidelines for zinc, but not at a very young age.
Probiotics reduce the duration of symptoms in one day and reduce the likelihood of symptoms lasting longer than four days by 60%. Lactobacillus probiotics may help prevent antibiotic-related diarrhea in adults but may not be children. For those with lactose intolerance, taking a digestive enzyme containing lactase when consuming dairy products often improves symptoms.
Epidemiology
Around the world in 2004, about 2.5 billion cases of diarrhea occurred, resulting in 1.5 million deaths among children under the age of five. Larger than half of them in Africa and South Asia. This dropped from the death rate of 4.5 million in 1980 to gastroenteritis. Diarrhea remains the second leading cause of death (16%) after pneumonia (17%) in this age group.
The majority of such cases occur in developing countries, with more than half of the recorded cases of childhood diarrhea occurring in Africa and Asia, with 696 million and 1.2 billion cases, respectively, compared to only 480 million worldwide.
Infectious diarrhea results in about 0.7 million deaths in children under five years in 2011 and 250 million lost school days. In America, diarrheal diseases account for a total of 10% of deaths among children aged 1-59 months while in Southeast Asia, it accounts for 31.3% of deaths. It is estimated that approximately 21% of child deaths in developing countries are due to diarrheal diseases.
Terminology
The word diarrhea comes from the Ancient Greek ???????? from ??? he "through" and ??? rheo "streamed".
Diarrhea is a spelling in American English while diarrhea is a spelling at Commonwealth English.
Slang terms for conditions include "the runs", "squirts", and "the trots".
References
External links
- Diarrhea in Curlie (based on DMOZ)
Source of the article : Wikipedia
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