Diarrhea 53951 225114803 2008-07-11T23:11:53Z 89.1.15.253 /* Dysentery */ {{Refimprove|date=December 2007}} {{otheruses}} In [[medicine]], '''diarrhea''', also spelled '''diarrhoea''' (see [[Spelling_differences#Simplification_of_ae_.28.C3.A6.29_and_oe_.28.C5.93.29|spelling differences]]), is frequent loose or liquid [[bowel movement]]s. Although for many people diarrhea is merely unpleasant, diarrhea that is both [[Acute (medical)|acute]] and severe is a common cause of death in [[Developing country|developing countries]] and the second most common cause of [[Infant mortality|infant deaths]] worldwide. It is often due to [[gastroenteritis]]. {{Infobox_Disease | Name = Diarrhea | Image = | Caption = | DiseasesDB = 3742 | ICD10 = {{ICD10|A|09||a|00}}, {{ICD10|K|59|1|k|55}} | ICD9 = {{ICD9|787.91}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = ped | eMedicineTopic = 583 | MeshID = D003967 | }} ==Causes== [[Image:Stomach colon rectum diagram.svg|right|thumb|250px|Diagram of the human [[gastrointestinal tract]].]] Diarrhea is most commonly caused by [[virus (biology)|viral]] infections, [[parasites]] or [[bacterium|bacteria]]l toxins.<ref name="pmid16267716">{{cite journal |author=Wilson ME |title=Diarrhea in nontravelers: risk and etiology |journal=Clin. Infect. Dis. |volume=41 Suppl 8 |issue= |pages=S541–6 |year=2005 |pmid=16267716 |doi=10.1086/432949 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID36827 }}</ref> In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy patient usually recovers from viral infections in a few days. However, for ill or malnourished individuals diarrhea can lead to severe [[dehydration]] and can become life-threatening without treatment.<ref name="pmid12608880">{{cite journal |author=Alam NH, Ashraf H |title=Treatment of infectious diarrhea in children |journal=Paediatr Drugs |volume=5 |issue=3 |pages=151–65 |year=2003 |pmid=12608880 |doi= }}</ref> Diarrhea can also be a symptom of more serious diseases, such as [[dysentery]], [[cholera]], or [[botulism]], and can also be indicative of a chronic syndrome such as [[Crohn's disease]] or severe [[Amanita phalloides#Symptoms| mushroom poisoning]] syndromes. Though [[appendicitis]] patients do not generally have diarrhea, it is a common symptom of a ruptured [[vermiform appendix|appendix]]. It is also an effect of severe [[radiation sickness]]. Diarrhea can also be caused by dairy intake in those who are [[lactose intolerant]]. Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with [[electrolyte]]s to provide essential [[salt]]s and some amount of [[nutrient]]s. 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 days; *Diarrhea that is associated with more general illness such as non-cramping [[abdominal pain]], [[fever]], [[weight loss]], etc; *[[Traveler's diarrhea|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 in children.<ref name="pmid2371542">{{cite journal |author=Ruuska T, Vesikari T |title=Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes |journal=Scand. J. Infect. Dis. |volume=22 |issue=3 |pages=259–67 |year=1990 |pmid=2371542| doi = 10.3109/00365549009027046 <!--Retrieved from CrossRef by DOI bot-->}}</ref> ==Types of diarrhea== There are at least four types of diarrhea: secretory diarrhea, osmotic diarrhea, motility-related diarrhea, and inflammatory diarrhea. ===Secretory diarrhea=== Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the [[Lumen (anatomy)|lumen]], sodium is carried with it, along with water. ===Osmotic diarrhea=== Osmotic diarrhea occurs when too much water is drawn into the bowels. This can be the result of maldigestion (e.g., pancreatic disease or [[Coeliac disease]]), in which the nutrients are left in the lumen to pull in water. Osmotic diarrhea can also be caused by osmotic [[laxatives]] (which work to alleviate [[constipation]] by drawing water into the bowels). In healthy individuals, too much [[magnesium]] or [[vitamin C]] or undigested [[lactose]] can produce osmotic diarrhea and distention of the bowel. A person who does not have lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who do not have [[fructose malabsorption]], excess fructose intake can still cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and 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 amounts, may lead to osmotic diarrhea. ===Motility-related diarrhea=== Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the GI tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a [[vagotomy]] or [[diabetic neuropathy]], or a complication of [[menstruation]]. [[Hyperthyroidism]] can produce hypermotility and lead to [[pseudodiarrhea]] and occasionally real diarrhea. Diarrhea can be treated with antimotility agents (such as [[loperamide]]). ===Inflammatory diarrhea=== Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. ===Dysentery=== Generally, if there is blood visible in the stools, it is not diarrhea, but [[dysentery]]. The blood is trace of an invasion of bowel tissue. Dysentery is caused by an excess of water by a release of antidiuretic hormone from the posterior pituitary gland. Dysentery is a symptom of, among others, [[Shigella]], [[Entamoeba histolytica|Entamoeba Histolytica]], and [[Salmonella]]. ==Infectious diarrhea== {{main|Infectious diarrhea}} [[Infectious diarrhea]] is diarrhea caused by a [[microbe]] such as a [[bacterium]], [[parasite]], or [[virus]]. ==Malabsorption== [[Malabsorption]] is the inability to absorb food, mostly in the small bowel but also due to the [[pancreas]]. Causes include [[celiac disease]] (intolerance to wheat, rye, and barley [[gluten]], the protein of the grain), [[lactose intolerance]] (intolerance to milk sugar, common in non-Europeans), [[fructose malabsorption]], [[pernicious anemia]] (impaired bowel function due to the inability to absorb [[vitamin B12]]), loss of pancreatic secretions (may be due to [[cystic fibrosis]] or [[pancreatitis]]), [[short bowel syndrome]] (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs, including agents used in [[chemotherapy]]. ==Inflammatory bowel disease== The two overlapping types here are of unknown origin: * [[Ulcerative colitis]] is marked by chronic bloody diarrhea and inflammation mostly affects the distal [[colon (anatomy)|colon]] near the [[rectum]]. * [[Crohn's disease]] typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel. ==Irritable Bowel Syndrome== {{main|Irritable Bowel Syndrome}} Another possible cause of diarrhea is Irritable Bowel Syndrome (IBS). Symptoms defining IBS: abdominal discomfort or pain relieved by defecation and unusual stool (diarrhea or [[constipation]] or both) or stool frequency, for at least 3 days a week over the previous 3 months.<ref>Longstreth GL, Thompson WG, Chey WD, Houghton LA, Mearin F, and Spiller RC. (2006). Functional Bowel Disorders. Gastroenterology 2006; 130:1480–1491</ref> IBS symptoms can be present in patients with a variety of conditions including food allergies, infective diarrhea, celiac, and inflammatory bowel diseases. Treating the underlying condition (celiac disease, food allergy, bacterial [[dysbiosis]], etc.) usually resolves the diarrhea.<ref>Wangen, S. "The Irritable Bowel Syndrome Solution". page 113. 2006; Innate Health Publishing. ISBN 978-0-9768537-8-7. Excerpted with the author's permission at http://www.IBSTreatmentCenter.com</ref> IBS can cause visceral hypersensitivity. While there is no direct treatment for undifferentiated IBS, symptoms, including diarrhea, can sometimes be managed through a combination of dietary changes, soluble fiber supplements, and/or medications. ==Other important causes== *[[Ischemia|Ischemic]] bowel disease. This usually affects older people and can be due to blocked arteries. *[[Bowel cancer]]: Some (but not all) bowel cancers may have associated diarrhea. Cancer of the large intestine is most common. *Hormone-secreting tumors: some hormones (e.g. [[serotonin]]) can cause diarrhea if excreted in excess (usually from a tumor). *Bile salt diarrhea: excess bile salt entering the [[colon (anatomy)|colon]] rather than being absorbed at the end of the [[small intestine]] can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a bad side-effect of [[gallbladder]] removal. It is usually treated with [[cholestyramine]], a [[bile acid sequestrant]]. ==Alcohol== Chronic diarrhea can be caused by chronic [[ethanol]] ingestion.<ref name=Harrison>Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. [[Harrison's Principles of Internal Medicine]]. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.</ref> Consumption of [[alcohol]] affects the body's capability to absorb water - this is often a symptom that accompanies a [[hangover]] after a heavy drinking session. The alcohol itself is absorbed in the intestines and as the intestinal cells absorb it, the toxicity causes these cells to lose their ability to absorb water. This leads to an outpouring of fluid from the intestinal lining, which is in turn poorly absorbed. The diarrhea usually lasts for several hours until the alcohol is detoxified and removed from the digestive system. Symptoms range from person to person and are influenced by both the amount consumed as well as physiological differences. ==Treatment== In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. Medicines that are available without a doctor's prescription include [[loperamide]] (Imodium) and [[bismuth subsalicylate]] (as found in [[Pepto-Bismol|Pepto Bismol]] and [[Kaopectate]]).<ref name="pmid18192963">{{cite journal |author=Schiller LR |title=Management of diarrhea in clinical practice: strategies for primary care physicians |journal=Rev Gastroenterol Disord |volume=7 Suppl 3 |issue= |pages=S27–38 |year=2007 |pmid=18192963 |doi= |url=http://www.medreviews.com/pubmed.cfm?j=3&v=7Suppl3&i=&p=S27 }}</ref> ==See also== * [[Constipation]] * [[Drinking water]] * [[Feces]] * [[Steatorrhea]] (fatty diarrhea) * [[Traveler's diarrhea]] * [[Wilderness diarrhea]] * [[Foodborne illness|Food poisoning]] * [[The Diarrhea Song]] ==Footnotes== {{reflist}} == External links == {{wiktionarypar|diarrhea}} *[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11100619&dopt=Abstract Reducing deaths from diarrhoea through oral rehydration therapy.] 1: ''Bull. World Health Organ.'' 2000;78(10):1246-55. *[http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm Travelers' Diarrhea] *[http://rehydrate.org/diarrhoea/index.html Rehydration Project] {{Gastroenterology}} [[Category:Gastroenterology]] [[Category:Water-borne diseases]] [[Category:Symptoms]] [[Category:Digestive disease symptoms]] [[Category:Conditions diagnosed by stool test]] [[ang:Meteūtsiht]] [[ar:إسهال]] [[ast:Foria]] [[ay:Jiphilla jaqukipata]] [[bn:উদরাময়]] [[ca:Diarrea]] [[cs:Průjem]] [[da:Diarre]] [[de:Durchfall]] [[es:Diarrea]] [[eo:Diareo]] [[fa:اسهال‌]] [[fr:Diarrhée]] [[gd:Buinneach]] [[ko:설사]] [[hr:Proljev]] [[id:Diare]] [[is:Niðurgangur]] [[it:Diarrea]] [[he:שלשול]] [[la:Alvei profluvium]] [[lt:Viduriavimas]] [[hu:Hasmenés]] [[ms:Diarea]] [[nl:Diarree]] [[ja:下痢]] [[no:Diaré]] [[nn:Diaré]] [[oc:Diarrèa]] [[pl:Biegunka]] [[pt:Diarreia]] [[qu:Q'icha]] [[ru:Диарея]] [[sq:Diarre]] [[scn:Cacaredda]] [[simple:Diarrhea]] [[sk:Hnačka]] [[sl:Driska]] [[sr:Дијареја]] [[sh:Proljev]] [[su:Diaré]] [[fi:Ripuli]] [[sv:Diarré]] [[te:అతిసారం]] [[tr:İshal]] [[uk:Діарея]] [[zh:腹瀉]]