DIARRHEA :

Definition:
It is defined as An increase in the frequency and looseness of stools compared to ones normal
bowl pattern

The overall weight and volume of the stool is increased (>200g or ml per day) and the water
content is increased up to 60-90 %. It is not a disease but a sign of an underlying problem such
as GIT disorder. (Roger Walker & CPR)

Etiology:
1: Viral Gastroentitis:

It is typically caused by the Noroviruses, which are transmitted by contaminated water or food.
Other attributable viruses include Rotavirus, Adenoviruses and Hepatitis A virus. Diarrhea
associated with the viral gastroentitis is usually self limiting for 2-3 days may last up to 2 weeks.

2: Bacterial Gastroentitis:
It typically results from consumption of contaminated water or food.commen contributers
include E.coli,Staphylococcus aurus,Vibrio cholera,Shigella ,Salmonella,Compylobacter and
Clostridium .Toxin producing bacteria affect small intestine resulting in watery stools,

invasiveBacteria e.g E.coli affect large intestine resulting in dysentery like stools (extreme
urgency to defecate, abdominal cramping, tenesmus, fever, chills, stool containing blood or
pus).Onset of diarrhea ranges between 1-72 hours depending upon infecting bacteria.

3: Protozoal Diarrhea:
It is caused by Giardic lambile, Entamoeba histolytic .It may be described as profuse watery
diarrhea which may be accompanied by flatulence or abdominal pain.

4: Diet Induced Diarrhea:

Induced by foods results from food allergies, high fiber diet, fatty or spicy food, large amount of
caffeine or lactose intolerance.

Some medicines particularly broad spectrum antibiotics such as ampiciilin, erythromycin

and neomycin also induce diarrhea secondary to therapy.

(Roger Walker & CPR)

Pathophysiology:
The epithelium of the digestive tube is protected from insult by a number of mechanisms
constituting the gastrointestinal, but like many barriers, it can be breached. Disruption of the
epithelium of the intestine due to microbial or viral pathogens is a very common cause of
diarrhea in all species. Destruction of the epithelium results not only in exudation of serum and
blood into the lumen but often is associated with widespread destruction of absorptive
epithelium. In such cases, absorption of water occurs very inefficiently and diarrhea results.

Sign and symptoms:

Acute onset is associated with loose or watery stools accompanied by dehydration or

water loss stools and nausea, vomiting, anorexia, abdominal cramp, flatulence and
bloating.
When there is blood in diarrhea ,it is DYSENTRY.
In case of moderate dehydration symptoms include sunken eyes, tachycardia, dizziness,
postural hypotension. If it is remain unchecked or in case of severe dehydration it can
cause hypovolaemic shock, oliguria, weak pulse low or undetectable blood pressure.
(Roger Walker)

Diagnosis:
Physical Examination:

Temperature check
B.P and pulse check
Sign for dehydration
Examination of abdomen for abdominal pain

Medication History:

It is needed to eliminate antibiotic (B Lactum or Cephalosporine) or other drug induced

diarrhea.
Testing of C. Defficile induced pseudo membranous colitis is indicated in those patients
with severe symptoms or where hospitalization or antibiotic therapy with lincomycins
has occurred within preceding 6 weeks.
For laxative overdose
 Blood Test:

CBC is performed to determine causing bacteria.

Stool Test:

It is done to determine whether bacterium or parasite is causing diarrhea.

Stool test is done also in immunocompromised patients.
To check bloody diarrhea.
To check severe symptoms
if no improvement still after 48 hours
(Roger Walker &
Mayoclinic.Org)