Diarrhea

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Diarrhea
ICD-10 A09, K59.1
ICD-9 787.91
DiseasesDB 3742
eMedicine ped/583 
MeSH D003967

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] M.Umer Tariq [3]

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Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements.

Although for many people diarrhea is merely unpleasant, diarrhea that is both acute and severe is a common cause of death in developing countries and a major cause of infant death worldwide. It is often due to gastroenteritis.

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, sodium is carried with it, along with water.

Osmotic diarrhea

Osmotic diarrhea occurs when there is a loss of water due to a heavy osmotic load. This can occur when there is maldigestion (e.g., pancreatic disease or Coeliac disease), where the nutrients are left in the lumen, which pulls water into the lumen.

Motility-related diarrhea

Motility-related diarrhea occurs when the motility of the gastrointestinal tract is abnormally high. If the food moves too quickly, 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.

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 disease.

Causes

The principal cause of diarrhea stems from ingestion of unsafe drinking water (typically from admixture of raw sewage to water supplies); the occurrence is predominantly in lesser developed countries.

Causes of diarrhea can be infection, allergy, food intolerance, foodborne illness and/or extreme excesses of Vitamin C and/or magnesium and may be accompanied by abdominal pain, nausea and vomiting. Temporary diarrhea can also result from the ingestion of laxative medications or large quantities of certain foods like prunes with laxative properties. There are other conditions which involve some but not all of the symptoms of diarrhea, and so the formal medical definition of diarrhea involves defecation of more than 200 grams per day (although formal weighing of stools to determine a diagnosis is rarely actually carried out).

Diarrhea occurs when insufficient fluid is absorbed by the colon. As part of normal digestion, food is mixed with large amounts of water. The water is supplied, as needed, by the stomach and small intestine. The colon recovers this water, leaving the remaining material as a semisolid stool. If the colon is damaged or inflamed, however, absorption is inhibited, and watery stools result.

Diarrhea is most commonly caused by viral infections or bacterial toxins. In sanitary living conditions and with ample food and water available, an otherwise healthy patient typically recovers from the common viral infections in a few days and at most a week. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment.

Diarrhea can also be a symptom of more serious diseases, such as dysentery, Montezuma's Revenge, cholera, or botulism, and can also be indicative of a chronic syndrome such as Crohn's disease. Though appendicitis patients do not generally have diarrhea, it is a common symptom of a ruptured 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 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.[1]

Causes According to Duration

Acute Diarrhea

Chronic Diarrhea

Causes According to Etiology

  • 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.

Complete Differential Diagnosis of the Causes of Diarrhea

(By organ system)

Cardiovascular

Myocarditis, Portal vein thrombosis, Superior mesenteric artery occlusion,


Chemical / poisoning

Acrodynia, Acute tin poisoning, Acute zinc toxicity, Arsenic poisoning, Amnesic shellfish poisoning, D. suaveolans) Arsenic poisoning, Ricinus communis Chlordane, Copper toxicity, Narcissus pseudonarcissus Diazinon, Endosulfan, Isomalt, Datura stramonium Lead poisoning, Mercury poisoning, Metal fume fever, Phoradendron serotinum Naphthalene, Oleander, Organophosphates, Phytohaemagglutinin, Phytolacca Americana, Solanum tuberosum, Abrus precatorious, Solanine,


Congenital

Adrenal hyperplasia, congenital type 3, Congenital disorder of glycosylation type 1B, Congenital short bowel, Congenital sucrose-isomaltose malabsorption, Congenital syndromes (chloridorrhea), Congenital toxoplasmosis, Intrinsic factor, congenital deficiency Juvenile polyposis of infancy, Lipoid congenital adrenal hyperplasia, Sucrase-isomaltase deficiency,


Dermatologic

Necrotizing fasciitis,

Drug Side Effect

2C-B, 2-Ethylhexanol, 5-HT3 antagonist, 5-Hydroxyindoleacetic acid, 5-MeO-AMT, 5-Methoxy-diisopropyltryptamine, Abacavir (Patient Information), Acamprosate (patient information), Acarbose, Acebutolol (patient information), Aciclovir, Acitretin (patient information), Aconitine, Adefovir (patient information), Alatrofloxacin Injection (patient information), Aldesleukin (patient information), Alendronate (patient information), Aliskiren (patient information), Allopurinol (patient information), Alosetron (patient information), Alpha-amanitin, Alpha-glucosidase inhibitor, Alprazolam, Altretamine, Amifostine, Amiloride and Hydrochlorothiazide (patient information), Aminocaproic acid, Aminophylline (patient information), Amlexanox (patient information), Amlodipine and Benazepril (patient information), Ammonium lauryl sulfate, Amoxicillin and Clavulanic Acid (patient information), Amphotericin B Injection (patient information), Amprenavir (patient information), Anadenanthera peregrina, Anagrelide (patient information), Anakinra (patient information), Anastrozole (patient information), Anisindione (patient information), Aprepitant (patient information), Atazanavir (patient information), Atenolol (patient information), Atorvastatin (patient information), Atovaquone (patient information), Auranofin (patient information), Azithromycin, Aztreonam Injection (patient information), Barium nitrate, Barium Sulfate (patient information), Beatrice (psychedelic), Bepridil (patient information), Bevacizumab Injection (patient information), Bezafibrate, Bicalutamide (patient information), Biguanide, Bisacodyl (patient information), Bisoprolol (patient information), Bortezomib (patient information), Brompheniramine (patient information), Bumetanide (patient information), Buspirone (patient information), Busulfan (patient information), Candesartan (patient information), Capecitabine (patient information), Carbamazepine (patient information), Carboplatin (patient information), Carmustine (patient information), Carteolol (patient information), Carvedilol (patient information), Cefaclor, Cefadroxil (patient information), Cefamandole Nafate Injection (patient information), Cefazolin, Cefazolin Sodium Injection (patient information), Cefdinir, Cefepime Injection (patient information), Cefoperazone Sodium Injection (patient information), Cefotaxime Sodium Injection (patient information), Cefotetan Disodium Injection (patient information), Cefoxitin Sodium Injection (patient information), Cefpodoxime (patient information), Ceftazidime Injection (patient information), Ceftizoxime Sodium Injection (patient information), Ceftriaxone Sodium Injection (patient information), Cefuroxime, Cephalexin (patient information), Cephradine Injection (patient information), Cerivastatin (patient information), Cetuximab Injection (patient information), Cevimeline, Chloral Hydrate (patient information), Chlorambucil (patient information), Chlordiazepoxide (patient information), 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information), Delavirdine (patient information), Deracoxib, Desoxyn, Dextroamphetamine and Amphetamine (patient information), Dextromethorphan, Diacerein, Diazepam (patient information), Diclofenac and Misoprostol (patient information), Dicloxacillin (patient information), Didanosine (patient information), Diflunisal (patient information), Diltiazem (patient information), Dipyridamole (patient information), Dirithromycin (patient information), Docetaxel (patient information), Dofetilide (patient information), Dolasetron (patient information), Donepezil (patient information), Doripenem, Doxorubicin (patient information), Doxycycline Injection (patient information), DTPA, Duloxetine, Efavirenz (patient information), Emtricitabine (patient information), Enalapril (patient information), Endosulfan, Enoxacin (patient information), Entacapone (patient information), Epirubicin Injection (patient information), Eplerenone (patient information), Epoetin Alfa Injection (patient information), Exemestane (patient information), Exenatide Injection (patient information), Ezetimibe (patient information), Famciclovir (patient information), Famotidine (patient information), Felbamate (patient information), Fexofenadine (patient information), Floxuridine (patient information), Fluconazole (patient information), Flucytosine, Fludarabine Phosphate (patient information), Fluoride (patient information), Fluorouracil (patient information), Fluoxetine, Flurazepam (patient information), Flutamide (patient information), Fluticasone Nasal Spray (patient information), Fluvastatin, Fluvoxamine, Erlotinib (patient information), Erythromycin, Esomeprazole (patient information), Estazolam (patient information), Estradiol Topical (patient information), Ethacrynic Acid (patient information), Ethosuximide, Etidronate (patient information), Etodolac (patient information), Etoposide, Fosamprenavir (patient information), Foscarnet Sodium Injection (patient information), Fosinopril (patient 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Injection (patient information), Irinotecan, Iron supplements, Isocarboxazid (patient information), Isradipine (patient information), Itraconazole, Lamivudine (patient information), Lamotrigine (patient information), Lanreotide, Lansoprazole (patient information), Lanthanum (patient information), Leflunomide (patient information), Letrozole (patient information), Leuprolide (patient information), Levalbuterol Oral Inhalation (patient information), Levetiracetam (patient information), Levocarnitine Injection (patient information), Levodopa and Carbidopa (patient information), Levofloxacin Injection (patient information), Linezolid, Liothyronine sodium, Lisinopril (patient information), Lithium (patient information), Lomefloxacin (patient information), Lopinavir, Loracarbef (patient information), Loratadine (patient information), Lorazepam (patient information), Loxapine Oral (patient information), Magnesium Hydroxide (patient information), Mebendazole (patient information), Mechlorethamine (patient information), Meclofenamate (patient information), Mefenamic Acid (patient information), Mefloquine (patient information), Megesterol, Meprobamate (patient information), Mercaptopurine (patient information), Meropenem, Mesalazine, Mesna (patient information), Mesoridazine Oral (patient information), Metformin (patient information), Methamphetamine, Methenamine (patient information), Methotrexate (patient information), Methoxychlor, Methsuximide Oral (patient information), Methyclothiazide (patient information), Methylergonovine, Methyprylon, Metoclopramide Oral (patient information), Metolachlor, Metolazone (patient information), Metoprolol, Metronidazole, Miconazole Injection (patient information), Mifepristone, Miglitol (patient information), Minocycline, Misoprostol, Mitotane, Moclobemide, Modafinil (patient information), Moexipril (patient information), Moricizine (patient information), Moxifloxacin, Mycophenolate (patient information), Nabumetone (patient information), Nafcillin, Naltrexone (patient information), Naphthalene, Natalizumab injection (patient information), Natamycin, Nateglinide oral (patient information), Nelfinavir (patient information), Nevirapine (patient information), Niclosamide, Nizatidine (patient information), Norfloxacin (patient information), Nystatin (patient information), Ofloxacin oral (patient information), Omalizumab injection (patient information), Omeprazole (patient information), Ondansetron (patient information), Oseltamivir (patient information), Oxaliplatin, Oxazepam, Oxcarbazepine (patient information), Oxtriphylline (patient information), Oxybutynin (patient information), Palivizumab injection (patient information), Pancrelipase (patient information), Pantoprazole (patient information), Pegaspargase (patient information), Peginterferon alfa-2a (patient information), Peginterferon alfa-2b (patient information), Pemetrexed injection (patient information), Pemoline (patient information), Penbutolol (patient information), Penicillin, Pentamidine, Pentostatin (patient information), Pergolide (patient information), Perindopril (patient information), Perphenazine oral (patient information), Phentermine (patient information), Pilocarpine, Pimecrolimus topical (patient information), Pimozide (patient information), Piroxicam (patient information), Plicamycin (patient information), Posaconazole (patient information), Pramipexole (patient information), Pramlintide injection (patient information), Prazepam (patient information), Praziquantel, Prazosin and polythiazide (patient information), Procainamide (patient information), Procarbazine (patient information), Promethazine (patient information), Propafenone (patient information), Propranolol Oral (patient information), Protriptyline (patient information), Pseudoephedrine and triprolidine (patient information), Pyridostigmine (patient information), Quinapril (patient information), Quinidine Oral (patient information), Quinupristin/dalfopristin, Rabeprazole (patient information), Ramipril (patient information), Ranitidine (patient information), Rasagiline (patient information), Repaglinide (patient information), Reserpine (patient information), Retapamulin (patient information), Ribavirin (patient information), Rifampin (patient information), Rilmenidine, Riluzole (patient information), Risedronate (patient information), Risperidone (patient information), Ritonavir (patient information), Rituximab injection (patient information), Rivastigmine (patient information), Rizatriptan (patient information), Salsalate (patient information), Saquinavir (patient information), Sargramostim injection (patient information), Selegiline (patient information), Sevelamer (patient information), Sildenafil (patient information), Simethicone, Simvastatin, Sirolimus (patient information), Sitagliptin (patient information), Sodium oxybate (patient information), Sodium picosulfate, Sodium polystyrene sulfonate (patient information), Solanine, Solifenacin (patient information), Sorafenib (patient information), Sotalol (patient information), Sparfloxacin (patient information), Spironolactone (patient information), Stavudine (patient information), Streptozocin (patient information), Sulfadiazine (patient information), Sulfasalazine (patient information), Sulfisoxazole (patient information), Sulfisoxazole and phenazopyridine (patient information), Sulindac (patient information), Sumatriptan, Sunitinib, Tacrine (patient information), Tamsulosin (patient information), TASB (psychedelics), Tegaserod (patient information), Telbivudine (patient information), Telithromycin (patient information), Telmisartan (patient information), Temozolomide (patient information), Teniposide (patient information), Tenofovir (patient information), Terbinafine (patient information), Teriparatide (rDNA origin) Injection (patient information), Theophylline (patient information), Thiabendazole, Thioguanine (patient information), Thioridazine (patient information), Thiothixene Oral (patient information), Thyroid Medication (patient information), Ticlopidine (patient information), Tiludronate (patient information), Tipranavir (patient information), Tocopherol, Tolcapone (patient information), Topiramate, Topotecan, Tranylcypromine (patient information), Trastuzumab (patient information), Trazodone (patient information), Treprostinil, Triamterene (patient information), Triazolam (patient information), Trifluoperazine Oral (patient information), Trihexyphenidyl (patient information), Trimeprazine (patient information), Trimethadione (patient information), Trimethobenzamide (patient information), Trimetrexate Glucuronate (patient information), Trimipramine (patient information), Trovafloxacin (patient information), Valacyclovir (patient information), Valganciclovir (patient information), Valproic Acid (patient information), Valsartan (patient information), Verapamil and Trandolapril (patient information), Vinblastine (patient information), Vinorelbine Tartrate (patient information), Voriconazole (patient information), Vorinostat (patient information), Zanamivir Inhalation (patient information), Zidovudine Injection (patient information), Ziprasidone (patient information), Zoledronic Acid Injection (patient information), Zolmitriptan Oral (patient information),

Ear Nose Throat No underlying causes
Endocrine

Addison's disease, Diabetes insipidus, Diabetic neuropathy, Glucagonoma Syndrome, Graves' Disease, Hyperthyroidism, Somatostatinoma, Subacute thyroiditis,

Environmental No underlying causes
Gastroenterologic

Abdominal abscess, Abdominal cancer, Achlorhydria, Acute appendicitis, Acute gastritis, Bile acid malabsorption syndrome, Bile acid sequestrant, Biliary atresia, Biliary tract cancer, Blind loop syndrome, Brainerd diarrhea, Caecitis, Carcinoid syndrome, Celiac disease, Cholestatic jaundice, Colitis, Colonic inertia, Colonic malakoplakia, Colonic villous adenomata, Colorectal cancer, Colorectal polyps, Crohn's disease, Diverticulitis, Enteritis, Enterocele, Enterocolitis, Food poisoning, Fructose malabsorption, Gastric dumping syndrome, Gastrinoma, Gastritis, Gastroenteritis, Gastro-enteropancreatic neuroendocrine tumor, Gastrointestinal amyloidosis, Gastrointestinal neoplasm, Glucose-galactose malabsorption, Gluten sensitivity, Inflammatory bowel disease, Ileitis, Intestinal Flu, Intestinal lymphangiectasis, Intestinal pseudoobstruction chronic idiopathic, Intususception of intestine, Irritable bowel syndrome, Ischemic colitis, Listeriosis, Malassimilation, Meckel diverticulitis, Proctitis, Protein losing enteropathy, Sclerosing Mesenteritis, Scombroid food poisoning, Sprue, Ulcerative colitis, Wheat intolerance, Whipple's disease, Zollinger-Ellison syndrome,

Genetic

Abetalipoproteinaemia, Cornelia de Lange syndrome 2, Fabry's disease, Familial amyloid polyneuropathy, Familial polyposis, autosomal recessive, Familial visceral myopathy, Gilbert's syndrome, Hartnup disease, Neurofibromatosis, familial intestinal, Sanfilippo syndrome, Slone's Disease,

Hematologic

Amyloidosis, Chronic myeloproliferative disorders, Megaloblastic anemia, Neutropenia, Porphyria,


Iatrogenic

Graft versus host disease, Percutaneous endoscopic gastrostomy, Postgastrectomy syndrome Radiation sickness, Short bowel syndrome,

Infectious Disease

Adenovirus, Adenophorea Infections, Adenoviridae Infections, AIDS, Ancylostoma duodenale, Ascaris, Astrovirus, Bacillary dysentery, Bacillus cereus, Bacterial overgrowth of small intestine, Bacterial toxins, Balantidiasis, Amebiasis, Anguillulosis, Anthrax, Ascariasis, Beef tapeworm, Blastocystis hominis, Borrelia anserina, Botulism food poisoning, Campylobacter jejuni, Candida, Capillaria, Cestoda, Ciguatera poisoning, Clostridium Difficile, Clostridium perfringens food poisoning, Clostridium sordellii, Clostridium welchii, Coccidia, Cryptosporidiosis, Cyclosporiasis, Cysticercosis, Cytomegalovirus, Dientamoeba fragilis, Diphyllobothrium infection, Dipylidium caninum infection, Ebola, Echinococcosis, Entamoeba histolytica, Entero-Aggregative Escherichia coli, Enterohemorrhagic Escherichia Coli Infection, Entero-Toxic Escherichia coli, Fasciolopsiasis, Filariasis, Flavivirus, Fusarium venenatum, Giardia lamblia, Hantavirus pulmonary syndrome, Helminthiasis, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E, Hepatitis X, Hookworm infection, Human ehrlichiosis, Isosporiasis, Katayama fever, Lassa fever, Legionnaires' disease, Leptospirosis, Lymphogranuloma venereum, Malaria, Marburg virus, Marine toxins, Measles, Metagonimiasis, Microsporidiasis, Mycobacterium avium Complex, Norwalk gastroenteritis, Opisthorchis infection, Paragonimus Infection, Pelvic abscess, Pneumatosis cystoides intestinalis, Pseudomembranous colitis, Psittacosis, Q fever, Rhabditida Infections, Rotavirus, Salmonella enteritidis, Salmonellosis, Sapporo-like virus, Roundworm, Sarcocystis, Sarcosporidiosis, Schistosomiasis, Secernentea Infections, Shigellosis, Staphylococcal food poisoning, Streptobacillus, Streptococcal Infections, Streptococcus suis, Strongyloides, Tapeworms, Trematoda, Trichinella spiralis, Trichinosis, Trichuriasis, Tularemia, Typhoid fever, Vibrio cholerae, Vibrio mimicus food poisoning, Vibrio parahemolyticus, Vibrio vulnificus, Whipworm Infection,

Musculoskeletal / Ortho

Myleofibrosis,

Neurologic

Common migraine,

Nutritional / Metabolic

Aspartylglycosaminuria, Arakawa's syndrome II, Aromatic amino acid decarboxylase deficiency, Classic galactosemia, Fabry's disease, Folate deficiency, Folic acid toxicity, Food allergies, Food intolerances, Galactosemia, Inborn amino acid metabolism disorder, Lactose Intolerance, Malonic aciduria, Malonyl-CoA decarboxylase deficiency, Mucopolysaccharidosis, Pellagra, Sphingolipidosis, Sucrose intolerance, Vitamin C toxicity, Vitamin D,


Obstetric/Gynecologic

Endometriosis, Ovarian hyperstimulation syndrome,

Oncologic

Ewing's sarcoma, Functioning pancreatic endocrine tumor, Kaposi's sarcoma, Mesothelioma, adult malignant – peritoneal, Multiple endocrine neoplasia type 1, Neuroendocrine tumors, Pancreatic adenoma, Small bowel lymphoma, Thymus cancer, Thyroid Carcinoma, Vipoma,

Opthalmologic No underlying causes
Overdose / Toxicity

Boron overuse, Carbon monoxide toxicity, Carnitine overuse, Colchicine toxicity, Digoxin, Ergotism, Heavy metal ingestion, Lycorine, Mazindol, Tetrodotoxin,

Psychiatric

Anxiety-tension syndrome,

Pulmonary No underlying causes
Renal / Electrolyte

Acute kidney failure, Hyperchloremia,


Rheum / Immune / Allergy

Angioedema, Amyloidosis, Anaphylaxis, Athabaskan severe combined immunodeficiency, Autoimmune adrenalitis, Autoimmune enteropathy, Autoimmune polyendocrine syndrome, Autonomic neuropathy, Chronic granulomatous disease, Complement 5 deficiency, Kawasaki disease, Omenn syndrome, Satoyoshi syndrome,


Trauma No underlying causes
Urologic
Miscellaneous

Alcohol intoxication, Alcohol withdrawal, Anopsology, Capsaicin, Chronic fatigue syndrome, Idiopathic hypereosinophilic syndrome, Idiopathic intestinal pseudoobstruction, Idiopathic sclerosing mesenteritis, POEMS syndrome, Smoking stools syndrome, Waldmann disease, Water hemlock (Cicuta sp.), Waterhouse-Friederichsen syndrome, Water-skier colon, Weil's syndrome,

The Complete Differential Diagnosis of the Causes of Diarrhea

(In alphabetical order)



Infectious diarrhea

Main article: Infectious diarrhea

Infectious diarrhea is diarrhea cased by a microbe such as a bacterium, parasite, or virus.

Malabsorption

These tend to be more severe medical illnesses. Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas.

Causes include celiac disease (intolerance to gluten, a wheat product), 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 such as 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 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 article: 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.[2] 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.[3] 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

  • 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 rather than being absorbed at the end of the small intestine can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a possible 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.[4] 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. Alcohol-induced diarrhea is often accompanied by "the follow through" where a feeling that the patient is going to break wind (flatulence) instead becomes an uncontrolled episode of diarrhea.

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

Physical Examination

  • Pulses
  • Blood pressure
  • Orthostatics
  • Skin examination
  • Signs of dehydration
  • Back, genital and rectal examinations
  • Complete abdominal examination

Laboratory Findings

MRI and CT

Other Diagnostic Studies

Treatment

  • 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)

Pharmacotherapy

Acute Pharmacotherapies

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

Chronic Pharmacotherapies

  • Prophylactic therapy with 5-aminosalicylic agents for patients with inflammatory bowel disease

Surgery and Device Based Therapy

  • Bowel resection may be necessary for those patients with inflammatory bowel disease

References

  1. ↑ Ruuska T, Vesikari T (1990). "Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes". Scand. J. Infect. Dis. 22 (3): 259–67. PMID 2371542.
  2. ↑ Longstreth GL, Thompson WG, Chey WD, Houghton LA, Mearin F, and Spiller RC. (2006). Functional Bowel Disorders. Gastroenterology 2006; 130:1480–1491
  3. ↑ 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
  4. ↑ 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.

See also

External links

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