Diarrhea

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]

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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.

Causes According to Duration

Acute Diarrhea

• Addison's Disease
• Adrenal insufficiency
• Appendicitis
• Bacterial:

  • Aeromonas
  • Campylobacter jejuni
  • Chlamydia
  • Clostridium Difficile
  • E.coli
  • Enterobacter
  • Klebsiella
  • Neisseria gonorrhea
  • Plesiomonas
  • Salmonella
  • Shigella
  • Staphylococcus aureus
  • Vibrio cholerae
  • Yersinia enterocolitica

• C-cell carcinoma
• Chronic inflammatory bowel disease (first manifestation)
• Colon cancer
• Drugs:

  • Abuse of laxatives
  • Alcohol
  • Antibiotics
  • Biguanides
  • Chemotherapeutics
  • Chemotherapy
  • Cholestyramin
  • Digitalis
  • Diuretics
  • Ergotamine
  • Hydralazine
  • Mushroom poisoning
  • Opiate withdrawal
  • Parasympathomimetics
  • Quinidine
  • Reserpine
  • Uremia
  • Warfarin

• Food:

  • Bacillus cereus
  • Clostridium perfringens
  • Staphylococcus aureus

• Food allergy
• Graft-host reaction after allogenic bone marrow transplantation
• Heavy metal intoxication
• HIV
• Hyperthyroidism
• Irritable Bowel Syndrome (IBS)
• Ischemic-hemorrhagic colitis
• Lactose intolerance
• Neoplasia
• Other hormone-producing tumor
• Parasites:

  • Cryptosporidium
  • Entamoeba histolytica
  • Giardia intestinalis
  • Hyperthyroidism

• Runner's diarrhea
• Traveler's diarrhea

  • Most commonly seen germs:

    • Aeromonas
    • Campylobacter jejuni
    • Enterotoxigenic Escherichia coli
    • Protozoa
    • Rotavirus
    • Salmonella
    • Shigella

• Typhoid Fever
• Viral:

  • Adenovirus
  • Coxsackie virus
  • Cytomegalovirus (CMV)
  • Enteric cytopathic human orphan (ECHO) viruses
  • Influenza virus
  • Norwalk virus
  • Poliovirus
  • Rotavirus

Chronic Diarrhea

• Achylia
• Addison's Disease
• Amebiasis
• Amyloidosis
• Anxiety
• Autonomous neuropathy
• Bacterial gastroenteritis
• Bacterial toxins
• Behcet syndrome
• Bile acid malabsorption
• Biliary fistula
• Carcinoid syndrome
• Carcinoma of the pancreas
• Celiac Sprue
• Chologenic diarrhea
• Collagenous colitis
• Colitis after radiation therapy
• Colon cancer
• Crohn's Disease
• Cryptosporidiosis
• Diabetes Mellitus
• Diabetic enteropathy
• Diverticular disease
• Drugs:

  • Antacids
  • Antipholgistics
  • Anthraquinones
  • Castor oil
  • Lactulose
  • Mannitol
  • Prostaglandins
  • Sorbitol

• Dumping syndrome
• Enteropathogenic viruses
• Excess coffee, tea, coke
• Exudative diarrhea
• Fecal impaction
• Food allergy
• Gastric surgery/Billroth operation
• Gastrinoma
• Gastrocolic fistula
• Giardia
• Hyperthyroidism
• HIV
• Idiopathic lymphangiectasis
• Inflammatory Bowel Disease
• Intestinal atrophy (post-radiation therapy)
• Irritable Bowel Syndrome (IBS)
• Irritable colon
• Lymphocytic colitis
• Lymphomas
• Malabsorption
• Maldigestion
• Medullary thyroid carcinoma
• Mesenteric ischemia
• Motility disorders of gastrointestinal (GI) tract
• Neuroendocrine tumors
• Nontropical sprue
• Obstructive jaundice
• Parasites:

  • Ascariasis
  • Hookworm
  • Whipworm

• Pellagra
• Polyarteritis
• Polyposis
• Postileal resection
• Postvagotomy
• Proctitis
• Prostaglandins
• Radiation proctitis
• Rectal surgery
• Scleroderma
• Short bowel syndrome
• Tuberculosis
• Ulcerative colitis
• Unabsorbed dietary fat
• Vegetative lability
• Verner-Morrison Syndrome
• Villous adenoma
• Villous carcinoma
• Whipple's Disease
• Zollinger-Ellison Syndrome

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.

Causes According to Organ System

(By organ system)

Cardiovascular
Chemical / poisoning
Dermatologic
Drug Side Effect	The list of drugs may cause diarrhea • The list of drug-drug interactions may cause diarrhea
Ear Nose Throat
Endocrine
Environmental
Gastroenterologic	Achlorhydria Acute gastritis
Genetic
Hematologic
Iatrogenic
Infectious Disease
Musculoskeletal / Ortho
Neurologic
Nutritional / Metabolic
Obstetric/Gynecologic
Oncologic	Abdominal cancer
Opthalmologic
Overdose / Toxicity
Psychiatric
Pulmonary
Renal / Electrolyte
Rheum / Immune / Allergy
Sexual
Trauma
Urologic
Miscellaneous	Abdominal abscess Acute appendicitis

The Complete Differential Diagnosis of the Causes of Diarrhea

(In alphabetical order)

2C-B 2-Ethylhexanol 3-hydroxyacyl-coenzyme A dehydrogenase deficiency 3-Methylcrotonyl-CoA carboxylase deficiency 5-HT3 antagonist 5-MeO-AMT 5-Methoxy-diisopropyltryptamine Abacavir Abdominal abscess Abdominal cancer Abetalipoproteinemia Abrin Acacia nilotica Acacia senegal Acamprosate Acarbose Acebutolol Achlorhydria Aciclovir Acitretin Aconitine Acquired angioedema Acquired Immune Deficiency Syndrome Acrodermatitis enteropathica Acrodynia Acute appendicitis Acute gastritis Acute kidney failure Acute pancreatitis Acute tin poisoning Acute zinc toxicity Addison's disease Adefovir Adenophorea Infections Adenoviridae Infections Adjustable gastric band Adrenal hyperplasia, congenital type 3 Adrenal tumor Aeromonas hydrophila Agastache rugosa Alatrofloxacin Injection Alchornea castaneifolia Alcohol intoxication Alcohol withdrawal Aldesleukin Alendronate Aliskiren Allergic disorders Allopurinol Alosetron Alpha-amanitin Alpha-glucosidase inhibitor Alprazolam Altretamine Amanita phalloides Ambenonium Amebiasis Amifostine Amikacin Amiloride and Hydrochlorothiazide Aminocaproic acid Aminophylline Amlexanox Amlodipine and Benazepril Ammonium lauryl sulfate Amnesic shellfish poisoning Amoxycillin Amphotericin B Ampicillin Amprenavir Amyloidosis Anadenanthera peregrina Anagrelide Anakinra Anastrozole Ancylostoma duodenale Angel's trumpet (D. suaveolans) Angioedema Anguillulosis Anisindione Anopsology Anthrax Antonine Plague Anxiety-tension syndrome Apomorphine Appendicitis Applesauce Aprepitant Arakawa's syndrome II Aromatic amino acid decarboxylase deficiency Arsenic poisoning Ascariasis Aspartylglycosaminuria Astrovirus Atazanavir Atenolol Athabaskan severe combined immunodeficiency Atorvastatin Atovaquone Attenuated familial polyposis Auranofin Autoimmune adrenalitis Autoimmune enteropathy Autoimmune polyendocrine syndrome Autonomic neuropathy Ayahuasca Azithromycin Azotemia Aztreonam Injection Baber's syndrome Bacillary dysentery Bacillus cereus Bacterial overgrowth of small intestine Bacterial toxins Balantidiasis Banti's syndrome Barium nitrate Barium Sulfate Bartters syndrome, antenatal , type 2 Bartter's syndrome, antenatal type 1 Beatrice (psychedelic) Beef tapeworm Behcet's disease Bepridil Bethanechol Bevacizumab Injection Bezafibrate Bicalutamide Biguanide Bile acid malabsorption syndrome Bile acid sequestrant Biliary atresia Biliary tract cancer Biotinidase deficiency Bisacodyl Bisoprolol Blastocystis hominis Blind loop syndrome Boron overuse Borrelia anserina Bortezomib Botulism food poisoning Brainerd diarrhea Brennemann's syndrome Bromelain Brompheniramine Brown-Symmers disease Bumetanide Buspirone Busulfan Caecitis Campylobacter jejuni Candesartan Candida Capecitabine Capillaria Capsaicin Carbamazepine Carbon monoxide toxicity Carboplatin Carcinoid syndrome Carmustine Carnitine overuse Carteolol Carvedilol Casanthranol Cascara sagrada Castor bean (Ricinus communis) Cefaclor Cefadroxil Cefamandole Nafate Injection Cefazolin Cefdinir Cefepime Injection Cefoperazone Sodium Injection Cefotaxime Sodium Injection Cefotetan Disodium Injection Cefoxitin Sodium Injection Cefpodoxime Ceftazidime Injection Ceftizoxime Sodium Injection Ceftriaxone Sodium Injection Cefuroxime Celiac disease Cellulose sodium phosphate Cephalexin Cephalosporins Cephalothoracic progressive lipodystrophy Cephradine Injection Cerivastatin Cestoda Cetuximab Injection Cevimeline Chemical pneumonia Chenodeoxycholic acid Chloral Hydrate Chlorambucil Chlordane Chlordiazepoxide Chlorodyne

Chloroquine Chlorothiazide Chlorpheniramine Chlorthalidone Cholecystitis Cholestatic jaundice Cholestyramine Chronic fatigue syndrome Chronic granulomatous disease Chronic myeloproliferative disorders Chronic vitamin A toxicity Ciclosporin Cidofovir Injection Ciguatera poisoning Cilostazol Cimetidine Cinacalcet Cinchonism Ciprofloxacin Cisapride Citalopram Cladribine Clamoxyquine Clarithromycin Classic galactosemia Clindamycin Clofarabine Clofibrate Clomipramine Clonazepam Clopidogrel Clorazepate Clostridium Difficile Clostridium perfringens food poisoning Clostridium sordellii Clostridium welchii Coccidia Colchicine toxicity Colestyramine Colistimethate Injection Colitis Colonic inertia Colonic malakoplakia Colonic villous adenomata Colorectal cancer Colorectal polyps Common migraine Common variable immunodeficiency Complement 5 deficiency Congenital disorder of glycosylation type 1B Congenital short bowel Congenital sucrose-isomaltose malabsorption Congenital syndromes (chloridorrhea) Congenital toxoplasmosis Copper toxicity Cornelia de Lange syndrome 2 Cree leukoencephalopathy Crohn's disease Cronkhite-Canada disease Cryptosporidiosis Cutaneous mastocytosis Cyclic vomiting syndrome Cyclophosphamide Cyclosporiasis Cyproheptadine Cysticercosis Cytarabine Cytomegalovirus Dactinomycin daffodil (Narcissus pseudonarcissus) Dantrolene Daptomycin Darbepoetin Alfa Injection Darifenacin Darunavir Darvocet withdrawal Dasatinib Daunorubicin Deal-Barratt-Dillon syndrome Deferasirox Degos disease Delavirdine Deracoxib Desoxyn Destroying angel Dextroamphetamine and Amphetamine Dextromethorphan Diabetes insipidus Diabetic neuropathy Diacerein Diarrheagenic Escherichia coli Diazepam Diazinon Dibasic aminoaciduria 2 Diclofenac and Misoprostol Dicloxacillin Didanosine Dientamoeba fragilis Diffuse systemic sclerosis Diflunisal Digoxin Dilaudid withdrawal Diltiazem Diphyllobothrium infection Dipylidium caninum infection Dipyridamole Dirithromycin Disseminated infection with mycobacterium avium complex Dissociative disorder Distigmine Distomatosis Diverticulitis Docetaxel Dofetilide Dolasetron Donepezil Doripenem Doxorubicin Doxycycline Injection Dracunculiasis DTPA Duloxetine Ebola Echinococcosis Efavirenz Egg Hypersensitivity Emtricitabine Enalapril End stage liver failure Endometriosis Endosulfan Enoxacin Entacapone Entamoeba histolytica Enteritis Entero-Aggregative Escherichia coli Enterocele Enterocolitis Enterohemorrhagic Escherichia Coli Infection Entero-Toxic Escherichia coli Enterovirus antenatal infection Envenomization by the Martinique lancehead viper Eosinophilic enteropathy, pattern II Epirubicin Injection Eplerenone Epoetin Alfa Injection Ergotamine Ergotism Erlotinib Erythromycin Escherichia coli Esomeprazole Estazolam Estradiol Topical Ethacrynic Acid Ethanol Ethosuximide Ethylmalonic encephalopathy Etidronate Etodolac Etoposide Everolimus Ewing's sarcoma Exemestane Exenatide Exenatide Injection Ezetimibe Fabry's disease Faecal impaction Famciclovir Familial amyloid polyneuropathy Familial polyposis, autosomal recessive Familial visceral myopathy Famotidine Fanconi-ichthyosis-dysmorphism Fasciolopsiasis Favism Felbamate Fexofenadine Filariasis Flavivirus Floxuridine Fluconazole Flucytosine Fludarabine Phosphate Fluke infections Fluoride Fluorouracil Fluoxetine Flurazepam Flutamide Fluticasone Nasal Spray Fluvastatin Fluvoxamine Folate deficiency Folic acid toxicity Food allergies Food intolerances Food poisoning Fosamprenavir

Foscarnet Sodium Injection Fosinopril Frovatriptan Fructose malabsorption Fulvestrant Injection Functional disorders Functioning pancreatic endocrine tumor Fusarium venenatum Gabapentin Galactosemia Galantamine Ganciclovir Gangrene Gardner syndrome Garlic Gastric dumping syndrome Gastrinoma Gastritis Gastroenteritis Gastro-enteropancreatic neuroendocrine tumor Gastrointestinal amyloidosis Gastrointestinal neoplasm Gatifloxacin Gefitinib Gemcitabine Hydrochloride Gemeprost Gemfibrozil Gentamicin Giardia lamblia Gilbert's syndrome Ginseng overuse Glanders Glatiramer Injection Glénard syndrome Glucagonoma Syndrome Glucosamine Glucose-galactose malabsorption Glutathione Synthetase Deficiency Gluten sensitivity Glycopyrrolate Gnathostoma Infection Graft versus host disease Granisetron Graves' Disease Griseofulvin Guanethidine Guanfacine Habba Syndrome Hantavirus pulmonary syndrome Hartnup disease Heavy metal ingestion Helminthiasis Hemophagocytic lymphohistiocytosis, familial, 4 Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatitis X Hepatorenal tyrosinemia Heroin dependence Heroin withdrawal Heterophyiasis Hirschsprung's disease holly (Ilex sp.) Hookworm infection Human ehrlichiosis Hydralazine Hydrochlorothiazide Hydrocodone withdrawal Hydroxychloroquine Hydroxyurea Hymenolepis infection Hyoscyamine Hyper IgM syndrome Hyperchloremia Hyper-IgD syndrome Hyperinsulinemic hypoglycemia, familial, 1 Hyperinsulinemic hypoglycemia, familial, 2 Hyperthyroidism Ibandronate Injection Ibuprofen Idarubicin Idiopathic hypereosinophilic syndrome Idiopathic intestinal pseudoobstruction Idiopathic sclerosing mesenteritis Iduronate-2-sulfatase deficiency Ileitis Imatinib Imipenem Inborn amino acid metabolism disorder Indomethacin Inflammatory bowel disease Infliximab Injection Insect sting allergies Interferon alpha Interferon Beta-1b Injection Intestinal Flu Intestinal lymphangiectasis Intestinal pseudoobstruction chronic idiopathic Intrinsic factor, congenital deficiency Intususception of intestine Invasive group A Streptococcal disease Irinotecan Iron supplements Irritable bowel syndrome Ischemic colitis Isocarboxazid Isomalt Isosporiasis Isradipine Itraconazole Jimsonweed (Datura stramonium) Juvenile polyposis of infancy Kanamycin Kaposi's sarcoma Katayama fever Kawasaki disease Keratosis palmoplantaris - adenocarcinoma of the colon Ketorolac Laburnum Lactose Intolerance Lamivudine Lamotrigine Lanreotide Lansoprazole Lanthanum Lapatinib ditosylate Lassa fever Laxative abuse Lead poisoning Leflunomide Legionella pneumophila Legionnaires' disease Leiner disease Leptospirosis Letrozole Leukocytoclastic angiitis – systemic Leuprolide Levalbuterol Oral Inhalation Levetiracetam Levocarnitine Injection Levodopa and Carbidopa Levofloxacin Injection Levy-Yeboa Syndrome Lincomycin Linezolid Liothyronine sodium Lipoid congenital adrenal hyperplasia Lisinopril Listeriosis Lithium Lomefloxacin Lopinavir Loracarbef Loratadine Lorazepam Lortab withdrawal Loxapine Oral Lycorine Lymphangiectasis Lymphocytic colitis Lymphogranuloma venereum Lymphomatoid granulomatosis Magnesium Hydroxide Magnesium salts Malabsorption syndrome Malakoplakia Malaria Malassimilation Malonic aciduria Malonyl-CoA decarboxylase deficiency Marburg virus Marine toxins Mastocytosis Mazindol Measles Mebendazole Mechlorethamine Meckel diverticulitis Meclofenamate Mefenamic acid Mefloquine Megaloblastic anemia Megesterol Melarsoprol Melioidosis Ménétrier's disease Meningitis Meprobamate Mercaptopurine Mercury poisoning Meropenem Mesalazine Mesna Mesoridazine Oral Mesothelioma, adult malignant – peritoneal

Metabolic disorders Metagonimiasis Metal fume fever Metformin Methenamine Methionine malabsorption syndrome Methotrexate toxicity Methoxychlor Methsuximide Oral Methyclothiazide Methylergonovine Methyprylon Metoclopramide Oral Metolachlor Metolazone Metoprolol Metronidazole Miconazole Injection Microsporidiasis Mifepristone Miglitol Mineral oil Minocycline Misoprostol mistletoe (Phoradendron serotinum) Mitochondrial neurogastrointestinal encephalopathy syndrome Mitotane Mixed connective tissue disease Moclobemide Modafinil Moexipril Moricizine Morphine withdrawal Moxifloxacin Mucoepithelial dysplasia, Witkop type Mucopolysaccharidosis Multiple endocrine neoplasia type 1 Muscarine Mycobacterium avium Complex Mycophenolate Myleofibrosis Myocarditis Nabumetone Nafcillin Nalidixic acid Naltrexone Naphthalene Natalizumab injection Natamycin Nateglinide oral Necrotizing fasciitis Nelfinavir Neonatal bacterial meningitis Neonatal sepsis Neostigmine Netilmicin Neuroblastoma Neuroendocrine tumors Neurofibromatosis, familial intestinal Neutropenia Nevirapine Nezelof's syndrome Niclosamide Nicotine poisoning Nizatidine Norfloxacin Norwalk gastroenteritis Norwalk Virus Nystatin Obal syndrome Ofloxacin oral Ogilvie's syndrome OHSS Oleander Omalizumab injection Omenn syndrome Omeprazole Ondansetron Opioid withdrawal Opisthorchis infection Organophosphates Orlistat Oseltamivir Ovarian Cancer Oxaliplatin Oxazepam Oxcarbazepine Oxtriphylline Oxybutynin OxyContin withdrawal Oxyphenisatine Palivizumab injection Pancreatic adenoma Pancrelipase Pantoprazole Para-amino salicylic acid Paragonimiasis Paragonimus Infection Paraneoplastic Autoimmune Syndromes Paraquat Parathion Pegaspargase Peginterferon alfa-2a Peginterferon alfa-2b Pellagra Pelvic abscess Pemetrexed injection Pemoline Penbutolol Penicillin allergy Penicillium marneffei Pentamidine Pentostatin Percutaneous endoscopic gastrostomy Pergolide Perindopril Periodic hyperlysinemia Pernicious anemia Perphenazine oral Persin Phenol sulfotransferase deficiency Phenolphthalein Phentermine Phentolamine Phycomycosis Phytohaemagglutinin Pilocarpine Pimecrolimus topical Pimozide Piroxicam Plicamycin Pneumatosis cystoides intestinalis POEMS syndrome pokeweed (Phytolacca Americana) Pollen allergy Porphyria Portal vein thrombosis Posaconazole Postgastrectomy syndrome potato (Solanum tuberosum) Powell-Buist-Stenzel syndrome Pramipexole Pramlintide injection Prazepam Praziquantel Prazosin and polythiazide Procainamide Procarbazine Proctitis Promethazine Propafenone Propranolol Oral Prostate cancer Protein losing enteropathy Protozoal Infection Protriptyline Pseudoephedrine and triprolidine Pseudomembranous colitis Psittacosis Ptomaine food poisoning Pyridostigmine Q fever Quinapril Quinidine Oral Quinupristin/dalfopristin Rabeprazole Radiation sickness Raltitrexed Rambaud-Galian syndrome Ramipril Ranitidine RAPADILINO syndrome Rasagiline Rectal cancer Refsum disease, infantile form Repaglinide Reserpine Retapamulin Rhabditida Infections Ribavirin Ricin Rifampin Rilmenidine Riluzole Risedronate Risperidone Ritonavir Ritter syndrome Rituximab injection Rivastigmine Rizatriptan Roflumilast Rosary pea (Abrus precatorious) Rotavirus Roundworm Sakamoto disease Salmonella enteritidis Salmonellosis Salsalate Sanfilippo syndrome Sapporo-like virus Saquinavir

Sarcocystis Sarcosporidiosis Sargramostim injection Satoyoshi syndrome Schistosomiasis Sclerosing Mesenteritis Scombroid food poisoning Secernentea Infections Selegiline Selenium – overuse Serotonin syndrome Sevelamer Severe acute respiratory syndrome Severe congenital neutropenia Shigellosis Short bowel syndrome Shy-Drager syndrome Sickle cell crisis Sildenafil Simethicone Simvastatin Sirolimus Sitagliptin Slone's Disease Small bowel bacterial overgrowth syndrome Small bowel lymphoma Small round structured virus Smith disease Smoking stools syndrome Sodium oxybate Sodium picosulfate Sodium polystyrene sulfonate Solanine Solifenacin Somatostatinoma Sorafenib Sorbitol Sotalol Sparfloxacin Spencer disease Sphingolipidosis Spira syndrome Spironolactone Spirurida Infections Spleen Cancer Sprue Stachybotrys chartarum Staphylococcal food poisoning Stavudine Streptobacillus Streptococcal Infections Streptococcus suis Streptozocin Strongyloides Subacute myelo-optico neuropathy syndrome Subacute thyroiditis Sucrase-isomaltase deficiency Sucrose intolerance Sulfadiazine Sulfasalazine Sulfisoxazole Sulindac Sumatriptan Sunitinib Superior mesenteric artery occlusion Tacrine Tamsulosin Tapeworms TASB (psychedelics) Tegafur Tegaserod Telbivudine Telithromycin Telmisartan Temozolomide Teniposide Tenofovir Terbinafine Teriparatide (rDNA origin) Injection Tetrodotoxin Thallium Theophylline Thiabendazole Thioguanine Thioridazine Thiothixene Oral Thymus cancer Thymus disorders Thyroid Carcinoma Thyroid Medication Ticlopidine Tiludronate Tipranavir Tocopherol Tolcapone Topiramate Topotecan Toxic epidermal necrolysis Toxocara Toxoplasmosis Tranexamic acid Tranylcypromine Trastuzumab Traveler's diarrhea Trazodone Trematoda - Intestinal, lung, liver flukes Treprostinil Triamterene Triazolam Trichinella spiralis Trichinosis Trichuriasis Trifluoperazine Oral Trihexyphenidyl Trimeprazine Trimethadione Trimethobenzamide Trimetrexate Glucuronate Trimipramine Trovafloxacin Tularemia Turcot syndrome Typhoid fever Ulcerative colitis Ultram withdrawal Urofollitropin Ursodeoxycholic acid Valacyclovir Valganciclovir Valinemia Valproic Acid Valsartan Vanadium - adverse effect Vasculitis hypersensitivity Verapamil and Trandolapril Vibrio cholerae Vibrio mimicus food poisoning Vibrio parahemolyticus Vibrio vulnificus Vicodin withdrawal Vinblastine Vinorelbine Tartrate Vipoma Viral meningitis Visceral leishmaniasis Vitamin C toxicity Vitamin D - adverse effects Von Gierke disease IB Voriconazole Vorinostat Waldmann disease Water hemlock (Cicuta sp.) Waterhouse-Friederichsen syndrome Water-skier colon Weil's syndrome West Nile fever Wheat intolerance Whipple's disease Whipworm Infection Whole-body acute irradiation - gastrointestinal syndrome Whooping cough Wolman disease Worm conditions X-linked agammaglobulinaemia Yellow fever Yersinia enterocolitica Yorifuji Okuno syndrome Zanamivir Inhalation ZAP70 deficiency Zidovudine Injection Zinc deficiency Ziprasidone Zoledronic Acid Injection Zollinger-Ellison syndrome Zolmitriptan Oral Zolpidem

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. 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. 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. 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

• Complete blood count (CBC)
• Glucose
• White blood cells (WBC)
• Urinalysis
• Calcium
• Thyroid stimulating hormone (TSH)
• Liver function tests (LFTs)
• Blood urea nitrogen (BUN) / creatinine
• Hepatitis serologies
• Stool examinations:

  • Stool cultures
  • Stool electrolytes
  • Stool osmolality
  • Ova and parasites
  • Fecal lactoferrin
  • Fecal leukocytes
  • Test for C. difficile

MRI and CT

• Abdominal CT scan may be necessary

Other Diagnostic Studies

• Breath hydrogen test
• Endoscopy
• Barium enema
• Colonoscopy
• Sigmoidoscopy
• HIV testing for those patients suspected of having HIV

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

See also

• Constipation
• Feces
• Drinking water
• Steatorrhea
• List of causes of diarrhea
• Diarrhea
• Acute gastroenteritis
• Gastroenteritis
• Shigellosis

External links

• Reducing deaths from diarrhoea through oral rehydration therapy. 1: Bull. World Health Organ. 2000;78(10):1246-55.
• Travelers' Diarrhea
• Rehydration Project
• The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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