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| == Patient information== | | ==Physical examination== |
| '''For the WikiDoc page for this topic, click [[Diarrhea|here]]'''
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| {{Diarrhea (patient information)}}
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| {{CMG}}; '''Assistant Editor-in-Chief:''' Meagan E. Doherty
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| ==Overview==
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| Diarrhea is loose, watery stools. A person with diarrhea typically passes stool more than three times a day. People with diarrhea may pass more than a quart of stool a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own without special treatment. Prolonged diarrhea persisting for more than 2 days may be a sign of a more serious problem and poses the risk of [[dehydration]]. Chronic diarrhea may be a feature of a chronic disease. Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and older people, and it must be treated promptly to avoid serious health problems. People of all ages can get diarrhea and the average adult has a bout of acute diarrhea about four times a year. In the United States, each child will have had seven to 15 episodes of diarrhea by age 5.
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| ==What are the symptoms of Diarrhea?==
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| Diarrhea may be accompanied by [[cramping]], [[abdominal pain]], [[bloating]], [[nausea]], or an urgent need to use the bathroom. Depending on the cause, a person may have a [[fever]] or bloody stools.
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| ==What are the causes of Diarrhea?==
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| Acute diarrhea is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea is usually related to functional disorders such as irritable bowel syndrome or inflammatory bowel disease.
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| A few of the more common causes of diarrhea include the following:
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| *'''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).
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| *'''Viral infections'''. Many viruses cause diarrhea, including [[rotavirus]], [[Norwalk virus]], [[cytomegalovirus]], [[herpes simplex virus]], and [[viral hepatitis]].
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| *'''Food intolerances'''. Some people are unable to digest food components such as artificial sweeteners and lactose—the sugar found in milk.
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| *'''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]].
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| *'''Reaction to medicines'''. [[Antibiotics]], [[blood pressure medications]], [[cancer drugs]], and [[antacids]] containing [[magnesium]] can all cause diarrhea.
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| *'''Intestinal diseases'''. [[Inflammatory bowel disease]], [[colitis]], [[Crohn’s disease]], and [[celiac disease]] often lead to diarrhea.
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| *'''Functional bowel disorders'''. Diarrhea can be a symptom of [[irritable bowel syndrome]].
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| Some people develop diarrhea after stomach surgery or removal of the [[gallbladder]]. The reason may be a change in how quickly food moves through the [[digestive system]] after stomach surgery or an increase in [[bile]] in the [[colon]] after gallbladder surgery.
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| People who visit foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Traveler’s diarrhea can be a problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.
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| In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.
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| ==Who is at risk for Diarrhea?==
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| Anyone can get diarrhea. This common problem can last a day or two or for months or years, depending on the cause. Most people get better on their own, but diarrhea can be serious for babies and older people if lost fluids are not replaced. Many people throughout the world die from diarrhea because of the large volume of water lost and the accompanying loss of salts.
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| ==Diagnosis==
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| Diagnostic tests to find the cause of diarrhea may include the following:
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| *'''Medical history and physical examination.''' The doctor will ask you about your eating habits and medication use and will examine you for signs of illness.
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| *'''Stool culture.''' A sample of stool is analyzed in a laboratory to check for [[bacteria]], [[parasites]], or other signs of disease and infection.
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| *'''Blood tests.''' Blood tests can be helpful in ruling out certain diseases.
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| *'''Fasting tests.''' To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask you to avoid [[lactose]], [[carbohydrates]], wheat, or other foods to see whether the diarrhea responds to a change in diet.
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| *'''Sigmoidoscopy'''. For this test, the doctor uses a special instrument to look at the inside of the [[rectum]] and lower part of the [[colon]].
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| *'''Colonoscopy'''. This test is similar to a [[sigmoidoscopy]], but it allows the doctor to view the entire [[colon]].
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| *'''Imaging tests'''. These tests can rule out structural abnormalities as the cause of diarrhea.
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| ==When to seek urgent medical care==
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| Diarrhea is not usually harmful, but it can become dangerous or signal a more serious problem. You should see the doctor if you experience any of the following:
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| * Diarrhea for more than 3 days
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| * Severe pain in the [[abdomen]] or [[rectum]]
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| * A [[fever]] of 102 degrees or higher
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| * Blood in your stool or black, tarry stools
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| * Signs of [[dehydration]]
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| ==Treatment options==
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| In most cases of diarrhea, replacing lost fluid to prevent [[dehydration]] is the only treatment necessary. Medicines that stop diarrhea may be helpful, but they are not recommended for people whose diarrhea is caused by a bacterial infection or parasite. If you stop the diarrhea before having purged the bacteria or parasite, you will trap the organism in the intestines and prolong the problem. Rather, doctors usually prescribe [[antibiotics]] as a first-line treatment. [[Viral infections]] are either treated with medication or left to run their course, depending on the severity and type of virus.
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| ===Tips About Food===
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| Until diarrhea subsides, try to avoid caffeine, milk products, and foods that are greasy, high in fiber, or very sweet. These foods tend to aggravate diarrhea.
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| As you improve, you can add soft, bland foods to your diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. For children, the pediatrician may also recommend a bland diet. Once the diarrhea has stopped, the pediatrician will likely encourage children to return to a normal and healthy diet if it can be tolerated.
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| ===Contraindicated medications===
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| {{MedCondContrPI
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| |MedCond =Diarrhea|Ethacrynic acid}}
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| ==Where to find medical care for Diarrhea==
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| [http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|yourdisease}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Diarrhea]
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| ==Prevention of Diarrhea==
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| * Wash your hands often, especially after going to the bathroom and before eating.
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| * Teach children to not put objects in their mouth.
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| * When taking antibiotics, try eating food with Lactobacillus acidophilus, a healthy bacteria. This helps replenish the good bacteria that antibiotics can kill. Yogurt with active or live cultures is a good source of this healthy bacteria.
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| * Use alcohol-based hand gel frequently.
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| Traveler’s diarrhea happens when you consume food or water contaminated with bacteria, viruses, or parasites. You can take the following precautions to prevent traveler’s diarrhea when you travel outside of the United States:
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| * Do not drink tap water or use it to brush your teeth.
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| * Do not drink unpasteurized milk or dairy products.
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| * Do not use ice made from tap water.
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| * Avoid all raw fruits and vegetables, including lettuce and fruit salads, unless they can be peeled and you peel them yourself.
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| * Do not eat raw or rare meat and fish.
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| * Do not eat meat or shellfish that is not hot when served.
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| * Do not eat food from street vendors.
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| You can safely drink bottled water—if you are the one to break the seal—along with carbonated soft drinks, and hot drinks such as coffee or tea.
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| Depending on where you are going and how long you will stay, your doctor may recommend that you take antibiotics before leaving to protect you from possible infection.
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| ==What to expect (Outlook/Prognosis)==
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| The Prognosis for diarrhea is usually good. Diarrhea is common and usually goes away on its own unless it is an underlying symptom of a chronic disease. It is important to replace lost fluid due to diarrhea because if you become severely dehydrated it can be fatal.
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| ==Sources==
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| http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/
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| [[Category:Patient information]]
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| [[Category:primary care]]
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| [[Category:Gastroenterology]]
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| [[Category:Water-borne diseases]]
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| [[Category:Digestive disease symptoms]]
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| [[Category:Conditions diagnosed by stool test]]
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| {{WH}}
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| {{WS}}
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| ==Pathophysiology Diarrhea==
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| Normal fluid intake for an adult is about 2 L/d. The average amount of gastrointestinal secretions (composed of salivary glands, gastric, biliary, and pancreatic secretions) is 7-8 L/d, depending on the weight and age. The absorptive surface of the small intestine is formed by villis that reabsorb the majority of secreted water and electrolytes. The small intestine absorbs 75% of upper GI tract secretions. The rest of the secretions absorb in the large intestine. Colon absorbs 90% of its exposed volume, means that colon is the most effective absorbing organ in the GI system.<br>
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| Decrease in the small intestine absorption, regardless of causes, may not cause diarrhea unless, there is a dysfunction in colon or the volume of the secretions exceeds the absorptive ability of the colon.
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| {{Family tree | | | | | | B01 | | | |B01='''[[CNS]] dysregulation and [[psychosocial factors]]''' }}
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| {{Family tree | | | | | | |!| | | | | }}
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| {{Family tree | | | | | | |!| | | | | }}
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| {{familytree |boxstyle=text-align: left; | A01 |-|-| A02 |-|-|-| A03 | |A01= '''Intrinsic [[gastrointestinal]] factors''': <br> • [[Motor]] abnormalities <br>• [[Visceral]] [[hypersensitivity]] <br>• [[Immune]] activation and [[mucosal]] inflammation <br>• Altered [[gut]] [[microbiota]] <br>• Abnormal [[serotonin]] pathways | A02= '''IRRITABLE BOWEL SYNDROME'''| A03='''Genetic factors''': <br>• Twin concordance <br>• Familial aggregation <br>• [[SNPs|Single nucleotide polymorphisms(SNPs)]] <br>• TNF polymorphism}}
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| {{Family tree | | | | | | |!| | | | | }}
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| {{Family tree | | | | | | |!| | | | | }}
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| {{familytree |boxstyle=text-align: left; | | | | | | B01 | | | |B01= '''Environmental factors''': <br>•Diet <br>•[[Infections]]}}
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| {{Family tree/end}}
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| [[Category:Primary care]]
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| [[Category:Gastroenterology]]
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| [[Category:Needs overview]]
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| ==D/Ds==
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| ==Differential Diagnosis of Diarrhea of other diseases==
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| '''''To review the differential diagnosis of diarrhea, click [[#Diarrhea|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea, click [[Acute diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea, click [[Chronic diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of traveler's diarrhea, click [[Traveler's diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute watery diarrhea, click [[Acute watery diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute bloody diarrhea, click [[Acute bloody diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute fatty diarrhea, click [[Acute fatty diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic watery diarrhea, click [[Chronic watery diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic bloody diarrhea, click [[Chronic bloody diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic fatty diarrhea, click [[Chronic fatty diarrhea differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea and fever, click [[Acute diarrhea and fever differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea and fever, click [[Chronic diarrhea and fever differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea and abdominal pain, click [[Acute diarrhea and abdominal pain differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea and abdominal pain, click [[Chronic diarrhea and abdominal pain differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea and weight loss, click [[Acute diarrhea and weight loss differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea and weight loss, click [[Chronic diarrhea and weight loss differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea, fever, and abdominal pain, click [[Acute diarrhea, fever, and abdominal pain differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea, fever, and abdominal pain, click [[Chronic diarrhea, fever, and abdominal pain differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of acute diarrhea, abdominal pain, and weight loss, click [[Acute diarrhea, abdominal pain, and weight loss differential diagnosis|here]].'''''
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| '''''To review the differential diagnosis of chronic diarrhea, abdominal pain, and weight loss, click [[Chronic diarrhea, abdominal pain, and weight loss differential diagnosis|here]].'''''
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| == Risk Factors ==
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| * Antibiotic use
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| * High-risk sexual behavior (STDs)
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| * Immunosuppression
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| * Recent travel to endemic area
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| ===Pathophysiology prev=== | | ===Pathophysiology prev=== |
| <div style="-webkit-user-select: none;"> | | <div style="-webkit-user-select: none;"> |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| [[Category:Primary care]]
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| [[Category:Gastroenterology]]
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| [[Category:Needs overview]]
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| ==Other Imaging Findings== | | ==Other Imaging Findings== |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| [[Category:Primary care]]
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| [[Category:Gastroenterology]]
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| [[Category:Needs overview]]
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| ===Pathophysiology prev=== | | ===Pathophysiology prev=== |
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| ===Image and text to the right=== | | ===Image and text to the right=== |
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| <figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Global distribution of leptospirosis.jpg|577x577px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017. | | <figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Global distribution of leptospirosis.jpg|577x577px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017. |
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| ===Gallery=== | | ===Gallery=== |
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Gastroenterology]]
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| [[Category:Hepatology]]
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| [[Category:Disease]]
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| {{WS}} | | {{WS}} |
| {{WH}} | | {{WH}} |
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| REFERENCES | | REFERENCES |
| <references /> | | <references /> |
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| | [[Category:Gastroenterology]] |
| | [[Category:Needs overview]] |
| | [[Category:Hepatology]] |
| | [[Category:Disease]] |
</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.
![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/2/2f/Pancreatic_insulinoma_histology_2.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/a/a3/Pancreatic_insulinoma_histopathology_3.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/d/d5/Pancreatic_insulinoma_histology_4.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_2.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histopathology_3.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_4.JPG)