In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the American and British English spelling differences are one aspect of American and British English differences. Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract

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. In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course Developing countries are countries that haven't reached Western-style standards of democratic government free market economy industrialization social programs and human rights guaranties Infant mortality is defined as the number of deaths of Infants (one year of age or younger per 1000 live births It is often due to gastroenteritis. Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the

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

Contents 1 Causes 2 Types of diarrhea 2.1 Secretory diarrhea 2.2 Osmotic diarrhea 2.3 Motility-related diarrhea 2.4 Inflammatory diarrhea 2.5 Dysentery 3 Infectious diarrhea 4 Malabsorption 5 Inflammatory bowel disease 6 Irritable Bowel Syndrome 7 Other important causes 8 Alcohol 9 Treatment 10 See also 11 Footnotes 12 External links

Causes

Diarrhea is most commonly caused by viral infections, parasites or bacterial toxins. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Parasitism is a type of symbiotic relationship between Organisms of different Species. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have ^[1] In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy patient usually recovers from viral infections in a few days. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object ^[2]

Diarrhea can also be a symptom of more serious diseases, such as dysentery, cholera, or botulism, and can also be indicative of a chronic syndrome such as Crohn's disease or severe mushroom poisoning syndromes. Dysentery (formerly known as flux or the bloody flux) is an infection of the digestive system that results in severe Diarrhea containing mucus and blood Cholera, sometimes known as Asiatic cholera or epidemic cholera, is an infectious Gastroenteritis caused by the Bacterium Botulism ( Latin, botulus, "sausage" is a rare but serious Paralytic illness caused by Botulin Toxin. Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus Amanita phalloides (generally æməˈnaɪtə fəˈlɔɪdiːz commonly known as the death cap, is a poisonous Basidiomycete Fungus, one Though appendicitis patients do not generally have diarrhea, it is a common symptom of a ruptured appendix. Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. In Human anatomy, the appendix (or vermiform appendix; also cecal (or caecal appendix; also vermix) is a blind ended tube connected to the It is also an effect of severe radiation sickness. Radiation poisoning, also called " radiation sickness " or a " creeping dose " is a form of damage to organ tissue due to excessive exposure to

Diarrhea can also be caused by dairy intake in those who are lactose intolerant. Lactose intolerance is the inability to metabolize Lactose, a sugar found in Milk and other Dairy products because the required enzyme

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. An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Salt is a Dietary mineral composed primarily of Sodium chloride that is essential for Animal life but toxic to most land plants A nutrient is food or chemicals that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment For many people, further treatment is unnecessary. The following types of diarrhea indicate medical supervision is required:

• Diarrhea in infants
• Moderate or severe diarrhea in young children;
• Diarrhea associated with blood
• Diarrhea that continues for more than two days;
• Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
• 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. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Traveler's diarrhea (in American English or traveller's diarrhœa (in British English abbreviated to TD, is the most common illness affecting travelers

A severity score is used to aid diagnosis in children. ^[3]

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. A lumen (Lat lūmen, an opening or light (pl lumina is the inside space or lining of a tubular structure such as an artery or intestine

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. Coeliac

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. A vagotomy is a surgical procedure that is performed only in humans Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry.

Inflammatory diarrhea

Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases.

Dysentery

Generally, if there is blood visible in the stools, it is not diarrhea, it is dysentery. Dysentery (formerly known as flux or the bloody flux) is an infection of the digestive system that results in severe Diarrhea containing mucus and blood The blood is trace of an invasion of bowel tissue. Dysentery is caused by an excess of water by a release of antidiuretic hormone from the posterior pituitary gland. Dysentry is a symptom of, among others, Shigella, Entamoeba Histolytica, and Salmonella. This article is about the bacteria For the disease see Shigellosis Shigella is a Genus of Gram-negative For the infection and disease caused by this parasite refer to Amoebiasis. Salmonella is a Genus of rod-shaped Gram-negative enterobacteria that causes Typhoid fever, Paratyphoid fever

Infectious diarrhea

Main article: Infectious diarrhea

Infectious diarrhea is diarrhea caused by a microbe such as a bacterium, parasite, or virus. Cholera --> See also Gastroenteritis and Enteritis Infectious diarrhea may be defined Cholera --> See also Gastroenteritis and Enteritis Infectious diarrhea may be defined A microorganism (also spelled micro organism or micro-organism and also called a microbe) is an Organism that is Microscopic (usually The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Parasitism is a type of symbiotic relationship between Organisms of different Species. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable

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. Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates.

Causes include celiac disease (intolerance to wheat, rye, and barley gluten, the protein of the grain), lactose intolerance (Intolerance to milk sugar, common in non-Europeans), fructose malabsorption, pernicious anemia (impaired bowel function due to the inability to absorb vitamin B12), loss of pancreatic secretions (may be due to cystic fibrosis or pancreatitis), short bowel syndrome (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs such as chemotherapy. Coeliac Gluten is a composite of the proteins Gliadin and Glutenin. These exist conjoined with Starch, in the Endosperms of some Lactose intolerance is the inability to metabolize Lactose, a sugar found in Milk and other Dairy products because the required enzyme Fructose malabsorption or Dietary Fructose Intolerance is a digestive disorder of the Small intestine in which the Fructose carrier in Enterocytes Pernicious anemia (also known as Biermer's anemia, Addison's anemia, or Addison-Biermer anemia) is a form of Megaloblastic anemia due to Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Short bowel syndrome ( SBS, also short gut syndrome or simply short gut) is a Malabsorption disorder caused by the surgical removal Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer.

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. Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals
• Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel. Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus

Irritable Bowel Syndrome

Main article: Irritable Bowel Syndrome

Another possible cause of diarrhea is Irritable Bowel Syndrome (IBS). In Gastroenterology, irritable bowel syndrome ( IBS) is a Functional bowel disorder characterized by mild to severe Abdominal pain, discomfort 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. Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that ^[4] 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. Dysbiosis (also called dysbacteriosis) is the condition of having microbial imbalances on or with in the body ) usually resolves the diarrhea. ^[5] 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. In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction This usually affects older people and can be due to blocked arteries.
• Bowel cancer: Some (but not all) bowel cancers may have associated diarrhea. Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and 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). Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons
• 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. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises Bile salt diarrhea is a possible side-effect of gallbladder removal. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process It is usually treated with cholestyramine, a bile acid sequestrant. Cholestyramine or colestyramine ( Questran Questran Light, Cholybar) is a Bile acid sequestrant, which binds Bile in the Gastrointestinal The bile acid sequestrants are a group of medications used for binding certain components of Bile in the gastrointestinal tract.

Alcohol

Chronic diarrhea can be caused by chronic ethanol ingestion. ^[6] 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. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon A hangover ( veisalgia) describes the sum of unpleasant physiological effects following heavy consumption of drugs particularly Alcoholic beverages The most commonly The alcohol itself is absorbed in the intestines and as the intestinal cells absorb it, the toxicity causes these cells to lose their ability to absorb water. This leads to an outpouring of fluid from the intestinal lining, which is in turn poorly absorbed. The diarrhea usually lasts for several hours until the alcohol is detoxified and removed from the digestive system. Symptoms range from person to person and are influenced by both the amount consumed as well as physiological differences.

Treatment

In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. Medicines that are available without a doctor's prescription include loperamide (Imodium) and bismuth subsalicylate Pepto Bismol and Kaopectate. Loperamide, a synthetic Piperidine derivative is a drug effective against Diarrhea resulting from Gastroenteritis or Inflammatory Bismuth subsalicylate, with a chemical formula C7H5BiO4 is a drug used to treat Nausea, Heartburn, Indigestion, Pepto-Bismol is an Over-the-counter drug produced by the Procter and Gamble company used to treat minor Digestive system upset Kaopectate, known medically as Bismuth subsalicylate, is an orally taken Medication from Chattem ^[7]

.

See also

• Constipation
• Drinking water
• Feces
• Steatorrhea (fatty diarrhea)
• Traveler's diarrhea
• Food poisoning
• The Diarrhea Song

Footnotes

External links

• Reducing deaths from diarrhoea through oral rehydration therapy. 1: Bull. World Health Organ. 2000;78(10):1246-55.
• Travelers' Diarrhea
• Rehydration Project

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