Date: 17-11-18  Time: 16:17 PM

Author Topic: ALL ABOUT DIARRHEA  (Read 77 times)

Offline ayeshanoor

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ALL ABOUT DIARRHEA
« on: July 26, 2018, 12:47:12 PM »
Diarrhea
In this sitting:
•   What is diarrhea?
•   What causes diarrhea?
•   What are the symptoms?
•   Diarrhea in Children
•   What is dehydration?
•   When should a doctor be consulted?
•   What tests might the doctor do?
•   What is the treatment?
•   WHO STRATEGY (IMCI)
•   Preventing traveler's diarrhea
•   Points to Remember
What is diarrhea? Stomach flu
Diarrhea--loose, watery stools occurring more than three times in one day--is a common problem that usually lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems.
The definition of diarrhea depends on what is normal for you. For some, diarrhea can be as little as one loose stool per day. Others may have three daily bowel movements normally and not be having what they consider diarrhea. So the best description of diarrhea is "an abnormal increase in the frequency and liquidity of stools."
Breast-fed babies have many soft bowel movements in a day. They may pass stool every time they eat. Twelve or more bowel movements a day may be OK. Bottle-fed babies don’t have as many bowel movements. Even so, 1 or 2 loose stools is not diarrhea. In a baby, diarrhea is many very runny bowel movements.
The basic physiology of acute diarrhea is simple: either not enough fluid is absorbed from the intestines, or the intestines produce too much fluid. The result is a lot more stool liquid then you're used to.
Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and the elderly, and it must be treated promptly to avoid serious health problems. Dehydration is discussed below.
People of all ages can get diarrhea. The average adult has a bout of diarrhea about four times a year.
What causes diarrhea?
Diarrhea may be caused by a temporary problem, like an infection, or a chronic problem, like an intestinal disease. A few of the more common causes of diarrhea are
•   Bacterial infections. Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common culprits include
Campylobacter, Salmonella, Shigella, and Escherichia 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 a component of food, such as 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.
•   Medicines, such as antibiotics, blood pressure medications, NSAIDS, laxatives, and antacids containing magnesium.
•   Intestinal diseases, like inflammatory bowel disease (Crohn’s disease or ulcerative colitis ) or celiac disease.
•   Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally.
•   Eating too much of foods one is not used to.
•   Getting upset.
•   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 that can occur after gallbladder surgery.
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.
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, sometimes, parasites.
What are the symptoms?
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.
Diarrhea can be either acute (short-term) or chronic (long-term). The acute form, which lasts less than 2 weeks, is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea lasts more than 2 weeks and is usually related to functional disorders like irritable bowel syndrome or diseases like celiac disease or inflammatory bowel disease.
Diarrhea in Children
Children can have acute or chronic forms of diarrhea. Causes include bacteria, viruses, parasites, medications, functional disorders, and food sensitivities. Infection with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus diarrhea usually resolves in 5 to 8 days.
Medications to treat diarrhea in adults can be dangerous to children and should be given only under a doctor's guidance.
Diarrhea can be dangerous in newborns and infants. In small children, severe diarrhea lasting just a day or two can lead to dehydration. Because a child can die from dehydration within a few days, the main treatment for diarrhea in children is rehydration.
Rehydration is discussed below.
Take your child to the doctor if any of the following symptoms appear:
•   stools containing blood or pus, or black stools
•   temperature above 101.4 degrees Fahrenheit
•   no improvement after 24 hours
•   signs of dehydration (see below)
What is dehydration?
General signs of dehydration include
•   thirst
•   less frequent urination
•   dry skin
•   fatigue
•   light-headedness
•   dark colored urine
Signs of dehydration in children include
•   dry mouth and tongue
•   no tears when crying
•   no wet diapers for 3 hours or more
•   sunken abdomen, eyes, or cheeks
•   high fever
•   listlessness or irritability
•   skin that does not flatten when pinched and released
If you suspect that you or your child is dehydrated, call the doctor immediately. Severe dehydration may require hospitalization.
Preventing Dehydration
Dehydration occurs when the body has lost too much fluid and electrolytes (the salts potassium and sodium). The fluid and electrolytes lost during diarrhea need to be replaced promptly--the body cannot function properly without them. Dehydration is particularly dangerous for children, who can die from it within a matter of days.
Although water is extremely important in preventing dehydration, it does not contain electrolytes. To maintain electrolyte levels, you could have broth or soups, which contain sodium, and fruit juices, soft fruits, or vegetables, which contain potassium.
For children, doctors often recommend a special rehydration solution ORS that contains the nutrients they need.
When should a doctor be consulted?
Doctors are often not consulted for diarrhea and self medication is very common however patients should at least see the doctor if
•   They have diarrhea for more than 3 days / 24 hours in children.
•   They have severe pain in the abdomen or rectum.
•   They have a fever of 102 degrees Fahrenheit or higher.
•   They see blood in your stool or have black, tarry stools.
•   They have signs of dehydration.
If a child has diarrhea, do not hesitate to consult the doctor for advice. Diarrhea can be dangerous in children if too much fluid is lost and not replaced quickly.
What tests might the doctor do?
Diagnostic tests, which in the needed cases may be helpful to find the cause of diarrhea, include the following:
•   Medical history and physical examination. The doctor will need to know about patients eating habits and medication use and will examine him for

signs of illness.
•   Stool culture. Lab technicians analyze a sample of stool to check for bacteria, parasites, or other signs of disease or infection.
•   Blood tests. Blood tests can be helpful in ruling out certain diseases.
•   Fasting tests. To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask the patient to avoid lactose (found in milk
carbohydrates, wheat, or other foods to see whether the diarrhea responds to a change in diet.
•   Sigmoidoscopy. For this test, the doctor uses a sigmoidoscop to look at the inside of the rectum and lower part of the colon.
•   Colonoscopy. This test is similar to sigmoidoscopy, but the doctor looks at the entire colon.
What is the treatment?
In most cases, replacing lost fluid to prevent dehydration is the only treatment necessary. (See Preventing Dehydration below.)
Medicines that stop diarrhea may be helpful in some cases, but they are not recommended for people whose diarrhea is from a bacterial infection or parasite--stopping the diarrhea traps the organism in the intestines, prolonging the problem. Instead, doctors usually prescribe antibiotics.
Viral causes are either treated with medication or left to run their course, depending on the severity and type of the virus.
Tips About Food
Until diarrhea subsides, try to avoid milk products and foods that are greasy, high-fiber, or very sweet. These foods tend to aggravate diarrhea.
As the patient improves, he 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 recommend what is called the BRAT diet: bananas, rice, applesauce, and toast.
Other dietary changes that may be helpful: Some foods contain sugars that are absorbed slowly, such as fructose in fruit juice or sorbitol in dietetic confectionery. Through a process called osmosis, these unabsorbed sugars hold onto water in the intestines, sometimes leading to diarrhea.1 By reading labels, people with chronic non-infectious diarrhea can easily avoid fruit juice, fructose, and sorbitol to see if this eliminates the problem.
People who are lactose intolerant—meaning they lack the enzyme needed to digest milk sugar—often develop diarrhea after consuming milk or ice cream. People whose lactose intolerance is the cause of diarrhea will rid themselves of the problem by avoiding milk and ice cream or in many cases by taking lactase, the enzyme needed to digest lactose. Lactase is available in a variety of forms in pharmacies (and in medicine stores in the form of lactase-treated milk in some countries).
Large amounts of vitamin C or magnesium found in supplements can also cause diarrhea, although the amount varies considerably from person to person. Unlike infectious diarrhea, diarrhea caused by high amounts of vitamin C or magnesium is not generally accompanied by other signs of illness. The same is true when the problem comes from sorbitol or fructose.2 In these cases, avoiding the offending supplement or food brings rapid relief.
Drinking several cups of coffee per day causes diarrhea in some people.3 People with chronic diarrhea who drink coffee should avoid all coffee for a few days to evaluate whether coffee is the culprit.

Allergies and food sensitivities are common triggers for diarrhea.4 For example, some infants suffer diarrhea when fed cow’s milk-based formula but improve when switched to soy-based formula.5 People with chronic diarrhea not attributable to other causes should discuss the possibility of food sensitivity with a doctor.

Colostrum might be useful for certain types of infectious diarrhea. In a double-blind trial, children with diarrhea caused by a rotavirus were treated with immunoglobulins extracted from colostrum derived from cows immunized with rotavirus. Compared with the placebo, colostrum extract significantly reduced the amount of diarrhea and the amount of oral rehydration solution required. The rotavirus was eliminated from the stool significantly more rapidly in the colostrum group than in the placebo group (1.5 days, vs. 2.9 days).

In addition to a positive effect against acute rotavirus diarrhea, there is also evidence that specific forms of colostrum (derived from specially immunized cows or those with confirmed presence of specific antibodies) are effective against diarrhea caused by Cryptosporidium parvum, Helicobacter pylori, Escherichia coli, and Clostridium difficile. However, it is not known whether commercially-available colostrum provides significant amounts of the specific immunoglobulins that are active against these organisms. Furthermore, unless the immunoglobulins are present in high enough concentrations, the preparation is not likely to be effective.

It is known vitamin A supplements support immune function and prevent infections. In a study of African children between six months and five years old, a 44% reduction in the risk of severe diarrhea was seen in those children given four 100,000–200,000 IU supplements of vitamin A (the lower amount for those less than a year old) during an eight-month period. On further investigation, the researchers discovered that the reduction in diarrhea occurred only in children who were very malnourished.

WHO STRATEGY:
Diarrhoea: correct management could save nearly 1.8 million lives per year
About two million children die each year in developing countries from diarrheal diseases, making it the second most serious killer of children under five worldwide. But diarrhea can in most cases be prevented or treated. Correct management of diarrhea could save the lives of up to 90% of children who currently die from the effects of the disease.

IMCI (Integrated Management of Childhood Illness )
Reduce the death toll from diarrhea by promoting:
o   Rapid and effective treatment through standard case management;
o   Prompt recognition and treatment of conditions that occur in association with diarrhea;
o   Improved home management;
o   Improved nutrition;
o   Prevention through increased breastfeeding and measles vaccination.

Diarrhea may be caused by a wide variety of infections but health workers following the IMCI approach learn to make rapid treatment decisions by determining the duration of the diarrhea, assessing the severity of dehydration and the presence of blood in stools. This leads them to selecting treatment protocols for either: persistent diarrhea (more than 14 days), acute watery diarrhea, or dysentery. This approach is both life-saving and cost-effective.
While urgent diagnosis and treatment of diarrhea may be a priority for saving a child's life, IMCI-trained health workers also consider the child's overall health status. For example, by treating the malnutrition that often accompanies diarrhea, further risk to the child's health can be reduced. Increasing vigilance to detect other diseases that can occur concurrently with diarrhea, such as measles or malaria, is also emphasized.

Preventing traveler's diarrhea
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 go abroad:
•   Do not drink any tap water, not even when brushing your teeth.
•   Do not drink unpasteurized milk or dairy products.
•   Do not use ice made from tap water.
•   Avoid all raw fruits and vegetables (including lettuce and fruit salad) unless they can be peeled and you peel them yourself.
•   Do not eat raw or rare meat and fish.
•   Do not eat meat or shellfish that is not hot when served to you.
•   Do not eat food from street vendors.

One can safely drink bottled water (if you are the one to break the seal), carbonated soft drinks, and hot drinks like coffee or tea.

Points to Remember
•   Diarrhea is a common problem that usually resolves on its own.
•   Diarrhea is dangerous if a person becomes dehydrated.
•   Causes include viral, bacterial, or parasitic infections; food intolerance; reactions to medicine; intestinal diseases; and functional bowel
disorders.
•   Treatment involves replacing lost fluids and electrolytes. Depending on the cause of the problem, a person might also need medication to stop
the diarrhea or treat an infection. Children may need an oral rehydration solution to replace lost fluids and electrolytes.
•   Call the doctor if a person with diarrhea has severe pain in the abdomen or rectum, a fever of 102 degrees Fahrenheit or higher, blood in the
stool, signs of dehydration, or diarrhea for more than 3 days. This may need antibiotics.
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