Diarrhea

Definition of Diarrhea

The term “diarrhea” is often used to describe an increase in frequency of defecation or

a change in the consistency of stool to that with a greater liquid content. However, the precise
definition of this condition requires that the daily stool output more 200 g – 400 g for adults.

Classification of Diarrhea

1. Acute diarrhea

Acute diarrhea lasting several days to weeks (less than 14 days) in the developed
world is most commonly due to viruses, and bacteria such as Campylobacter jejuni or
Salmonella spp., E. Coli, S. Aureus.

2. Chronic diarrhea

Chronic diarrhea lasting more than 2 weeks or 14 days. The most common causes are
infection and inflammatory. Most bacteria may causes are Shigella spp., Mycobacterium
tuberculosis, Salmonella spp., Yersinia enterocolitica and Tropheryma whippelii.

Pathophysiology

The pathophysiology of diarrhea can therefore be considered in terms of factors that

promote secretion or attenuate absorption, favoring a net increase in fluid and electrolyte
movement into the intestinal lumen. These factors fall into four categories:
 Active secretion
Stimulation of active intestinal secretion occurs as a result of secretogogues which
bind to the enterocyte and activate three principal second messengers: cyclic AMP,
cyclic GMP and calcium. These then promote the active secretion of chloride ions
into the intestinal lumen by opening apical (luminal) chloride channels, following the
induction of a phosphorylation cascade. Chloride ions are followed passively by
sodium and subsequently water into the intestinal lumen
 Inhibition of absorption
Many secretogogues in addition to stimulating active secretion also directly inhibit the
enterocyte s ability to absorb fluid. Furthermore, the activation of inhibitory neural
secretory reflexes also downregulates absorption.
  Osmotic diarrhea
Non-absorbed or poorly absorbed aqueous solutes increase the osmotic potential of
the intestinal lumen. This high luminal osmolality attenuates the absorptive capacity
of the intestine and promotes the passive inward movement of fluid and electrolytes.
This may simply be the result of ingested non-absorbable substances such as lactulose
and sorbitol.
 Altered intestinal motility
Increasing intestinal transit with pro-motility agents such as erythromycin reduces the
intestinal capacity to absorb thus leading to diarrhea
Causes

 Infection
Infections can causes by virus. Viruses induce diarrhea through epithelial invasion,
causing inflammation and cell destruction, which impairs absorption. Most bacteria cause
diarrhea by direct invasion, inducing an inflammatory response, and through the production
of secretory toxins.
 Dilutional diarrhea

When consistency of stools is very liquid such as urine, water and tea.

 Surgery

Vagotomy and sympathectomy appear to alter intestinal secretion and motility resulting
in diarrhea.
 HIV-associated diarrhea

Diarrhea associated with HIV is frequently attributed to opportunistic Infections. Can

causes microsporidia, cytomegalovirus, cryptosporidia and Mycobacterium avium complex.
The other most common cause is the use of protease inhibitors, which has been found to
induce diarrhea in 12–56% of patients.
 Intestinal lymphangiectasia

Intestinal lymphagiectasia is common cause by cancer. Obstruction of the lymphatics

results in an increase in the interstitial hydrostatic pressure. This results in the disruption of
cellular tight junctions with an increase in epithelial permeability to solutes, water and larger
molecules such as proteins. The consumption of fat increases the pressure in the lymphatics,
thereby inducing further fluid and electrolyte loss resulting in diarrhea.
Symptoms

If the cause of diarrhea is caused by ingesting foods that contain poisons from germs,
there will be other symptoms of nausea to vomiting. In cases of food poisoning, usually
diarrhea symptoms such as vomiting will appear more dominant than the diarrhea itself.
Fever may also accompany diarrhea caused by infection. In addition, the presence of injury to
the intestinal mucosa will cause the presence of blood or mucus in the stool so it is necessary
to prevent diarrhea to minimize the possibility of complications diarrhea. Abdominal pain to
abdominal cramps can occur in diarrhea which occurs due to acceleration of bowel
movements or which injures the intestinal mucosa. In addition to diarrhea signs and
symptoms, the important thing to note if you experience diarrhea is to recognize the symptom
of fluid deficiency which is one of the most common complications of diarrhea. The
symptoms are as follows:

Dehydration :

 Mild (loss of water 5 % weight)

 Moderate ( 5 – 8 % weight)
 Severe ( > 8 % weight, marked shock & metabolic acidosis)
Symptom in Children:
 Dry mouth, tongue & skin
 Few or no tears when crying
 decrease urination
 sunken eyes
 heeks or abdomen
 grayish skin
 sunken fontanel in infants
 decreae skin turgor & irritability.
Symptom in Adult:
 Increase thirst
 decrease urination
 feeling weak or light-headed
 dry mouth & tounge
Pharmacology therapy

In the treatment of diarrhea, there are 2 kinds of pharmacological and non-

pharmacological treatments

for pharmacological treatment using antibiotics to kill bacteria, laxative as insulin,

metformin for type 2 diarrhea, sorbitol as sugar for diarrhea and protease inhibitors

Drugs

Antibiotics

Ex: Pseudomembranous colitis

Erythromycin

Laxatives

Ex: Senna

Docusate sodium

Magnesium salts

Non-Pharmacology therapy

1. Avoid foods and drinks that are not clean (We have to eat clean foods)
2. Wash hands with soap and clean water before eating and after eating (So we must
wash our hands with soap and clean water before eating and after eating, so that we
are protected from microbe, specifically the germs that cause diarrhea)
3. Defecate in the toilet ( So we must defecate ini the toilet, don't ini the road or your
room no!!!)
4. Use clean water for cooking (For cooking anything)
5. Cook: rise, fish, chiken, meat dsb.