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Diarrhea
Edited by: Joe Hing Kwok Chu
The functions of the digestive tract include secretion, digestion, absorption,
and movements. If any of these functions are impaired, it can cause diarrhea.
Since the functions are inter-related, it is very seldom that only one is
impaired. Usually chronic diarrhea involves the impairment of more than one
functions.
Successful treatment is
dependent on the accuracy of the diagnosis.
Diagnosis should include history, symptoms, digital
examination of the rectum, stool examination. If the problem can not be
identified, endoscope with flexible fiberoptic sigmoidoscope examination, X ray
examination, ultra-sound examination can be performed. If necessary, the
absoption function of small intestine (like glucose tolerance test,
pathophysiological analysis is effective in the diagnosis of diarrhea but in
practice many patients and health professionals are reluctant to handle the
large amount of stool samples. Frequently anti-diarrheal drugs like loperamide,
diphenoxylate with atropine, are prescribed for symptomatic therapy. These will
not solve the real problems.
General description
I.
Definition of Diarrhea
Diarrhea
can be referred to as symptom of diarrhea or
sign of diarrhea.
When a
patient describes he/she has chronic diarrhea, it can means:
As symptoms:
(1)
Decrease in stool consistency, increase in frequencies of defecation,
increase in volume, or increase in both frequencies and volume; or any
combinations of the above mentioned symptoms.
(2)
Several small stool excretions, with urgency, frequency, and with
painfully but ineffectual attempt to defecate, without systemic
symptoms, like inflammation of the anus or rectum, or
(3) three
or four large bulky defecations accompanied with about 8 kg (20 lbs) of
body weight loss and accompanied with a skin sensation, such as burning,
prickling, itching, or tingling, with no apparent physical cause. This
can be caused by celiac sprue, which is characterized by defective
digestion and utilization of fats (shown in fatty stools).
As sign of diseases:
Increase
in stool weight or volume of 225 to 250 grams
or c.c. per 24 hours.
Infection:
-
Bacterial
infections. Campylobacter, Salmonella, Shigella, and
Escherichia coli (E. coli).
-
Viral
infections. rotavirus, Norwalk virus, cytomegalovirus,
herpes simplex virus, and viral hepatitis.
-
Parasites.
Giardia lamblia, Entamoeba histolytica, and
Cryptosporidium.
Food intolerance:
-
lactose
intolerance
(like milk sugar in milk products)
-
artificial sweetener
Colitis
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