Diarrhea:- Part 1 – How to diagnose Diarrhea?

How to diagnose Diarrhea?

What Sample is needed to diagnose diarrhea?

1. A fresh stool sample is ideal.
2. Blood may be needed for antigen and antibody testing

How will you define diarrhea?

1. 3-loose stools per day characterize diarrhea and may be accompanied by the following:
   1. Abdominal pain.
   2. Nausea and vomiting.
   3. Fatigue.

What are the causes of Diarrhoea?

1. Diarrhea may be:
   1. Acute.
   2. Chronic.
2. This may be due to the following:
   1. Viral infections. The most common cause is retrovirus among children. Other viruses are Adenovirus, cytomegalovirus, and HIV.
   2. Bacterial infections are due to Salmonella, Vibrio, Campylobacter, and Yersinia.
   3. Other causes include toxigenic bacteria such as Staphylococcus and Bacillus cereus, Shigella, and E. Coli.
   4. Parasitic infestation, e.g., Giardia Lamblia and Entamoeba histolytica.

How will you discuss the pathophysiology of Diarrhea?

1. Most diarrhea is due to infections.
2. Age:
   1. Mostly, the young are susceptible due to poor health.
   2. Poor general health and nutrition will predispose one to diarrhea.
3. Bacteria leading to diarrhea depend upon the following:
   1. A dose of the bacterial infection.
   2. Production of enterotoxin.
   3. It has the ability to attach to the intestinal mucosa and to invade the mucosa.
4. Other factors for diarrhea are:
   1. Poor sanitation.
   2. Contaminated food and water.
   3. Personal hygiene, washing hands with soap after defecation, prevents the fecal-oral spread.
   4. Food stored at room temperature allows rapid bacterial growth and the production of toxins.
   5. Food stored at 4 °C cannot kill bacteria; it can only prevent their multiplication.
      1. Avoid keeping food at room temperature, as this leads to the rapid proliferation of the organism.
   6. AIDS has a prominent feature of diarrhea.

What are the types of diarrhea?

Diarrhea may be:

1. Acute.
2. Chronic.

Diarrhea may be:

1. Watery diarrhea.
2. Blood diarrhea.
3. Diarrhea with a lot of mucus.

What are the causes of various types of diarrhea?

What are the causes of diarrhea, and how will you diagnose it?

What are other types of diarrhea?

How will you define Osmotic diarrhea (Malabsorption)?

1. It is defined as diarrhea with a <3 weeks to 8 weeks duration.
2. It is due to increased osmotically active solutes in the stool.
3. This type of diarrhea stops during fasting.

How will you define secretory diarrhea?

1. It is due to abnormal electrolyte transport.
2. Secretory diarrhea is caused by an increase in water and chloride secretion.

How will you define exudative diarrhea?

1. There is active inflammation of the intestinal mucosa.
2. Primarily due to infectious bacteria.

How will you discuss diarrhea due to motility issues?

1. There is decreased motility of the small intestine.
   1. It may be seen in hypothyroidism, diabetes mellitus, postvagatomy, and amyloidosis.
2. There may be increased motility of the small intestine.
   1. It may be seen in hyperthyroidism, carcinoid syndrome, and irritable bowel syndrome.

How will you discuss diarrhea due to malabsorption?

1. It is due to defective digestion or absorption.
   1. It may be seen in lymphatic obstruction.
   2. In surgery, the resection of the intestine.
   3. G. lamblia causes impaired absorption.

Chronic diarrhea:

How will you define chronic diarrhea?

1. Chronic diarrhea is defined as diarrhea that has lasted for at least 4 weeks.
2. It may be 6 to 8 weeks in duration.
3. What are the causes of chronic diarrhea?
   1. It can be seen in infections such as giardiasis and amoebiasis.
   2. It is seen in ulcerative colitis and collagenous colitis.
   3. In foods that contain sorbitol, fructose, caffeine, and ethanol.
   4. Drugs like antibiotics, colchicine, chemotherapy, and antihypertensives.
   5. Hormonal origins include diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency.
   6. Infiltration of the GIT by amyloidosis, scleroderma, and lymphomas.
   7. Surgery, such as resection of the intestine, vagotomy, and gastrectomy.
   8. Celiac sprue.
   9. Whipple disease.
   10. Allergy to some foods.
   11. It may be idiopathic in origin.

How to diagnose Diarrhea?

1. History of the patient regarding the duration of clinical symptoms.
2. Any history of travel to a foreign country.
3. Food history of the other people living with the patient.
4. Take a stool sample or rectal swab.
5. Take a sample of suspected food.
6. Get the vomitus sample.
7. Stool examination for ova and parasites.
8. Stool cultures for pathogenic organisms.
9. Blood culture in severe cases. It is recommended for both very young and elderly patients.
10. Take a sample of the suspected food if possible.
11. Antigen tests for G.lamblia and E. coli.
    1. A rapid antigen test can diagnose the retrovirus.
12. Antibody tests can diagnose parasitic diseases.
13. Causes of noninfectious disease are diagnosed by:
    1. Fecal fat.
    2. Lactose intolerance test.
    3. Anti-endomysial and anti-gliadin antibodies are used to diagnose celiac disease.
    4. Tests other than laboratory tests include colonoscopies, endoscopies, and sigmoidoscopies.
14. In case of an outbreak, advice:
    1. Fecal samples from the kitchen personnel.
    2. Food handling practices among kitchen workers.

What are the electrolyte findings in Diarrhea?

Questions and answers: