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 acute or chronic.
2. This may be due to the following:
3. Viral infections. The most common cause is retrovirus among children. Other viruses are Adenovirus, cytomegalovirus, and HIV.
4. Bacterial infections are due to salmonellosis, Vibrio, Campylobacter, and Yersinia. Other causes are toxigenic bacteria like Staphylococcus and Bacillus cereus, Shigella, and E.Coli.
5. Parasitic infestation, e.g., Giardia Lamblia and Entamoeba histolytica.

How to diagnose Diarrhea?: Diarrheal causes

Pathophysiology of Diarrhea:

1. Most of the diarrhea is due to infections.
2. Age: Mostly, the young are susceptible due to poor health.
   1. Poor general health and nutrition will predispose to diarrhea.
3. Bacteria leading to diarrhea depend upon the following:
   1. A dose of the bacterial infection.
   2. Production of enterotoxin.
   3. Its 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 the bacteria; it can only prevent the multiplication of bacteria.
      1. Avoid keeping the food at room temperature, which 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 diarrhea, and how will you diagnose it?

Other types of diarrhea:

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.

Secretory diarrhea:

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

Exudative diarrhea:

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

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.

Diarrhea due to malabsorption:

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

Chronic diarrhea:

1. Chronic diarrhea is defined when the diarrhea is at least 4 weeks.
2. It may be 6 to 8 weeks in duration even.
   1. It may be seen in infections like 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 antihypertensive.
   5. Hormonal origins include diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency.
   6. Infiltration of GIT by amyloidosis, scleroderma, and lymphomas.
   7. Surgery like 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 as regards the duration of the clinical symptoms.
   1. Any history of travel to a foreign country.
   2. Food history of the other people living with the patient.
2. Take a stool sample or rectal swab.
   1. Take a sample of suspected food.
   2. Get the vomitus sample.
3. Stool examination for ova and parasites.
4. Stool cultures for pathogenic organisms.
5. Bood culture in severe cases. It is advised in very young and old patients.
6. Take a sample of the suspected food if possible.
7. Antigen tests for G.lamblia and E. coli.
8. Antibodies tests can diagnose parasitic diseases.
9. A rapid antigen test can diagnose the retrovirus.
10. Causes of noninfectious disease are diagnosed by:
    1. Fecal fat.
    2. Lactose intolerance test.
    3. Anti-endomysial and antigliadin antibodies diagnose celiac disease.
    4. Tests other than lab are colonoscopy, endoscopy, and sigmoidoscopy.
11. In case of an outbreak, advice:
    1. Fecal samples from the kitchen personnel.
    2. Food handling practices by the workers in the kitchen.

How to diagnose Diarrhea? Diarrhea Diagnosis

What are the Electrolytes findings in Diarrhea?

Diarrhea lab findings

Questions and answers: