BALIGENS: Diarrhea

DIARRHEA

A. Definition

Diarrhea is a disease in which patients experienced bowel stimulation constant and feces that still has excessive water content. Diarrhea is an increase in the number of stools and the passage of liquid unformed feces and is a symptom of disorders affecting digestion, absorption, and secretion in the GI tract. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over and 1,5 million deaths in children under the age of 5. Oral rehydration salts and zinc tablets are the treatment of choice and have been estimated to have saved 50 million children in the past 25 years.

B. Type of Diarrhea

The types of diarrhea based on the cause

a. Diarrhea because of virus

A common cause of diarrhea is caused by disruption of virus in the body. The virus causes diarrhea is rotavirus, Echovirus, Astrovirus.

b. Diarrhea because of bacterial

One type of diarrhea is diarrhea caused by bacterial attack. For example, the bacteria E. Coli, Sallmonella, Vibrio cholerae or Shigella. Usually infect humans who have less clean lifestyle.

c. Diarrhea because of Fungi

Candida albican is one type of fungus that can cause diarrhea. Other fungi that can cause diarrhea is a common fungus that grows on spoiled food.

d. Diarrhea because of Worms

When the worm disease, is generally a person will easily diarrhea. Examples of common worm is Ascaris lumbricoides.

e. Diarrhea because of Protozoa

Entamoeba histolytica is one type of protozoa that can cause diarrheal disease.

Type of diarrhea based on severity

a. Acute Diarrhea

Acute diarrhea disease is a type of diarrhea that usually occurs only in a few days and can recover quickly. This diarrhea disease is generally could be due to medicine, psychological as well bacterial infection that is not too severe.

b. Chronic Diarrhea

One of the dangerous type of diarrhea is chronic diarrhea. Chronic Diarrhea different with Acute Diarrhea, chronic diarrhea is a diarrheal disease that can be experienced by someone in a long time could be days or even weeks.

Diarrhea is very difficult to cure and sufferers should receive maximum treatment. Causes of chronic diarrhea, can damage the function of the small intestine or the presence of infectious bacteria and viruses in large numbers.

C. Diarrhea Causes

Diarrhea can be caused by five factors, namely:

Infection Factor

a. Enteral infection: infection of the digestive tract of food which is the major cause of diarrhea in children such as:

o Bacterial infections: vibrio, E. Coli, Salmonella, Stigella, Campilobacter, Yersinia, Aeromonas, etc.

o Virus Infection: Entrovirus (Echovirus, Coxsackie, Poliomyelitis).

o Parasitic infections: worms (Ascaris, Trichuris, Oxyuris, strongyloides).

b. Parental infection is an infection outside the digestion of food equipment such as: acute otitis media (AOM), tonsillitis / tonsilofaringis, bronchopneumonia, encephalitis etc.

Malabsorption Factor

A state of disorder in the presence of absorption and digestion process normally in one or more nutrients, include : malabsorption of carbohydrates, malabsorption of fat, malabsorption of protein.

Food Factors

Spoiled food, toxic, allergic to food

Psychological Factors

Fear and anxiety (Rare, but can occur in older children).

The Factors who Increase the Risk of Diarrhea

§ Environmental factors

-Inadequate water supply

-Water contaminated with feces

-Less of cleanliness facility

-Poor personal hygiene, such as not handswashing after using the toilet

-The cleaning of the house is bad. For example, do not throw children feces on the toilet

-Preparation and storage methods of food is not hygienes. For example, cooked foods without washing first, or do not close the food that has been cooked.

§ Poor weaning practices

-Exclusive feeding was stopped before the infants aged 4-6 months and through the provision of milk through a bottle.

-Stop breast feeding before the child one years old.

§ Individual factors

-Poor nutrition

-Poor or lack of body's natural defense mechanism. For example, diarrhea is more occur in children include, who have measles.

§ Reduced gastric acid production

§ The movement of the intestine decreases which affect the normal flow of food

D. Diarrhea Symptoms

Symptoms that are found, include :

Defecate continuously be accompanied by nausea and vomiting.

Soreness in the back

Abdominal cramps

Abdominal pain

Fever

Dizziness

An urgent need to use the bathroom

An inability to control the bowels (fecal incontinence)

Chills

Headache

Low heart rate

Alternating constipation

Blood in stool

Mucus in stool.

E. How diarrhea can occur?

Diarrhea may occur because :

1. Osmotic Disruption

Because the presence of food or substance that can not be absorbed will cause osmotic pressure rises in the intestinal cavity, resulting in a shift of water and electrolytes into a special cavity. The contents of this excessive intestinal cavity will stimulate the intestines to release it causing diarrhea.

2. Secretion Disruption

Because certain stimuli (eg, by a toxin) in the intestinal wall will increase the secretion of water and electrolytes into the intestinal cavity and subsequent diarrhea a rises because there is an increasing content of the gut cavity.

3. Motility Disruption

Hiperperistaltik (increase in bowel movement) will result in reduced opportunities to absorb food intestines, causing diarrhea. In contrast when intestinal peristaltic decline would result in excessive growth of bacteria which can cause diarrhea as well.

F. Transmission of Diarrhea

Is in contact with feces of directly infected, such as:

v Food and beverages that have been contaminated, either already infected by insects or contamination by dirty hands.

v Playing with a toy that is contaminated, especially in infants often include hands / toys / anything into the mouth. Because the virus can survive on the surface of the air until a few days.

v The use of contaminated water sources and no water to cook properly

v Wash and use of milk bottles that are not clean.

v Not clean to handswashing after defecation or cleaning the feces of infected children, so will contaminating the furniture and equipment held.

G. Effect of Diarrhea

Acute or chronic diarrhea can lead to loss of water and electrolytes (dehydration) that lead to the occurrence of acid-base balance disturbances (metabolic acidosis, hypokalemia, etc.), nutritional disorders as a result of starvation (intake less, spending increases), hypoglycemia (decrease in blood sugar levels ), and blood circulation disorders.

H. Diarrhea Treatment

There are two types of diarrhea: acute diarrhea and chronic diarrhea. Treatment options for each type will vary.

Treatment for Acute Diarrhea

The principal components of the treatment of acute diarrhea are fluid and electrolyte replacement, dietary modifications, and drug therapy. All recommendations agree with the guidelines on acute infectious diarrhea in adults published by the American College of Gastroenterology.

Ø Dehydration

In most cases of acute diarrhea, fluid and electrolyte replacement are the most important forms of therapy. If patients are otherwise healthy and are not dehydrated, adequate oral intake can be achieved with soft drinks, fruit juice, broth, soup, and salted crackers. In those with excessive fluid losses and dehydration, more aggressive measures such as IV fluids or oral rehydration therapy with isotonic electrolyte solutions containing glucose or starch should be instituted.

Ø Diet

Total food abstinence is unnecessary and not recommended. Foods providing calories are necessary to facilitate renewal of enterocytes. Patients should be encouraged to take frequent feedings of fruit drinks, tea, flat carbonated beverages, and soft, easily digested foods such as bananas, applesauce, rice, potatoes, noodles, crackers, toast, and soups. Dairy products should be avoided, because transient lactase deficiency can be caused by enteric, viral, and bacterial infections. Caffeinated beverages and alcohol, which can enhance intestinal motility and secretions, should be avoided.

Treatment for Chronic Diarrhea

a) Avoid dehydration. Drink lots of clear fluid -- no alcohol or caffeine. Milk will usually prolong diarrhea, but it might help provide nutrients for folks with very mild cases. For moderate to severe cases, use an electrolyte solution like Gatorade or Pedialyte.

b) Eat probiotic yogurt. These active cultures can ease the symptoms of some types of diarrhea and shorten their duration.

c) Try the BRAT diet: bananas, rice, apples or applesauce, and dry toast. This diet is often suggested for kids, but adults can eat it as well. It's not necessary to restrict kids or adults to this diet, but adding these foods may help shorten episodes of diarrhea.

d) Avoid diarrhea medications, unless the doctor tells you to take them. The function of diarrhea is to rid the body of bad bugs. Often the only way to get better is to suffer through the loose stools.

e) The following cases require seeking emergency treatment:

ü Vomiting or diarrhea in a newborn under 3 months (call as soon as it starts)

ü Kids older than 3 months vomiting for more than 12 hours

ü Diarrhea lasting more than 3 days

ü Bloody, black, or oily looking stools

ü Abdominal pain that doesn't get better with a bowel movement

ü Dehydration symptoms including dizziness, weakness or muscle cramps

ü Fever, along with diarrhea, of more than 101 in adults or 100.4 in kids

f) Get plenty of rest.

I. Diarrhea Prevention

Many cases of diarrhea are spread from person-to-person. The following precautions can help an individual avoid diarrhea and other viral or bacterial infections:

Individuals caring for sick children or adults in any setting should carefully wash their hands after changing diapers, helping an individual use the bathroom, or assisting an individual around the home.
Children should be instructed to wash their hands frequently, especially after using the bathroom.
Practice safe food-handling. Always wash hands before and after handling food.
Use care when preparing raw poultry or meat. Food should be cooked to the recommended temperatures. Avoid raw or rare meat and poultry. Utensils coming in contact with raw food should be cleaned in soap and hot water.
Fruits and vegetables consumed raw should be thoroughly rinsed in clean water.
Unpasteurized (raw) milk may be contaminated with bacteria and should always be avoided. Unpasteurized fruit juice or cider should generally be avoided even if the source is not known because the fruit may have come in contact with contaminated animal feces in the orchard.
Caution when traveling, especially to foreign countries. Do not eat foods from street vendors. Don't drink water or drinks with ice cubes made from tap water if the country is deemed unsafe. Check the Travelers' Health Web site of the Centers for Disease Control and Prevention for travel information for your destination.