2. Diarrhea
• Definition: Diarrhea is defined as loose, watery stools that
occur more than three times a day.
• Acute diarrhea is diarrhea that lasts a short time. It is a
common problem. It usually lasts about one or two days,
• Chronic diarrhea -- diarrhea that lasts at least four weeks
can be a symptom of a chronic disease
• Functional diarrhea: Some cases of chronic diarrhea are
called "functional" because a clear cause cannot be found.
In the developed world, irritable bowel syndrome (IBS) is
the most common cause of functional diarrhea.
• traveler's diarrhea: When traveling in developing countries,
diarrhea caused by bacteria and parasites is often called
traveler's diarrhea
3. • Causes:
• The most common causes of diarrhea include
• Bacteria from contaminated food or water
• Common bacterial causes of diarrhea include campylobacter, salmonella,
shigella and Escherichia coli
• Usually, diarrhea is caused by a virus that infects your gut. Some people
call it "intestinal flu" or "stomach flu.“ (gastroenteritis)
• Norwalk virus, cytomegalovirus and viral hepatitis. Rotavirus is a
common cause of acute childhood diarrhea.
• STOMACH FLU: It is also known as viral-gastroenteritis, is intestinal
infection caused through contact of infected person or through ingestion,
marked by watery diarrhea, abdominal cramps, nausea, vomiting and
sometimes fever.
4. • Parasites, which are tiny organisms found in contaminated food or
water.
• Giardia lamblia and cryptosporidium can cause diarrhea.
• Medications. Many medications, such as antibiotics, can cause
diarrhea. Antibiotics destroy both good and bad bacteria, which can
disturb the natural balance of bacteria in your intestines. Other
drugs that cause diarrhea are cancer drugs and antacids with
magnesium.
• Antacids are medications which neutralizes stomach acidity. Antacid
containing MgOH also works as laxative which reduces constipation.
So it is thought to work as osmotic laxative that functions by
drawing water into intestine, an effect that helps to cause
movement of an intestine.
• Food intolerances and sensitivities, which are problems digesting
certain ingredients or foods. An example is lactose intolerance
5. • Lactose intolerance. Lactose is a sugar found in milk and other dairy
products. People who have difficulty digesting lactose have diarrhea after
eating dairy products.
• Your body makes an enzyme that helps digest lactose, but for most
people, the levels of this enzyme drop off rapidly after childhood. This
causes an increased risk of lactose intolerance as you age.
• Lactose intolerance is caused by a deficiency of the intestinal enzyme
lactase that splits lactose into two smaller sugars, glucose and galactose,
and allows lactose to be absorbed from the intestine. The enzyme that
splits lactose into glucose and galactose is called lactase, and it is located
on the surface of the cells lining the small intestine. Lactase deficiency
may occur for one of three reasons, congenital, secondary or
developmental.
• Congenital deficiency: Lactase deficiency may occur because of a
congenital absence (absent from birth) of lactase due to a mutation in the
gene that is responsible for producing lactase
6. • Secondary cause: Another cause of lactase
deficiency is secondary lactase deficiency. This
type of deficiency is due to diseases that destroy
the lining of the small intestine along with the
lactase. An example of such a disease is celiac
disease (sprue).
• Geneticallly programmed: is a decrease in the
amount of lactase that occurs after childhood and
persists (continue) into adulthood, referred to as
adult-type hypolactasia. This decrease in lactase
is genetically programmed.
7. • Surgery. Some people have diarrhea after undergoing abdominal
surgery or gallbladder removal surgery.
• Other major causes of chronic diarrhea include:
• Microscopic colitis: This is a persistent (knocking)diarrhea that
usually affects older adults, often during the night.
• it is an inflammation of the large intestine (colon) that causes
persistent watery diarrhea. The disorder gets its name from the fact
that it's necessary to examine colon tissue under a microscope to
identify it,
• Diarrhea in MC mostly belongs to the secretory type.
• The major pathophysiological mechanism could be explained by a
decrease of active sodium absorption. decreased Cl/HCO3 exchange
rate and increased chloride secretion are coexistent pathways
8. • Intestinal absorption of water and electrolytes
• Absorption of water from the small intestine is caused by osmotic gradients that
are created when solutes (particularly sodium) are actively absorbed from the
bowel lumen by the villous epithelial cells.
• There are several mechanisms whereby sodium is absorbed in the small
intestine. To enter the epithelial cells, 1-sodium is linked to the absorption of
chloride, 2-or absorbed directly as sodium ion, 3-or exchanged for hydrogen ion, 4-
or linked to the absorption of organic materials such as glucose or certain amino
acids. The addition of glucose to an electrolyte solution can increase sodium
absorption in the intestine as much as threefold.
• Secretory diarrhoea
• Secretory diarrhoea is caused by the abnormal secretion of fluid (water and salts)
into the small bowel. This occurs when the absorption of sodium by the villi is
impaired while the secretion (discharge) of chloride in the crypts continues or is
increased. Net fluid secretion results and leads to the loss of water and salts from
the body as watery stools; this causes dehydration.
9. Villi (singular is villus) are small, finger-like
structures in the small intestine. They help to
absorb digested food. Each villus has micro-
villi which increase the surface area of the
intestinal walls. A larger surface area allows
nutrients to be taken in more quickly.
10. • Crypt cells: Crypt cells of
the small intestine provide stem cells for
renewal of the intestinal epithelium, which
turns over each 3 to 4 days.
• Chloride secretion occurs in the intestinal
crypt cells throughout the small intestine,
whereas chloride is generally absorbed in
the large intestine
11. • Malabsorptive and maldigestive diarrhea: The
first is caused by impaired nutrient absorption,
the second by impaired digestive function. Celiac
disease is one example.
• Chronic infections: A history of travel
or antibiotic use can be clues to chronic diarrhea.
Various bacteria and parasites can be the cause.
• Endocrine causes: Sometimes hormonal factors
cause diarrhea, for example, in the case of
Addison disease and carcinoid tumors.
12. • Addison’s disease is a disorder in which the adrenal glands– which sit on top of
the kidneys – do not produce enough of the hormones cortisol and aldosterone.
(Hormones are chemicals that control the function of tissues or organs.)
• Cortisol helps the body respond to stress, including the stress of illness, injury, or
surgery. It also helps maintain blood pressure, heart function, the immune system
and blood glucose (sugar) levels.
• Aldosterone affects the balance of sodium and potassium in the blood. This in
turn controls the amount of fluid the kidneys remove as urine, which affects blood
volume and blood pressure.
• Addison’s disease is also called “primary adrenal insufficiency.” A related disorder,
“secondary adrenal insufficiency,” occurs when the pituitary, a small gland at the
base of the brain, does not secrete enough adrenocorticotropic hormone (ACTH),
which activates the adrenal glands to produce cortisol.
• Pituitary gland-----adrenocorticotropic hormone-------adrenal to produce cortisol
• Causes: autoimmune, Infection, including tuberculosis, HIV/AIDS -related
infections, and fungal infections
• Symptoms: Abdominal pain, Abnormal menstrual periods, Dehydration,
Depression, Diarrhea, Irritability
13. • Cancer causes: Neoplastic (neoplasm-abnormal
new growth) diarrhea is associated with a
number of gut cancers. neuroendocrine tumors,
usually begin in the digestive tract (stomach,
appendix, small intestine, colon, rectum) or in the
lungs.
• Some cancer treatments can cause diarrhea,
including chemotherapy, radiation, surgery (if
certain parts of the intestine need to be
removed) and bone marrow transplants.
14. • Carcinoid tumors in the digestive tract:
• Signs and symptoms of carcinoid tumors in the digestive tract include:
• Abdominal pain
• Diarrhea
• Nausea, vomiting and inability to pass stool due to intestinal blockage
(bowel obstruction)
• Rectal bleeding
• Rectal pain
• Redness or a feeling of warmth in your face and neck (skin flushing)
• CAUSE: It's not clear what causes carcinoid tumors. In general, cancer
occurs when a cell develops mutations in its DNA. The mutations allow
the cell to continue growing and dividing when healthy cells would
normally die.
• The accumulating cells form a tumor. Cancer cells can invade nearby
healthy tissue and spread to other parts of the body.
15. • Alcohol abuse: Alcohol is easily absorbed into many tissues in the body. As soon
as alcohol enters the body, it starts making its way into the bloodstream. Some of
this absorption happens in the stomach.
• If there is food in the stomach at the time, the absorption rate will slow. This is
why people feel the effects of alcohol more quickly on an empty stomach.
• Once it leaves the stomach, alcohol starts getting absorbed by the small intestine.
Much of the alcohol is absorbed here, but the remainder goes into the large
intestine and exits with the stool and urine.
• These changes which alcohol causes include:
1. Inflammation: The gastrointestinal tract becomes inflamed when it comes into
contact with alcohol. Alcohol can also lead to more acid production in the
stomach, which can increase the irritation and inflammation. This irritation can
often lead to diarrhea.
2. Water absorption: Water is usually absorbed from the foods and liquids reaching
the intestines. The large intestine pulls liquids out of the stool before passing it
out of the body. When alcohol is present, the large intestine does not function
as well. This can result in liquid stools and dehydration.
16. 3- Faster digestion: Alcohol agitates the intestines and causes
them to react by speeding up digestion. The muscles in the
colon contract more frequently, pushing stool out faster than
usual. This quickening can lead to diarrhea, as the intestines
do not have time to digest the passing food properly.
4- Bacterial imbalance: There are a variety of bacteria in the
intestines that work to keep the body in balance by attacking
harmful pathogens. Alcohol may temporarily kill off some
bacteria species or allow others to grow rapidly, which can
cause the intestines to malfunction.
17. • Diabetes: high blood sugar can damage the tiny blood vessels and nerves in your
body, including your digestive system. A speed-up or slow-down of the process in
your intestines could result in diarrhea or constipation. Diabetes medications,
certain foods, and related illnesses can cause diarrhea, too.
• When diabetes damages the nerves going to your stomach and intestines, they
may not be able to move food through normally. This causes constipation, but you
can also get alternating bouts of constipation and diarrhea, especially at night.
• Overactive thyroid (hyperthyroidism): Hyperthyroidism is an overactivity of the
thyroid. This means that your thyroid produces and releases more hormones than
your body needs. This can affect your body and the way it functions.
• Causes: Graves disease-This is a disorder in which the immune system attacks the
thyroid, causing it to make too much thyroid hormone.
• Diarrhea is symptom of hyperthyroidism
• Hyperthyroidism causes sympathetic overactivation such that many of the
symptoms of thyroid storm can be alleviated by beta-blockers. The sympathetic
nervous system “fright, flight or fight” response opposes the parasympathetic
nervous system “rest and digest” response and shuts down gastrointestinal
function
18. • hyperthyroidism has a sympathomimetic
effect and hypothyroidism has a
sympatholytic effect. But for the
gastrointestinal system, it is the opposite.
19. • Symptoms:
• Loose, watery stools
• Abdominal cramps
• Abdominal pain
• Fever
• Blood in the stool
• Bloating
• Nausea
• thirst
• weight loss
• Urgent need to have a bowel movement/use toilet
If a virus or bacteria is the cause of your diarrhea, you may also have a fever, chills, and bloody stools.
• Diarrhea is a symptom of other conditions, some of which can be serious.
• Other possible symptoms are:
• blood or pus in the stools
• persistent vomiting
• dehydration
20. • Diagnosis:
• Do a physical exam:
• If there's blood or mucus in your diarrhea
• How watery it is
• How long you've had it
• Do you have belly pain, or pain in your bottom?
• Do you have a fever?
• Have you traveled anywhere recently?
• Are you taking antibiotics, or have you recently finished some?
• Do certain foods make you better or worse?
• Ask about any medicines you are taking
21. • Test your stool or blood to look for bacteria, parasites, or other
signs of disease or infection
• Ask you to stop eating certain foods to see whether your diarrhea
goes away
• If your doctor thinks a specific food is causing your problem, he may
ask you to stay away from that item for a while to see if it helps. A
common example is intolerance to milk products, called lactose
intolerance. If you have this, changes to your diet usually help.
• If your doctor needs more information to figure out what's going
on, you may need to have a test called a colonoscopy. Your doctor
will use a snake-like tube that lets him see the walls of your colon
and rectum.
22. • If a person has chronic or persistent diarrhea, the doctor will order
tests according to the suspected underlying cause.
• These may include the following investigations:
• Full blood count: Anemia or a raised platelet count will
suggest inflammation.
• Liver function tests: This will include testing albumin levels.
• Tests for malabsorption: These will check the absorption
of calcium, vitamin B-12, and folate. They will also assess iron status
and thyroid function.
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP):
Raised levels may indicate inflammatory bowel disease (IBD).
• Testing for antibodies: This may detect celiac disease.
23. • Complications:
• Diarrhea can cause dehydration, which can be life-
threatening if untreated.
• Indications of dehydration in adults
• These include:
• Excessive thirst
• Dry mouth or skin
• Little or no urination
• Weakness, dizziness or lightheadedness
• Fatigue
• Dark-colored urine
24. Osmotic diarrhea
• Absorption of water in the intestines is dependent on adequate absorption of solutes. If excessive
amounts of solutes are retained in the intestinal lumen, water will not be absorbed and diarrhea
will result. Osmotic diarrhea typically results from one of two situations:
• Ingestion of a poorly absorbed substrate: The offending molecule is usually a carbohydrate or
divalent ion. Common examples include mannitol or sorbitol, epson salt (MgSO4) and some
antacids (MgOH2).
• Malabsorption: Inability to absorb certain carbohydrates is the most common deficit in this
category of diarrhea, but it can result virtually any type of malabsorption. A common example of
malabsorption, afflicting many adults humans and pets is lactose intolerance resulting from a
deficiency in the brush border enzyme lactase. In such cases, a moderate quantity of lactose is
consumed (usually as milk), but the intestinal epithelium is deficient in lactase, and lactose cannot
be effectively hydrolyzed into glucose and galactose for absorption. The osmotically-active lactose
is retained in the intestinal lumen, where it "holds" water. To add insult to injury, the unabsorbed
lactose passes into the large intestine where it is fermented by colonic bacteria, resulting in
production of excessive gas.
• Treatment: A distinguishing feature of osmotic diarrhea is that it stops after the patient is fasted or
stops consuming the poorly absorbed solute
25. • Treatment:
• Treatment
• Mild cases of acute diarrhea may resolve without treatment. Persistent or
chronic diarrhea will be diagnosed and any underlying causes will be
treated in addition to the symptoms of diarrhea.
• Dehydration
• For all cases of diarrhea, rehydration is key:
• Fluids can be replaced by simply drinking more fluids, or they can be
received intravenously in severe cases. Children and older people are
more vulnerable to dehydration.
• Oral rehydration solution or salts (ORS) refers to water that contains salt
and glucose. It is absorbed by the small intestine to replace the water and
electrolytes lost in the stool. In developing countries, ORS costs just a few
cents. The World Health Organization (WHO) says ORS can safely and
effectively treat over 90 percent of non-severe diarrhea cases.
26. • Antidiarrheal medication
• Over-the-counter (OTC) antidiarrheal medicines are also available:
• Loperamide, or Imodium, is an antimotility drug that reduces stool
passage. Loperamide and Imodium are both available to purchase over-the-
counter or online.
• Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output
in adults and children. It can also be used to prevent traveler's diarrhea.
• Loperamide (Imodium) slows the movement of food through your intestines,
which lets your body absorb more liquid.
• Bismuth subsalicylate (Kaopectate, Pepto-Bismol) balances out how fluid moves
through your digestive tract.
• Antibiotics
• Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the
cause is a certain medication, switching to another drug might be possible.
27. • Diet
• Nutritionists from Stanford Health Care offer some nutritional tips for diarrhea:
• Sip on clear, still liquids such as fruit juice without added sugar.
• After each loose stool, replace lost fluids with at least one cup of liquid.
• Do most of the drinking between, not during meals.
• Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes
without the skin, and bananas.
• Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and
salted crackers.
• Other advice from the nutritionists is to:
• eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help
thicken the stool
• limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods
• Probiotics (containing live bacteria for therapeutics ex- yogurt)
• There is mixed evidence for the role of probiotics in diarrhea. They may help
prevent traveler's diarrhea. In children, there is evidence that they might reduce
diarrheal illness by 1 day.
28. • Antibiotic-associated diarrhea might be
reduced by the use of probiotics, as may
diarrhea related to Clostridium difficile,
although the evidence is mixed.
29. • Preventions:
• Use only bottled or purified water for drinking, making ice cubes, and brushing
your teeth
• If you do use tap water, boil it or use iodine tablets
• Make sure that the cooked food you eat is fully cooked and served hot
• Avoid unwashed or unpeeled raw fruits and vegetables
• Vaccination
• You can help protect your infant from rotavirus, the most common cause of viral
diarrhea in children, with one of two approved vaccines. Ask your baby's doctor
about having your baby vaccinated.
• Preventing traveler's diarrhea
• Diarrhea commonly affects people who travel to countries where there's
inadequate sanitation and contaminated food. To reduce your risk:
• Watch what you eat. Eat hot, well-cooked foods. Avoid raw fruits and vegetables
unless you can peel them yourself. Also avoid raw or undercooked meats and dairy
foods.
30. • Home remedies:
• Adults, infants, toddlers, and children should be encouraged to follow the
"BRAT" diet (bananas, rice, applesauce, and toast). The BRAT diet
(diarrhea diet) is a combination of foods to eat to treat diarrhea.
• Herbal treatment: Certain plant leaves contain tannins that are
considered to be diarrhea remedies. Notably blackberry, blueberry,
and raspberry leaves when taken as tea may help diarrhea.
• Do not eat fresh blueberries because they may make the diarrhea worse.
• If you're pregnant avoid high doses of tannins.
• Chamomile tea may also act as a diarrhea remedy.
• family Asteraceae or Compositae (flowering family of Jamu & Kashmir)
• Chamomile tea is an herbal infusion made from dried chamomile flowers
and hot water.
31. • Uvaria afzelii is used in the treatments of liver
problems, pulmonary troubles, naso-pharyngeal
infections, food poisoning and venereal diseases
• Acacia nilotica Linn, is used in the treatments
of intestinal pains, diarrhea, nerve stimulant, cold,
congestion, coughs, dysentery, fever, hemorrhages,
leucorrhea, ophthalmia and sclerosis.
• Terminalia avicennioides Guill & Perr is used in the
treatment of diarrhoea, dysentery, dropsy, swellings,
oedema, gout, leprosy, mucosae, vermifuges, skin
irritations and as pain killers
32. • Uvaria afzelii [family ANNONACEAE].
• Part used: roots
• Habitate: Thickets surrounded with grass in
places inundated during the rainy season
• Terminalia avicennioides Guill
• Shrub/small tree like plant
• Family: COMBRETACEAE
• Acacia nilotica Linn
• Family: legumes
• Habitate: moist areas (sodan,
33. Dysentery
• Definition: Dysentery, infectious
disease characterized by inflammation of
the intestine, abdominal pain,
and diarrhea with stools that often
contain blood and mucus.
• Types: There are two major types: bacillary
dysentery and amebic dysentery, caused
respectively by bacteria and by amoebas.
34. • Bacillary dysentery, or shigellosis, is caused by bacilli of the
genus Shigella.
• Symptomatically, the disease ranges from a mild attack to a severe
course that commences suddenly and ends in death caused
by dehydration and poisoning by bacterial toxins.
• After an incubation period (the period of time b/w infection with
germs and appearance of symptoms) of one to six days, the disease
has an abrupt onset with fever and the frequent production of
watery stools that may contain blood.
• Vomiting may also occur, and dehydration soon becomes obvious
owing to the copious loss of bodily fluids.
• In advanced stages of the disease, chronic ulceration of the large
intestine causes the production of bloody stools.
35. • The most severe bacillary infections are caused by Shigella
dysenteriae type 1 (formerly Shigella shigae), which is found chiefly in
tropical and subtropical regions.
• S. flexneri, S. sonnei, and S. boydii are other Shigella bacilli that cause
dysentery.
• Other types of bacterial infections, including salmonellosis (caused
by Salmonella) and campylobacteriosis (caused by Campylobacter), can
produce bloody stools and are sometimes also described as forms of
bacillary dysentery.
• The treatment of bacillary dysentery is based on the use of antibiotics.
• The administration of fluids and, in some cases, blood transfusions may
be necessary.
• Tropical= hot, humid, dense, green forest
• Sub-tropical= surrounded by warm ocean, have wet season in winter &
dry in summer
36. • Amebic dysentery: or intestinal amebiasis, is caused by the
protozoan Entamoeba histolytica. This form of dysentery, which
traditionally occurs in the tropics, is usually much more chronic
and insidious (harm)than the bacillary disease and is more difficult to
treat because the causative organism occurs in two forms, a motile one
and a cyst, each of which produces a different disease course.
• The motile form causes an acute dysentery, the symptoms of which
resemble those of bacillary dysentery.
• The cyst form produces a chronic illness marked by intermittent episodes
of diarrhea and abdominal pain. Bloody stools occur in some patients.
The chronic type is the more common of the two and is marked by
frequent remissions and exacerbations of symptoms.
• The chronic form may also produce ulcerations of the large intestine and
pockets of infection in the liver. Both forms of amebic dysentery are
treated with drugs that specifically kill the amebic parasites that thrive in
the intestines.
37. • Transmission of disease:
• Dysentery is transmitted through the ingestion of food or water
that has been contaminated by the feces of a human carrier of the
infective organism. The transmission is often by infected individuals
who handle food with unwashed hands.
• The spread of amebic dysentery is often accomplished by people
who are carriers of the disease but who at the time show no
symptoms.
• Dysentery is commonly found when people are crowded together
and have access only to primitive sanitary facilities.
• Spread of the disease can be controlled by boiling drinking water
and by adequately disposing of human waste to avoid the
contamination of food.
38. • Symptoms: The symptoms of dysentery range from mild to
severe, largely depending on the quality of sanitation in the
areas where infection has spread.
• In developed countries, signs and symptoms of dysentery
tend to be milder than in developing nations or tropical
areas.
• Mild symptoms include:
• a slight stomach-ache
• cramping
• diarrhea
• These usually appear from 1 to 3 days after infection, and
the patient recovers within a week.
39. • Symptoms of bacillary dysentery
• Symptoms tend to appear within 1 to 3 days of infection. There is
normally a mild stomach ache and diarrhea, but no blood or mucus
in the feces. Diarrhea may be frequent to start with.
• Less commonly, may be:
• blood or mucus in the feces
• intense abdominal pain
• fever
• nausea
• vomiting
• Often, symptoms are so mild that a doctor's visit is not required,
and the problem resolves in a few days.
40. • Symptoms of amoebic dysentery
• A person with amoebic dysentery may have
• abdominal pain
• fever and chills
• nausea and vomiting (due to infection which causes hard to digest the food)
• watery diarrhea, which can contain blood, mucus, or pus
• the painful passing of stools
• fatigue
• intermittent constipation (when diarrhea symptoms resolves then constipation
occur and dysentery recurs)
• If amoeba tunnel through the intestinal wall, they can spread into the bloodstream
and infect other organs.
• Ulcers can develop. These may bleed, causing blood in stools.
• Symptoms may persist for several weeks.
• The amoebae may continue living within the human host after symptoms have
gone. Then, symptoms may recur when the person's immune system is weaker.
41.
42. • Diagnosis
• The doctor will ask the patient about their signs
and symptoms and carry out a physical
examination.
• A stool sample may be requested, especially if
the patient has recently returned from the
tropics.
• If symptoms are severe, diagnostic imaging may
be recommended. This could be an ultrasound
scan or an endoscopy.
43. • Treatment:
• However, any patient with diarrhea or vomiting should drink plenty of fluids to
prevent dehydration.
• If they are unable to drink, or if diarrhea and vomiting are profuse, intravenous
(IV) fluid replacement may be necessary. The patient will be placed on a drip and
monitored.
• Treatment for mild bacillary dysentery
• Mild bacillary dysentery, the kind commonly found in developed countries with
good sanitation, will normally resolve without treatment.
• However, the patient should drink plenty of fluids.
• In more severe cases, antibiotic drugs are available.
• Treatment for amoebic dysentery
• Amoebicidal medications are used to treat Entamoeba histolyca. These will ensure
that the amoeba does not survive inside the body after symptoms have resolved.
• Flagyl, or metronidazole, is often used to treat dysentery. It treats both bacteria
and parasites.
44. • Complications of dysentery are few, but they can be severe.
• Dehydration: Frequent diarrhea and vomiting can quickly lead to dehydration. In
infants and young children, this can quickly become life-threatening.
• Liver abscess: If amoebae spread to the liver, an abscess (a cavity formed by tissue
destruction and filled with pus) can form there.
• Post-infectious arthritis: Joint pain may occur following the infection.
• Hemolytic uremic syndrome: Shigella dysenteriae can cause the red blood cells
to block the entrance to the kidneys (urea & other waste products build up in the
body due to blockage), leading to anemia, low platelet count, and kidney failure.
• Patients have also experienced seizures after infection.
• Seizures= due to hypoxia & other metabolic changes such as hyponetremia that
are result of infection)
• Hyponetremia: Sodium conc less than 135mmol/L its symptoms in mid case are
headache, nausea, poor balance, severe case symptoms include: confusion,
seizure & coma.
45. • Prevention
• Dysentery mostly stems from poor hygiene.
• To reduce the risk of infection, people should wash their
hands regularly with soap and water, especially before and
after using the bathroom and preparing food.
• This can reduce the frequency of Shigella infections and
other types of diarrhea by up to 35 percent
• when traveling, include:
• Only drink reliably sourced water, such as bottled water
• Watch the bottle being opened, and clean the top of the
rim before drinking
• Make sure food is thoroughly cooked
46.
47. • Herbal treatment
• Holarrhena pubescens is a species of flowering
plant in the
• Apocynaceae family.
• It is native (belonging to one by birth)to central
and southern Africa, the Indian Subcontinent,
Indochina, and parts of China.
• Eng: Kura Kurchi
• Uses: Antidysenterica
• Kurchi consists of the dried stem bark
48. • Pulsitilla
• Pulsatilla is a plant.
• Part used: The parts of the plant that grow above the
ground are dried and used as medicine.
• Uses: disorders of the gastrointestinal (GI)
• Family: Ranunculaceae
• Pulsatilla, also known as pasque flower, is a plant that
has been used in homeopathic medicine for centuries.
It is commonly used for pain relating to the female and
male reproductive systems, but has also been used for
headaches and sleeping problems.
49. • PODOPHYLLUM
• Podophyllum is an herbaceous perennial plant
• family Berberidaceae
• Part used: Podophyllum is a plant. The root and underground stem
(rhizome) are used to make medicine.
Podophyllum is highly poisonous when taken by mouth. Nevertheless,
some people take it orally for yellowed skin (jaundice), liver ailments,
fever, syphilis, hearing loss, and cancer.
• Podophyllum is also used to empty the bowels, kill parasitic worms in the
intestine, and counteract snakebite. Some women take it to cause an
abortion.
• MOA: Podophyllum can stop cell duplication and new growth. It can also
have laxative effects.
50. Difference between diarrhea &
dysentery
• Diarrhea and dysentery are among those medical
conditions which are often used as synonym terms but
these both clinical conditions have clear differences.
Below is a list of those differences.
• Difference in target area:
• In diarrhea more specifically watery diarrhea affected
area is small bowl whereas dysentery targets the colon.
Small bowl consist of fluid flux so whenever infection
occur at small bowl part it produces watery
diarrhea. Fluid contents in colon are smaller in
proportion and if infection occurs at colon it does not
cause watery diarrhea.
51.
52. • Difference in symptoms:
• The stool of diarrhea is watery with or without
cramps and pain but in dysentery patient
complaints for mucoid stool (presence of
mucus in stool) that is presented with blood.
• Fever is more common in dysentery than in
diarrhea
53. • Difference in mechanism:
• There is clear difference between the mechanism of diarrhea and
dysentery. For example
• Diarrhea: when a person suffers from diarrhea the infection is
located and targets only intestinal lumen and upper epithelial
cells. Different antibiotics are used to treat this infection but these
cannot remove the toxins which are secreted by causative micro-
organisms. Death of cells is not resulted in this condition.
Dehydration is only risk due to diarrhea.
• Dysntery: In case of dysentery not only upper epithelial cells are
targeted but colon ulceration also results. This infection may also
cause certain other complications as bacteremia.
54. If untreated:
• If diarrhea is not treated it will recover within 2 or 3 days as our
immune system work against the infection but if dysentery is not
treated it could be very fatal.
Home remedies:
• It would be helpful to use certain home remedies in both of these
clinical conditions. It include
• Drink lot of water
• Do no take milk
• Avoid food which is rich in fats
Note:
• Severe stage of diarrhea could lead to dysentery but the stools in
dysentery also contain blood with fever
55. Constipation
• Definition:
• Constipation is defined medically as fewer than three stools per week and
severe constipation as less than one stool per week.
• Constipation means different things to different people. For many people,
1. it simply means infrequent passage of stool (feces).
2. For others, however, it means hard stools, difficulty passing them (straining),
3. or a sense of incomplete emptying after a bowel movement.
The cause of each of these symptoms of constipation vary, so the approach to each
should be tailored to each specific patient.
• Constipation usually is caused by the slow movement of material through the
colon (large bowel).
• The slower the food moves through the digestive tract, the more water the colon
will absorb from it. Consequently, the feces become dry and hard.
• When this happens, emptying the bowels can become very painful.
• Constipation generally occurs because too much water is absorbed from food
56. • Constipation may be considered chronic if
you've experienced two or more of these
symptoms for the last three months.
57. • Symptoms:
• Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining (struggle) to have bowel movements
• Feeling as though there's a blockage in your rectum
that prevents bowel movements
• Feeling as though you can't completely empty the stool
from your rectum
• Needing help to empty your rectum, such as using your
hands to press on your abdomen and using a finger to
remove stool from your rectum
58. • Causes
• Constipation happens when the colon absorbs too much water. This can occur if
the muscles in the colon are contracting slowly or poorly, causing the stool to
move too slowly and lose more water.
• These are the most common causes of constipation:
• Lack of fiber in the diet
• It is important to consume foods rich in fiber such as fruits, vegetables, and whole
grains.
• Fiber promotes bowel movements and prevents constipation.
• Foods that are low in fiber include high-fat foods, such as cheese, meat, and eggs.
• Physical inactivity
• Constipation can occur if someone becomes too physically inactive. This is
especially the case in older adults.
• For individuals who have been bedridden for a long time, perhaps for several days
or weeks, their risk of having constipation is significantly increased. Experts are not
sure why. Some believe that physical activity keeps the metabolism high, making
the processes in the body happen more rapidly.
59. • Medications
• The most common medications to cause constipation are:
• narcotic (opioid) pain drugs including codeine (Tylenol), oxycodone
(Percocet), and hydromorphone (Dilaudid)
• Antidepressants including amitriptyline (Elavil) and imipramine
(Tofranil)
• anticonvulsants including phenytoin (Dilantin) and carbamazepine
(Tegretol) iron supplements
• calcium channel blocking drugs including diltiazem (Cardizem) and
nifedipine (Procardia)
• aluminum-containing antacids including Amphojel and Basaljel
• diuretics including chlorothiazide (Diuril)
60. • Milk
• Some people become constipated when they consume milk and dairy products.
(who are sensitive to the proteins found in cow's milk)
• 5) Irritable bowel syndrome
• People who suffer from irritable bowel syndrome (IBS) get constipation much
more frequently, compared with the rest of the population.
• (IBS) is a common disorder that affects the large intestine. Signs and symptoms
include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or
both. it's been linked to things like food passing through your gut too quickly or
too slowly,
• 6) Pregnancy
• Pregnancy brings about hormonal changes that can make a woman more
susceptible to constipation. Also, the uterus may compress the intestine, slowing
down the passage of food.
• Aging
• As a person gets older, the metabolism slows down, resulting in less intestinal
activity. The muscles in the digestive tract do not work as well as they used to.
61. • Changes in routine
• Laxatives can be habit-forming. When a person becomes dependent on them,
there is a significant risk of constipation when they are stopped.
• Laxatives are substances that either loosen stool or stimulate a bowel movement.
They can also accelerate intestinal transit, which helps speed up the movement of
the digestive tract to spur a bowel movement. Laxatives are typically prescribed
for constipation.
• When a person travels, their normal routine changes. This can affect the digestive
system, which sometimes results in constipation. Meals are eaten at different
times, or a person might go to bed, get up, and go to the toilet at different times.
All these changes can raise the risk of constipation.
• 9) Overuse of laxatives
• Some people believe a person should go to the toilet at least once a day - this is
not true. However, to make sure this happens, some people self-medicate with
laxatives.
• Laxatives are effective at helping bowel movements. However, using them
regularly allows the body to get used to their action and gradually the dose needs
to increase to get the same effect.
62. • Not going to the toilet when needed
• If individuals ignore the urge to have a bowel movement, the urge can gradually go away until the
individual no longer feels the need to go. The longer it is delayed, the drier and harder the stool
will become.
• 11) Not drinking enough water
• If constipation is already present, drinking more liquids might not relieve it. However, regularly
drinking plenty of water reduces the risk of constipation.
• Many sodas and drinks contain caffeine which can cause dehydration and worsen constipation.
Alcohol also dehydrates the body and should be avoided by individuals who are constipated or very
susceptible to constipation.
• Problems with the colon or rectum
• Tumors can compress or restrict the passages and cause constipation. Also, scar tissue,
diverticulosis, and abnormal narrowing of the colon or rectum, known as colorectal stricture.
• Colon stricture: A colon stricture is the narrowing of the large intestine. A stricture slows or
prevents waste from passing through your large intestine. Reasons may be hronic inflammation
and scars from inflammatory bowel disease, such as Crohn disease
• Your colon looping around itself (volvulus), Adhesions in your abdomen, Hernias, Tumors inside
or outside of your colon
63. • Some diseases and conditions
• Diseases that tend to slow down the movement of feces through the colon,
rectum, or anus can cause constipation.
• These include the following:
• Hirschsprung disease: This disorder is characterized by the absence of particular
nerve cells (ganglions) in a segment of the bowel in an infant. The absence of
ganglion cells causes the muscles in the bowels to lose their ability to move stool
through the intestine (peristalsis).
• Neurological disorders: Multiple Sclerosis (MS), Parkinson's disease, stroke, spinal
cord injuries, and chronic idiopathic intestinal pseudo-obstruction can lead to
constipation.
• PK= lack of dopamine (a neurotransmitter) in the brain – impairs control of muscle
movement throughout the body. Bowel muscles can become slow and rigid.
• Endocrine and metabolic conditions: Uremia, diabetes, hypercalcemia, poor
glycemic control, and hypothyroidism.
• Systemic diseases: These are diseases that affect a number of organs and tissues,
or affect the body as a whole, they include lupus, scleroderma, amyloidosis.
64. • Hormonal disorders: Hormones can affect bowel
movements. For example: Too little thyroid
hormone (hypothyroidism) and too much
parathyroid hormone (by raising the calcium
levels in the blood).
• At the time of a woman's menstrual periods,
estrogen and progesterone levels are high.
• However, this is rarely a prolonged condition.
High levels of estrogen and progesterone during
pregnancy also cause constipation.
65. • Diagnosis:
• Health care professional will take a medical history and
physical examination to allow the doctor to define the type
of constipation that's present; uncover any supplements or
prescription products you are taking; or diseases or other
health problems you have. This, in turn, directs the
diagnosis and therapy. For example, if defecation is painful,
the doctor knows to look for anal problems such as a
narrowed anal sphincter or an anal fissure.
• If small stools are the problem, eating foods low in fiber
may be the cause. If the patient is experiencing significant
straining, then pelvic floor dysfunction is likely.
66. • Physical examination
• A physical examination may identify diseases (for
example, scleroderma) that can cause constipation. A rectal
examination with the finger may uncover a tight anal sphincter that
may be making defecation difficult or it may find that the muscles
of the pelvic floor do not relax normally. If a material filled colon
can be felt through the abdominal wall, it suggests that it is severe.
Stool in the rectum suggests a problem with the anal, rectal, or
pelvic floor muscles
• Blood tests
• Blood tests may be appropriate in evaluating your condition. More
specifically, blood tests for thyroid hormone (to detect
hypothyroidism) and for calcium (to uncover excess parathyroid
hormone) may be helpful.
67. • Abdominal X-ray
• Large amounts of material in the colon usually can be
visualized on simple X-ray films of the abdomen, and the
more severe the constipation, the more visualized on X-ray.
• Barium enema
• A barium enema (lower gastrointestinal [GI] series) is an X-
ray study in which liquid barium is inserted through the
anus to fill the rectum and colon. The barium outlines the
colon on the X-rays and defines the normal or abnormal
anatomy of the bowel and rectum. Tumors and narrowings
(strictures) are among the abnormalities that can be
detected with this test.
68. • Colonic transit (marker) studies
• Colonic transit studies are simple X-ray studies that determine how long it
takes for food to travel through the intestines. For transit studies,
individuals swallow capsules for one or more days. Inside the capsules are
many small pieces of plastic that can be seen on X-rays. The gelatin
capsules dissolve and release the plastic pieces into the small intestine.
The pieces of plastic then travel (as would digesting food) through the
small intestine and into the bowel. After 5 or 7 days, an X-ray of the
abdomen is taken and the pieces of plastic in the different parts of the
bowel are counted. From this count, it is possible to determine if and
where there is a delay in the colon.
• In people who are not constipated, all of the plastic pieces are
eliminated in the feces and none remain in the colon. When pieces are
spread throughout the colon, it suggests that the muscles or nerves
throughout the colon are not working, which is typical of colonic inertia.
When pieces accumulate in the rectum, it suggests pelvic floor
dysfunction.
69. • Defecography
• Defecography is a modification of the barium enema
examination. For this procedure, a thick paste of
barium is inserted into the rectum of a patient through
the anus. X-rays then are taken while the patient
defecates the barium. The barium clearly outlines the
rectum and anus and demonstrates the changes taking
place in the muscles of the pelvic floor during
defecation. Thus, defecography examines the process
of defecation and provides information about
anatomical abnormalities of the rectum and pelvic
floor muscles during defecation.
70. • Ano-rectal motility studies
• Ano-rectal motility studies, which complement defecography tests,
provide an assessment of the function of the muscles and nerves of
the anus and rectum. For ano-rectal motility studies, a flexible
tube, approximately an eighth of an inch in diameter, is inserted
through the anus and into the rectum. Sensors within the tube
measure the pressures that are generated by the muscles of the
anus and rectum. With the tube in place, the individual performs
several simple maneuvers such as voluntarily tightening the anal
muscles. Ano-rectal motility studies can help determine if the
muscles of the anus and rectum are working normally. When the
function of these muscles is impaired, the flow of material through
the GI tracts is obstructed, thereby causing a condition similar to
pelvic floor dysfunction.
71. • Treatment: In the majority of cases, constipation resolves itself
without any treatment or risk to health.
• The treatment of recurring constipation can include lifestyle
changes such as doing more exercise, eating more fiber, and
drinking more water.
• Usually, laxatives will successfully treat most cases of constipation -
but should be used with care and only when necessary. In more
difficult cases, the person may need a prescription medication.
• some gastroenterologists comment that there are people who do
not allocate enough time for their defecation. Set aside enough
time to allow your toilet visit to be unstressed and uninterrupted,
and do not ignore an urge to have a bowel movement.
72. • OTC laxatives
• Only use these laxatives as a last resort:
• Stimulants: These make the muscles in the intestines contract rhythmically. These
include Correctol, Dulcolax, and Senokot.
• Stimulant laxatives
• Stimulant laxatives cause the muscles of the small intestine and colon to propel
their contents more rapidly. They also increase the amount of water in it, either
by reducing the absorption of the water in the colon or by causing active secretion
of water in the small intestine.3
• The most commonly-used stimulant products contain cascara (castor oil), senna
(for example, Ex-Lax, Senokot), and aloe. Stimulant products are very effective,
• ADT: but they can cause severe diarrhea with resulting dehydration and loss
of electrolytes (especially potassium). They also are more likely than other types of
laxatives to cause intestinal cramping. There is concern that chronic use of
stimulant laxatives may damage the colon and worsen the condition,
73. • Lubricants: These help the stool move down the colon more easily. These include
mineral oil and Fleet.
• Lubricant laxatives contain mineral oil as either the plain oil or an emulsion
(combination with water) of the oil. The oil stays within the intestine, coats the
particles of stool, and presumably prevents the removal of water from the
material. This retention of water results in softer stool. Mineral oil generally is
used only for the short-term treatment since its long-term use has several
potential disadvantages.
• ADR: The oil can absorb fat-soluble vitamins from the intestine and, if used for
prolonged periods, may lead to deficiencies of these vitamins. This is of particular
concern in pregnancy during which an adequate supply of vitamins is important
for the fetus. In the very young or very elderly in whom the swallowing mechanism
is not strong or is impaired by strokes, small amounts of the swallowed oil may
enter the lungs and cause a type of pneumonia called lipid pneumonia. Mineral oil
also may decrease the absorption of some drugs such as warfarin (Coumadin)
and oral contraceptives, thereby decreasing their effectiveness. Despite these
potential disadvantages, mineral oil can be effective when short-term treatment is
necessary.
74. • Stool softeners: These moisten the stool. Stool softeners
include Colace and Surfak.
• Emollient laxatives (stool softeners)
• Emollient laxatives are generally known as stool softeners.
They contain a compound called docusate (for
example, Colace). Docusate is a wetting agent that
improves the ability of water within the colon to
penetrate and mix with the material in the bowel. This
increased water within it softens the stool, although studies
have not shown docusate to be consistently effective in
relieving constipation. These softeners often are used in
the long-term management of the condition. It may take a
week or more for docusate to be effective. The dose should
be increased after one to two weeks if no effect is seen.
75. • Fiber supplements: These are perhaps the safest laxatives. They are also called
bulk laxatives. They include FiberCon, Metamucil, Konsyl, Serutan, and Citrucel and
should be taken with plenty of water.
• Osmotics: These facilitate the movement of fluids through the colon. These
include Cephulac, Sorbitol, and Miralax.
• Saline laxatives: These draw water into the colon and include milk of magnesia.
• Saline laxatives
• Saline laxatives contain non-absorbable ions such as magnesium, sulfate,
phosphate, and citrate [for example, magnesium citrate (Citroma), magnesium
hydroxide, sodium phosphate). These ions remain in the colon and cause water to
be drawn into the colon. Again, the effect is soften feces.
• Magnesium also may have mild stimulatory effects on the colonic muscles. The
magnesium in magnesium-containing products is partially absorbed from the
intestine and into the body. Magnesium is eliminated from the body by the
kidneys. Therefore, patients with impaired kidney function may develop toxic
levels of magnesium from chronic (long duration) use of magnesium-
76. • 5-HT-4 agonists: They increase the secretion of
fluid in the intestines and speed up the rate at
which food passes through the colon. They
include Prucalopride.
• If the constipation does not respond to any
treatment, as a last resort, surgery to remove
part of the colon may be undertaken. In the
procedure, the segment of the anal sphincter or
rectum that causes the constipation is removed.
77. • Enemas: Enemas are particularly useful when there is impaction, when
stool hardens in the rectum
• There are many different types of enemas. By distending the rectum, all
enemas (even the simplest type, the tap water enema) stimulate the colon
to contract and eliminate the material. Other types of enemas have
additional mechanisms of action. For example, saline enemas cause water
to be drawn into the colon. Phosphate enemas (for example, Fleet
phosphosoda) stimulate the muscles of the colon. Mineral oil enemas
lubricate and soften hard stool. Emollient enemas (for example, Colace,
Microenema) contain agents that soften the stool.
• Suppositories:
As is the case with enemas, different types of suppositories have different
mechanisms of action. There are stimulant suppositories containing
bisacodyl (for example, Dulcolax). Glycerin suppositories are believed to
have their effect by irritating the rectum. The insertion of the finger into
the rectum when the suppository is placed may itself stimulate a bowel
movement.
78. • Natural remedies:
• Elevate your feet: Place your feet short platform,
such as a step, and make sure the knees are
above hip-level while passing stools. This can
reduce constipation.
• Homeopathic remedies: While their effectiveness
is disputed, some studies have suggested that
treatments for constipation offered by
homeopathic doctors can be successful. These
include calcarea carbonica, nux vomica, silica,
bryonia, and lycopodium.
79. • Nux vomica is a plant- STRYCHNINE TREE
• Family: Loganiaceae
• Scientific name: Strychnos nux-vomica
• Other names of tree : Vomiting nut or the poison
nut tree
• Part used: The seed is used to make medicine.
• Uses: Despite serious safety concerns, nux
vomica is used for diseases of the digestive tract,
disorders of the heart and circulatory system,
diseases of the eye, and lung disease.
