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Diseases » Diarrhea » Causes
 

Causes of Diarrhea

Contents
  1. Diarrhea: Introduction
  2. List of Causes
  3. Causes Discussion
  4. Drugs/substances (2686 causes)
  5. Drug interaction (1681 causes)
  6. Hidden causes
  7. Excerpts from book chapters
  8. Complication causes
  9. Causes of symptoms
  10. News
  11. Statistics about causes
  12. Related cause information

List of causes of Diarrhea

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Diarrhea) that could possibly cause Diarrhea includes:

More causes: see full list of causes for Diarrhea

Causes of Diarrhea (Diseases Database):

The follow list shows some of the possible medical causes of Diarrhea that are listed by the Diseases Database:

Source: Diseases Database

Diarrhea Causes: Book Excerpts

Diarrhea as a complication of other conditions:

Other conditions that might have Diarrhea as a complication may, potentially, be an underlying cause of Diarrhea. Our database lists the following as having Diarrhea as a complication of that condition:

Diarrhea as a symptom:

Conditions listing Diarrhea as a symptom may also be potential underlying causes of Diarrhea. Our database lists the following as having Diarrhea as a symptom of that condition:

Medications or substances causing Diarrhea:

The following drugs, medications, substances or toxins are some of the possible causes of Diarrhea as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 2686 medications causing Diarrhea


Drug interactions causing Diarrhea:

When combined, certain drugs, medications, substances or toxins may react causing Diarrhea as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Misoprostol and magnesium-containing antacid interaction
  • Cytotec magnesium-containing antacid interaction
  • Lithium (Eskalith) and ACE Inhibitor interaction
  • Lithium (Eskalith) and Angiotensin Receptor Blocker (ARBs) interaction
  • Lithium (Eskalith) and COX-2 Inhibitor interaction
  • more interactions...»

See full list of 1681 drug interactions causing Diarrhea

What causes Diarrhea?

Causes: Diarrhea: Causes include viral, bacterial, or parasitic infections; food intolerance; reactions to medicine; intestinal diseases; and functional bowel disorders. (Source: excerpt from Diarrhea: NIDDK)
Article excerpts about the causes of Diarrhea:
Diarrhea may be caused by a temporary problem, like an infection, or a chronic problem, like an intestinal disease. A few of the more common causes of diarrhea are

  • Bacterial infections. Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli.

  • Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.

  • Food intolerances. Some people are unable to digest a component of food, such as lactose, the sugar found in milk.

  • Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.

  • Reaction to medicines, such as antibiotics, blood pressure medications, and antacids containing magnesium.

  • Intestinal diseases, like inflammatory bowel disease or celiac disease.

  • Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon that can occur after gallbladder surgery.

In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

People who visit foreign countries are at risk for traveler's diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or, sometimes, parasites. Traveler's diarrhea is a particular problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler's diarrhea. (Source: excerpt from Diarrhea: NIDDK)

Medical news summaries relating to Diarrhea:

The following medical news items are relevant to causes of Diarrhea:

Cause statistics for Diarrhea:

The following are statistics from various sources about the causes of Diarrhea:

Related information on causes of Diarrhea:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Diarrhea may be found in:

Causes of Diarrhea: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Diarrhea.

Diarrhea - Acute: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Infectious etiologies
    –Acute (viral) gastroenteritis
    –“Traveler's diarrhea”: Shigella, Salmonella, enterotoxigenic E. coli, Campylobacter
    –Rotavirus
    –Norwalk virus
    –Yersinia enterocolitica
    –Clostridium difficile (pseudomembranous enterocolitis): Follows antibiotic use
    –Giardiasis: Foul-smelling, explosive diarrhea
    –Enterovirus
  • Lactose intolerance
  • IBS: Alternating diarrhea and constipation
  • Ischemic colitis: Associated with history of atherosclerotic disease (CAD, PVD, AAA)
  • Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
  • Medications (e.g., laxatives, antibiotics, anticholinergics, chemotherapy, metformin)
  • Malabsorption syndromes
  • Vasculitis
  • Neoplasia
  • Appendicitis
  • Adrenal insufficiency
  • Hyperthyroidism
  • HIV
  • Less common etiologies include E. coli O157:H7 (commonly associated with raw meat; invasive, bloody diarrhea), Cryptosporidium, Cyclospora, Isospora belli, typhoid fever

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Diarrhea - Chronic: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Diarrhea due to deranged motility presents with alternating diarrhea and constipation, bloating, mucus or blood in the stool, relief of abdominal pain upon defecation, worsening diarrhea with stress
    –IBS: Usually presents in the morning, seldom at night; more common in women; rectal urgency
    –Diabetic neuropathy: Uncontrolled, explosive, postprandial diarrhea; usually seen in patients with neurologic dysfunction and uncontrolled blood sugar
    –Hyperthyroidism
    –Postileal resection
    –Scleroderma
    –Carcinoid syndrome: Diaphoresis and diarrhea
  • Secretory diarrhea will persist even after a 48–72 hour fast; stool osmotic gap <50
    –Bacterial gastroenteritis
    –Bile acid malabsorption
    –Colitis
    –Hyperthyroidism
    –Collagen vascular diseases (SLE, MCTD, scleroderma)
    –Neuroendocrine tumors (e.g., VIPoma, gastrinoma, carcinoid)
  • Osmotic diarrhea will cease upon fasting; stool osmotic gap >100 mOsm/kg
    –Malabsorption (celiac sprue, nontropical sprue, Whipple's disease)
    –Nonabsorbable substances (e.g., laxatives, lactose, magnesium)
  • Inflammatory diarrhea presents with blood and mucus in the stools, urgency, fevers
    –Inflammatory bowel disease
    –Behçet syndrome
    –Invasive bacterial disease (Campylobacter jejuni)
    –Intestinal neoplasm

    • '>

    » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Diarrhea – Acute: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Viral gastroenteritis
      –Rotavirus, most common (winter)
      –Norwalk-like virus
      –Calcivurus
      –Enteric adenovirus
      –Astrovirus
    • Bacterial gastroenteritis
      –Campylobacter jejuni (associated with Guillain-Barré syndrome)
      –Salmonella
      –Shigella: May cause seizures (up to 30%), HUS
      –Escherichia coli (various types): Enteropathogenic, enterohemorrhagic (O157:H7) verotoxin can cause HUS (6–8% of cases), enterotoxigenic (traveler's diarrhea), enteroinvasive
      –Clostridium difficile (toxin A or B)
      –Yersinia enterocolitis (mimics acute appendicitis)
      –Vibrio cholerae
      –Aeromonas hydrophila
      –Toxin-mediated food poisoning: Bacillus cereus, Staphylococcus aureus, Clostridium perfringens
      • Parasitic infestations
        –Giardia lamblia
        –Cryptosporidium (severe in AIDS patients)
        –Entamoeba histolytica
        • Food allergies
          –Cow's milk and soy protein allergy are most common in infancy
      • Malbasorption (celiac disease, CF)
      • Lactose or fructose intolerance
      • Overfeeding (relative lactase deficiency)
      • Vitamin deficiency (e.g., niacin )
      • Zinc deficiency
      • Laxative abuse
      • Irritable bowel syndrome
      • Constipation with encopresis
      • Bacterial overgrowth
      • Antibiotics
      • Hirschsprung toxic colitis
      • Adrenogenital syndrome

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Diarrhea – Chronic, No Blood or Weight Loss: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Osmotic: Presence of nonabsorbable solute, pH <5, volume <200 mL/day, normal electrolytes, stops with fasting
    • Secretory: Mostly due to toxins, pH >6, volume >200 mL/day, no response to fasting, stool Na >70 mEq/L, negative reducing substances
    • Toddler's diarrhea: Chronic nonspecific diarrhea, onset 3 months to 3 years of age, average 4–6 stools daily, due to excessive juice intake or low-fat diet
    • Excessive intake of nonabsorbable solutes (lactulose, sorbitol, magnesium hydroxide)
    • Congenital lactose deficiency: Very rare in infancy, but may occur in extremely premature infants; adult-onset type of hypolactasia may be seen in older children (over age 5), autosomal recessive, 15% white adults, 85% of black adults, 90% of Asian adults
    • Secondary lactase deficiency: Follows a viral gastroenteritis, most commonly rotavirus, may persist for months
    • Fructose intolerance
    • Sucrase-isomaltase deficiency: Autosomal recessive, found in 0.2% of North Americans, symptoms commence on starting sucrose or glucose polymer-containing foods
    • Glucose-galactose malabsorption: Rare, autosomal recessive disorder
      • Infections
        –Giardiasis (most common infectious cause of chronic diarrhea in toddlers)
        –Cryptosporidium
        –Microsporidium
      • Irritable bowel syndrome (IBS)
        –Abnormality of intestinal motility and pain perception with no organic basis
        –Abdominal pain associated with intermittent diarrhea or constipation
    • Bacterial overgrowth: Enteric bacteria colonizes the upper small intestine
    • Trehelase deficiency (trehelose is the sugar found in mushrooms)
    • Zinc deficiency
      –Acrodermatitis enteropathica is typical rash
    • Low-fat diet
    '>>

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Diarrhea – Chronic, with Weight Loss: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Allergic enteritis: Typically cow's milk or soy in infants
    • Inflammatory bowel disease (IBD)
    • Cystic fibrosis (CF)
      –Chronic diarrhea may be the only sign
      –90% have pancreatic insufficiency (PI)
    • Celiac disease (CD): Gluten sensitivity, increased incidence in selective IgA deficiency, DM, and Down syndrome
    • Immune deficiency (e.g., hypogammaglobulinemia)
    • Sucrase-isomaltase deficiency: Autosomal recessive, symptoms with starting sucrose or glucose polymer-containing diet
    • Microvillus inclusion disease: Most common cause of persistent diarrhea in the neonatal period
      • Schwachman-Diamond syndrome
        –Pancreatic insufficiency, neutropenia, short stature, skeletal abnormalities
      • Johannson-Blizzard syndrome
        –Pancreatic insufficiency, scalp defects, agenesis of nasal cartilage, deafness, imperforate anus
    • Whipple disease:
      –Tropheryma whippelii (actinomycete)
      –Diagnosed mainly in adults
      –Weight loss, diarrhea, and arthropathy
    • Tropical sprue: Common in developing countries; folate deficiency and diarrhea
    • Neural crest tumors: Pheochromocytoma, VIPoma, Zollinger-Ellison syndrome, carcinoid tumors
    • Mastocytoma
    • Neuroblastoma
    • Abetalipoproteinemia
    • Giardiasis, Strongyloides, coccidia
    • AIDS
    • Acrodermatitis enteropathica: Zinc deficiency, acral perioral and perianal rashes, consider underlying cystic fibrosis
      • Mutational defects in ion transport proteins
        –Chloride-losing diarrhea: Rare, ileal chloride transport defect, maternal polyhydramnios
        –Congenital sodium diarrhea
    • Tufting enteropathy (epithelial dysplasia)
    • Enterokinase deficiency

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Fecal incontinence: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Dementia

    Any chronic degenerative brain disease can produce fecal as well as urinary incontinence. Associated signs and symptoms include impaired judgment and abstract thinking, amnesia, emotional lability, hyperactive deep tendon reflexes, aphasia or dysarthria and, possibly, diffuse choreoathetoid movements.

    Head trauma

    Disruption of the neurologic pathways that control defecation can cause fecal incontinence. Additional findings depend on the location and severity of the injury and may include a decreased level of consciousness, seizures, vomiting, and a wide range of motor and sensory impairments.

    Inflammatory bowel disease

    Nocturnal fecal incontinence occurs occasionally with diarrhea. Related findings include abdominal pain, anorexia, weight loss, blood in the stools, and hyperactive bowel sounds.

    Rectovaginal fistula

    Fecal incontinence occurs in tandem with uninhibited passage of flatus.

    Spinal cord lesions

    Any lesion that causes compression or transsection of sensorimotor spinal tracts can lead to fecal incontinence. Incontinence may be permanent, especially with severe lesions of the sacral segments. Other signs and symptoms reflect motor and sensory disturbances below the level of the lesion, such as urinary incontinence, weakness or paralysis, paresthesia, analgesia, and thermanesthesia.

    Other causes

    Drugs

    Chronic laxative abuse may cause insensitivity to a fecal mass or loss of the colonic defecation reflex

    Surgery

    Pelvic, prostate, or rectal surgery occasionally produces temporary fecal incontinence. Colostomy or ileostomy causes permanent or temporary fecal incontinence

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Diarrhea: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Anthrax, GI

    Anthrax manifests after the patient has eaten contaminated meat from an animal infected withBacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and a fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

    Carcinoid syndrome

    With carcinoid syndrome, severe diarrhea occurs with flushing — usually of the head and
    neck — that's commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

    Cholera

    After ingesting water or food contaminated by the bacteriumVibrio cholerae,the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

    Clostridium difficile infection

    The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; a fever; and a white blood cell count as high as 20,000/ml. In severe cases, the patient may develop toxic megacolon, colon perforation, or peritonitis.

    Crohn's disease

    Crohn's disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness and nausea. The patient may also display a fever, chills, weakness, anorexia, and weight loss.

    Escherichia coli

    Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication ofE. coli0157:H7 in children age 5 and younger and elderly people.

    Infections

    Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and a fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

    Intestinal obstruction

    Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

    Irritable bowel syndrome

    Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

    Ischemic bowel disease

    Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

    Lactose intolerance

    Diarrhea occurs within several hours of ingesting milk or milk products. It's accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

    Listeriosis

    With listeriosis, diarrhea occurs in conjunction with a fever, myalgia, abdominal pain, nausea, and vomiting. A fever, a headache, nuchal rigidity, and an altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis. This infection, caused by the ingestion of food contaminated with the bacteriumListeria monocytogenes primarily affects pregnant women, neonates, and those with weakened immune systems. Listeria infections during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

    Pseudomembranous enterocolitis

    Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, a fever, and dehydration.

    Q Fever

    Q Fever is caused by the bacterium Coxiella burnetiiand causes diarrhea along with a fever, chills, a severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

    Rotavirus gastroenteritis

    Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and can last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

    Thyrotoxicosis

    With thyrotoxicosis, nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, an enlarged thyroid, heat intolerance and, possibly, exophthalmos accompany diarrhea.

    Ulcerative colitis

    The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, a low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

    Other causes

    Herb alert  

    Herbal reme-
    dies — such as ginkgo biloba, ginseng, and licorice — may cause diarrhea.

    Drugs

    Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

    Treatments

    Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Fecal incontinence: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Dementia

    Any chronic degenerative brain disease can produce fecal as well as urinary incontinence. Associated signs and symptoms include impaired judgment and abstract thinking, amnesia, emotional lability, hyperactive deep tendon reflexes (DTRs), aphasia or dysarthria and, possibly, diffuse choreoathetoid movements.

    Gastroenteritis

    Severe gastroenteritis may result in temporary fecal incontinence manifested by explosive diarrhea. Nausea, vomiting, and colicky, peristaltic abdominal pain are typical. Other findings include headache, myalgia, and hyperactive bowel sounds.

    Head trauma

    Disruption of the neurologic pathways that control defecation can cause fecal incontinence. Additional findings depend on the location and severity of the injury and may include decreased level of consciousness, seizures, vomiting, and a wide range of motor and sensory impairments.

    Inflammatory bowel disease

    Nocturnal fecal incontinence occurs occasionally with diarrhea. Related findings include abdominal pain, anorexia, weight loss, blood in the stool, and hyperactive bowel sounds.

    Multiple sclerosis

    Fecal incontinence occasionally appears as one of this disorder’s extremely variable signs. Other effects depend on the area of demyelination and may include muscle weakness, ataxia, and paralysis; gait disturbances; sensory impairment, such as paresthesia and genital anesthesia; visual blurring, diplopia, or nystagmus; urinary disturbances; and emotional lability.

    Rectovaginal fistula

    Fecal incontinence occurs in tandem with uninhibited passage of flatus.

    Spinal cord lesion

    Any lesion that causes compression or transsection of sensorimotor spinal tracts can lead to fecal incontinence. Incontinence may be permanent, especially with severe lesions of the sacral segments. Other signs and symptoms reflect motor and sensory disturbances below the level of the lesion, such as urinary incontinence, weakness or paralysis, paresthesia, analgesia, and thermanesthesia.

    Stroke

    Temporary fecal incontinence occasionally occurs in a stroke patient but usually disappears when muscle tone and DTRs are restored. Persistent fecal incontinence may reflect extensive neurologic damage. Other findings depend on the location and extent of damage and may include urinary incontinence, hemiplegia, dysarthria, aphasia, sensory losses, reflex changes, and visual field deficits. Typical generalized signs and symptoms include headache, vomiting, nuchal rigidity, fever, disorientation, mental impairment, seizures, and coma.

    Tabes dorsalis

    This late sign of syphilis occasionally results in fecal incontinence. It also produces urinary incontinence, ataxic gait, paresthesia, loss of DTRs and temperature sensation, severe flashing pain, Charcot’s joints, Argyll Robertson pupils, and possibly impotence.

    Other causes

    Drugs

    Chronic laxative abuse may cause insensitivity to a fecal mass or loss of the colonic defecation reflex.

    Surgery

    Pelvic, prostate, or rectal surgery occasionally produces temporary fecal incontinence. A colostomy or an ileostomy causes permanent or temporary fecal incontinence.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Diarrhea: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Anthrax, GI

    This disease follows ingestion of contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

    Carcinoid syndrome

    In this disorder, severe diarrhea occurs with flushing—usually of the head and neck—that’s commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, anorexia, weight loss, weakness, palpitations, valvular heart disease, and depression.

    Cholera

    After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

    Clostridium difficile infection

    The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

    Crohn’s disease

    This recurring inflammatory disorder produces diarrhea, abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

    Escherichia coli O157:H7

    Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

    Infections

    Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain or cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

    Intestinal obstruction

    Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

    Irritable bowel syndrome

    Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

    Ischemic bowel disease

    This life-threatening disorder causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

    Lactose intolerance

    Diarrhea occurs within several hours of ingesting milk or milk products in patients with this disorder. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

    Large-bowel cancer

    In this disorder, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

    Listeriosis

    This infection, caused by ingestion of food contaminated with the bacterium Listeria monocytogenes, primarily affects pregnant women, neonates, and those with weakened immune systems. Characteristic findings include diarrhea, fever, myalgia, abdominal pain, nausea, and vomiting. Fever, headache, nuchal rigidity, and altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis.

    Gender Cue: Listeriosis during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

    Malabsorption syndrome

    Occurring after meals, diarrhea is accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

    Pseudomembranous enterocolitis

    This potentially life-threatening disorder commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

    Q fever

    This infection is caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

    Rotavirus gastroenteritis

    This disorder commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can be mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

    Thyrotoxicosis

    In this disorder, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

    Ulcerative colitis

    The hallmark of this disorder is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, possibly, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

    Other causes

    Drugs

    Many antibiotics—such as ampicillin, cephalosporins, tetracyclines, and clindamycin—cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, with high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

    Foods

    Foods that contain certain oils may inhibit the food’s absorption, causing acute uncontrollable diarrhea and rectal leakage.

    Herb Alert

    Herbal remedies, such as ginkgo biloba, ginseng, and licorice, may cause diarrhea.

    Lead poisoning

    Alternating diarrhea and constipation may be accompanied by abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

    Treatments

    Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Acute Diarrhea: Differential Overview
    (Field Guide to Bedside Diagnosis)

    ❑ Viral gastroenteritis

    ❑ Staphylococcal enterotoxin

    ❑ E. coli

    ❑ Salmonella

    ❑ Campylobacter

    ❑ Drugs

    ❑ C. difficile colitis

    ❑ Giardia

    ❑ Shigella

    ❑ Yersinia

    ❑ Entamoeba histolytica

    ❑ Typhoid fever

    ❑ Vibrio parahaemolyticus

    ❑ Cryptosporidia

    ❑ Cholera

    ❑ Strongyloides

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Chronic Diarrhea: Differential Overview
    (Field Guide to Bedside Diagnosis)

    Altered Intestinal Motility

    ❑ Irritable bowel syndrome

    ❑ Diabetic enteropathy

    Inflammatory

    ❑ Inflammatory bowel disease

    ❑ Giardiasis

    ❑ Cryptosporidiosis

    Osmotic

    ❑ Lactase deficiency

    ❑ Drugs

    ❑ Pancreatic insufficiency

    ❑ Post-gastrectomy

    ❑ Celiac sprue

    ❑ Small bowel lymphoma

    Secretory

    ❑ Villous adenoma

    ❑ Pancreatic cholera

    ❑ Carcinoid

    ❑ Zollinger-Ellison syndrome

    ❑ Medullary carcinoma of the thyroid

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Diarrhea: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Anthrax, GI.

    GI anthrax manifests after the patient has eaten contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

    Carcinoid syndrome.

    With carcinoid syndrome, severe diarrhea occurs with flushing — usually of the head and neck — that’s commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

    Cholera.

    After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

    Clostridium difficile infection

    The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul-smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

    Crohn’s disease

    Crohn’s disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

    Escherichia Coli O157:H7

    Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with E. coli O157:H7. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

    Infections

    Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

    Intestinal obstruction

    Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

    Irritable bowel syndrome

    Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

    Ischemic bowel disease.

    Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

    Lactose intolerance

    Diarrhea occurs within several hours of ingesting milk or milk products. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

    Large-bowel cancer

    With large-bowel cancer, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

    Lead poisoning

    . Alternating diarrhea and constipation occur with lead poisoning. Other GI effects include abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

    Listeriosis

    With listeriosis — an infectious disease —  diarrhea occurs in conjunction with fever, myalgias, abdominal pain, nausea, and vomiting. Fever, headache, nuchal rigidity, and altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis. This infection, caused by the ingestion of food contaminated with the bacterium Listeria monocytogenes primarily affects pregnant females, neonates, and those with weakened immune systems.

    Malabsorption syndrome

    Occurring after meals, diarrhea is accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

    Pseudomembranous enterocolitis.

    Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

    Q fever.

    Q fever is caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may occur.

    Rotavirus gastroenteritis.

    Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

    Thyrotoxicosis.

    With thyrotoxicosis, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

    Ulcerative colitis

    The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

    Other causes

    Drugs

    Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

    Foods

    Foods that contain certain oils may inhibit absorption of food causing acute uncontrollable diarrhea and rectal leakage.

    Herbal remedies

    Certain herbal remedies, such as ginkgo biloba, ginseng, and licorice, may cause diarrhea.

    Medical treatments

    Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Diarrhea: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Anthrax, GI

    Early signs and symptoms of GI anthrax, an infectious disease caused by eating meat contaminated with the bacterium Bacillus anthracis, include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

    Clostridium difficile infection

    With a Clostridium difficile infection, the patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

    Crohn’s disease

    Crohn’s disease, a recurring inflammatory disorder, produces diarrhea accompanied by abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

    Escherichia coli 0157:H7

    Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with the Escherichia coli 0157:H7 strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of   E. coli 0157:H7 in children age 5 and younger and elderly people.

    Infections

    Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

    Intestinal obstruction

    Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention. Other signs and symptoms may include borborygmi and rushes on auscultation and vomiting of fecal material.

    Irritable bowel syndrome

    Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea. The patient may also report passage of mucus and pasty pencil-like stools.

    Ischemic bowel disease

    A life-threatening disorder, ischemic bowel disease causes bloody diarrhea with abdominal pain. The patient may also experience abdominal distention, nausea, and vomiting. If severe, shock may occur, requiring surgery.

    Lactose intolerance

    Diarrhea occurs within several hours of ingesting milk or milk products. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

    Large-bowel cancer

    With large-bowel cancer, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

    Lead poisoning

    Alternating diarrhea and constipation occur in a patient with lead poisoning. Other GI effects include abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

    Malabsorption syndrome

    In a patient with malabsorption syndrome, diarrhea occurs after meals, accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

    Pseudomembranous enterocolitis

    Pseudomembranous enterocolitis, a potentially life-threatening disorder, commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

    Q Fever

    Q Fever is an infection that’s caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow. Chronic Q fever may cause prolonged fever, night sweats, chills, fatigue, and dyspnea.

    Rotavirus gastroenteritis

    Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

    Thyrotoxicosis

    With thyrotoxicosis, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

    Ulcerative colitis

    The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

    Other causes

    Drugs

    Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea. Herbal remedies — such as ginkgo biloba, ginseng, and licorice — may also cause diarrhea.

    Foods

    Foods that contain certain oils may inhibit absorption causing acute uncontrollable diarrhea and rectal leakage.

    Treatments

    Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis, which is associated with diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Fecal Incontinence: Principal Causes of Fecal Incontinence
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Maturationaldelay or developmental conflict
    2. Stress-related factors
    3. Constipation
    4. Neurologic disorders
      1. Mentalretardation
      2. Spinal dysraphism
      3. Spinal cord injury
      4. Spinal cord tumor
    5. Primary psychologic disturbance

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Diarrhea: Principle Causes of Acute Diarrhea
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Infection
      1. Gastroenteritis
        1. Viral
          1. Rotavirus
          2. Other viruses
        2. Bacterial
          1. Salmonella
          2. Shigella
          3. Campylobacter jejuni
          4. Escherichia coli
          5. Other bacterial pathogens
        3. Parasitic
          1. Giardia lamblia
          2. Entamoeba histolytica
          3. Cryptosporidium parvum
          4. Strongyloides stercoralis
          5. Ascaris lumbricoides
          6. Hookworm infection
          7. Trichuris trichiura
        4. Fungal
          1. Candida species
      2. Other infections
    2. Food poisoning
    3. Antibiotic-associated diarrhea
    4. Allergic disorders
      1. Cow milkprotein sensitivity
      2. Soy protein sensitivity
      3. Other food allergy
    5. Congenital aganglionic megacolon (Hirschsprungdisease)
    6. Hemolytic-uremic syndrome
    7. Intussusception

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Fecal incontinence: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Dementia.Any chronic degenerative brain disease can produce fecal as well as urinary incontinence. Associated signs and symptoms include impaired judgment and abstract thinking, amnesia, emotional lability, hyperactive deep tendon reflexes, aphasia or dysarthria and, possibly, diffuse choreoathetoid movements.

    Head trauma.Disruption of the neurologic pathways that control defecation can cause fecal incontinence. Additional findings depend on the location and severity of the injury and may include a decreased level of consciousness, seizures, vomiting, and a wide range of motor and sensory impairments.

    Inflammatory bowel disease.Nocturnal fecal incontinence occurs occasionally with diarrhea in inflammatory bowel disease. Related findings include abdominal pain, anorexia, weight loss, blood in the stools, and hyperactive bowel sounds.

    Rectovaginal fistula.With a rectovaginal fistula, fecal incontinence occurs in tandem with uninhibited passage of flatus.

    Spinal cord lesions.Any lesion that causes compression or transsection of sensorimotor spinal tracts can lead to fecal incontinence. Incontinence may be permanent, especially with severe lesions of the sacral segments. Other signs and symptoms reflect motor and sensory disturbances below the level of the lesion, such as urinary incontinence, weakness or paralysis, paresthesia, analgesia, and thermanesthesia.

    Other causes

    Drugs.Chronic laxative abuse may cause insensitivity to a fecal mass or loss of the colonic defecation reflex.

    Surgery.Pelvic, prostate, or rectal surgery occasionally produces temporary fecal incontinence. Colostomy or ileostomy causes permanent or temporary fecal incontinence.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Diarrhea: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Anthrax (GI).Anthrax manifests after the patient has eaten contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and a fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

    Carcinoid syndrome.With carcinoid syndrome, severe diarrhea occurs with flushing—usually of the head and neck—that's commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

    Cholera.After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

    Clostridium difficile infection. The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; a fever; and a white blood cell count as high as 20,000/ml. In severe cases, the patient may develop toxic megacolon, colon perforation, or peritonitis.

    Crohn's disease.Crohn's disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness and nausea. The patient may also display a fever, chills, weakness, anorexia, and weight loss.

    Escherichia coli O157:H7. Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

    Infections.Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and a fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

    Intestinal obstruction.Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

    Irritable bowel syndrome (IBS).With IBS, diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

    Ischemic bowel disease.Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

    Lactose intolerance.With lactose intolerance, diarrhea occurs within several hours of ingesting milk or milk products. It's accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

    Listeriosis.With listeriosis, diarrhea occurs in conjunction with a fever, myalgia, abdominal pain, nausea, and vomiting. A fever, a headache, nuchal rigidity, and an altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis.

    Pseudomembranous enterocolitis.Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, a fever, and dehydration.

    Q fever.Q fever is caused by the bacterium Coxiella burnetii and causes diarrhea along with a fever, chills, a severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

    Rotavirus gastroenteritis.Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and can last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

    Thyrotoxicosis.With thyrotoxicosis, nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, an enlarged thyroid, heat intolerance and, possibly, exophthalmos accompany diarrhea.

    Ulcerative colitis.The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, a low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

    Other causes

    Drugs.Many antibiotics—such as ampicillin, cephalosporins, tetracyclines, and clindamycin—cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

    Treatments.Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Diarrhea - Case 17-1: 2-Month-Old Boy: I. Differential Diagnosis
    (Pediatric Complaints and Diagnostic Dilemmas)

    In this case, diarrhea was associated with vomiting and a critical physical finding, that of an inguinal mass. This essential finding directed the differential diagnosis toward causes of inguinal or scrotal swelling. An important distinction to make is between a painful and a painless mass. A hydrocele is a common entity that causes painless inguinal or scrotal swelling. It is primarily differentiated from an inguinal hernia by the ability to palpate above the mass, revealing discontinuity between the mass and the inguinal canal. The mass, as a result, does not change in size with straining or crying. In addition, a hydrocele is not reducible and usually transilluminates, although the ability to transilluminate the mass does not exclude the possibility of an incarcerated hernia.
    Another cause of a painful scrotal mass is testicular torsion. There often is no history of a prior scrotal mass, and in fact there may be a history of undescended testis. This mass is very tender and does not extend into the inguinal canal.
    Torsion of the appendix testis results in a painful scrotal mass that may appear as a tender blue nodule on the upper pole of the testis, which itself is not tender. Inguinal lymphadenopathy may be tender or painless, but the key to diagnosis is the lateral and inferior location of these nodes in relation to the inguinal canal. Signs of infection in the area of lymphatic drainage are also important in making this diagnosis. An inguinal hernia is usually characterized by a painless swelling in the inguinal area that often increases in size with crying or straining. Incarceration of the hernia results in extreme pain and signs of bowel obstruction. If strangulation occurs, bloody diarrhea may result.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Complaints and Diagnostic Dilemmas, 2003

    Diarrhea - Case 17-4: 15-Month-Old Boy: I. Differential Diagnosis
    (Pediatric Complaints and Diagnostic Dilemmas)

    The chronic nature of his diarrhea for the last 3 months, associated with weight loss, moved the differential diagnosis away from the diagnosis of acute infectious diarrhea due to either bacterial or viral causes. A prolonged bout of postinfectious diarrhea due to disaccharidase deficiency was possible but unlikely. Chronic diarrhea due to infection with C. difficile or ova and parasites was a possibility even without a history of antibiotic use, bloody diarrhea, foreign travel, or use of untreated water sources. The key observation in making this diagnosis occurred while the patient was in the hospital: he took nothing by mouth but continued to produce profuse voluminous watery diarrhea. This finding indicated the presence of secretory, rather than osmotic, diarrhea. In this differential diagnosis, the list is rather brief and includes rare congenital and paraneoplastic conditions. Congenital defects in chloride or sodium transport are more likely to manifest in infancy. Infectious causes of secretory diarrhea include small-bowel overgrowth or infection with immuno adherent E. coli stimulating gastrointestinal secretions. Any cause of villous atrophy, whether congenital, autoimmune, or secondary to immune deficiency (e.g., HIV infection, severe combined immunodeficiency) may also result in this presentation. Neuroblastoma or other tumors of neural crest origin (e.g., ganglioneuroma) may secrete vasoactive intestinal peptide (VIP), resulting in secretory diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Complaints and Diagnostic Dilemmas, 2003

    Chronic Diarrhea: Chronic Diarrhea - pathophysiology
    (The 5-Minute Pediatric Consult)

    The major categories are osmotic and secretory. Inflammatory and motility disorders are smaller but important subcategories to consider.

    • Osmotic diarrhea occurs when unabsorbable solute accumulates in the lumen of the small intestine and colon:
      • This increases the intraluminal osmotic pressure and results in excessive fluid and electrolyte losses in stool.
      • Osmotic diarrhea will improve with fasting.
      • Osmotic diarrhea is usually related to malabsorption of dietary products or to the presence of congenital or acquired disaccharidase deficiency or glucose-galactose defects.
    • Secretory diarrhea occurs when the net secretion of fluid and electrolyte is in excess of absorption in the intestine:
      • The intestinal mucosa is normally very active in both of these processes.
      • The diarrhea occurs independently of the osmotic load in the intestinal lumen and does not improve with fasting.
      • The mechanisms for secretory diarrhea include the activation of intracellular mediators such as cAMP, cGMP, and calcium-dependent channels.
      • These mediators stimulate active chloride secretion from the crypt cells and inhibit the neutral coupled sodium chloride absorption.
    • Inflammation in the intestine can cause an alteration in mucosal integrity resulting in exudative loss of mucus, blood, and/or protein. Increased permeability and altered mucosal surface area may affect absorption and result in diarrhea owing to a malabsorptive process.
    • Motility disorders will affect the intestinal transit time. Hypomotility states such as stasis from bacterial overgrowth can lead to diarrhea.

    » READ BOOK EXCERPT ONLINE »

    Source: The 5-Minute Pediatric Consult, 2008


     » Next page: Risk Factors for Diarrhea

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