ACUTE INFECTIOUS DIARRHEA

Definition:

Normal bowel frequency ranges from three times a day to three times a week in the
normal population. Increased stooling, with stool consistency less solid than normal,
constitutes a satisfactory, if somewhat imprecise, definition of diarrhea. Acute
diarrhea is defined as a greater number of stools of decreased form from the normal
lasting for less than 14 days. If the illness persists for more than 14 days, it is called
persistent. If the duration of symptoms is longer than 1 month, it is considered
chronic diarrhea. Most cases of acute diarrhea are self-limited, caused by infectious
agents (e.g. viruses, bacteria, parasites), and do not require medication unless the
patient is immunocompromised.

Pathophysiology:

Approximately 8 to 9 L of fluid enter the intestines daily—1 to 2 L represents food

and liquid intake, and the rest is from endogenous sources such as salivary, gastric,
pancreatic, biliary, and intestinal secretions. Most of the fluid, about 6 to 7 L, is
absorbed in the small intestine, and only about 1 to 2 L is presented to the colon.
Most of this is absorbed as it passes through the colon, leaving a stool output of
about 100 to 200 g/day. Although many organisms simply impair the normal
absorptive processes in the small intestine and colon, others, organisms, such as
Vibrio cholerae, secrete a toxin that causes the colonic mucosa to secrete, rather
than absorb, fluid and electrolytes. Voluminous diarrhea may result.

Diarrhea-causing pathogens are usually transmitted through the fecal-oral route.

Risk factors for this type of transmission include improper disposal of feces and lack
of proper hand washing following defecation and feces contact before handling
food. Other risk factors include improper food hygiene, inadequate food
refrigeration, food exposure to flies, and consumption of contaminated water.
Multiple host factors that determine the level of illness once exposure to infectious
agents has occurred include age, personal hygiene, gastric acidity and other
barriers, intestinal motility, enteric microflora, immunity, and intestinal receptors.

Viruses (e.g., adenovirus, rotavirus, Norwalk virus) are the most common cause of
diarrhea in the United States. Escherichia coli, Clostridium difficile, and
Campylobacter, Salmonella, and Shigella spp. are common bacterial causes.
Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella spp.,
and others cause food poisoning. Entamoeba histolytica and Giardia,
Cryptosporidium, and Cyclospora spp. are parasitic or protozoal agents that cause
diarrhea.
Acute watery diarrhea is most commonly seen with traveler's diarrhea caused by
enterotoxigenic E. coli (ETEC), parasite-induced diarrhea from Giardia and
Cryptosporidium spp. and, in cases of food poisoning (ingestion of preformed
toxins), from B. cereus and S. aureus.

Some infectious agents cause mucosal inflammation, which may be mild or severe.
Bacteria such as enteroadherent or enteropathogenic E. coli and viruses such as
rotavirus, Norwalk agent, and HIV can cause minimal to moderate inflammation.
Bacteria that destroy enterocytes such as Shigella, enteroinvasive E. coli, the
parasite E. histolytica, and bacteria that penetrate the mucosa such as Salmonella,
Campylobacter jejuni, and Yersinia enterocolitica result in moderate to severe
inflammation with or without ulceration.

Ingestion of preformed toxin produced by bacteria such as B. cereus, S. aureus, and

Clostridium perfringens can result in acute jejunitis. Aeromonas, Shigella, and Vibrio
spp. (e.g., V. parahaemolyticus) produce enterotoxins and also invade the intestinal
mucosa. Patients therefore often present with watery diarrhea, followed within
hours or days by bloody diarrhea. Bacteria that produce inflammation from
cytotoxins include Clostridium difficile and hemorrhagic E. coli O157:H7.

Exudative diarrhea results from extensive injury of the small bowel or colon mucosa
as a result of inflammation or ulceration, leading to a loss of mucus, serum proteins,
and blood into the bowel lumen. Increased fecal water and electrolyte excretion
results from impaired water and electrolyte absorption by the inflamed intestine
rather than from secretion of water and electrolytes into the exudates.

Noninfectious causes of diarrhea include inflammatory bowel disease, irritable

bowel syndrome, ischemic bowel disease, partial small bowel obstruction, pelvic
abscess in the rectosigmoid area, fecal impaction, and the ingestion of poorly
absorbable sugars, such as lactulose and acute alcohol ingestion. Diarrhea is one of
the most frequent adverse effects of prescription medications; it is important to
note that drug-related diarrhea usually occurs after a new drug is initiated or the
dosage increased.
PS. Wala ko kabalo unsay concept map ninyo sa nursing kay lahi man gud
sa amoa >.< here’s the link nga ako gikuhaan ana.. nay mga chart2.. hehe
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroente
rology/acute-diarrhea/