Understanding Chronic and Acute Diarrhoea

As a child, my mum was always very concerned about me not having diarrhoea. This was because there was an outbreak of diarrhoea in our neighbourhood, which affected children who consumed public water and caused an epidemic. My mum was very scared and didn't want me to get diarrhoea, she was scared to even when the entire diarrhoea issue went down. Whenever I remember how paranoid she was about the diarrhoea outbreak in the community and I laugh, although it is understandable. Today, I will be creating a post on Diarrhoea, its cause, and its treatment.

Diarrhoea can be said to be an increase in bowel movement, with a decrease in the consistency of the stool, causing it to be watery. It is important to know that the normal water content of a stool is approximately 10mL/kg/day in children and about 200g/day in adults, with diarrhoea, the water augmentation is imbalanced. Diarrhoea can also be regarded as a situation accompanied by 3 or more bowel movements (liquid stool) in a day. According to the World Health Organization, there are about 1.7 billion cases of diarrhoea in children, it is the second leading cause of death in children below the age of 5 years, as it has killed about 525,000 children. In chronic diarrhoea, the incidence of diarrhoea caused by Crohn's disease is 6 person in a 100,000 people and 1 person in 100,000 in cases caused by ulcerative colitis in a year.

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This said Diarrhea can exist in two ways, Acute Diarrhea, and Chronic Diarrhea. These types of diarrhoea are determined by its longevity. Acute diarrhoea is described as diarrhoea that occurs within a period of 14 days. while chronic diarrhoea has a longer period than acute diarrhoea which is beyond 14 days. Acute diarrhoea is infectious in nature, while chronic diarrhoea is a non-infectious diarrhoea which leads to a chronic clinical condition.

Acute Diarrhea is basically infectious caused, by Bacteria, Viruses, or protozoans, but it becomes different from Chronic Diarrhea as it is always caused by an underlying clinical case such as Chron's, or Irritable bowel syndrome. It is also necessary to know that when chronic diarrhoea is in its early stage, it can be misconstrued as acute diarrhoea, so it will require a proper medical examination. Certain things can cause acute diarrhoea, such as travelling (travel history) to countries with cases of diarrhoea, coming in contact with people who have diarrhoea, food intake (food poisoning), nosocomial infections causing diarrhoea, and use of antibiotics or medication (laxative abuse).

Acute diarrhoea is associated with abdominal pain (cramps), and fever (in a few cases), the stool can be watery or non-watery, and bloody or non-bloody. Acute Diarrhea can be inflammatory/non-inflammatory. With non-inflammatory or enterotoxin diarrhoea, there is an inability to absorb nutrients, as well as efflux of ions into the gastrointestinal lumen, taking water away from the gastrointestinal cells can cause diarrhoea. In cases of invasive diarrhoea, microorganisms invade the gastrointestinal lining, leading to the destruction of the gastrointestinal cells, and could lead to breaks in vessels and underlying tissues of the gastrointestinal lining causing blood to be in the stool. The invasion of the bacteria causes a break of the gastrointestinal tract leading to fever, leukocytosis, lactoferrin, and tenesmus.

For enterotoxic/non-inflammatory diarrhoea causes can range from Enterotoxic E. Coli, Vibrio Cholerae, Clostridium Difficile, Staphylococcus aureus, Giardia Lamblia, Bacillus Cereus, and viruses such as norovirus, rotavirus, and cytomegalovirus. In the case of invasive or inflammatory diarrhoea, microorganisms such as Salmonella, Enterohemorrhagic E.Coli (O157:H7), Shigella, Entamoeba histolytica, and Campylobacter jejuni.

Chronic Diarrhea causes would include a family history of medical conditions that could cause diarrhoea, medications, food sensitivities, and other underlying conditions that cause diarrhoea such as Addison disease, hyperthyroidism, vasculitis, lactose intolerance, irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticulitis, ischemic bowel, tuberculosis, radiation colitis, chronic pancreatitis, Celiac disease, Giardia lamblia, and Chronic Cholestasis. Patients with chronic diarrhoea have symptoms such as abdominal pain, and non-bloody and bloody diarrhoea. Chronic diarrhoea can be secretory, osmotic, functional, inflammatory, and malabsorptive.

Treatments for Diarrhoea includes Rehydration (including Oral rehydration solution or salts (ORS)), Antidiarrheal medication ( loperamide and bismuth subsalicylate), Antibiotics, Probiotics, and Dietary changes. Prevention includes, properly washing hands, and proper food safety, people who suffer from diarrhoea should not prepare food for other people in a household, rotavirus vaccination, and six months of exclusive breastfeeding.

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Reference

National Library of Medicine - Diarrhea

www.healthdirect.gov - Diarrhoea

www.medicalnewstoday.com - What you should know about diarrhea

www.who.int - Diarrhoeal disease

National Library of Medicine - Acute Diarrhea

American Academy - Acute Diarrhea in Adults

National Library of Medicine - Chronic Diarrhea

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition