classification-and-causes-of-diarrhea

Dr. Long Chelsea98.com Wisdom Week Million Dragon Health Education

In normal people, about 9L of liquid enters the gastrointestinal tract every day and absorbs water through the intestinal tract. The final water content in the stool is only about 100-200mL. If the amount of fluid entering the colon exceeds the absorptive capacity of the colon or (and) the absorptive capacity of the colon decreases, it will lead to an increase in the amount of water excreted in the feces, and diarrhea will occur.

Diarrhea (diarrhea) is a common disease symptom, commonly known as "diarrhea" and "diarrhea". It refers to the frequency of bowel movements significantly exceeding the frequency of usual habits, thin stools (loose or watery stools), increased water content, and daily stool volume More than 200g, or containing undigested food, pus, blood, or mucus. Diarrhea is often accompanied by symptoms such as urgency to defecate, anal discomfort, and incontinence.

classification-and-causes-of-diarrhea

Clinically, according to the length of the disease, diarrhea is divided into acute, persistent diarrhea and chronic 3class.

1. Acute diarrhea: duration is less than or equal to 14 days;

2. Persistent diarrhea: lasts more than 14 days but less than 30 days;

3. Chronic diarrhea: lasts more than 30 days.

Acute diarrhea has a rapid onset, and the course of the disease is within 2-3 weeks, mostly caused by infection; chronic diarrhea refers to recurrent diarrhea that has a course of more than two months or an intermittent period of 2-4 weeks.

Diarrhea classification based on cause

The causes of disease are more complex and diverse, which can be caused by infectious and non-infectious factors. In addition, there are other types of diarrhea. Infectious diarrhea mostly occurs in summer and autumn and is divided into three categories. Among them, infectious diarrhea caused by viruses is the most common, which mostly occurs in autumn and winter, and most cases can heal on their own. However, if the treatment of severe cases is not timely or the treatment method is incorrect, the patient will become dehydrated, and even worse, it may also be combined with encephalitis. , Pneumonia, intestinal bleeding, intussusception, or viral myocarditis and endangering life.

First look at infectious and non-infectious diarrhea.

1, Infectious diarrhea:

The main causes of acute infectious diarrhea (also called acute gastroenteritis) include viral, bacterial, and protozoan infections. This is diarrhea caused by pathogens invading epithelial cells and causing inflammation.

(1) Bacterial infection. Taking food or drink contaminated by bacteria can cause bacterial diarrhea. Bacteria mainly include Vibrio cholerae, dysentery, Salmonella typhi, Campylobacter, Shigella, enterotoxin-producing Escherichia coli and Clostridium difficile.

(2) Viral infection, viral diarrhea caused by infection through food or other means. Viruses mainly include Norovirus, Rotavirus, Adenovirus, Astrovirus, Coxsackie virus, Echo virus and so on.

(3) Parasitic infections, mild infections usually have no obvious symptoms. When the infection is severe, the patient may have lower abdominal pain and tenderness, chronic diarrhea, and stool with blood or occult blood. Patients with severe infections may experience prolapse, anemia, malnutrition, and weight loss. The protozoa mainly include Cryptosporidium, Giardia, Cyclospora, and Entamoeba.

Taken together, most cases of acute infectious diarrhea may be caused by viruses and are self-limiting. This is because in most studies of diarrhea, only 1.5%-5.6% cases with positive fecal bacterial culture. However, in patients with severe diarrhea, most cases are caused by bacterial causes. Parasites are rarely found as the pathogen of acute gastrointestinal diseases.

2, Non-infectious diarrhea:

(1) Acute toxic diarrhea caused by eating undercooked, spoiled toxic food or artificial chemical additives;

(2) Diarrhea caused by gastrointestinal indigestion caused by eating gas-producing foods, cold foods and beverages;

(3) Diarrhea caused by eating foods that contain certain anti-nutrients or cause inflammation;

(4) Diarrhea caused by accelerated bowel movements due to cold and other factors;

(5) Diarrhea caused by gastrointestinal motility disorder and gastrointestinal dysfunction;

(6) Diarrhea caused by gastrointestinal tumors or other diseases.

3, Dysentery

Dysentery is an aggressive diarrhea, often accompanied by fever and abdominal pain. It is an acute intestinal infectious disease caused by dysentery bacillus, rather than bacterial enteritis in a broad sense. Defined as diarrhea with visible blood or mucus, which is different from watery diarrhea.

In fact, dysentery is the name of a disease in traditional Chinese medicine, which is roughly equivalent to acute infectious diarrhea in Western medicine. Chinese medicine believes that dysentery is clinically characterized by red, white, pus, blood, abdominal pain, and tenesmus. The main cause is the pathogenic virus from exogenous infection, internal injury and unclean diet; the disease is located in the intestine, which is closely related to the spleen and stomach.

According to different infectious pathogenic organisms, it is divided into bacillary dysentery and amoebic dysentery. The vast majority of invasive diarrhea caused by bacterial enteritis does not need to be treated with antibiotics, just use probiotics.

(1) Bacillary dysentery (shigellosis), referred to as bacillary dysentery, is a kind of pseudomembranous enteritis (fibrinitis) caused by dysentery bacillus. Shigella directly invades the intestinal mucosa from epithelial cells. The lesions are mostly confined to the colon (sigmoid colon and rectum), and are characterized by a large amount of cellulose sticking out to form pseudomembranous inflammation. The pseudomembrane falls off with irregular superficial ulcers. Divided into acute bacillary dysentery, chronic bacillary dysentery, and toxic bacillary dysentery.

Bacterial dysentery is mainly spread through the hands of carriers. Bacillary dysentery caused by contaminated water or food occurs mostly in summer. Bacterial dysentery has a wide range of prevalence, rapid spread and high incidence. It is more common in adolescents and children. After the disease, there is only a short-term and unstable immunity. Humans are generally susceptible to bacillary dysentery, causing the disease to break out, especially in flood disaster areas. Once the water source is polluted, it is more likely to occur. The main clinical manifestations are diarrhea, abdominal pain, tenesmus, pus-blood stool, and fever.

(2) Amoebic dysentery (amoebic dysentery) is caused by the infection of the colon by amoebic histolytica, which is mainly transmitted through fecal pollution. It is more common in rural areas with poor sanitation in tropical areas. The incidence is higher in summer and autumn, among which adult male patients are more common. Patients have no immunity after illness and are prone to repeated infections. Severe patients may experience intestinal bleeding, intestinal perforation, and peritonitis. Some patients will be asymptomatic. Generally speaking, the onset is relatively slow, there is no fever, diarrhea, foul smell, bloating, and abdominal pain in the right lower abdomen. Frail and malnourished patients may have outbreak symptoms: rapid onset, high fever, severe abdominal pain, and watery stools.

The difference between dysentery and diarrhea

First of all, dysentery can cause diarrhea; and diarrhea does not include dysentery (some medical institutions believe that dysentery is more prone to enteritis), and there are many other types of diarrhea. Secondly, dysentery is an intestinal infectious disease caused by dysentery bacilli. If it is not treated in time, it will be transmitted to other people. Most diarrhea is not infectious and the causes are also diverse. As long as it is controlled by drugs in time , And pay attention to diet, the possibility of recurrence will be greatly reduced. Finally, dysentery can occur all year round, but it is more common in summer and autumn. Acute diarrhea is more common in summer and autumn. Due to different conditions, acute and chronic diarrhea will occur. The course of chronic diarrhea is relatively long, and diarrhea will occur repeatedly.

What dysentery and diarrhea have in common

The common point of dysentery and diarrhea is that they will have abdominal pain. In severe cases, they will cause dehydration and electrolyte imbalance, which is life-threatening, especially for the elderly and children with weaker resistance. Therefore, in the treatment of dysentery and diarrhea, it is necessary to replenish fluids in time to prevent dehydration and relieve electrolyte disturbances.

classification-and-causes-of-diarrhea1

Let’s look at other types of diarrhea.

1, COVID-19Diarrhea caused by a virus

A report in the “Intestine”, a professional journal focusing on gastrointestinal diseases, summarized some of the research results: The incidence of typical gastrointestinal symptoms (such as diarrhea) caused by the COVID-19 virus is low, ranging from 1% To 3.8%. But later research in China found that the incidence of diarrhea caused by the COVID-19 virus was higher. One of the studies in 95 hospitalized patients found that about 12% patients had gastrointestinal symptoms at the time of admission. Later, about 50% patients developed GI (gastrointestinal) symptoms (that is, gastrointestinal GI symptoms, including diarrhea, nausea, And vomiting). In some cases, the patient is taking antibiotics, which may also cause diarrhea.

The report also said that some studies have found the virus in stool samples and the intestinal lining, indicating that the virus may infect the intestines of some people. The report warned that the virus may last longer in the intestines than in the respiratory tract. It is not clear whether the virus can be transmitted through feces (feces). In fact, the target that the COVID-19 virus binds to human cells is called angiotensin-converting enzyme 2 (ACE2) receptor, which causes inflammation of blood vessels. Therefore, the symptoms of enteritis and diarrhea are inevitable.

2, Diarrhea caused by cholera

Cholera is an acute diarrheal infectious disease caused by the contamination of food or water with Vibrio cholerae. Every year, there are an estimated 3 to 5 million cases of cholera and another 100,000 to 120,000 deaths. The peak of the disease is in summer, which can cause diarrhea, dehydration and even death within a few hours. Vibrio cholerae is found in water, and the most common cause of infection is the consumption of water that has been contaminated by patient feces. Vibrio cholerae can produce cholera toxins and cause secretory diarrhea. Even if you no longer eat, it will continue to have diarrhea. Rice-washed feces are a characteristic of cholera.

3, Antibiotic-related diarrhea

About one-fifth of children taking antibiotics have diarrhea. Any type of antibiotics can cause diarrhea. Antibiotic-related diarrhea is relatively rare in children 2 years of age and older. For most children, this type of diarrhea is mild. As long as the child is not dehydrated, it is generally harmless. Dehydration means that the body does not have enough fluid. Signs of dehydration include decreased urination, irritability, fatigue, and dry mouth. Children's love to play means good hydration.

Children with antibiotic-related diarrhea during antibiotic use have loose and watery stools. In most cases, diarrhea lasts from 1 to 7 days. Diarrhea usually starts between the 2nd and 8th days of antibiotic medication. However, diarrhea occurs on the first day after stopping antibiotics for several weeks.

The cause of antibiotic-related diarrhea is that there are millions of tiny bacteria (probiotics) in the human intestine (gastrointestinal) that help digest food. When antibiotics kill harmful bacteria that can cause infection, they also kill these beneficial bacteria. The process of death and regeneration of these bacteria in the gastrointestinal tract causes diarrhea.

4, Leaky gut syndrome

The intestinal mucosa of healthy people has a mucus protective film (including a film composed of probiotics). The probiotic film on this protective film allows the digested nutrients to penetrate into the blood system for human use. Macromolecules that should not enter the blood are blocked from the cells of the intestinal wall. Of course, this probiotic membrane can also help break down and digest some macromolecules until they can penetrate into the blood system.

When the human intestinal permeability increases, a large number of probiotic membranes in the intestinal lining die, forming some invisible "holes", many macromolecules that should not enter the blood, such as food proteins and fats that have not been completely digested , Bacteria and bacterial toxins in the intestines will take the opportunity to enter and enter the blood circulation system of the human body, thereby triggering a series of abnormal immune reactions, and even autoimmune reactions.

Symptoms of patients with leaky gut syndrome may include: diarrhea, flatulence, stomach pain, constipation, diarrhea, skin rash (eczema, atopic dermatitis), food intolerance, muscle pain, joint pain, poor memory in adults, and childhood Motility, lack of concentration, unexplained fever, headache, physical deterioration, anxiety, fatigue syndrome, etc. Even more frightening is that leaky gut syndrome may also directly lead to the occurrence of autoimmune diseases! The latest research shows that almost all patients with autoimmune diseases have already suffered from leaky gut syndrome before the disease. The clearest relationship with intestinal leakage is that the autoimmune disease is celiac disease (inflammation of the intestinal mucosa, villi atrophy and crypt hyperplasia).

5, Travelers diarrhea

Diarrheal diseases related to travel behavior are collectively referred to as travelers' diarrhea. The main symptoms of traveler's diarrhea include three or more bowel movements a day, irregular stools, watery stools as the most common form, and gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. The theory of traditional Chinese medicine is that the soil is not accustomed to it.

Pathogenic pathogens such as bacteria, viruses, parasites and fungi are the main causes of travellers' diarrhea. Sudden changes in weather can also cause diarrhea. Under normal circumstances, travelers may be infected by drinking water and food contaminated by pathogens such as bacteria, viruses, parasites, and fungi. In addition, it may be infected through close contact with animals.

6, Tension diarrhea

Tension diarrhea is mostly caused by "irritable bowel syndrome" caused by excessive stress and excessive emotional tension, causing disorders of intestinal movement and secretion and absorption. This type of diarrhea is clinically manifested as hyperintestinal sounds, abdominal pain, bloating, loose stools, insomnia, loss of appetite, etc. After the mental stress is relieved, the symptoms will disappear soon. In fact, diarrhea is caused by the linkage of the gut-brain axis between the brain and the gut brain (second brain).

7, Infant diarrhea

In the first few months of life, it is normal for many breastfed babies to have loose stools. If the baby has a sudden increase in stool, it may be diarrhea. Other signs of diarrhea include mucus or blood in stool, and foul smelling stool is also a sign of diarrhea. If you think that your baby has diarrhea, please continue to increase the number of feedings; when your baby has diarrhea, please do not stop breastfeeding; milk powder-fed babies should continue to eat the usual milk powder when they have diarrhea, do not dilute the milk powder; if the baby does not vomit, then According to the baby's needs, provide more milk powder and increase the number of feedings.

The cause of infant diarrhea is that the baby’s gastrointestinal tract is not mature enough, and the enzyme activity is low, but the nutritional needs are relatively high, and the gastrointestinal tract is heavy; the nerve, endocrine, circulatory system and liver and kidney function development are all immature in infancy , The regulation function is poor; the immune function of the baby is not perfect, the serum E. coli antibody titer is the lowest from birth to 2 years old, and then gradually increases; the body fluid distribution of the baby is different from that of the adult, the extracellular fluid accounts for a higher proportion, and the water metabolism is strong , The regulation function is poor, and the body fluid and electrolyte disorder are more likely to occur; the digestive function disorder caused by food and so on.

8, Newborn lactose intolerance

Neonatal lactose intolerance is also one of the causes of diarrhea, but there are few studies on the incidence of neonatal lactase deficiency. Dairy products are the main energy source for newborns. Lactose provides about 20% of energy for newborns and participates in the development of the brain. If lactase deficiency causes lactose malabsorption and clinical symptoms of the digestive system appear, it is called lactose intolerance. One of the commonly used clinical treatments after neonatal diarrhea is to replace the milk consumed by the children with lactose-free formula milk, because these children may have lactose intolerance.

9,other

Patients with persistent fever, bloody diarrhea, severe abdominal pain, history of inflammatory bowel disease, or symptoms of insufficient volume (eg, oliguria or dark color, symptoms of orthostatic hypotension, etc.) need to be evaluated for acute diarrhea in the clinic. If the patient has these problems, especially if the patient has obvious vascular or cardiovascular disease or a complicated history of immunosuppression (eg, due to treatment of malignant tumors, a history of transplantation, or advanced HIV infection), the patient may need to be admitted to the hospital.

In addition, flood disease refers to seven types of diseases that are prone to occur in flood-affected areas: intestinal infectious diseases, such as cholera, dysentery, typhoid fever, hepatitis A, infectious diarrhea, etc.; natural foci diseases, such as epidemic hemorrhagic fever, Leptospirosis, etc.; vector-borne infectious diseases, such as malaria, Japanese encephalitis, etc.; parasitic diseases, such as schistosomiasis, etc.; poisoning, such as food poisoning, pesticide poisoning. Among them, most diseases will have diarrhea symptoms.

Regardless of the cause of diarrhea, keeping these excrement in the body is not the best choice, especially the toxins and necrotic cells in the intestines can cause further infections. Moderate diarrhea is also a protective mechanism for the human body to its own health, which can excrete toxins and necrotic cells in the intestine.

The problem of diarrhea is also consumption. In particular, diarrhea caused by dysentery and cholera may cause patients to have more than 20 diarrhea a day, causing dehydration of the body. Therefore, the more severe the diarrhea, the more electrolytes and adequate water needs to be added in time; if you can’t eat it, you must use infusion to replenish it.

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Finally, talk about the concept of enteritis.

Enteritis is enteritis and colitis caused by bacteria, viruses, fungi and parasites. The main clinical manifestations are abdominal pain, diarrhea, loose watery stools or mucus pus and bloody stools. Some patients may have fever and tenesmus, so it is also called infectious diarrhea.

Enteritis is divided into acute and chronic according to the length of the disease. Acute is usually caused by a virus. The course of chronic enteritis is generally more than two months. The common clinical symptoms include chronic bacillary dysentery, chronic amoebic dysentery, schistosomiasis, non-specific ulcerative colitis and limited enteritis.

Causes of enteritis

1. Viral enteritis: Viral enteritis is found in enteritis caused by canine distemper virus, canine parvovirus, and canine and cat coronavirus. In viral enteritis, rotavirus is the main cause of diarrhea in infants and young children, while Norwalk virus is the main cause of epidemic viral gastroenteritis in adults and older children.

2. Bacterial enteritis: bacterial enteritis can be caused by Escherichia coli, Salmonella, Yersinia (causing enterocolitis), Bacillus trichomonas, Campylobacter jejuni, Clostridium (canine hemorrhagic gastroenteritis), etc. enteritis. The most common pathogenic bacteria of bacterial enteritis is Shigella, followed by Campylobacter jejuni and Salmonella.

3. Fungal enteritis: Fungal enteritis can be caused by histoplasma, algae, Aspergillus, Candida albicans, etc. Fungal enteritis is most caused by Candida albicans.

4. Parasitic intestine: parasitic enteritis can be caused by flagella, coccidia, toxoplasma, roundworm, hookworm, etc. Enteritis caused by parasites is more common with endoamoeba histolytica.

5. Enteritis caused by diet: Polluted or spoiled food, irritating chemicals, certain heavy metal poisoning, and certain allergies can cause enteritis.

6. Enteritis caused by antibiotics: the abuse of antibiotics leads to imbalance of intestinal flora, or enteritis caused by antibiotic-resistant strains.

Final conclusion

1. Diarrhea is the name of clinical symptoms, and enteritis is the name of pathological diagnosis. The two may refer to the same type of disease, or they may be different, but the emphasis is different;

2. Diarrhea is concerned with dehydration, electrolytes, nutrition, toxins, and germs, while enteritis is concerned with inflammation, gastrointestinal and digestive problems, including liver, gallbladder, pancreas and so on. In addition to diarrhea, enteritis also has clinical manifestations such as abdominal pain, indigestion, and bloody stools in severe cases.

3. Generally speaking, diarrhea and enteritis are intestinal problems. To solve emergencies, you can temporarily consider antidiarrheal drugs or antibiotics, but detoxification and nutrition need to be paid attention to at the same time; the first one or two days to empty toxins or germs, so one or two fasting meals is wise, but it is also necessary to add water and electrolytes of. For chronic diseases, nutritional balance and microecological preparations are the best choice; of course, abdominal massage and abdominal warmth are the focus of abdominal health management. For specific personalized professional programs, please consult Huizhou Million Dragon Education, a Canadian registered dietitian and registered health manager: Dr. Long.

*** Every article, Huizhou’s experts have carefully written, edited and checked, please trust the experts’ opinions and suggestions,If you have any questions, please email info@chelsea98.com *** Dr. Kyle Long, Chief Health Officer of Million Dragons of Huizhou, registered dietitian, registered health manager – "sincerity, clarity and efficiency" personalized improvement of FAH financial quotient

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