DIARRHEA

Acute  diarrhea  is ≤14 days in duration  and is commonly due to infections with viruses and bacteria .
Most cases are self limited ,but work up is indicated in the following instances:
Profuse watery diarrhea with signs of hypovolemia
Passage of many small volume stools containing blood and mucus
Bloody diarrhea
Temperature ≥38.5ºC (101.3ºF)
Passage of ≥6 unformed stools per 24 hours or a duration of illness >48 hours
Severe abdominal pain
Recent use of antibiotics or hospitalized patients
Diarrhea in the elderly (≥70 years of age) or the immunocompromised

Stool cultures on initial presentation in the following groups of patients:
Immunocompromised patients
Patients with more severe, inflammatory diarrhea (including bloody diarrhea)
Patients with underlying inflammatory bowel disease
Some employees, such as food handlers, occasionally require negative stool cultures to return to work
Treatment
General measures such as hydration and alteration of diet.
Boiled starches and cereals ( potatoes, rice ) with salt, crackers, bananas, soup, and boiled vegetables are indicated in patients with watery diarrhea.
Secondary lactose malabsorption is common following infectious enteritis and temporary avoidance of lactose-containing foods may be reasonable.
Antimotility agent loperamide (Imodium) can  be used for the symptomatic treatment of patients with acute nonbloody diarrhea in whom fever is absent

Antibiotic therapy is not required in most cases since the illness is usually self-limited.

Chronic diarrhea, defined as the production of loose stools with or without increased stool

frequency for more than 4 weeks, is a common symptom that has prevalence in the United

States of approximately 3%–5%.

CAUSES
Irritable bowel syndrome
Inflammatory bowel disease   ( Crohn’s  and Ulcerative colitis)
Infections –   Clostridium difficile, Camyplobacter, Giardia, Amebae
Medications

DIAGNOSIS

A detailed medical history often points to the underlying cause of chronic diarrhea.

Blood tests and stool evaluation should be done prior to endoscopic evaluations

TREATMENT
Treat the underlying cause ( such as Colitis)
Relieve the diarrhea (peptobismol, psyllium, Loperamide, Lomotil)
Address any complications that result from long-standing or severe diarrhea

For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.cdc.gov/
www.niddk.nih.gov
www.gastro.org
www.ccfa.org
www.ibsgroup.org
www.aboutibs.org