Example of each type of Diarrhea Secretory Secretory diarrhea means that there is an increase in the active secretion, or there

is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin . Cholera toxin is a protein complex secreted by the bacterium Vibrio cholerae .CTX is responsible for the massive, watery diarrhea characteristic of cholera infection. Cholera is an infection in the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are watery diarrhea and vomiting. Transmission occurs primarily by drinking water or eating food that has been contaminated by the feces (waste product) of an infected person. The primary treatment is oral rehydration therapy, typically with oral rehydration solution, to replace water and electrolytes. If this is not tolerated or does not provide improvement fast enough, intravenous fluids can also be used. Antibacterial drugs are beneficial in those with severe disease to shorten its duration and severity. Prevention of the disease is normally straightforward if proper sanitation practices are followed. Osmotic Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also be the result of maldigestion (e.g. Coeliac disease), in which the nutrients are left in the lumen to pull in water. Vitamin deficiencies are often noted in people with coeliac disease owing to the reduced ability of the small intestine to properly absorb nutrients from food. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In most cases this causes symptoms which may include abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi (rumbling stomach), or vomiting after consuming significant amounts of lactose. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped. Exudative Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis. Crohn's disease is a type of inflammatory bowel disease that may affect any part of the gastrointestinal from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting (can be continuous), or weight loss. Crohn's disease is one type of inflammatory bowel disease (IBD). It typically manifests in the gastrointestinal tract and can be categorized by the specific tract region affected. A disease of both the ileum (the last part of the small intestine that

connects to the large intestine) and the large intestine, Ileocolic Crohn's accounts for fifty percent of cases. Crohn's ileitis, manifest in the ileum only, accounts for thirty percent of cases, while Crohn's colitis, of the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis. Gastroduodenal Crohn's disease causes inflammation in the stomach and first part of the small intestine, called the duodenum. Jejunoileitis causes spotty patches of inflammation in the top half of the small intestine, called the jejunum .The disease can attack any part of the digestive tract, from mouth to anus. A colonoscopy is the best test for making the diagnosis of Crohn's disease, as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement. On occasion, the colonoscope can travel past the terminal ileum, but it varies from patient to patient. During the procedure, the gastroenterologist can also perform a biopsy, taking small samples of tissue for laboratory analysis, which may help confirm a diagnosis.Acute treatment uses medications to treat any infection (normally antibiotics) and to reduce inflammation (normally aminosalicylate anti-inflammatory drugs and corticosteroids). Ulcerative colitis is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the colon (large intestine), includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset. There are no direct known causes for ulcerative colitis, but there are many possible factors such as genetics and stress. Ulcerative colitis can be treated with a number of medications including 5-ASA drugs such as Sulfasalazine and Mesalazine. Corticosteroids such as prednisone can also be used due to their immunosuppressing and short term healing properties, but due to the risks outweighing the benefits, they are not used long term in treatment. Immunosuppressive medications such asazathioprine, and biological agents such as infliximab and adalimumab are given lastly, only if patients cannot achieve remission with 5-ASA and Corticosteroids, due to their possible risk factors, including, but not limited to increased risk of cancers in teenagers and adults, TB and new or worsening heart failure. (These side effects are rare.)

Motility-related Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and occasionally real diarrhea .Pseudodiarrhea, formerly known as hyperdefecation, is defined as increased stool frequency (more than three times daily) with a normal daily stool weight of less than 300g .Pseudodiarrhea is often associated with rectal urgency and accompanies irritable bowel syndrome, hyperthyroidism, and anorectal disorders such as proctitis. Patients with rectal obstruction (e.g., from fecal impaction, obstruction due to a vaginal pessary) may also present with pseudodiarrhea, since only liquid stool can make it through. Diarrhea can be treated with antimotility

agents (such as loperamide). Hypermotility can be observed in people who have had portions of their bowel removed, allowing less total time for absorption of nutrients.

Inflammatory Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by Tuberculosai, Colon Cancer and Enteritis.Tuberculosis infectious disease caused by various strains ofmycobacteria, usually Mycobacterium tuberculosis. Infection of other organs causes a wide range of symptoms. Diagnosis of active TB relies on radiology(commonly chest X-rays), as well as microscopic examination and microbiological culture of body fluids. Diagnosis of latent TB relies on thetuberculin skin test (TST) and/or blood tests. Treatment is difficult and requires administration of multiple antibiotics over a long period of time. Social contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in multiple drug-resistant tuberculosis (MDR-TB) infections. Prevention relies on screening programs and vaccination with the bacillus Calmette Gurin vaccine.Colorectal cancer, commonly known as colon cancer or bowel cancer, is a cancer from uncontrolled cell growth in the colon or rectum (parts of the large intestine), or in the appendix. Genetic analysis shows that essentially colon and rectal tumours are genetically the [1] same cancer. Symptoms of colorectal cancer typically include rectal bleeding and anemia which are sometimes associated with weight loss and changes in bowel habits. Localized bowel cancer is usually diagnosed through sigmoidoscopy or colonoscopy.Cancers that are confined within the wall of the colon are often curable with surgery while cancer that has spread widely around the body is usually not curable and management then focuses on extending the person's life via chemotherapy and improving quality of life.enteritis from Greek words enteron (Small Intestine) and suffix -itis (Inflammation), refers to inflammation of the small intestine. It is most commonly caused by the ingestion of substances contaminated with pathogenic microorganisms. Symptoms include abdominal pain, cramping, diarrhea, dehydration and fever.

Dysentery Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella. Shigella infection is typically via ingestion (fecaloral contamination); depending on age and condition of the host, fewer than 100 bacterial cells can be enough to cause an infection. Shigellacauses dysentery

that results in the destruction of the epithelial cells of the intes The diagnosis of Shigellosisis made by isolating the organism from diarrheal fecal samples submitted for culture.tinal mucosa in the cecum and rectum. Hand washing before handling food and thoroughly cooking all food before eating decreases the risk of getting Shigella. Severe dysentery can be treated with ampicillin, TMP-SMX, or fluoroquinolones, such as ciprofloxacin, and of course rehydration. Medical treatment should only be used in severe cases or for certain populations with mild symptoms (elderly, immunocompromised, food service industry workers, child care workers). Antibiotics are usually avoided in mild cases because some Shigella are resistant to antibiotics, and their use may make the germ even more resistant. Antidiarrheal agents may worsen the sickness, and should be avoided.For Shigella-associated diarrhea,antibiotics shorten the length of infection. Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus Entamoeba. It can be diagnosed by stool samples, but it is important to note that certain other species are impossible to distinguish by microscopy alone. Trophozoites may be seen in a fresh fecal smear and cysts in an ordinary stool sample. ELISA or RIA can also be used. Metronidazole for the invasive trophozoites PLUS a lumenal amoebicide for those still in the intestine.Paromomycin (Humatin) is the luminal drug of choice, since Diloxanide furoate (Furamide) is not commercially available in the USA or Canada (being available only from the Centers for Disease Control and Prevention). A direct comparison of efficacy showed that Paromomycin had a higher cure rate.Paromomycin (Humatin) should be used with caution in patients with colitis, as it is both nephrotoxic and ototoxic. Absorption through the damaged wall of the intestinal tract can result in permanent hearing loss and kidney damage. Recommended dosage: Metronidazole 750 mg three times a day orally, for 5 to 10 days FOLLOWED BY Paromomycin 30 mg/kg/day orally in 3 equal doses for 5 to 10 days or Diloxanide furoate 500 mg 3 times a day orally for 10 days, to eradicate lumenal amoebae and prevent relapse. Salmonella is closely related to the Escherichia genus and are found worldwide in cold- and warmblooded animals (including humans), and in the environment. They cause illnesses such as typhoid fever, paratyphoid fever, and foodborne illness. Salmonella infections are zoonotic and can be transferred between humans and nonhuman animals. Many infections are due to ingestion of contaminated
food.