Materiały źródłowe

• #1 Stomach woes: causes and solutions for vomiting and diarrhea | CityMD

  https://www.citymd.com/health-and-wellness/stomach-woes-causes-and-solutions-for-vomiting-and-diarrhea

  Sometimes, your body resorts to this „one-two punch” as a defense mechanism against something it perceives as harmful. […] Your stomach and intestines are well-connected. When your stomach senses trouble like bacteria or a virus, it can respond by emptying its contents rapidly, leading to vomiting. […] At the same time, your intestines might speed up their processes, resulting in diarrhea. This helps flush out anything harmful. […] Having diarrhea and vomiting at the same time is usually your body’s way of swiftly dealing with a potential threat. It’s a sign that your body’s defenses are at work; however, monitor your symptoms to ensure they don’t become severe. […] In most cases, these symptoms are temporary and your body’s way of dealing with irritants or discomfort.

• #1 Diarrhea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928598-overview

  Diarrhea is the reversal of the normal net absorptive status of water and electrolyte absorption to secretion. The augmented water content in the stools (above the normal value of approximately 10 mL/kg/d in the infant and young child, or 200 g/d in the teenager and adult) is due to an imbalance in the physiology of the small and large intestinal processes involved in the absorption of ions, organic substrates, and thus water. […] Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretory state induced in the enterocytes. In the former case, diarrhea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in lactose malabsorbers. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-induced diarrhea.

• #1 Travelers’ Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html

  Travelers’ diarrhea (TD) is a clinical syndrome that can result from a variety of intestinal pathogens. Bacteria are the predominant enteropathogens and are thought to account for 75%90% of cases. Intestinal viruses account for at least 10%25% of illnesses and are more commonly associated with vomiting. […] In toxin-mediated illness, both vomiting and diarrhea can be present; symptoms usually resolve spontaneously within 1224 hours. […] Bacterial and viral TD present with the sudden onset of symptoms that can range from mild cramps and urgent loose stools to severe abdominal pain, bloody diarrhea, fever, and vomiting; with norovirus, vomiting can be more prominent. Diarrhea caused by protozoa (e.g., Cryptosporidium, Giardia duodenalis) may have a more gradual onset of low-grade symptoms, with 25 loose stools per day.

• #1 Infectious diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3035144/

  Diarrhea caused by enteric infections is a major factor in morbidity and mortality worldwide. This review highlights the cellular and molecular mechanisms underlying diarrhea associated with the three classes of infectious agents, i.e., bacteria, viruses and parasites. The underlying mechanisms of infectious diarrhea discussed include alterations in ion transport and tight junctions as well as the virulence factors, which alter these processes either through direct effects or indirectly through inflammation and neurotransmitters. […] Enteric pathogens can either directly modulate epithelial ion transport processes and barrier function or do so indirectly through inflammation, neuropeptides or loss of absorptive surface. […] This review highlights selected pathogens, which provide both a broad overview of the mechanisms pertaining to ion transport and barrier function that underlie pathophysiology of diarrhea, and presents recent advances regarding specific infectious agents. Major emphasis will be placed on the mechanisms underlying the pathogenesis of bacterial diarrhea, which has been extensively studied in recent years and has served as an important prototype for understanding regulation of intestinal epithelial processes at the cellular and molecular level.

• #1 What Causes Concurring Vomiting and Diarrhea

  https://www.advanceer.com/resources/blog/2023/october/what-causes-concurring-vomiting-and-diarrhea/

  Many viral infections can cause concurrent vomiting and diarrhea. One of the most common culprits is the norovirus, which is notorious for causing gastroenteritis outbreaks on cruise ships, in schools, and other crowded settings. Rotavirus, another viral infection, primarily affects infants and young children and can lead to severe diarrhea and vomiting. […] Bacterial infections, particularly those caused by pathogens like Salmonella, E. coli, and Campylobacter, can lead to a condition called bacterial gastroenteritis. These infections typically result from consuming contaminated food or water. The toxins these bacteria produce can irritate the gastrointestinal lining, leading to vomiting and diarrhea. […] Certain parasites, such as Giardia and Cryptosporidium, can cause gastrointestinal distress, resulting in both vomiting and diarrhea. These infections are typically contracted by ingesting contaminated water or food.

• #1 Pathophysiology of Diarrhea

  https://vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/diarrhea.html

  Diarrhea is an increase in the volume of stool or frequency of defecation. […] There are numerous causes of diarrhea, but in almost all cases, this disorder is a manifestation of one of the four basic mechanisms described below. […] A distinguishing feature of osmotic diarrhea is that it stops after the patient is fasted or stops consuming the poorly absorbed solute. […] Diarrhea occurs when secretion of water into the intestinal lumen exceeds absorption. […] Many millions of people have died of the secretory diarrhea associated with cholera. […] Exposure to toxins from several other types of bacteria induce the same series of steps and massive secretory diarrhea that is often lethal unless the person or animal is aggressively treated to maintain hydration. […] Disruption of the epithelium of the intestine due to microbial or viral pathogens is a very common cause of diarrhea in all species. […] The immune response to inflammatory conditions in the bowel contributes substantively to development of diarrhea. […] Disorders in motility than accelerate transit time could decrease absorption, resulting in diarrhea even if the absorptive process per se was proceeding properly.

• #1 Pediatric Gastroenteritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/964131-overview

  Adequate fluid balance in humans depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract; diarrhea occurs when intestinal fluid output overwhelms the absorptive capacity of the gastrointestinal tract. The 2 primary mechanisms responsible for acute gastroenteritis are (1) damage to the villous brush border of the intestine, causing malabsorption of intestinal contents and leading to an osmotic diarrhea, and (2) the release of toxins that bind to specific enterocyte receptors and cause the release of chloride ions into the intestinal lumen, leading to secretory diarrhea. […] Even in severe diarrhea, however, various sodium-coupled solute co-transport mechanisms remain intact, allowing for the efficient reabsorption of salt and water. By providing a 1:1 proportion of sodium to glucose, classic oral rehydration solution (ORS) takes advantage of a specific sodium-glucose transporter (SGLT-1) to increase the reabsorption of sodium, which leads to the passive reabsorption of water. Rice and cereal-based ORS may also take advantage of sodium-amino acid transporters to increase reabsorption of fluid and electrolytes.

• #1 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Vomiting and diarrhea in pregnancy can also be caused by hormonal changes, new food sensitivities, and dietary changes. Prenatal vitamins also cause diarrhea in some people. […] Overindulging in food or drink can cause vomiting and diarrhea at the same time along with: upset stomach, heartburn, belching, a feeling of uncomfortable fullness. […] The type of food you eat also matters. Eating large amounts of greasy or sugary foods may irritate your stomach and cause vomiting and diarrhea at the same time within hours. […] Vomiting and diarrhea are potential side effects of many medications. This may be related to the way the medication works or because it contains additives that irritate the stomach. […] One way antibiotics can cause vomiting and diarrhea is by killing the good bacteria that live in your GI tract. This allows bacteria called Clostridioides difficile to become overgrown, which can result in symptoms similar to severe food poisoning.

• #1 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Vomiting and watery diarrhea are the most common symptoms of food poisoning. Other symptoms include: abdominal pain and cramping, nausea, fever, bloody diarrhea. […] Travelers diarrhea is a digestive tract disorder thats most often caused by viruses, parasites, or bacteria in water or food. […] Travelers diarrhea generally clears up within a week. Watery diarrhea and cramps are the most common symptoms, but travelers diarrhea can also cause: nausea, fever, flatulence (gas), bloating, tenesmus, or the urgent need to have a bowel movement. […] Gastrointestinal function may be influenced by the stress response. In fact, stress and anxiety commonly cause a number of gastrointestinal symptoms, including: nausea, constipation, indigestion, heartburn. […] Stress hormones slow motility, or movement, in the stomach and small intestine. They also trigger an increase in motility in the large intestine, leading to some of these symptoms.

• #1 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Dehydration is a complication of vomiting and diarrhea, and it occurs when the body loses too much fluid. Dehydration can prevent your cells, tissues, and organs from functioning properly, leading to serious health challenges, including shock and even death. […] Symptoms of dehydration in babies, toddlers, and children include: persistent thirst, urinating less than usual, or going 3 or more hours without a wet diaper, dry mouth, sunken eyes or cheeks, decreased skin turgor, or elasticity, lack of energy, no tears when crying. […] Symptoms in adults include: extreme thirst, urinating less than usual, dry mouth, sunken eyes or cheeks, decreased skin turgor, fatigue, lightheadedness, dark-colored urine. […] Vomiting and diarrhea usually resolve within a few days without treatment. Home remedies and medications can help you manage your symptoms and avoid dehydration.

• #1 Post-Travel Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html

  Giardia duodenalis is the most likely parasitic pathogen to cause persistent diarrhea. […] Infection with Entamoeba histolytica, or amebiasis, can result in intestinal symptoms ranging from mild diarrhea to dysentery. […] Cryptosporidium spp. are emerging as common protozoans causing persistent diarrhea in both returning travelers and U.S. residents. […] Cyclospora spp. may cause protozoal infection generally acquired by ingestion of contaminated food. […] In some cases, persistent symptoms relate to chronic underlying GI disease or to a susceptibility unmasked by the enteric infection. […] Idiopathic inflammatory bowel disease, including Crohn’s disease, microscopic colitis, and ulcerative colitis, can occur after acute bouts of TD. One prevailing hypothesis is that in genetically susceptible people, an initiating exogenous pathogen changes the microbiota of the gut, thereby triggering inflammatory bowel disease.

• #1 Post-Travel Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html

  In some patients who present with persistent GI symptoms, healthcare professionals will not find a specific cause. After an acute diarrheal infection, patients might experience a temporary enteropathy characterized by villous atrophy, decreased absorptive surface area, and disaccharidase deficiencies, which can lead to osmotic diarrhea, particularly after consuming large amounts of fructose, lactose, sorbitol, or sucrose.

• #1 Gastroenteritis: Causes, Symptoms, and Treatment

  https://patient.info/digestive-health/diarrhoea/gastroenteritis

  Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, kidney failure may also develop. […] IBS is sometimes triggered by a bout of gastroenteritis. […] A lactose intolerance can sometimes occur for a while after gastroenteritis. This is known as secondary or acquired lactose intolerance. Your gut lining can be damaged by the episode of gastroenteritis.

• #1 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Viral or bacterial infections may cause diarrhea and vomiting, but these symptoms can also occur with other health conditions, like anxiety and parasites. […] Though a virus is usually the culprit, certain medical conditions and side effects of medications can also lead to vomiting and diarrhea at the same time. […] Vomiting and diarrhea can happen for a number of reasons. […] A stomach virus or bacterial gastrointestinal (GI) infection is the most likely cause in children, but these infections can also affect adults. […] A number of other reasons exist for these symptoms, such as drinking too much alcohol. Often, vomiting and diarrhea occur together with fever, but not always. […] Viral gastroenteritis is an intestinal infection and its often referred to as the stomach flu. It is, however, unrelated to influenza (the flu) since it is caused by different viruses.

• #2 Vomiting With Diarrhea

  https://www.seattlechildrens.org/conditions/a-z/vomiting-with-diarrhea/

  Most vomiting is caused by a viral infection of the stomach. Sometimes, mild food poisoning is the cause. […] Throwing up is the body’s way of protecting the lower intestines. […] Diarrhea is the body’s way of getting rid of the germs. […] The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid. […] Vomiting with watery diarrhea is the most common cause of dehydration.

• #2 Diarrhea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928598-overview

  In osmotic diarrhea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive; diarrheal stools promptly regress with discontinuation of the offending nutrient, and the stool ion gap is high, exceeding 100 mOsm/kg. […] In secretory diarrhea, the epithelial cells ion transport processes are turned into a state of active secretion. The most common cause of acute-onset secretory diarrhea is a bacterial infection of the gut. Several mechanisms may be at work. After colonization, enteric pathogens may adhere to or invade the epithelium; they may produce enterotoxins (exotoxins that elicit secretion by increasing an intracellular second messenger) or cytotoxins. They may also trigger release of cytokines attracting inflammatory cells, which, in turn, contribute to the activated secretion by inducing the release of agents such as prostaglandins or platelet-activating factor. Features of secretory diarrhea include a high purging rate, a lack of response to fasting, and a normal stool ion gap (ie, 100 mOsm/kg or less), indicating that nutrient absorption is intact.

• #2 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings

  Diarrheal disease is a leading cause of death worldwide. Among adults in resource-abundant settings, diarrhea is often a „nuisance disease” in the healthy individual. Most cases of acute diarrhea in adults are of infectious etiology, and most cases resolve with symptomatic treatment alone. When clinicians care for adults with diarrhea, two important decision points are when to perform stool testing and whether to initiate empiric antimicrobial therapy. Our approach to adults with acute diarrhea will be reviewed here and generally focuses on distinguishing those infectious etiologies for which treatment is beneficial from other causes. […] Diarrhea is defined as the passage of loose or watery stools, typically at least three times in a 24-hour period. It reflects increased water content of the stool, whether due to impaired water absorption and/or active water secretion by the bowel. Most cases of acute diarrhea are due to infections and are self-limited. The major causes of acute infectious diarrhea include viruses (norovirus, rotavirus, adenoviruses, astrovirus, and others), bacteria (Salmonella, Campylobacter, Shigella, enterotoxigenic Escherichia coli, Clostridioides difficile, and others), and protozoa (Cryptosporidium, Giardia, Cyclospora, Entamoeba, and others). Taken together, most cases of acute infectious diarrhea are likely viral, as indicated by the observation that stool cultures are positive in only 1.5 to 5.6 percent of cases in most studies. Among those with severe diarrhea, however, bacterial causes are responsible for more cases.

• #2 What Causes Concurring Vomiting and Diarrhea

  https://www.advanceer.com/resources/blog/2023/october/what-causes-concurring-vomiting-and-diarrhea/

  Many viral infections can cause concurrent vomiting and diarrhea. One of the most common culprits is the norovirus, which is notorious for causing gastroenteritis outbreaks on cruise ships, in schools, and other crowded settings. Rotavirus, another viral infection, primarily affects infants and young children and can lead to severe diarrhea and vomiting. […] Bacterial infections, particularly those caused by pathogens like Salmonella, E. coli, and Campylobacter, can lead to a condition called bacterial gastroenteritis. These infections typically result from consuming contaminated food or water. The toxins these bacteria produce can irritate the gastrointestinal lining, leading to vomiting and diarrhea. […] Certain parasites, such as Giardia and Cryptosporidium, can cause gastrointestinal distress, resulting in both vomiting and diarrhea. These infections are typically contracted by ingesting contaminated water or food.

• #2 Infectious diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3035144/

  The pathogenic process of C. difficile infection starts with initial colonization followed by the production of two distinct exotoxins, Toxin A and B (TcdA and TcdB), as well as an additional toxin called binary toxin (CDT) which is found in some hypervirulent strains of C. difficile. […] The C. difficile toxins initiate an extensive inflammatory cascade that causes increased damage to host tissues resulting in fluid exudation. […] The overall picture of E. histolytica infection depends both on parasite components, including cysteine proteases, amoebapores, serotonin and PGE2 as well as the host inflammatory response with no single component providing a complete answer.

• #2 Infectious diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3035144/

  Diarrhea caused by enteric infections is a major factor in morbidity and mortality worldwide. This review highlights the cellular and molecular mechanisms underlying diarrhea associated with the three classes of infectious agents, i.e., bacteria, viruses and parasites. The underlying mechanisms of infectious diarrhea discussed include alterations in ion transport and tight junctions as well as the virulence factors, which alter these processes either through direct effects or indirectly through inflammation and neurotransmitters. […] Enteric pathogens can either directly modulate epithelial ion transport processes and barrier function or do so indirectly through inflammation, neuropeptides or loss of absorptive surface. […] This review highlights selected pathogens, which provide both a broad overview of the mechanisms pertaining to ion transport and barrier function that underlie pathophysiology of diarrhea, and presents recent advances regarding specific infectious agents. Major emphasis will be placed on the mechanisms underlying the pathogenesis of bacterial diarrhea, which has been extensively studied in recent years and has served as an important prototype for understanding regulation of intestinal epithelial processes at the cellular and molecular level.

• #2 Pathophysiology of Diarrhea

  https://vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/diarrhea.html

  Diarrhea is an increase in the volume of stool or frequency of defecation. […] There are numerous causes of diarrhea, but in almost all cases, this disorder is a manifestation of one of the four basic mechanisms described below. […] A distinguishing feature of osmotic diarrhea is that it stops after the patient is fasted or stops consuming the poorly absorbed solute. […] Diarrhea occurs when secretion of water into the intestinal lumen exceeds absorption. […] Many millions of people have died of the secretory diarrhea associated with cholera. […] Exposure to toxins from several other types of bacteria induce the same series of steps and massive secretory diarrhea that is often lethal unless the person or animal is aggressively treated to maintain hydration. […] Disruption of the epithelium of the intestine due to microbial or viral pathogens is a very common cause of diarrhea in all species. […] The immune response to inflammatory conditions in the bowel contributes substantively to development of diarrhea. […] Disorders in motility than accelerate transit time could decrease absorption, resulting in diarrhea even if the absorptive process per se was proceeding properly.

• #2 Travelers’ Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html

  An acute (less than 2 weeks) bout of TD can lead to persistent enteric symptoms, even in the absence of continued infection. This presentation is commonly referred to as post-infectious irritable bowel syndrome. […] Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens. […] Antibiotics are effective in reducing the duration of diarrhea by approximately 12 days in cases caused by bacterial pathogens susceptible to the antibiotic prescribed. However, concerns about the adverse consequences of using antibiotics to treat TD remain.

• #2 Nausea and Diarrhea: 20 Causes, Symptoms, and Treatment

  https://www.healthline.com/health/nausea-and-diarrhea

  When your digestive system becomes irritated, or is exposed to something potentially damaging to your health, the nerves signal your system to expel its contents as quickly as possible. Vomiting, diarrhea, or both are the result. […] Gastroenteritis usually clears up on its own within a few days. Treatment is centered on avoiding dehydration by sipping water or other fluids. […] Symptoms include: diarrhea, vomiting, achiness, fever, chills. […] Food poisoning is caused by eating or drinking something contaminated with bacteria, a virus, or parasite. […] Symptoms include: watery diarrhea, nausea, vomiting, stomach cramps. […] Your digestive system can be adversely affected by fear, stress, or anxiety. It can cause diarrhea, vomiting, or dry heaving. […] Powerful emotions trigger the fight-or-flight response. This puts your body on high alert, activating stress hormones, such as adrenaline and cortisol. These hormones signal your intestines to empty.

• #2 Diarrhoea – symptoms, causes, self care and treatments | healthdirect

  https://www.healthdirect.gov.au/diarrhoea

  Medical treatments that may cause diarrhoea as a side effect include: some medicines for example, antibiotics, laxatives, if too many are taken, some treatments for cancer. […] Diarrhoea can lead to dehydration and an electrolyte (salt) imbalance, making it dangerous especially in very young or older people, who can get worse quickly. […] Gastroenteritis is the most common cause of diarrhoea. It is highly infectious, and mostly spread by contact with another person who has the illness. Gastroenteritis can also come from contaminated food. […] Diarrhoea may cause dehydration because more fluids are lost than normal. It can also lead to an imbalance in electrolytes (salts and minerals your body needs to function properly.) […] Ongoing diarrhoea can make it difficult for you to absorb nutrients from food and can lead to malnutrition.

• #2 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings

  The management of patients with acute diarrhea begins with general measures such as fluid repletion and nutrition maintenance, with adjustments in diet if necessary. Patients who have bothersome symptoms may benefit from symptomatic pharmacologic therapy. Antibiotic therapy is not indicated in most cases since the illness is usually self-limited. Nevertheless, empiric and specific antibiotic therapy may be appropriate in certain situations, mainly in patients with severe disease, with symptoms and signs suggestive of invasive bacterial infection, or at high risk for complications. […] The most critical therapy in diarrheal illness is rehydration, preferably by the oral route, with solutions that contain water, salt, and sugar. Oral rehydration solutions (ORS) may be more appropriate in patients with more severe diarrheal disease. ORSs were developed following the realization that, in many small bowel diarrheal illnesses, intestinal glucose absorption via sodium-glucose cotransport remains intact.

• #2 Diarrhoea causes – health conditions, infections, treatments | healthdirect

  https://www.healthdirect.gov.au/what-causes-diarrhoea

  Long-term health conditions that can cause diarrhoea are: inflammatory bowel disease, irritable bowel syndrome, food intolerances, malabsorption, encopresis, parasites. […] Crohn’s disease and ulcerative colitis are collectively known as inflammatory bowel disease. […] These conditions both cause flare-ups of gut symptoms, including diarrhoea that is watery. […] Irritable bowel syndrome is a bowel disorder with no clear physical cause. […] Symptoms of food intolerance can be: flatulence (wind), bloating, diarrhoea. […] Malabsorption disorders are conditions where your digestive system cannot absorb enough nutrients from your food. […] Diarrhoea then leaks out around the hard stool, without any warning. […] Parasites can cause ongoing diarrhoea.

• #2 Vomiting and diarrhea: Causes, treatments, and remedies

  https://www.medicalnewstoday.com/articles/vomiting-and-diarrhea

  Many conditions can cause diarrhea and vomiting, including intestinal infections and food poisoning. […] Gastroenteritis is an intestinal infection that can occur due to viruses, bacteria, or parasites. […] Viral gastroenteritis is highly contagious and spreads easily from person to person. […] Food poisoning occurs when someone eats or drinks contaminated food or water. […] The NIDDK state that some medications can also cause vomiting and diarrhea as a side effect. […] Long-term antibiotic use can change the gut flora in the large intestine and cause chronic digestive problems. […] Complications of diarrhea and vomiting include dehydration, electrolyte imbalances, fainting, and heart rhythm abnormalities. […] Young children can become dehydrated within a day after developing diarrhea and vomiting. […] Vomiting and diarrhea have many potential causes, but viruses, food poisoning, and medications are common. […] However, some causes of vomiting and diarrhea are more serious.

• #3 Diarrhea – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea

  Diarrhea is defined as stool weight 200 g/day. […] There are a number of causes of diarrhea. Several basic mechanisms cause most clinically significant diarrheas. The 3 most common are increased osmotic load, increased secretions/decreased absorption, and decreased contact time/surface area. […] Diarrhea occurs when unabsorbable, water-soluble solutes remain in the bowel and retain water. […] Diarrhea occurs when the bowels secrete more electrolytes and water than they absorb. […] Infections (eg, gastroenteritis) are the most common causes of secretory diarrhea. […] Unabsorbed dietary fat and bile acids (as in malabsorption syndromes and after ileal resection) can stimulate colonic secretion and cause diarrhea. […] Impaired absorption of bile salts, which can occur with several disorders, can cause diarrhea by stimulating water and electrolyte secretion.

• #3 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Common causes of gastroenteritis include: norovirus, rotavirus, adenovirus, astrovirus. […] These viruses are transmitted from person to person by contact with infected stool and vomit. This can happen when a person with the infection doesnt wash their hands thoroughly after using the restroom and then touches objects or prepares food for others. […] In addition to vomiting and watery diarrhea, symptoms of viral gastroenteritis include: abdominal pain and cramping, nausea, fever, on occasion. […] Food poisoning is an infection of the GI tract often caused by bacteria, parasites, or viruses. […] You can get food poisoning by eating contaminated food. This can happen at home or in restaurants when food is handled incorrectly or not cooked properly. […] Symptoms of food poisoning can start within hours of eating and often resolve within a few hours or days. Unless symptoms are severe, this usually happens without medical treatment.

• #3 Infectious diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3035144/

  The pathogenic process of C. difficile infection starts with initial colonization followed by the production of two distinct exotoxins, Toxin A and B (TcdA and TcdB), as well as an additional toxin called binary toxin (CDT) which is found in some hypervirulent strains of C. difficile. […] The C. difficile toxins initiate an extensive inflammatory cascade that causes increased damage to host tissues resulting in fluid exudation. […] The overall picture of E. histolytica infection depends both on parasite components, including cysteine proteases, amoebapores, serotonin and PGE2 as well as the host inflammatory response with no single component providing a complete answer.

• #3 Post-Travel Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-diarrhea.html

  While individual bacterial infections rarely cause persistent symptoms, travelers infected with bacteria known to cause mucosal inflammation, such as Campylobacter spp., Shigella spp., or Salmonella spp., as well as diarrheagenic Escherichia coli, can experience persistent diarrhea, including cases where the organism may be resistant against antibiotics commonly used for empiric treatment of TD. […] Clostridioides difficile-associated diarrhea can occur after or during antibiotic use, including malaria chemoprophylaxis. The association between C. difficile and antimicrobial treatment is especially important to consider in patients with persistent TD that seems refractory to multiple courses of empiric antibiotic therapy. […] As a group, parasites are the pathogens most likely to be isolated from patients with persistent diarrhea. Most parasitic infections have a less acute onset of symptoms than those caused by bacteria or viruses, and the probability of a traveler having a parasitic infection increases with increasing duration of symptoms.

• #3 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings

  In addition to informing the severity of disease, details on the frequency and nature of the stool can suggest whether the diarrhea is originating in the small or the large bowel, and thus can suggest certain pathogens. Diarrhea of small bowel origin is typically watery, of large volume, and associated with abdominal cramping, bloating, and gas. In contrast, diarrhea of large intestinal origin often presents with frequent, regular, small volume, and often painful bowel movements. […] These inflammatory signs associated with large bowel infection suggest invasive bacteria (e.g., Salmonella, Shigella, or Campylobacter), enteric viruses, Entamoeba histolytica, or a cytotoxic organism such as C. difficile. Visibly bloody acute diarrhea is relatively uncommon and raises the possibility of Shiga toxin-producing E. coli (STEC) infection. Other bacterial causes of visibly bloody diarrhea are Shigella, Campylobacter, and Salmonella species.

• #3 Diarrhoea causes – health conditions, infections, treatments | healthdirect

  https://www.healthdirect.gov.au/what-causes-diarrhoea

  Bacterial infections that can cause diarrhoea include salmonella, E. coli, and campylobacter. […] Some bacteria cause food poisoning because of the toxins (poisons) they produce. […] Vomiting, nausea and abdominal pain may come on within hours if you have food poisoning. […] Diarrhoea symptoms can take longer to appear. […] Antibiotics may be prescribed if a specific infection caused by bacteria (such as shigella) has been diagnosed. […] Parasites can cause ongoing diarrhoea. […] Diarrhoea is a common side effect of drinking too much alcohol. […] Stress and anxiety can cause episodes of diarrhoea. […] Taking antibiotics can sometimes lead to diarrhoea. […] C. diff can produce toxins that attack your bowel lining causing diarrhoea and cramping abdominal pain. […] Diarrhoea can sometimes be a symptom of a chronic (ongoing) health condition.

• #3 Gastroenteritis: Causes, Symptoms, and Treatment

  https://patient.info/digestive-health/diarrhoea/gastroenteritis

  Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, kidney failure may also develop. […] IBS is sometimes triggered by a bout of gastroenteritis. […] A lactose intolerance can sometimes occur for a while after gastroenteritis. This is known as secondary or acquired lactose intolerance. Your gut lining can be damaged by the episode of gastroenteritis.

• #3 Pediatric Gastroenteritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/964131-overview

  Adequate fluid balance in humans depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract; diarrhea occurs when intestinal fluid output overwhelms the absorptive capacity of the gastrointestinal tract. The 2 primary mechanisms responsible for acute gastroenteritis are (1) damage to the villous brush border of the intestine, causing malabsorption of intestinal contents and leading to an osmotic diarrhea, and (2) the release of toxins that bind to specific enterocyte receptors and cause the release of chloride ions into the intestinal lumen, leading to secretory diarrhea. […] Even in severe diarrhea, however, various sodium-coupled solute co-transport mechanisms remain intact, allowing for the efficient reabsorption of salt and water. By providing a 1:1 proportion of sodium to glucose, classic oral rehydration solution (ORS) takes advantage of a specific sodium-glucose transporter (SGLT-1) to increase the reabsorption of sodium, which leads to the passive reabsorption of water. Rice and cereal-based ORS may also take advantage of sodium-amino acid transporters to increase reabsorption of fluid and electrolytes.

• #3 Diarrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448082/

  Diarrhea results from reduced water absorption by the bowel or increased water secretion. Most acute diarrheal cases have an infectious etiology. Chronic diarrhea is commonly categorized into 3 groups: watery, fatty (malabsorption), or infectious. Another way of classifying the pathophysiology of diarrhea is into secretory and osmotic forms. […] In the secretory form of diarrhea, bacterial and viral infections are the common causes. In this instance, the watery stool results from injury to the gut epithelium. Epithelial cells line the intestinal tract and facilitate water absorption, electrolytes, and other solutes. Infectious etiologies cause damage to the epithelial cells, which leads to increased intestinal permeability. The damaged epithelial cells cannot absorb water from the intestinal lumen, leading to loose stool.

• #4 Diarrhea – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea

  Rapid intestinal transit and diminished surface area impair fluid absorption and cause diarrhea. […] The stool osmotic gap, which is calculated 290 2 (stool sodium + stool potassium), indicates whether diarrhea is secretory or osmotic. An osmotic gap 50 mEq/L indicates secretory diarrhea; a larger gap suggests osmotic diarrhea. […] Undiagnosed secretory diarrhea requires testing for endocrine-related causes.

• #4 Is it stomach flu or food poisoning? | UCI Health | Orange County, CA

  https://www.ucihealth.org/blog/2016/01/stomach-flu-or-food-poisoning

  The constellation of symptoms nausea, abdominal pain, diarrhea and vomiting are virtually the same whether the gastrointestinal distress is caused by a virus or a food-borne bacteria. […] Food poisoning is caused by bacterial contamination and usually comes on within two to six hours of eating, whereas a viral infection can appear within a few hours or a few days after exposure, according to the National Institutes of Health. […] Viral gastroenteritis is usually caused by one of four types: rotavirus, adenovirus, astrovirus and the caliciviruses, the most common of which is the highly contagious norovirus. […] Norovirus causes 48 percent of food-borne illness outbreaks compared to 46 percent caused by the usual bacterial culprits salmonella, E. coli, campylobacter, listeria and staphylococcus put together, according to the Centers for Disease Control and Infection (CDC).

• #4 Gastroenteritis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/gastroenteritis

  Bacterial infections cause bacterial gastroenteritis. Common bacterial gastrointestinal infections include Campylobacter, Clostridioides difficile (C. diff), Escherichia coli (E. coli), Salmonella, Shigella, and Staphylococci (Staph). […] Chemicals can injure and inflame the lining of your stomach and intestines. Some chemicals do this even in small amounts. Others, like alcohol and certain medications, can cause gastroenteritis in larger doses. […] Infectious gastroenteritis is contagious. When you have an infection in your gastrointestinal system, it infects your poop. Infections can spread from your poop to anyone who comes into contact with it. […] Gastroenteritis happens when your immune system activates to defend your stomach and intestines from harm. It sends inflammatory cells to help fight infections and repair injured tissues.

• #4 Infectious diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3035144/

  The pathogenic process of C. difficile infection starts with initial colonization followed by the production of two distinct exotoxins, Toxin A and B (TcdA and TcdB), as well as an additional toxin called binary toxin (CDT) which is found in some hypervirulent strains of C. difficile. […] The C. difficile toxins initiate an extensive inflammatory cascade that causes increased damage to host tissues resulting in fluid exudation. […] The overall picture of E. histolytica infection depends both on parasite components, including cysteine proteases, amoebapores, serotonin and PGE2 as well as the host inflammatory response with no single component providing a complete answer.

• #4 Chemotherapy-Induced Diarrhea: Options for Treatment and Prevention

  https://jhoponline.com/issue-archive/2012-issues/december-2012-vol-3-no-4/15408:chemotherapy-unduced-diarrhea-options

  The exact mechanism of CID is not completely understood; however, various theories point to a multifactorial process resulting in an imbalance between the absorption and the secretion of fluid in the GI tract. […] Fluorouracil therapy results in mitotic arrest and apoptosis of the crypt cells in the GI tract. […] Necrosis of this tissue enhances the imbalance of the ratio of immature secretory crypt cells to mature villus enterocytes. […] It also causes bowel wall inflammation, thereby stimulating additional secretion of fluid and electrolytes into the intestinal lumen and significantly altering the osmotic gradient in the GI tract, which contributes to the increased secretion of fluid into the stool. […] Irinotecan is a prodrug converted into its active form, SN-38, both of which are released into the feces by hepatobiliary and intestinal secretions.

• #4 Gastroenteritis (stomach flu) | Gouvernement du Québec

  https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis

  Gastroenteritis, also referred to as „stomach flu,” is inflammation of the stomach and intestinal lining, which causes diarrhea and vomiting. […] It can be caused by a virus, a bacteria or a parasite. Norovirus is the most common cause of gastroenteritis in adults. In children, rotavirus is more often involved. […] The main complication of gastroenteritis is dehydration. It occurs when the body eliminates too large a quantity of water and mineral salts, which are essential to the proper functioning of the body. […] Gastroenteritis is a contagious illness. An infected person can transmit the illness as long they have symptoms and up to 2 weeks after they have disappeared. […] Gastroenteritis can be transmitted: Through consumption of contaminated water or food. […] Rotavirus is the main virus responsible for gastroenteritis in children. Giving young children vaccination against this virus is the best way to protect them against gastroenteritis.

• #4 Chemotherapy-Induced Diarrhea: Options for Treatment and Prevention

  https://jhoponline.com/issue-archive/2012-issues/december-2012-vol-3-no-4/15408:chemotherapy-unduced-diarrhea-options

  Octreotide inhibits the secretion of hormones in the gut, including serotonin, gastrin, insulin, and secretin. […] Through these mechanisms, octreotide increases GI transit time and reduces intestinal secretions. […] Clinical trials suggest that diarrhea may be induced by the overproduction of thromboxane A and prostaglandins in the GI tract. […] The body uses cyclooxygenase (COX), an enzyme found in normal tissue, to convert arachidonic acid into prostaglandins. […] The prostaglandin PGE2 stimulates mucous and chloride secretion from the epithelial cells in the colon, leading to significant diarrhea.

• #4 Diarrhea: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928598-overview

  Diarrhea is the reversal of the normal net absorptive status of water and electrolyte absorption to secretion. The augmented water content in the stools (above the normal value of approximately 10 mL/kg/d in the infant and young child, or 200 g/d in the teenager and adult) is due to an imbalance in the physiology of the small and large intestinal processes involved in the absorption of ions, organic substrates, and thus water. […] Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretory state induced in the enterocytes. In the former case, diarrhea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in lactose malabsorbers. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-induced diarrhea.

• #5 Pathophysiology of Diarrhea

  https://vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/diarrhea.html

  Diarrhea is an increase in the volume of stool or frequency of defecation. […] There are numerous causes of diarrhea, but in almost all cases, this disorder is a manifestation of one of the four basic mechanisms described below. […] A distinguishing feature of osmotic diarrhea is that it stops after the patient is fasted or stops consuming the poorly absorbed solute. […] Diarrhea occurs when secretion of water into the intestinal lumen exceeds absorption. […] Many millions of people have died of the secretory diarrhea associated with cholera. […] Exposure to toxins from several other types of bacteria induce the same series of steps and massive secretory diarrhea that is often lethal unless the person or animal is aggressively treated to maintain hydration. […] Disruption of the epithelium of the intestine due to microbial or viral pathogens is a very common cause of diarrhea in all species. […] The immune response to inflammatory conditions in the bowel contributes substantively to development of diarrhea. […] Disorders in motility than accelerate transit time could decrease absorption, resulting in diarrhea even if the absorptive process per se was proceeding properly.

• #5 Pediatric Gastroenteritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/964131-overview

  Adequate fluid balance in humans depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract; diarrhea occurs when intestinal fluid output overwhelms the absorptive capacity of the gastrointestinal tract. The 2 primary mechanisms responsible for acute gastroenteritis are (1) damage to the villous brush border of the intestine, causing malabsorption of intestinal contents and leading to an osmotic diarrhea, and (2) the release of toxins that bind to specific enterocyte receptors and cause the release of chloride ions into the intestinal lumen, leading to secretory diarrhea. […] Even in severe diarrhea, however, various sodium-coupled solute co-transport mechanisms remain intact, allowing for the efficient reabsorption of salt and water. By providing a 1:1 proportion of sodium to glucose, classic oral rehydration solution (ORS) takes advantage of a specific sodium-glucose transporter (SGLT-1) to increase the reabsorption of sodium, which leads to the passive reabsorption of water. Rice and cereal-based ORS may also take advantage of sodium-amino acid transporters to increase reabsorption of fluid and electrolytes.

• #5 Diarrhea – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea

  Diarrhea is defined as stool weight 200 g/day. […] There are a number of causes of diarrhea. Several basic mechanisms cause most clinically significant diarrheas. The 3 most common are increased osmotic load, increased secretions/decreased absorption, and decreased contact time/surface area. […] Diarrhea occurs when unabsorbable, water-soluble solutes remain in the bowel and retain water. […] Diarrhea occurs when the bowels secrete more electrolytes and water than they absorb. […] Infections (eg, gastroenteritis) are the most common causes of secretory diarrhea. […] Unabsorbed dietary fat and bile acids (as in malabsorption syndromes and after ileal resection) can stimulate colonic secretion and cause diarrhea. […] Impaired absorption of bile salts, which can occur with several disorders, can cause diarrhea by stimulating water and electrolyte secretion.

• #6 Diarrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448082/

  Diarrhea results from reduced water absorption by the bowel or increased water secretion. Most acute diarrheal cases have an infectious etiology. Chronic diarrhea is commonly categorized into 3 groups: watery, fatty (malabsorption), or infectious. Another way of classifying the pathophysiology of diarrhea is into secretory and osmotic forms. […] In the secretory form of diarrhea, bacterial and viral infections are the common causes. In this instance, the watery stool results from injury to the gut epithelium. Epithelial cells line the intestinal tract and facilitate water absorption, electrolytes, and other solutes. Infectious etiologies cause damage to the epithelial cells, which leads to increased intestinal permeability. The damaged epithelial cells cannot absorb water from the intestinal lumen, leading to loose stool.

• #6 Vomiting With Diarrhea

  https://www.seattlechildrens.org/conditions/a-z/vomiting-with-diarrhea/

  Most vomiting is caused by a viral infection of the stomach. Sometimes, mild food poisoning is the cause. […] Throwing up is the body’s way of protecting the lower intestines. […] Diarrhea is the body’s way of getting rid of the germs. […] The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid. […] Vomiting with watery diarrhea is the most common cause of dehydration.

• #7 Diarrhoea causes – health conditions, infections, treatments | healthdirect

  https://www.healthdirect.gov.au/what-causes-diarrhoea

  Diarrhoea is often short term and can clear up after a few days without treatment. […] Some causes of diarrhoea are infectious; others are not infectious. […] Viral gastroenteritis is a common cause of short-term diarrhoea and can clear up without treatment. […] Diarrhoea caused by long-term conditions may be continuous, or it can come and go, or it may alternate with constipation. […] Diarrhoea can be a side effect of some medicines, including antibiotics. […] The most common cause of acute or sudden diarrhoea is infection of the digestive system. […] Gut infections can involve viruses, bacteria or parasites. […] Viral infections that cause gastroenteritis include rotavirus or norovirus. […] Viral infections commonly cause vomiting and nausea, along with diarrhoea. […] Diarrhoea can be caused by viral gastroenteritis, which commonly clears up without needing special treatment after a few days.

• #7 Vomiting and Diarrhea at the Same Time: Causes and Management

  https://www.healthline.com/health/diarrhea-and-vomiting

  Dehydration is a complication of vomiting and diarrhea, and it occurs when the body loses too much fluid. Dehydration can prevent your cells, tissues, and organs from functioning properly, leading to serious health challenges, including shock and even death. […] Symptoms of dehydration in babies, toddlers, and children include: persistent thirst, urinating less than usual, or going 3 or more hours without a wet diaper, dry mouth, sunken eyes or cheeks, decreased skin turgor, or elasticity, lack of energy, no tears when crying. […] Symptoms in adults include: extreme thirst, urinating less than usual, dry mouth, sunken eyes or cheeks, decreased skin turgor, fatigue, lightheadedness, dark-colored urine. […] Vomiting and diarrhea usually resolve within a few days without treatment. Home remedies and medications can help you manage your symptoms and avoid dehydration.

• #8 Gastroenteritis (stomach flu) | Gouvernement du Québec

  https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis

  Gastroenteritis, also referred to as „stomach flu,” is inflammation of the stomach and intestinal lining, which causes diarrhea and vomiting. […] It can be caused by a virus, a bacteria or a parasite. Norovirus is the most common cause of gastroenteritis in adults. In children, rotavirus is more often involved. […] The main complication of gastroenteritis is dehydration. It occurs when the body eliminates too large a quantity of water and mineral salts, which are essential to the proper functioning of the body. […] Gastroenteritis is a contagious illness. An infected person can transmit the illness as long they have symptoms and up to 2 weeks after they have disappeared. […] Gastroenteritis can be transmitted: Through consumption of contaminated water or food. […] Rotavirus is the main virus responsible for gastroenteritis in children. Giving young children vaccination against this virus is the best way to protect them against gastroenteritis.

• #9 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings

  The management of patients with acute diarrhea begins with general measures such as fluid repletion and nutrition maintenance, with adjustments in diet if necessary. Patients who have bothersome symptoms may benefit from symptomatic pharmacologic therapy. Antibiotic therapy is not indicated in most cases since the illness is usually self-limited. Nevertheless, empiric and specific antibiotic therapy may be appropriate in certain situations, mainly in patients with severe disease, with symptoms and signs suggestive of invasive bacterial infection, or at high risk for complications. […] The most critical therapy in diarrheal illness is rehydration, preferably by the oral route, with solutions that contain water, salt, and sugar. Oral rehydration solutions (ORS) may be more appropriate in patients with more severe diarrheal disease. ORSs were developed following the realization that, in many small bowel diarrheal illnesses, intestinal glucose absorption via sodium-glucose cotransport remains intact.

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