Stomach Diarrhea: Bloody-Stools

Showing posts with label Bloody-Stools. Show all posts

Hematochezia Red, Maroon-colored Bowel Movements

Blood as seen in the stool can originate anywhere along the intestinal tract. Black stool usually means that the blood is coming from the upper part of the GI tract. The following may be the causes:

bleeding ulcer
gastritis
esophageal varices
a tear in the esophagus from violent vomiting

Maroon-colored bowel movements or bright red blood usually suggest that the blood is coming from large bowel or rectum.

all the causes of black color stool
diverticular bleeding
vascular malformation
intestinal infection (such as bacterial enterocolitis)
inflammatory bowel disease
tumor
colon polyps or colon cancer
Some upper GI causes may result to vomiting blood such as in peptic ulcer disease.
Red blood in the stool might be due to hemorrhoids.
Amebiasis, anal fissures, or colorectal cancer.
Colonic polyps or tumors, diverticulosis,
Abnormal small vessels called AVMs
Melena, if at least 6 Tablespoons (or 200 milliliters) of blood is lost

Bright red color -

all the causes of black or maroon color stool
hemorrhoids
anal fissures ("cracks" in the anal area)

Diagnostic Tests for Bloody Bowel Movements

Colonoscopy
The color of the stool can suggest the location of the bleeding however this is not reliable.
A definitive diagnosis will require radiographic and/or endoscopic investigation.

Bloody Stools Due to Cow's Milk Allergy

Cow's milk allergy is said to occur in 2 - 8% of infants. About 5 -15% of infants have a reaction to the cow's milk protein, but not all of these are allergic reactions.

For example, lactose intolerance is not an allergy as such, but children do have a reaction to cow's milk. Read more about lactose intolerance.

Allergic reactions to cow's milk may be:
immediate - within minutes up to 1 hour after having cow's milk. Symptoms include hives, eczema, facial swelling, wheeze, vomiting, diarrhea. Severe reactions include anaphylaxis.
These are IgE mediated reactions

delayed - these can occur several hours or even days after having the milk. Symptoms include eczema, vomiting, diarrhea or asthma. Babies may even fail to thrive. These are non IgE mediated reactions.
Cow's milk protein intolerance is an example of this - sometimes you will see blood in the stool.

How is Cow's Milk Allergy diagnosed?
The first thing is a good story (history) of a reaction after having cow's milk.

If your infant has had an immediate reaction, then skin prick tests, or blood tests (such as CAP, EAST, RAST) will usually be helpful. These tests detect IgE mediated allergies.

In other cases, milk and dairy products may need to be eliminated from the diet in a trial of treatment. If the symptoms resolve and then return when milk is reintroduced into the diet, this is diagnostic for allergy - called Elimination/Reintroduction. If your child has had a severe reaction to milk products, then reintroduction should be done under medical supervision.

Some centers offer patch testing, which may be useful in detecting non IgE mediated allergies.

What is the treatment of cow's milk allergy?
Cow's milk will need to be excluded from your baby's diet. This can be difficult and you may need the help of a dietician.

Some breast-fed babies will get symptoms if their mother has cow's milk (dairy) products in her diet. In these cases, the mother will need to exclude dairy products from her diet.

Foods to be avoided in cow's milk allergy include:
any food with cow's milk or goat's milk
cheese
butter
ghee
milk powder
cream fraiche, sour cream, cottage cream
whey
casein
margarine
custard
lactalbumin, lactulose, lactoglobulin
any foods containing any of the above list
What milk alternative should I feed my infant with cow's milk allergy?

Alternatives to cow's milk include:
soy protein formula - about half children who are allergic to cow's milk will also be allergic to soy. Soy formula is not recommended for infants under 6 months but can be tried first as an alternative milk in infants over 6 months of age
extensively hydrolysed formula (EHF) - this is milk that has been treated to break down most of the enzymes that cause allergic symptoms. These are the first choice alternative for infants under 6 months with cow's milk allergy. Examples of EHF include PeptiJunior and Alfare. Partially hydrolysed formula (PHF) are not suitable for cow's milk allergic infants
amino acid based formula - AAF - this is milk that is completely broken down eliminating the protein that causes allergy. It will be necessary in about 10% of cow's milk allergic children. Examples of an amino acid based formula include Neocate and Elecare.
AAF should be used in children who do not tolerate EHF (after a 2-4 week trial) or as a first choice in infants with an anaphylactic reaction
Should I give my baby goat's milk for cow's milk allergy?
No. Goat's milk and cow's milk share similar proteins so children who are allergic to one will be allergic to the other. Goat's milk, sheep's milk, and rice milk are not suitable alternatives in cow's milk allergic children.

Should I stop breast-feeding my cow's milk allergic baby?
No, keep breast feeding your baby. Cow's milk allergy is less likely in breast fed infants.

If your baby has symptoms of cow's milk protein allergy, then you should exclude dairy products and eggs from your diet - you need to continue this for at least 2 weeks, but probably for 4 weeks, to see if there is an improvement. If there is improvement, one food per week can be introduced into your diet until you know what food is causing your baby's problems and then you can just avoid that food.

If you need to continue to eliminate milk from your diet, you may need a calcium supplement.

When you do wean your baby, you should use an extensively hydrolysed formula (or soy if your baby is over 6 months of age).

Will my child grow out of her allergy?
Most children grow out of their cow's milk allergy by age 3 years. Once your child is over 12 months old and has been without diary in the diet for at least 6 months, you could try introducing some cow's milk into the diet - you might want to start with yoghurt or cheese as these are sometimes tolerated better than actual milk.

If your child had a severe reaction to the milk in the first place, like anaphylaxis, then you should have the milk challenge under medical supervision - do not try re-introducing milk at home.

Some children grow out of the dairy allergy but develop other allergic diseases, like asthma as they grow older.
Does diary allergy cause mucus?
Symptoms that relate to the respiratory system, such as runny nose and mucus, usually are a result of what we breath not what we eat. Any symptoms of mucus after ingesting milk are not dangerous and in infants are more likely to be the result of a respiratory tract infection rather than an allergy.

Is eczema caused by milk allergy?
In most cases of eczema, there will not be any allergy. However, some infants, particularly young babies with severe eczema, allergy may be a factor. In these cases, skin prick tests may be positive and even if they are not, it may be worthwhile trying an elimination diet (no dairy or cow's milk) for 4 weeks to see if there is improvement. If no improvement occurs, cow's milk is unlikley to be contributing to the eczema.
What is lactose intolerance?
Lactose intolerance occurs because the body lacks an enzyme, lactase, that is necessary to digest the milk sugar, lactose. People with lactose intolerance will get diarrhea, vomiting and tummy pains - these symptoms are similar to cow's milk allergy, but do not involve the skin. Although the symptoms are a nuisance, lactose intolerance is not dangerous.

If you have lactose intolerance, you can usually manage to eat small amounts of cow's milk. Other dairy products, such as yoghurt and cheese, are usually well tolerated because they have easier to digest milk sugars.

The diagnosis is made on a stool test which shows sugars (reducing substances) in the stool or a breath hydrogen test. Treatment is reducing or avoiding products containing lactose (milk sugar) - so reducing or avoiding dairy. Infants require a lactose-free formula.

Bloody Stools in Toddlers

Don't worry if there is a small amount of blood on the surface of the stool or the toilet tissue. This probably indicates an anal fissure, a painful but non-serious condition. Larger amounts of blood, blood mixed with the stool, or blackening of the stool, however, may indicate a more serious condition.

There are a number of reasons a baby may have bright red blood in the the stool (poop, poo).
The most common cause is a hard stool (poop, poo), that occurs with constipation, causing a small tear in the baby's back passage (anus) that then bleeds. This is not a serious problem and all you need to do is manage the constipation.

Newborn babies who are breast-feeding can have blood in the stool which is from a mother's cracked nipple. This is not a serious condition for the baby.

An infant who is having bouts of screaming and drawing up the legs, maybe with vomiting as well, who then passes what looks like red currant jelly in the bowel motion may have intussusception and you need to see your doctor urgently.

Infants who have a cow' milk protein allergy may have blood in the stool (poop, poo), but they will probably have other symptoms as well, such as poor growth, irritability and maybe even a skin rash.

A baby or toddler who has blood in the stool may also have a condition called a Meckels' diverticulum. If your toddler has blood in stool (poop, poo) over a long period or is pale, see your doctor for consideration for more tests.

What causes a baby or toddler to have blood in diarrhea?
Bloody diarrhea can be caused by a bacteria. Most gastroenteritis causing diarrhea is viral but sometimes a bacteria can be the cause and antibiotics may be needed. If your infant or toddler has blood in diarrhea, see your doctor for a stool (poop, poo) test.

What causes a baby or toddler to have black diarrhea (stool, poop, poo)?

Black stool usually contains blood that has been altered by stomach acids. Babies or toddlers who have black diarrhea or stool (also called melena) have had bleeding in the top half of the gut. This can be for reasons that are not serious, like after vomiting with gastroenteritis when the lining of the esophagus can get little tears that bleed. This usually settles quickly within 24 hours.

Melena that persists can occasionally (but it's rare) be due to other more serious causes. See your doctor is melena persists or your child looks pale.

When should I see my doctor for blood in stool?
See your doctor if:
you are very worried about your child
your child looks pale or is lethargic
your child has had crying episodes and then a red currant jelly stool
your child had blood in diarrhea
your child has had melena (black diarrhea / stool) which is not explained by a vomiting illness

Diagnosing Stomach Problems with Stool Color

Dark-colored stools may be seen in platelet function disorders, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. Liver disease may include a yellow tone to the skin and whites of eyes (jaundice) and brownish urine.

Black or tarry stools (Melena)

The passage of black, tarry and foul-smelling stools; can be an indication of digested blood in the stool. Other causes are, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. In advanced cirrhosis (liver disease), the abdomen becomes distended with fluid and ruptured blood vessels in the stomach and esophagus cause bleeding. The person may vomit blood or pass black stools. Very dark stools, for example, may indicate an ulcerative lesion in the higher digestive tract.

Note: The ingestion of black licorice, lead, iron pills, Pepto-Bismol, or blueberries can all cause black stools or false melena. Stools should be tested for the presence of hidden blood.

Blood in the stool (Hematochezia) - the passage of red, or maroon- colored stools. Red or "frank" blood in the stool could be caused by hemorrhoids. Bloody stools can also be seen in amebiasis, anal fissures, or colorectal cancer. Bright red bleeding with bowel movements may be due to hemorrhoids; however, other conditions such as colonic polyps or tumors, diverticulosis, and abnormal small vessels called AVMs also may cause bleeding. Unusually, the bleeding is coming from the upper intestine or stomach. Bleeding such as you describe usually is evaluated by colonoscopy. Blood, as seen in the stool, can originate anywhere along the intestinal tract. A black stool usually means that the blood is coming from the upper part of the GI tract. At least 6 Tablespoons (or 200 milliliters) of blood must have been lost in order to cause passage of melena. Maroon-colored stools or bright red blood usually suggest that the blood is coming from large bowel or rectum. However, sometimes can be caused by massive upper GI tract bleeding. Some upper GI causes of bloody stools can also cause vomiting blood such as in peptic ulcer disease. The color of the stool can suggest the location of the bleeding however this is not reliable. A definitive diagnosis will require radiographic and/or endoscopic investigation.

Black color -

- bleeding ulcer
- gastritis
- esophageal varices
- a tear in the esophagus from violent vomiting

Maroon color -

- all the causes of black color stool
- diverticular bleeding
- vascular malformation
- intestinal infection (such as bacterial enterocolitis)
- inflammatory bowel disease
- tumor
- colon polyps or colon cancer

Bright red color -

- all the causes of black or maroon color stool
- hemorrhoids
- anal fissures ("cracks" in the anal area)

Gray stools

Gray stools pale stools, putty or clay colored stools may be seen in hepatitis, gallbladder disorders, or malabsorption conditions. Bile salts in the stool excreted by the liver give it a normal brown color. Obstruction to bile flow out of the liver (you may see the word "cholestasis"), or liver infections like viral hepatitis (A, B, C, etc.), may produce clay colored stools. Possible causes for clay colored stool result from problems in the biliary system (the drainage system of the gallbladder, liver, and pancreas): Malabsorption problems can cause undigested fat in the stool (steatorrhea) which is characterized by foul smelling, light yellow to gray, greasy or frothy stools. This may also be caused by low bile output.

Orange Stool

Artificial orange or yellow colorings, or other artificial colorings can product orange stools. Where on earth did you ever get the idea that bright yelloe stool indicates excessive bile involvement ? . Nothing coud be further from the truth. It's the opposite. It is the addition of bile into the intestinal tract as part of the digestive process that actually turns the stool brown. Orange stools may be due to certain medications. Beta-carotene (a form of vitamin A) may cause orange stools as a side effect so check any sources of vitamins or supplements, as well as intake of foods high in beta-carotene (carrots, sweet potatoes, etc.). Another possibility is if the stool is more pale-orange, it might indicate lack of bile salt (which gives stool a brownish color). Other sources are antacids containing aluminum hydroxide, barium from recent barium enema test, and hepatitis. Consider checking some baseline liver tests to evaluate proper liver function.

Green Stool

Stool starts out green , then turns bright yellow as it goes through the digestive tract. It is bile and bacteria that finally turn it brown. Yellow or green stools can indicate stool is passing through the digestive tract too rapidly not giving it a chance to change colour. Bright yellow stools can also indicate not enough bile / bilary obstruction. Green stools may be bacteria, or a green or blue food eaten. Green, blue, or yellow artificial colorings too.

What is Diarrhea? Normal & Loose/Excessive Bowel Movements (Diarrhea)

What Is a Diarrhea?

Diarrhea (Greek dia = through, rhein = flowing) means having more than three bowel movements, or passing more than 300g of watery stool daily (1).

NOTE: American English spelling is diarrhea, UK English spelling is diarrhoea.

What Is Not a Diarrhea?

Ten diapers a day are usual in a 14 days old infant. Three soft bowel movements a day may be considered normal for adult on a fibre-rich diet. Stool soiling in children who are already toilet trained may be due to defective anus. Stool incontinence or mucus seeping in adults may be due to rectal inflammation, rectal prolapse, hemorrhoids, uncoordinated pelvic floor muscles, or anal muscle or nerve damage (2). In all mentioned cases, bowel movements tend to be of normal volume and consistency.
Occasional single loose stool still isn't a diarrhea. Unripe fruits, green potatoes, spicy or hot food may all irritate the bowel. Insufficiently cooked or chewed food, a heavy sugary or fatty meal may be hard to digest. Wrong food combinations, like meat with sugar, may result in a loose stool. Food which is psychically rejected, after ingesting, might flow through the intestine quickly. Caffeine stimulates peristalsis, as can strong emotions like fear.

Normal Stool

Stool frequency. A newborn passes its first stool in the first two days. During the first month, breast-fed babies usually have 8-10 stools per day, at one month 4 per day, at four months 2 per day, and a child at four years usually has 1 stool per day (7). Three stools per day down to 3 stools per week may be normal for children and adults on solid food.
Stool quantity depends on the amount of ingested food and its fiber content. Two liters of mixed food yields about 200g of stool. The more fiber in the diet, the bulkier the stool.
Stool consistency. A normal stool is semi-solid. Food fibers make stools soft as they tend to bind water. If not enough water is consumed, stools will be hard; on the other hand a lot (up to 20 liters/day) of water consumption will not result in a softer stool, since most of the water is absorbed in the intestine.
The color of the stool in a healthy adult is any shade of brown, or even green. A green stool may originate from green vegetables, fruit juices, or iron supplements. A newborn's first stool (meconium) is greenish black. A black stool may come from licorice, iron supplements, or Pepto-Bismol. A red stool may originate from beetroot, tomato sauce, red Jelly-O, etc.
Stool composition: 60-90% of water, the rest are fibers and other undigested substances, bacteria, shed intestinal cells, bile pigments, and minerals.

Mechanisms of Diarrhea

Osmotic diarrhea. When a particular nutrient (solute) is not absorbed, it attracts water from blood vessels in the intestinal wall (where it is found in lower concentrations) into the intestinal hollow (with high concentrations). This process is called osmosis and occurs after ingestion of large amounts of unabsorbable solutes (e.g. sorbitol), or when nutrients stay within the intestine, because they can't be digested (in lack of digestive enzymes), or absorbed (in inflammation or surgical resection of a part of intestine).
Secretory diarrhea. Unabsorbed fatty or bile acids trigger water secretion from colonic mucosa; toxins from some bacteria (E. coli, V. cholerae) or some drugs (quinine) have the same effect on the small intestinal mucosa. Secretory diarrhea is watery.
Exudative diarrhea. From ulcerated intestinal mucosa (in shigellosis, amebiasis, ulcerative colitis), the blood, proteins and pus may exudate and appear in the stool. Exudative diarrhea is often of low volume.
Motility diarrhea. In increased gut motility (psychic stress, irritant food, bacterial toxins, laxatives, hyperthyroidism) there is not enough time for adequate water and nutrient absorption, thus resulting in motility diarrhea.
More than one mechanism is usually involved in each diarrheal event.

Diarrheal Stool

The frequency of diarrheal stool may vary from three a day to twenty a day or more in extreme cases. Over 20 liters of water with electrolytes (potassium, sodium, magnesium) may be lost in one day in severe diarrhea. Diarrheal stool may be anything from clear liquid to soft formed mass.
Water in diarrheal stools originates from food, unabsorbed digestive juices, or increased intestinal secretion. White diarrheal stool is from unabsorbed fats (>6g fats/day is abnormal), and yellow stool from lack of bile acids. Green diarrhea is from unabsorbed bile acids. Bloody diarrhea is from ulcerated colonic, or (rarely) small intestinal mucosa. Black colored diarrheal stool is from bleeding from the mouth, nose, throat, lungs, esophagus or stomach, or from antidiarrheal drug Pepto-Bismol. Other components of diarrheal stool: undigested substances, mucus, sugars (e.g. lactose), and microorganisms.

Is Diarrhea Harmful?

In many cases, diarrhea is only an unpleasant event. However, a few liters of body water lost during diarrhea may lead to dehydration within 24 hours, may severely affect metabolism, muscles, nerves, heart, or consciousness, and may cause permanent damage of affected organs. About 2.2 million children die from diarrhea (mostly from dehydration) every year, mostly in countries where medical help is not easily accessible; malnourished children with lowered immunity or chronic diseases are at greatest risk (8). Repeating acute or chronic diarrhea may lead to malnutrition.

Causes of Diarrhea

Main causes of diarrhea are:

Gastrointestinal infections: viruses (mostly Rotavirus), bacteria (e.g. Escherichia coli, Campylobacter, Salmonella, Shigella), parasites (e.g. Giardia, intestinal worms); primarily non-gastrointestinal infections (e.g. measles, tuberculosis)
Inappropriate food (artificial sweeteners, overfeeding)
Psychic factors
Food intolerance: lactose intolerance, celiac disease, food allergies
Medication: antibiotics;
Toxins: pesticides, poisonous plants
Intestinal disease: e.g. inflammatory bowel disease, lymphoma
Other abdominal disease: liver, pancreatic, gallbladder disease
Other causes: AIDS, hyperthyroidism, cystic fibrosis, competitive running, etc.

Connection between Hemorrhoids and Diarrhea

A person may have a fever or even bloody stool due to different causes. If diarrhea is prolonged, its symptoms can be similar to hemorrhoids symptoms; both may cause rectum bleeding.

Diarrhea is very rare the cause of hemorrhoids, but it can contribute if you already have other symptoms. Treat it seriously and persistently and it should go away, usually all it takes is to find what food your body does not absorb well.

Long-term diarrhea causes hemorrhoids, due to bulging of the veins in the anal canal, and that is what causes hemorrhoids.

Many people do not take diarrhea seriously, but there are several cases when delay in going to a doctor to get a proper diagnosis might result serious complications.

For example: if it lasts for more then three days, you suffer from abdominal or rectal pain, along with high fever, there is blood in your stool or if you are dehydrated. If any of these symptoms apply you should immediately see your doctor.

Children are exception, do not hesitate going to see the doctor, diarrhea is a very dangerous for children, because young children loss of fluid and minerals more speedily than elders.
Diagnose of diarrhea

Your doctor can perform tests like sigmoidoscopy and colonoscopy to diagnose the cause or physical examination (using special instruments to check inside rectum and colon), take stool samples to check for parasites, bacteria or any other sign of disease, take blood tests, perform food test (for allergies).

Diet during Hemorrhoids

Treatment of hemorrhoids with diet is quite possible. You need to eat foods that will soften your stool.

Traveler's Diarrhea

Europe, Canada, Japan, New Zealand and Australia (urban areas have one of the highest standards in the world for hygiene, but Australia is something different) all have very high standards when it comes to food and water.

Most of Africa, You should watch your food and water when you are in Asia and South America. Don't drink tap water, don't drink dairy products, don't eat raw fruits or vegetables, avoid raw or rare meat. Use bottled water or water purifying tablets or kits.

Diarrhea - Symptoms Treatments and drugs and Home Remedies

Symptoms

Signs and symptoms associated with diarrhea may include:

* Abdominal cramps
* Abdominal pain
* Blood in the stool
* Bloating
* Fever
* Frequent, loose, watery stools

In addition, other signs and symptoms such as nausea and vomiting may follow diarrhea due to an infection. Other causes of bloody stools include bacterial or parasitic. If you are an adult, see your doctor if you have one or more of following conditions:

Diarrhea remains more than three days
Dehydration as evidenced by dry mouth or skin, excessive thirst, little or no urination or dark-colored urine, severe weakness, dizziness or lightheadedness
Severe abdominal or rectal pain
Bloody or black stools
Fever of 102 F (39 C) or more, indications of dehydration even after drinking plenty of liquids

Causes, Symptoms and Remedies of Acute Viral Diarrhea in Babies, Children, Adults and Old Peoples

Causes of Infant Diarrhea

Diarrhea in first 3 days of life: congenital diseases of liver, pancreas, biliary tract, small or large intestine.
Fever, vomiting, diarrhea: Rotavirus, rarely other microbes;
Mild diarrhea: overfeeding, neonatal drug withdrawal;
Skin rash, strain to vomiting (gagging), irritability, diarrhea: allergy to cow's milk or soy formula;

Remedies

Newborn normally have bowel movement 8-10 times a day.
Medications to treat diarrhea in adults can be dangerous for children.

Infant and Toddler Diarrhea

ACUTE DIARRHEA:

Fever, vomiting, diarrhea: Rotavirus; less commonly: bacteria, parasites, middle ear and urinary tract infections, intusussception, hemolytic-uremic syndrome;
mild diarrhea: newly introduced food, liquid starvation diet, food allergies, antibiotics.

CHRONIC DIARRHEA:

Diarrhea with undigested food particles, the toddler looks healthy: excessive drinking of fruit juices (toddler's diarrhea);
Constipation, alternating with diarrhea: post-infectious irritable bowel syndrome;
Coughing, hives, face flushing, watery/bloody diarrhea: food allergy;
Skin rash, underweight, watery/bloody diarrhea: parasites, celiac disease, autoimmune enteropathy; rarely: Crohn's disease, ulcerative colitis, tuberculosis, AIDS, cystic fibrosis, congenital diseases of biliary tract, liver, pancreas or intestine, surgery of small intestine, marasmus, kwashiorkor, zinc deficiency.
Diarrhea fakedby child's caregiver (usually mother): factitious diarrhea, Munchausen by Proxy Syndrome (1).

Diarrhea in Older Children and Adults

ACUTE DIARRHEA:

Sudden diarrhea: bacteria; rare: pesticides or heavy metals poisoning, Pseudomembranous colitis;
Mild (recurrent) diarrhea: stress, medications, bowel investigation or surgery, parasites, appendicitis, diarrhea in pregnancy;
Diarrhea after eating, vomiting: food poisoning (staph, mushrooms, tropical fish, alcohol), plant poisoning.

CHRONIC DIARRHEA:

Diarrhea after eating: IBS, lactose intolerance, food allergies, rapid gastric emptying (Dumping syndrome), carcinoid syndrome;
Mild chronic diarrhea: fructose malabsorption, diabetes, alcoholism, pregnancy, rare: collagenous/lymphocytic colitis, neuroendocrine tumors;
Weight loss, bloody diarrhea, recurrent fever, skin rash: Crohn's disease, ulcerative colitis, typhoid fever, chronic infection (tuberculosis, AIDS, HSV, CMV);
Weight loss, bloating, pale loose stool: malabsorption due to gallbladder, liver or pancreatic disease, Crohn's disease, celiac disease, small intestinal bacterial overgrowth, chronic infection, or laxative abuse; rare: tropical sprue, Whipple disease, intestinal lymphoma, systemic sclerosis, amyloidosis.
White coated tongue, fatigue, sugar craving, anal itching: candida (see other candida symptoms);
Diarrhea after travel: parasites,tropical sprue;
Constipation/diarrhea in children: encopresis, post-infectious irritable bowel syndrome;
Weakness, dizziness, salt craving: dehydration or Addison's disease;
Irritability, sweating, bulging eyes, enlarged thyroid, weight loss, diarrhea: hyperthyroidism;
Leg swelling, mucous diarrhea: protein-losing enteropathy (in ulcerations of the esophagus, stomach or duodenum, Crohn's disease, intestinal lymphangiectasia, tuberculosis, lymphoma, congestive heart failure, carcinoid syndrome etc), (2).

Typical Causes of Diarrhea in Old People

CHRONIC DIARRHEA:

Constipation and/or diarrhea: diverticulitis, ischemic colitis, partial obstruction of the colon or small intestine (fecal impaction, polyps, cancer, adhesions);
Pins and needles sensations in hands and feet, early satiety, diarrhea, blurred vision, difficult swallowing, urine retention/incontinence, fainting, etc: autonomic neuropathy (in diabetes, alcoholism, Parkinson's disease, vit B12/folate deficiency, Sjögren syndrome, SLE, amyloidosis);
Diarrhea after eating: carcinoid, VIPoma;
Mild constant diarrhea: small intestinal bacterial overgrowth, intestinal lymphoma, systemic sclerosis.

Abdominal Pain and Diarrhea

Exact location of abdominal pain may help in finding the cause of diarrhea.

Upper right quadrant: gallbladder, biliary tract, liver disease; rarely: duodenal, pancreatic disease;
Upper middle abdomen: gastric, duodenal, pancreatic disease;
Upper left quadrant (rarely): gastric, pancreatic disease;
Lower right quadrant: Crohn's disease, appendicitis;
Lower left quadrant: Ulcerative colitis, diverticulitis, ischemic colitis; rarely: colorectal cancer.

How Can a Doctor Find the Cause of Diarrhea?

History. Expect these questions from a doctor :

When did diarrhea start?
Color and consistency of the stool, any blood or mucus?
Is diarrhea related to meals, stress, or daytime? Any recent travel in tropics?
Fever, abdominal pain or other symptoms?
Diet, alcohol intake?
Chronic disease, medications, recent investigation or surgery?
Family members: anyone has diarrhea or chronic disease?

Physical examination. Doctor will look for signs of underlying disease:

Skin: rash, jaundice, pale skin, scaling, turgor;
Abdomen: distension or lumps, enlarged liver or spleen, painful spots;
Neck: enlarged thyroid, lymph nodes;
Rectal examination: internal hemorrhoids, polyps, inflamed skin around the anus, fistula.

Bacteria and Food-Borne Illnesses

What are foodborne illnesses?

Foodborne illnesses are caused by eating food or drinking beverages contaminated with bacteria, parasites, or viruses. Harmful chemicals can also cause foodborne illnesses if they have contaminated food during harvesting or processing. Foodborne illnesses can cause symptoms that range from an upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration. Most foodborne infections are undiagnosed and unreported, though the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from pathogens, or disease-causing substances, in food. Of these people, about 5,000 die.

What are the causes of foodborne illnesses?

Harmful bacteria are the most common cause of foodborne illnesses. Some bacteria may be present on foods when you purchase them. Raw foods are the most common source of foodborne illnesses because they are not sterile; examples include raw meat and poultry that may have become contaminated during slaughter. Seafood may become contaminated during harvest or through processing. One in 10,000 eggs may be contaminated with Salmonella inside the egg shell. Produce such as spinach, lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7. Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of produce contamination are varied as these foods are grown in soil and can become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in a restaurant or a home kitchen. The most common form of contamination from handled foods is the calcivirus, also called the Norwalk-like virus.

When food is cooked and left out for more than 2 hours at room temperature, bacteria can multiply quickly. Most bacteria grow undetected because they don't produce a bad odor or change the color or texture of the food. Freezing food slows or stops bacteria's growth but does not destroy the bacteria. The microbes can become reactivated when the food is thawed. Refrigeration also can slow the growth of some bacteria. Thorough cooking is needed to destroy the bacteria.

What are the symptoms of foodborne illnesses?

In most cases of foodborne illnesses, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include

abdominal cramps
nausea
vomiting
diarrhea, which is sometimes bloody
fever
dehydration

What are the risk factors of foodborne illnesses?

Some people are at greater risk for bacterial infections because of their age or an unhealthy immune system. Young children, pregnant women and their fetuses, and older adults are at greatest risk.

What are the complications of foodborne illnesses?

Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious symptoms than vomiting and diarrhea. They can cause spontaneous abortion or death.

In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7, and can lead to kidney failure and death. HUS is a rare disorder that affects primarily children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. A child may become infected after consuming contaminated food or beverages, such as meat, especially undercooked ground beef; unpasteurized juices; contaminated water; or through contact with an infected person.

The most common symptoms of HUS infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 5 to 10 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Other symptoms of HUS include fever, lethargy or sluggishness, irritability, and paleness or pallor. In about half the cases, the disease progresses until it causes acute renal failure, which means the kidneys are unable to remove waste products from the blood and excrete them into the urine. A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely.

See a doctor right away if you or your child has any of the following symptoms with diarrhea:

High fever—temperature over 101.5°, measured orally
Blood in the stools
Diarrhea that lasts more than 3 days
Prolonged vomiting that prevents keeping liquid down and can lead to dehydration
Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urination, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing rate
Signs of shock, such as weak or rapid pulse or shallow breathing
Confusion or difficulty reasoning

How are foodborne illnesses diagnosed?

Your doctor may be able to diagnose foodborne illnesses from a list of what you've eaten recently and from results of appropriate laboratory tests. Diagnostic tests for foodborne illnesses should include examination of the feces. A sample of the suspected food, if available, can also be tested for bacterial toxins, viruses, and parasites.

How are foodborne illnesses treated?

Most cases of foodborne illnesses are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. People who experience gastrointestinal or neurologic symptoms should seek medical attention.

In the most severe situations, such as HUS, hospitalization may be needed to receive supportive nutritional and medical therapy. Maintaining adequate fluid and electrolyte balance and controlling blood pressure are important. Doctors will try to minimize the impact of reduced kidney function. Dialysis may be needed until the kidneys can function normally. Blood transfusions also may be needed.

How are foodborne illnesses prevented?

Most cases of foodborne illnesses can be prevented through proper cooking or processing of food, which kills bacteria. In addition, because bacteria multiply rapidly between 40°F and 140°F, food must be kept out of this temperature range.

Follow these tips to prevent harmful bacteria from growing in food:

Refrigerate foods promptly. If prepared food stands at room temperature for more than 2 hours, it may not be safe to eat. Set your refrigerator at 40°F or lower and your freezer at 0°F.
Cook food to the appropriate internal temperature—145°F for roasts, steaks, and chops of beef, veal, and lamb; 160°F for pork, ground veal, and ground beef; 165°F for ground poultry; and 180°F for whole poultry. Use a meat thermometer to be sure. Foods are properly cooked only when they are heated long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses.
Prevent cross-contamination. Bacteria can spread from one food product to another throughout the kitchen and can get onto cutting boards, knives, sponges, and countertops. Keep raw meat, poultry, seafood, and their juices away from all ready-to-eat foods.
Handle food properly. Always wash your hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. Wash your hands after using the bathroom, changing diapers, or touching animals.
Wash utensils and surfaces before and after use with hot, soapy water. Better still, sanitize them with diluted bleach—1 teaspoon of bleach to 1 quart of hot water.
Wash sponges and dish towels weekly in hot water in the washing machine.
Keep cold food cold and hot food hot.
Maintain hot cooked food at 140°F or higher.
Reheat cooked food to at least 165°F.
Refrigerate or freeze perishables, produce, prepared food, and leftovers within 2 hours.
Never defrost food on the kitchen counter. Use the refrigerator, cold running water, or the microwave oven.
Never let food marinate at room temperature—refrigerate it.
Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.
Remove the stuffing from poultry and other meats immediately and refrigerate it in a separate container.
Wash all unpackaged fruits and vegetables, and those packaged and not marked "pre-washed," under running water just before eating, cutting, or cooking. Scrub firm produce such as melons and cucumbers with a clean produce brush. Dry all produce with a paper towel to further reduce any possible bacteria.
Do not pack the refrigerator. Cool air must circulate to keep food safe.

For more information about prevention of foodborne illnesses, the U.S. Department of Agriculture provides a fact sheet on safe food handling.

What is food irradiation?

Food irradiation is the treatment of food with high energy such as gamma rays, electron beams, or x rays as a means of cold pasteurization, which destroys living bacteria to control foodborne illnesses. The United States relies exclusively on the use of gamma rays, which are similar to ultraviolet light and microwaves and pass through food leaving no residue. Food irradiation is approved for wheat, potatoes, spices, seasonings, pork, poultry, red meats, whole fresh fruits, and dry or dehydrated products. Although irradiation destroys many bacteria, it does not sterilize food. Even if you're using food that has been irradiated by the manufacturer, you must continue to take precautions against foodborne illnesses—through proper refrigeration and handling—to safeguard against any surviving organisms. If you are traveling with food, make sure perishable items such as meats are wrapped to prevent leakage. Be sure to fill the cooler with plenty of ice and store it in the car, not the trunk. If any food seems warmer than 40°F, throw it out.

Links to Other Disorders Related to Foodborne Illnesses

Scientists suspect that foodborne pathogens are linked to chronic disorders and can even cause permanent tissue or organ destruction. Research suggests that when some people are infected by foodborne pathogens, the activation of their immune system can trigger an inappropriate autoimmune response, which means the immune system attacks the body's own cells. In some people, an autoimmune response leads to a chronic health condition. Chronic disorders that may be triggered by foodborne pathogens are

arthritis
inflammatory bowel disease
kidney failure
Guillain-Barré syndrome
autoimmune disorders

Further research is needed to explain the link between these disorders and foodborne illnesses.

Common Sources of Foodborne Illness

Sources of illness: Raw and undercooked meat and poultry
Symptoms: Abdominal pain, diarrhea, nausea, and vomiting
Bacteria: Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, Salmonella

Sources of illness: Raw foods; unpasteurized milk and dairy products, such as soft cheeses
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacteria: L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, C. jejuni

Sources of illness: Raw and undercooked eggs. Raw eggs are often used in foods such as homemade hollandaise sauce, caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacterium: Salmonella enteriditis

Sources of illness: Raw and undercooked shellfish
Symptoms: Chills, fever, and collapse
Bacteria: Vibrio vulnificus, Vibrio parahaemolyticus

Sources of illness: Improperly canned goods; smoked or salted fish
Symptoms: Double vision, inability to swallow, difficulty speaking, and inability to breathe. Seek medical help right away if you experience any of these symptoms.
Bacterium: C. botulinum

Sources of illness: Fresh or minimally processed produce; contaminated water
Symptoms: Bloody diarrhea, nausea, and vomiting
Bacteria: E. coli O157:H7, L. monocytogenes, Salmonella, Shigella, Yersinia enterocolitica, viruses, and parasites

Points to Remember

Foodborne illnesses result from eating food or drinking beverages that are contaminated with bacteria, viruses, or parasites.

People at greater risk for foodborne illnesses include young children, pregnant women and their fetuses, older adults, and people with lowered immunity.

Symptoms usually resemble intestinal flu. See a doctor immediately if you have more serious problems or do not seem to be improving as expected.

Treatment may range from replacement of lost fluids and electrolytes for mild cases of foodborne illnesses to hospitalization for severe conditions such as HUS.

You can prevent foodborne illnesses by taking the following precautions:

Wash your hands with warm, soapy water before and after preparing food and after using the bathroom or changing diapers.
Keep raw meat, poultry, seafood, and their juices away from ready-to-eat foods.
Cook foods properly and at a high enough temperature to kill harmful bacteria.
Refrigerate foods within 2 hours or less after cooking because cold temperatures will help keep harmful bacteria from growing and multiplying.
Clean surfaces well before and after using them to prepare food.

Diarrhea - Advice

Of the childhood diseases parents must deal with, diarrhea is one of the least pleasant, especially with a child in diapers. Unfortunately, it is among the most common. With an understanding of the mechanisms of diarrhea and the appropriate treatment, we can minimize our children's discomfort and our own custodial chores.

Diarrhea, defined as both frequent and watery stools, is most often caused by a gastro-intestinal viral infection. Certainly there are other causes, including bacterial infections, parasitic infections, food intolerance, food allergies, bowel functional problems and other inflammatory conditions. The viral, bacterial and parasitic forms are contagious, which is why, just as in other infectious diseases, good hand-washing, particularly after using sanitary facilities, is imperative.

Associated symptoms, such as persistent fever, prolonged diarrhea (over 7 days despite proper therapy) and weight loss, are suggestive of a process other than simple viral diarrhea. Bacterial and parasitic infections require specific laboratory testing and prescription therapy. Although food intolerance, food allergies, bowel functional problems (e.g., Irritable Bowel Syndrome and constipation) and inflammatory conditions (regional enteritis and ulcerative colitis) are often associated with diarrhea, these specific medical conditions require specialized therapy that is individualized to the patient by their personal physician. That management is beyond the scope of this article. Any suspicion that these conditions are present should trigger a visit to the child's doctor.

The viruses that cause gastrointestinal upset are typically acquired directly from another human. These viruses enter the body through the mouth, eyes or nose either by respiratory secretions or from touching the face with unclean hands. Recent reports have identified the water supply on some cruise ships as a source of outbreaks of shipboard diarrhea. Fever and cold symptoms are commonly associated with these infections. This differs from parasitic infections, which are devoid of cold symptoms and fever, or bacterial infections, which may be associated with fever, but not cold symptoms. Bloody loose stools are otherwise more suggestive or non-viral causes of the diarrhea. Of note is that cancer is almost never a cause of bloody stools in children. Bacterial, parasitic, inflammatory and mechanical causes (constipation or benign polyps) are the things that should come to mind first.

Bacterial enteritis is acquired by ingestion of contaminated food or water. Responsibility for outbreaks of certain enteral bacterial infections has been attributed to nearly every food group from salad and milk products to meat and vegetables, especially when stored or washed improperly. Whether here or abroad, be sure your restaurant food is served and eaten while hot and freshly cooked and avoid partaking of food from curbside vendors (even in the U.S.) because of the uncertainty of the cart heating unit being able to maintain temperature of the food at a level that kills bacteria. Poultry, especially chicken eggs and turkey, are known common carriers of salmonella. Some authorities recommend not rinsing the Thanksgiving turkey before cooking it, since you would risk splashing salmonella all over the food preparation area. Hand washing after handling chicken egg shells (or after handling pet amphibians) will also help avoid contamination. Avoid raw egg products (some Caesar salad dressings). Typhoid vaccine is available for prevention of salmonella infections in travelers to countries where this infection is prevalent.

Travelers to developing countries and campers are at increased risk for parasitic, as well as bacterial, intestinal infections. In countries that do not have sanitary drinking water supply systems (especially common in rural areas), waste water may contaminate drinking water. In these situations, it is best to drink only commercially bottled carbonated beverages or water. Campers may wish to carry iodine pills to sanitize ground water for drinking. Alternatively and more effectively, camping suppliers can provide small portable water pumps, which filter out all infectious organisms. Vigorous boiling for one minute eliminates parasitic and bacterial organisms, but may not kill all viruses.

The mainstay of management of viral diarrhea is dietary. Fluid replacement is critical, especially in the young infant. There is no fluid that particularly stops diarrhea, but there are liquids that will not exacerbate it. Electrolyte solutions, such as Pedialyte®, Lytren®, Kaolectrolyte® and Gerber Liquilytes Oral Maintenance Solution® are all appropriate, either in liquid or freeze push-pop form, depending on the age of the child. Older children with diarrhea often resort to sports drinks, such as Gatorade® or Powerade® for their fluid and electrolyte replacement. Although supported by some studies, fruit juice is usually not recommended in this situation because it tends to be laxative. Cow milk products are not recommended because of four factors:

The dissolved mineral content (solute load) causes an obligatory urinary fluid loss which may compromise the child's fluid balance further
Cow milk sugar, called lactose, is difficult to digest in the presence of a viral enteritis because the necessary enzyme, lactase, is not being produced during and after the illness (Cow milk products should be avoided for at least three days or longer after a viral intestinal insult)
Cow milk protein may not be well digested in the presence of a viral enteritis
Conventional belief holds that nasopharyngeal mucus becomes thicker after ingestion of milk (there is currently no solid scientific evidence to prove or disprove this supposition)

Occasionally, rice or soy beverages are recommended for children who need an enhanced calorie intake or who refuse other liquids. When the child exhibits a desire to eat solid foods, the usual initial offerings consist of foods that are naturally constipating: Bananas, Rice, Apples and Toast (called the BRAT diet). Fruits other than bananas and apples are laxative. Toast represents starchy foods, such as bread, cake, cracker, pasta, potatoes, etc. Vegetables and meats are neither harmful during diarrhea nor helpful in making the stool quality less uncomfortable.

In the occasional child whose diarrhea is very frequent and very watery, a plant extract called attapulgite, sold under the names of Kaopectate® and Diasorb®, will help make the stool less frequent and less watery. (These brands also market a product containing bismuth subsalicylate. We do NOT recommend these for children.) Attapulgite is not absorbed and there is no toxicity associated with it. The same brands, however, market other ingredients under similar brand names, so care should be taken to read the label before administering these preparations to a child. Note that these preparations do not cure an intestinal viral illness. Only time and supportive care can accomplish this goal. We do not recommend agents that inhibit intestinal motility (e.g., Lomotil®, paragoric or Immodium®) to treat viral diarrhea. These agents can make a child more lethargic and lead to accumulation of the diarrhea in the intestine, which allows enhanced absorption of bacterial toxins. They appear to work only by hiding the diarrhea from the child's caretaker. Custodial care of the infant in this situation includes prevention of diaper rash by application of a topical diaper rash cream (e.g., Desitin®, A and D Ointment®, Diaperene®, J&J Ointment®, Balmex®, etc.).

If any of the warning signs mentioned in this article appear during the course of your child's diarrhea, you should consult with your child's doctor. In uncomplicated viral diarrhea, as long as you administer adequate fluid intake, the process will eventually end.

Signs and symptoms

Gastroenteritis is called stomach flue bit it is not exactly same as influenza. Flu (influenza) affects your respiratory system, nose, throat and lungs. Gastroenteritis affects your intestines, causing signs and symptoms such as:

Watery, usually non-bloody diarrhea. Bloody diarrhea indicates serious condition.
Nausea, vomiting or both.
Abdominal cramps and pain.
Low-grade fever.
You're not able to keep liquids down for 24 hours.
You've been vomiting for more than two days.
You're vomiting blood.
Dehydrated. Signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness.
Blood in bowel movements.
Fever above 101 F.
Hasn't had a wet diaper in three hours
Has bloody stools or severe diarrhea
Has a sunken fontanel (the soft spot on the top of a baby's head)
Has a dry mouth or cries without tears
Is unusually sleepy, drowsy or unresponsive

Signs and symptoms may look within one to three days after real infection and may be mild to severe. These symptoms may last just one or two days, but normally they may persist as long as 10 days.

Because the symptoms are similar, it's easy to confuse viral diarrhea with diarrhea caused by bacteria such as salmonella and Escherichia coli (E. coli) or parasites such as giardia.