loose motions – Evolution of Medical profession-Extinction of good doctors

Overview

Diarrhea — loose, watery and possibly more-frequent bowel movements — is a common problem. It may be present alone or be associated with other symptoms, such as nausea, vomiting, abdominal pain or weight loss.

Luckily, diarrhea is usually short-lived, lasting no more than a few days. But when diarrhea lasts beyond a few days into weeks, it usually indicates that there’s another problem — such as irritable bowel syndrome (IBS) or a more serious disorder, including persistent infection, celiac disease or inflammatory bowel disease (IBD).

Symptoms

Signs and symptoms associated with diarrhea (loose, watery stools) may include:

Abdominal cramps or pain
Bloating
Nausea
Vomiting
Fever
Blood in the stool
Mucus in the stool
Urgent need to have a bowel movement

When to see a doctor

If you’re an adult, see your doctor if:

Your diarrhea persists beyond two days with no improvement
You become dehydrated
You have severe abdominal or rectal pain
You have bloody or black stools
You have a fever above 102 F (39 C)

In children, particularly young children, diarrhea can quickly lead to dehydration. Call your doctor if your child’s diarrhea doesn’t improve within 24 hours or if your child:

Becomes dehydrated
Has a fever above 102 F (39 C)
Has bloody or black stools

Causes

A number of diseases and conditions can cause diarrhea, including:

Viruses. Viruses that can cause diarrhea include Norwalk virus (also known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) has also been associated with gastrointestinal symptoms, including nausea, vomiting and diarrhea.
Bacteria and parasites. Exposure to pathogenic bacteria, such as E. coli or parasites through contaminated food or water, leads to diarrhea. When traveling in developing countries, diarrhea caused by bacteria and parasites is often called traveler’s diarrhea. Clostridioides difficile (also known as C. diff) is another type of bacterium that causes diarrhea, and it can occur after a course of antibiotics or during a hospitalization.
Medications. Many medications, such as antibiotics, can cause diarrhea. Antibiotics alleviate infections by killing bad bacteria, but they also kill good bacteria. This disturbs the natural balance of bacteria in your intestines, leading to diarrhea or a superimposed infection such as C. diff. Other drugs that cause diarrhea are anti-cancer drugs and antacids with magnesium.
Lactose intolerance. Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop as you get older.
Fructose. Fructose is a sugar found naturally in fruits and honey. It’s sometimes added as a sweetener to certain beverages. Fructose can lead to diarrhea in people who have trouble digesting it.
Artificial sweeteners. Sorbitol, erythritol and mannitol — artificial sweeteners are nonabsorbable sugars found in chewing gum and other sugar-free products — can cause diarrhea in some otherwise healthy people.
Surgery. Partial intestine or gallbladder removal surgeries can sometimes cause diarrhea.
Other digestive disorders. Chronic diarrhea has a number of other causes, such as IBS, Crohn’s disease, ulcerative colitis, celiac disease, microscopic colitis and small intestinal bacterial overgrowth (SIBO).

Complications

Diarrhea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

If you have signs of serious dehydration, seek medical help.

Indications of dehydration in adults

These include:

Excessive thirst
Dry mouth or skin
Little or no urination
Weakness, dizziness or lightheadedness
Fatigue
Dark-colored urine

Indications of dehydration in infants and young children

These include: Not having a wet diaper in three

or more hours
Dry mouth and tongue
Fever above 102 F (39 C)
Crying without tears
Drowsiness, unresponsiveness or irritability
Sunken appearance to the abdomen, eyes or cheeks

Prevention

Preventing infectious diarrhea

Wash your hands to prevent the spread of infectious diarrhea. To ensure adequate hand-washing:

Wash frequently. Wash your hands before and after preparing food. Wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing and blowing your nose.
Lather with soap for at least 20 seconds. After putting soap on your hands, rub your hands together for at least 20 seconds. This is about as long as it takes to sing “Happy Birthday” twice through.
Use hand sanitizer when washing isn’t possible. Use an alcohol-based hand sanitizer when you can’t get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the fronts and backs of both hands. Use a product that contains at least 60% alcohol.

Vaccination

You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines. Ask your baby’s doctor about having your baby vaccinated.

Preventing traveler’s diarrhea

Diarrhea commonly affects people who travel to countries where there’s inadequate sanitation and contaminated food. To reduce your risk:

Watch what you eat. Eat hot, well-cooked foods. Avoid raw fruits and vegetables unless you can peel them yourself. Also avoid raw or undercooked meats and dairy foods.
Watch what you drink. Drink bottled water, soda, beer or wine served in its original container. Avoid tap water and ice cubes. Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.

Beverages made with boiled water, such as coffee and tea, are probably safe. Remember that alcohol and caffeine can aggravate diarrhea and worsen dehydration.

Ask your doctor about antibiotics. If you’re traveling to a developing country for an extended time, ask your doctor about antibiotics before you go, especially if you have a weakened immune system.
Check for travel warnings. The Centers for Disease Control and Prevention maintains a travelers’ health website where disease warnings are posted for various countries. If you’re planning to travel outside of the United States, check there for warnings and tips for reducing your risk.
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Diarrhoea –loose motions has many causes. Bacterial, protozoal or viruses all can cause diarrhoea. Infections like cholera caused by bactweria Vibrio cholera can be life threatening. Similarly Shigella, another bacteria can be fatal occasionally, if treatment is delayed. Shigellosis is not a very common infection, and it can be treated easily, doctors say. But a delay in getting to a doctor can complicate the effects of the food poisoning. Young children and those with weakened immune systems are more vulnerable.

The Kerala health department on Tuesday (May 3) identified Shigella bacteria as the cause for the food poisoning incident in Kasaragod, which claimed the life of a 16-year-old girl and led to 30-odd others being admitted to hospital.

The presence of the bacteria was confirmed in the blood and faeces of people undergoing treatment after they consumed chicken shawarma from an eatery at Cheruvathur in Kasaragod last week. Police have arrested the owner and staff of the eatery.

While food poisoning is fairly common and can occur in a range of situations, how common is Shigella infection, what are its symptoms, and when should you consult a doctor?

First, what is Shigella?

Shigella is a bacterium that belongs to the Enterobacter family — a group of bacteria that reside in the intestine, not all of which cause disease in humans. It mainly affects the intestine and results in diarrhoea, sometimes bloody, stomach pain, and fever.

The infection spreads easily as it takes only “a small number of bacteria to make someone ill”, says the US Centres for Disease Control and Prevention (CDC). It is a food- and water-borne infection, and can happen when someone consumes contaminated food — like in the case from Kerala — unwashed fruit or vegetables.

The disease is easily spread by direct or indirect contact with the excrement of the patient. You can get the infection if you swim or take a bath in contaminated water.

How widespread is Shigella infection?

Shigella outbreaks appear to be exacerbated during pregnancy and in children under five years of age, and in those with weakened immune systems.

There are four types of Shigella bacteria that affect humans — Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae. The fourth type causes the most severe disease because of the toxin it produces.

But is it common for people to die of the infection?

It is not. Doctors say that the infection does not generally kill, unless the patient has a weak immune system or the pathogen is resistant to the antibiotics that are prescribed. It is a very treatable condition; if a patient reaches hospital on time they can effectively be treated using IV antibiotics.

He said that doctors usually send samples of patients with severe diarrhoea for culture to see what pathogen is causing the symptoms, in order to decide which antibiotics were likely to work the best. In the meanwhile, doctors prescribe antibiotics for the most common infections that cause diarrhoea, and they will generally work for Shigella as well.

The problem though, occurs when the antibiotics do not work because the bacteria are resistant to it.

The problem with Shigella is that it produces a lot of toxins that can affect all other organs. So, if the bacteria continue to proliferate in the body even after giving the antibiotics, it will continue to produce toxins, which can then affect the kidney, cause seizures, lead to multi-organ failure, and shock, and even turn fatal. This, however, does not happen in most cases, the mortality of the infection is less than 1%.

So if you have abdominal discomfort or an upset stomach, at which point should you start worrying?

There is no need to rush to a doctor or a hospital every time you have loose motions. However, if you have loose motions accompanied with high fever, blood in the stool, or constant vomiting such that you cannot keep any fluids down, you must get yourself to a doctor.

A person who has severe diarrhoea — which means 20 or more bowel movements in a day — must see a doctor within a day; a patient with mild diarrhoea may wait for three to four days before going to a doctor.

This is true of any diarrhoea, whether it is because of Shigella or any other reason. It is possible that the student from Kerala who died after eating the shawarma did not get medical treatment in time, he said.

What precautions should you take?

The measures to prevent a Shigella infection are the same as that of any other food- and water-borne infection. Wash your hands thoroughly before and after a meal. Wash your hands properly after a bowel movement. Ensure the water that you drink is clean and the fruits and vegetables are fresh.