Definitions of diarrhea | Medical Science Optional Notes for UPSC PDF Download

Intermittent Diarrhea?

• Definition: Diarrhea is characterized by alterations in stool consistency and frequency, specifically referring to liquid or watery stools occurring more than three times a day.
• Dysentery and Blood in Stools: If blood is present in stools, the condition is referred to as dysentery.
• Acute Diarrhea Duration: Diarrhea that lasts for more than two weeks is categorized as persistent diarrhea.
• Chronic Diarrhea Definition: Chronic diarrhea is described as diarrhea with a gradual onset lasting for more than two weeks in children and more than four weeks in adults.
• Clarification on Chronic Diarrhea: It's essential to note that the term "chronic diarrhea" does not have the same meaning as "persistent diarrhea." Persistent diarrhea specifically refers to diarrhea lasting for more than two weeks.

Malabsorption syndromes

Almost all the malabsorption disorders are accompanied by chronic diarrhea which further worsens the malabsorption.

Upper Jejunal Mucosal Immunopathology

Flat Mucosa

• Autoimmune enteropathy
• Tropical sprue
• Giardiasis
• HIV enteropathy
• Bacterial overgrowth
• Crohn disease
• Eosinophilic gastroenteritis
• Cow's milk enteropathy 
• Soy protein enteropathy
• Primary immunodeficiency
• Graft-versus-host disease
• Chemotherapy and radiation
• Protein energy malnutrition 
• Tuberculosis
• Lymphoma 
• Non-gluten food intolerances

Management of Celiac disease

Managing celiac disease mainly consists of maintaining a lifelong gluten-free diet.

Improvement

Supplementation with:

• Iron 
• Vitamin D
• Calcium 
• Other nutrients

Gluten free diet means

• The Codex Alimentarius Guidelines establish the gluten-free threshold as less than 20 parts per million (ppm). 
• While analytical methods for detecting gluten have advanced significantly, there is a lack of comprehensive information regarding the daily amount of gluten that individuals with celiac disease can tolerate. 
• Current data indicates that a threshold of less than 50 milligrams per day may be appropriate, but setting a universal standard is challenging due to individual variations.

[Intext Question]

Management of coeliac disease-Repeats

Q1: A 4-year-old male child is admitted with history of diarrhea, pain abdomen, vomiting since the age of one year. He had taken treatment from various practitioners without significant improvement. On examination, child is malnourished, weight 9 kg, height 90 cm. There are signs of vitamin and mineral deficiency. Enumerate all the probable causes of this condition.
(ii) What investigations will you advise to diagnose the cause?
(iii) Describe the management of celiac disease. (2012) 

Q2: Define "persistent diarrhoea" in under-five children. How is it different from "chronic diarrhoea"? Discuss the dietary management of persistent diarrhoea. Enumerate few common causes of chronic diarrhoea. (2016) 

Q3: A 4-year-old child presents with stunted growth and moderate pallor. The child had history of intermittent diarrhoea. (2017)