Introduction

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose or
liquid bowel movements each day. It often lasts for a few days and can result
in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal
stretchiness of the skin and changes in personality. This can progress to
decreased urination, loss of skin color, a fast heart rate, and a decrease in
responsiveness as it becomes more severe. Loose but non watery stools in babies who
are breastfed, however, may be normal.
The most common cause is an infection of the intestines due to either
a virus, bacteria, or parasite; a condition known as gastroenteritis. These infections are
often acquired from food or water that has been contaminated by stool, or directly from
another person who is infected. It may be divided into three types: short duration watery
diarrhea, short duration bloody diarrhea, and if it lasts for more than two weeks,
persistent diarrhea. The short duration watery diarrhea may be due to an infection
by cholera. If blood is present it is also known as dysentery. A number of non-infectious
causes

may

also

result

in

diarrhea,

including

hyperthyroidism, lactose

intolerance, inflammatory bowel disease, a number of medications, and irritable bowel

syndrome. In most cases stool cultures are not required to confirm the exact cause.
Prevention of infectious diarrhea is by improved sanitation, clean drinking water,
and hand

washing with

soap. Breastfeeding for

at

least

six

months

is

also

recommended as is vaccination against rotavirus. Oral rehydration solution (ORS),

which is clean water with modest amounts of salts and sugar, is the treatment of
choice. Zinc tablets are also recommended. These treatments have been estimated to
have saved 50 million children in the past 25 years. When people have diarrhea it is
recommended that they continue to eat healthy food and babies continue to be
breastfeed. If commercial ORS are not available, homemade solutions may be used. In
those with severe dehydration, intravenous fluids may be required. Most cases;
however, can be managed well with fluids by mouth. Antibiotics, while rarely used, may
2

be recommended in a few cases such as those who have bloody diarrhea and a high
fever, those with severe diarrhea following travelling, and those who grow specific
bacteria or parasites in their stool. Loperamide may help decrease the number of bowel
movement but is not recommended in those with severe disease.
About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing
countries, where young children get diarrhea on average three times a year. Total
deaths from diarrhea are estimated at 1.26 million in 2013 down from 2.58 million in
1990. In 2012, it is the second most common cause of deaths in children younger than
five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause
of malnutrition and the most common cause in those younger than five years of
age.Other long term problems that can result include stunted growth and poor
intellectual

development.

International
272,000,000 per year, 22,666,666 per month, 5,230,769 per week, 745,205 per day,
31,050 per hour, 517 per minute, 8 per second. Note: this extrapolation calculation uses
the incidence statistic: almost 100% annually (NIDDK)
National
Over 70,000 Filipino children have died of diarrhea in span of seven years, the World
Health Organization (WHO) said in a study released Friday.
The study showed that if the trend continues, it is expected to cause 10,000 deaths
every year.

Definition of Diagnosis
What is the definition of diarrhea?
Diarrhea can be defined in absolute or relative terms based on either the frequency of
bowel movements or the consistency (looseness) of stools.
Frequency of bowel movements:Absolute diarrhea is having more bowel movements
than normal. Thus, since among healthy individuals the maximum number of daily
bowel movements is approximately three, diarrhea can be defined as any number of
stools greater than three. "Relative diarrhea" is having more bowel movements than
usual. Thus, if an individual who usually has one bowel movement each day begins to
have two bowel movements each day, then relative diarrhea is present-even though
there are not more than three bowel movements a day, that is, there is not absolute
diarrhea.
Consistency of stools: Absolute diarrhea is more difficult to define on the basis of the
consistency of stool because the consistency of stool can vary considerably in healthy
individuals depending on their diets. Thus, individuals who eat large amounts of
vegetables will have looser stools than individuals who eat few vegetables and/or fruits.
Stools that are liquid or watery are always abnormal and considered diarrheal. Relative
diarrhea is easier to define based on the consistency of stool. Thus, an individual who
develops looser stools than usual has relative diarrhea--even though the stools may be
within the range of normal with respect to consistency.
Why does diarrhea develop?
With diarrhea, stools usually are looser whether or not the frequency of bowel
movements is increased. This looseness of stool--which can vary all the way from
slightly soft to watery--is caused by increased water in the stool. During
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normaldigestion, food is kept liquid by the secretion of large amounts of water by the
stomach, upper small intestine, pancreas, and gallbladder. Food that is not digested
reaches the lower small intestine and colon in liquid form. The lower small intestine and
particularly the colon absorb the water, turning the undigested food into a more-or-less
solid stool with form. Increased amounts of water in stool can occur if the stomach
and/or small intestine secrete too much fluid, the distal small intestine and colon do not
absorb enough water, or the undigested, liquid food passes too quickly through the
small intestine and colon for enough water to be removed.
Another way of looking at the reasons for diarrhea is to divide it into five types.
1 The first is referred to as secretory diarrhea because too much fluid is secreted
into the intestine.
2 The second type is referred to as osmotic diarrhea in which small molecules that
pass into the colon without being digested and absorbed draw water and electrolytes
into the colon and stool.
3 The third type is referred to as motility-related diarrhea in which the intestinal
muscles are overactive and transport the intestinal contents through the intestine
without enough time for water and electrolytes to be absorbed.
4 The

fourth

type

is

unusual.

It

is

best

represented

by a

condition

calledcollagenous colitis. In collagenous colitis, the mechanism of the diarrhea may

be the inability of the colon to absorb fluid and electrolytes because of the extensive
scarring of the intestinal lining. Inflammation may also play a role.
5 The fifth type of diarrhea is referred to as inflammatory diarrhea and involves
more than one mechanism. For example, some viruses, bacteria, and parasites
cause increased secretion of fluid, either by invading and inflaming the lining of the
small intestine (inflammation stimulates the lining to secrete fluid) or by producing
toxins (chemicals) that also stimulate the lining to secrete fluid but without causing
inflammation. Inflammation of the small intestine and/or colon from bacteria or from
non-bacterial ileitis/colitis can increase the rapidity with which food passes through
the intestines, reducing the time that is available for absorbing water.
Diarrhea generally is divided into two types, acute and chronic.
6 Acute diarrhea lasts from a few days up to a week.
5

7 Chronic diarrhea can be defined in several ways but almost always lasts more
than three weeks.
It is important to distinguish between acute and chronic diarrhea because they usually
have different causes, require different diagnostic tests, and require different treatment.
Reference: http://www.medicinenet.com/diarrhea/page2.htm
Patients Profile
Name:

Age:

27 years of age

Birthday:

09/08/1987

Address:

Mintal Davao City

Civil Status:

Single

Sex:

Female

Nationality:

Filipino

Religion:

Roman Catholic

Height:

155cm

Weight:

55kg

Admitting Physician :

Dr. C. Castillo

Date of Admission:

08/30/15

Chief Complaint:

LBM

Admitting Diagnosis:

Acute Gastroenteritis with

moderate dehydration

A. Past health history

Prior to the admission, the patient had 1 previous admission. The patient was
admitted 5years ago due to Amoebiasis.
B. Present Health History
The patient was a non-alcoholic. Her diet consist of foods rich in vegetables and
fruits, because she loves to eats those. She seldom consumed foods rich in fats,
but she was at frequent consumer of coffee. She doesnt exercise since she had
been very busy with her work and some household chores. She always slept late
at night and wake up early often.
C. Family History
Only her father was diagnosed with hypertension. No other trace of underlying
condition was reported by the patient.

Chief Complaint and History of Present Illness

A case of pt. X, 27 years old, female, from Mintal Davao City, 1day prior to admission,
patient noted that 6x episodes of watery stool with abdominal cramping.

August

30/2015 at around 12 midnight, due to her chief complaint of LBM she was admitted at
Davao Doctors Hospital and was diagnosed by Dr. Castillo that she suffered Acute
Gastroenteritis with moderate dehydration.

Anatomy and Physiology

The digestive system processes the food you eat. Food travels via the esophagus into
the stomach and then into the small and large intestines. The small intestine starts at
the pylorus of the stomach and ends at the cecum of the large intestine. The main
function of the small intestine is continued digestion and absorption of nutrients.

The small intestine has three segments: the duodenum, the jejunum, and the ileum.
The duodenum
The duodenum is the first segment of the small intestine and is also the shortest (about
25 centimeters, or roughly 10 inches). It starts at the pylorus and ends at the
duodenojejunal junction. It has four parts:

Superior part: Horizontal to and in front of the 1st lumbar vertebra.

Descending part: Runs inferiorly along the right borders of the 2nd and 3rd
lumbar vertebrae. Its close to the head of the pancreas.

Inferior part: Crosses to the left, in front of the inferior vena cava, close to the
level of the 3rd lumbar vertebra.
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Ascending part: Starting near the 3rd lumbar vertebra, this part runs upward
along the left side of the aorta. It joins the jejunum at the duodenojejunal junction.
Its supported by the suspensory muscle of the duodenum, also called the ligament
of Treitz.

Parasympathetic nerve supply to the duodenum comes from the vagus nerve, and
sympathetic nerves in this area include the greater and lesser splanchnic nerves. Blood
is supplied to the duodenum by the superior pancreaticoduodenal artery, a branch of the
gastroduodenal artery, and the inferior pancreaticoduodenal artery, a branch of the
superior mesenteric artery. Blood is drained by the corresponding veins into the hepatic
portal system. Lymphatic vessels follow the arteries to the pancreaticoduodenal lymph
nodes, pyloric lymph nodes, and the superior mesenteric lymph nodes. Lymph flows
from those nodes to the celiac lymph nodes.
The jejunum and the ileum
The jejunum is the middle portion of the small intestine. It starts at the duodenojejunal
junction and changes into the ileum, which is the third portion. The jejunum takes up
about two-fifths of the length of the small intestine, but no clear line demarcates where it
turns into the ileum. The ileum ends at the ileocecal junction. The ileum and jejunum are
attached to the posterior abdominal wall by the mesentery.
Sympathetic and parasympathetic nerves are brought by the superior mesenteric
plexus. Blood is brought to the jejunum and ileum by branches from the superior
mesenteric artery. Blood is drained by the superior mesenteric vein. Lymph nodes that
drain this area include the juxtaintestinal lymph nodes, mesenteric lymph nodes, and
central nodes. Lacteals are specialized lymphatic vessels found in the small intestine
that absorb fat from the foods you eat.
The large intestine
Most of the large intestine is located in the abdomen; the sigmoid colon and rectum are
in the pelvic cavity. The abdominal portion of the large intestine includes the cecum and
the ascending, transverse, and descending colon. The main function of the large
intestine is to absorb water from fecal material before its eliminated from the body. The
colon is also home to friendly bacteria that synthesize vitamin K and keep bad microbes
in check.
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The large intestine is much larger in diameter than the small intestine and has omental
appendages attached to it.
The cecum
The cecum is a pouch of intestine that hangs below the ileocecal junction in the right
lower quadrant of the abdomen. Folds of mucosal tissue form the ileocecal valve that
covers the ileal orifice. The appendix extends from the posteromedial part of the cecum.
Sympathetic and parasympathetic nerves come from the superior mesenteric plexus.
Blood supply to the cecum comes via the ileocolic artery, a branch of the superior
mesenteric artery. The appendicular artery branches from the ileocolic artery. Lymphatic
vessels pass to the ileocolic lymph nodes and the superior mesenteric lymph nodes.
The ascending colon
The ascending colon travels from the cecum upward on the right side of the abdominal
cavity to the right colic flexure near the right side of the liver. This part of the colon is
retroperitoneal.
Nervous supply is brought to the ascending colon by the superior mesenteric plexus.
The ileocolic and right colic arteries supply blood. Blood is drained away by the ileocolic
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and right colic veins. Lymph is drained by the epicolic and paracolic lymph nodes, and
then it travels to the ileocolic and right colic lymph nodes.
The transverse colon
The transverse colon crosses from the right side of the abdomen to the left, ending at
the left colic flexure. The sympathetic nerves that serve the transverse colon come from
the superior and inferior mesenteric plexuses; the parasympathetic nerves arise from
the vagus nerves and the pelvic splanchnic nerves.
Blood is brought to the transverse colon primarily by the middle colic artery. The distal
portion of the transverse colon is served by the left colic artery, a branch of the inferior
mesenteric artery. Venous blood is removed by the superior mesenteric and inferior
mesenteric veins. Lymph is drained into the colic lymph nodes and into the colic nodes.
The descending colon
The descending colon travels behind the peritoneum and downward from the left colic
flexure to the left iliac fossa where it continues as the sigmoid colon. Sympathetic nerve
supply comes from the lumbar splanchnic nerves, the inferior mesenteric plexus, and
the periarterial plexuses that surround the inferior mesenteric artery. Parasympathetic
nerve supply comes from the pelvic splanchnic nerve.
Blood is brought to the descending colon by the left colic and sigmoid arteries, branches
of the inferior mesenteric artery. Blood is drained away by the inferior mesenteric vein.
Lymph is drained into the epicolic and paracolic lymph nodes, which drain into the
intermediate colic lymph nodes. From here the lymph drains into the inferior mesenteric
lymph nodes.

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Comprehensive Health Assessment

A. Integumentary
During the assessment reveals evenly colored skin tones without discolorations, mildly
rough during our assessment, good skin turgor, no presence of scaling and any
unusualities. The patient has a short, thick, black, well distributed and no presence of
hair infestations seen.
Fingernails and Toenails
Nails are well trimmed, clean and no unusualities around the nails and pink tones
returns immediately to blanched nail beds when pressure is released.
B. Head and Neck
Head is symmetric, round, erect, and in midline and appropriately related to body
size(normocephalic). No lesions are visible. The neck is symmetric, with head centered
and without bulging masses. No difficulties in head motion.
Nose and Sinuses
Color is the same as the rest of the face, the nasal structure is smooth and symmetric.
Client is able to sniff through each nostril while other is occluded.
Mouth and Pharynx
Lips noted dry without lesions or swelling, no decayed teeth and patient is not using
dentures, no ulcers and foul odor noted. Gag reflex is present but dry mucosal lining
noted.
C. Eyes and Ears
The patient can distinguish what the person with normal vision and can read what the
normal client can read from a distance of 14inches. Patient is able to see with her
peripheral vision. The reflection of light on the corneas are exact same spot on each
eye. No lesions with her external eyes but sunken eyes noted during the assessment.
Blink reflex is voluntary. Pupils and iris consensual light response is constriction. Noted
of sunken eyes.
Ears

13

Ears are equal in size bilaterally and no lesions noted. The auricle aligns with the corner
of each eye. The patient has no difficulty or problem in hearing and can hear in both
ears.
D. Cardiopulmonary
Heart and Vascular
Jugular vein is not distended and no bulging noted. Blood pressure is 110/70 mmHg,
Pulse rate is 72 bpm, capillary refill time is less than 2 seconds.
Thorax and Lungs
No diminished sounds noted, no presence of productive or non prodcutive cough.
Respiratory rate is 21 cpm and not in distress.
E. Gastrointestinal
Abdomen is flat, no pain was felt as verbalized by the patient, soft and bowel sounds is
present in all quadrants.
Nutritional/Metabolic Patterns
Height : 155cm
Weight : 55kg
BMI = indicates normal. (155/100 = 1.55X2 = 3.1 (55/3.01 = 18.27)
Underweight: BMI is less than 18.5
Normal weight: BMI is than 18.5 - 24.9
Overweight: BMI is 25 - 29.9
Obese: BMI is 30 or more
F. Musculoskeletal
No abnormalities was assessed with her gait and posture. During the assessment
patient had gain strength so no decreased in range of motion noted.
G. Neurological System
Patient is alert, oriented, able to communicate and cooperative. No changed in level of
her consciousness noted.
Cranial Nerve Function
CN I

- Intact

CN IV

- Intact

CN VII

- Intact
14

CN IX

- Intact

CN X

- Intact

CN XI

- Intact

CN XII

- Intact

Sensory Function
Touch

- Intact

Pain

- Intact

Motor Function
No loss of imbalance noted.
Reflexes
Normal, visible muscle twitch and extension of lower leg.

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