Diarrhea

context: 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 irritable behaviour. 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.
qas: answers: text: the condition of having at least three loose or liquid bowel movements each day
question: What is diarrhea?

answers: text: can result in dehydration due to fluid loss
question: What is one of the effects of diarrhea?

answers: text: loss of the normal stretchiness of the skin and irritable behaviour
question: What are the warning signs of dehydration?

answers: text: decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness
question: What are other signs of dehydration?

context: 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, although this is rare in the developed world. 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.
qas: answers: text: an infection of the intestines
question: What is the most common cause of diarrhea?

answers: text: a virus, bacteria, or parasite
question: What can cause an infection in the intestines?

answers: text: short duration watery diarrhea, short duration bloody diarrhea, and if it lasts for more than two weeks, persistent diarrhea
question: What are the three types of diarrhea?

answers: text: dysentery
question: What is it known as if blood is present?

context: 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 breastfed. 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 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.
qas: answers: text: improved sanitation, clean drinking water, and hand washing with soap
question: What are some ways to prevent diarrhea?

answers: text: Breastfeeding for at least six months
question: What else can a mom do to prevent diarrhea for her baby?

answers: text: Oral rehydration solution (ORS), which is clean water with modest amounts of salts and sugar
question: What is the treatment of choice for diarrhea?

answers: text: 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
question: What conditions would a doctor prescribe antibiotics?

context: 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.
qas: answers: text: 1.7 to 5 billion cases
question: HOw many cases of diarrhea are there a year?

answers: text: average three times a year
question: How often do kids get diarrhea in developing countries?

answers: text: malnutrition
question: Frequent episodes of diarrhea are common in what type of cases?

answers: text: stunted growth and poor intellectual development
question: What long term issues can arise from frequent diarrhea?

context: Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting. It continues even when there is no oral food intake.
qas: answers: text: an increase in the active secretion, or there is an inhibition of absorption
question: What is secretory diarrhea?

answers: text: cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions
question: What are the causes of secretory diarrhea?

answers: text: . There is little to no structural damage.
question: Is there any structural damage associated with secretory diarrhea?

context: Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also be the result of maldigestion (e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped.
qas: answers: text: s when too much water is drawn into the bowels
question: What occures with osmotic diarrhea?

answers: text: If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel
question: What causes osmotic diarrhea?

answers: text: alleviate constipation by drawing water into the bowels
question: How do osmotic lazatives work?

answers: text: too much magnesium or vitamin C or undigested lactose
question: What can cause osmotic diarrhea in healthy people?

context: Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea[clarification needed] can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.[citation needed]
qas: answers: text: when there is damage to the mucosal lining or brush border
question: When does inflammatory diarrhea occur?

answers: text: a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids
question: What happens with inflammatory diarrhea?

answers: text: bacterial infections, viral infections, parasitic infections, or autoimmune problems
question: What can cause inflammatory diarrhea?

answers: text: tuberculosis, colon cancer, and enteritis.
question: What other causes are there for inflammatory diarrhea?

context: Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults," and diarrhea is a primary cause of childhood malnutrition. Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for helminth infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence.
qas: answers: text: a negative impact on both physical fitness and mental development
question: Diarrheal disease has what effects on a person?

answers: text: reduces physical fitness and work productivity in adults
question: What can early childhood malnutrition cause?

answers: text: diarrhea
question: What is the cause of childhood malnutrition?

answers: text: significantly lower scores on a series of tests of intelligence
question: Children who have experienced sever diarrhea are more likely to have what effect?

context: Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements, and/or medications such as loperamide or codeine. About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test.
qas: answers: text: irritable bowel syndrome
question: What is IBS?

answers: text: abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months
question: What symptoms do you have with IBS?

answers: text: a combination of dietary changes, soluble fiber supplements, and/or medications
question: How can symptoms be managed with IBS?

context: Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste (sanitation), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care."
qas: answers: text: Poverty
question: What is a good indicator of the rate of infectious diarrhea?

answers: text: from the conditions under which impoverished people live
question: Why does living in poverty raise your risk of diarrhea?

answers: text: the lack of adequate, available, and affordable medical care.
question: What causes this to be exacerbated?

context: Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency, a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in the severity of diarrheal episodes, however there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction.
qas: answers: text: for health and functioning, including the prevention of infectious diarrhea
question: Why is proper nutrition important?

answers: text: greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever
question: What effects does lower levels of zinc have in children?

answers: text: cause an increase in the severity of diarrheal episodes
question: What can having a vitamin A deficiency cause?

answers: text: 127 million
question: What is the rate of  vitamin A deficiency in children worldwide?

context: According to two researchers, Nesse and Williams, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".
qas: answers: text: diarrhea may function as an evolved expulsion defense mechanism
question: What did Nesse and Williams learn?

answers: text: there might be a delay in recovery.
question: If diarrhea is stopped, would could happen?

answers: text: caused people to stay feverish twice as long as those not so treated.
question: What happened with people with Shigella were treated with anti-diarrheal medication?

context: Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 42–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC: "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.
qas: answers: text: Basic sanitation techniques
question: What has had major effects on the transmission of diarrheal diseases?

answers: text: approximately 42–48%
question: How much does hand washing reduce the chances of disease?

answers: text: access to soap and water is limited
question: Why do developing countries not wash their hands as much as other countries?

answers: text: implementation of educational programs that encourage sanitary behaviours
question: What is a solution to help this problem?

context: Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease.
qas: answers: text: water contamination
question: What is a major means of the spread of diarrhea disease?

answers: text: clean water supply and improved sanitation
question: What has cut the rate of diarrhea disease incidents? 

answers: text: 22–27% reduction in disease incidence
question: What would be the reduction in deisease incedence if there was better water and sanitation?

context: Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2-3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6-10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease. Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.
qas: answers: text: it does require targeting certain pathogens for vaccination
question: What is the downfall of using immunization against the pathogens that cause disease?

answers: text: Rotavirus
question: What is responsible for 6% of dearrheal disease?

answers: text: 20%
question: What percent is the rotavirus responsible for in diarrheal disease deaths?

answers: text: (2-3%) decrease in total diarrheal disease incidence
question: What was the effect of the Rotavirus vaccine?

answers: text: 1985
question: What year was the Rotovirus vaccine used?

context: Dietary deficiencies in developing countries can be combated by promoting better eating practices. Supplementation with vitamin A and/or zinc. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group. The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence. Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.
qas: answers: text: promoting better eating practices
question: What can be done to combate dietary deficiences?

answers: text: Zinc
question: What has been used and shown successful in a decrease in incidence of diarrheal disease?

answers: text: zinc supplementation
question: WHat strategy was found out to be more cost effective?

context: In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously. Diet restrictions such as the BRAT diet are no longer recommended. Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea. To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning. CDC recommends that children and adults with cholera also continue to eat.
qas: answers: text: replacing lost fluid and salts is the only treatment needed
question: What is the basic treatment many cases of diarrhea need?

answers: text: This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously
question: How is this treatment given?

answers: text: BRAT diet
question: What type of diet is no longer recommended?

answers: text: children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain
question: What does WHO recommend to do?

context: Oral rehydration solution (ORS) (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added (approximately the "taste of tears"). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse.
qas: answers: text: Oral rehydration solution (ORS)
question: What can be used to prevent dehydration?

answers: text: salted rice water, salted yogurt drinks, vegetable and chicken soups with salt
question: What are some good standard home solutions?

answers: text: Pedialyte
question: What is a commercial solution that can also be used?

answers: text: one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added
question: What is the WHO's recipe for ORS?

context: Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall. A nasogastric tube can be used in young children to administer fluids if warranted.
qas: answers: text: Drinks especially high in simple sugars, such as soft drinks and fruit juices
question: What are not recommended for younger kids because it can casue more dehydration?

answers: text: A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water
question: Why are sodas and high sugar fruit juices not recommended?

answers: text: A nasogastric tube
question: What can be used to give fluids when they can not drink?

context: WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. A child should also continue to be breastfed. The WHO states "Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued." And in the specific example of cholera, CDC also makes the same recommendation. In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery.
qas: answers: text: a child with diarrhea continue to be fed
question: What does WHO recommend?

answers: text: Continued feeding speeds the recovery of normal intestinal function
question: What does continuing to eat do for your illness?

answers: text: children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly
question: What happens when a childs food is restricted?

context: While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations. There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7. In resource-poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance, particularly Shigella. Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics.
qas: answers: text: they are usually not used except in specific situations
question: Are antibiotics used in diarrhea instances?

answers: text: may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7
question: What are the concerns with anitbiotics?

answers: text: some bacteria are developing antibiotic resistance
question: What are bacteria doing that makes them not work as well?