By Tedler D. Depaynos, MD
It was late at night when the male patient was brought to the Emergency Room. They came from a distant barangay and because their ancient pick-up refused to start, it took them nearly 2 hours waiting for a ride. It was fortunate that an empty taxi suddenly passed by because during that time, the patient had to go back to their house at least 3 or 4 times to relieve himself. It was good that he was able to control his sphincters while on the way. I could imagine him probably pleading silently to the driver to hurry and praying that there would be no traffic or else ….
The family members were all together being a Sunday and they all ate in a nearby popular restaurant for lunch after the morning church service. They practically all ate the same kind of food but it was only the patient that developed loose bowel movements the following early morning. It was so sudden in appearance and it became uncontrollable that he could only guess that he had to visit their comfort room more than 20 times the whole day long. Although he tried drinking bottles of Gatorade bought from their small sari-sari store neighbor, he felt that he was getting weak and his vision was becoming blurred. He even thought he felt his lower legs getting stiff although he denied any pain. When he observed that his stools were getting bloody. It was then that he stopped contradicting his wife that he should be brought to the hospital immediately.
Obviously, the patient was starting to suffer sudden dehydration which was buttressed by his highly colored and reduced usual urine. His legs were about to experience “cramps” due to electrolyte imbalance which was perhaps partially reduced by his Gatorade intake. At the ER, he was immediately given intravenous fluids and electrolytes to correct the complications he was starting to experience.
Our old medical textbooks define Acute Diarrhea as lasting not more than 2-3 weeks but in our limited experience we have not encountered patients manifesting diarrhea that long. Episodes of on and off day long diarrhea recurring every few weeks or months is common in our locality and most of the time it is due to Amoebiasis. Treatment may be adequate but recurrence is common because patients take in the same kind of water or food causing re-infection.
The patient denied any history of previous episodes of diarrhea nor any rectal bleeding. He was afebrile and despite the audible abdominal contractions he felt no significant pain. There was no nausea or vomiting so that he was able to take in fluids.
There are various causes of sudden diarrhea, but one of the most common culprits would be an infection so that it is termed “infectious diarrhea”. If other individuals who ate the same kind of food are affected, it would still be infectious in origin but the more dangerous “food poisoning” is entertained. In simple infectious diarrhea, relief usually follows when you passed out what you ate even with no medications. In food poisoning, the “poison” may be absorbed into the systemic circulation so that the manifestations would be more serious. The loose bowel movements may be massive and the abdominal pain would be more significant and vomiting would be present. Apparently a simple “infectious diarrhea” was the initial consideration in this patient.
Bleeding associated with diarrhea may imply inflammation of the colon or “colitis” especially if it is associated with fever. This is termed in general as “dysentery”. Various etiologic bacteria are entertained like Amoeba, Salmonella, Shigella, etc. Medications effective against the considered bacterial etiologies are routinely given by experienced MDs. In those cases, however, the antibiotics are usually intravenously given because the intestinal absorption may not be adequate.
Even if “colitis” is entertained as the cause of bleeding, other possibilities are routinely considered. If bleeding is fresh and drips in the bowl, usually it comes from the rectal opening and may be caused by “hemorrhoids”. Bleeding coming from the upper gastro intestinal tract like the stomach causes stools admixed “with digested blood” or in layman’s term “dinuguan-like” unless very massive. Stools admixed with fresh bleeding usually comes from the colon. This was entertained in this patient but the possibility that it originated from a more serious condition like a “tumor” could not be ruled out because of his significant “anemia” which necessitated a blood transfusion. It could be that even before his diarrhea he had been bleeding undetected which is termed “occult bleeding”. He was referred to a gastroenterologist for possible gastro-endo-colonoscopy.
Fortunately for the patient, the diarrhea ceased after 2-3 days in the hospital and the findings of the gastroenterologist was just “colitis” and nothing serious. He was discharged with all smiles and with home medications. He promised himself to be now careful with his food intake and to avoid his favorite “kilawen” which probably caused his problem because he practically consumed all that was served.**
