Biomolecular medicine focuses on the etiologic agent (e.g., bacteria, virus, parasite, yeast) to define most diseases. Since diarrhea is a natural response of the body to expel infectious agents, organisms from any of these classes can produce diarrhea. When stool samples are analyzed to determine pathogens, it is usually the case, especially in developing countries, that a definitive causal organism is not identified. More commonly a "mixed infection" of several pathogenic organisms is present. In those cases that require treatment, the initial step is fluid replacement. Antibiotic therapy, when applied, tends not to be pathogen-specific.
The most important signs include stool characteristics such as quantity, consistency, color, and presence of parasites. The quantity of diarrhea produced is particularly significant in that frequency and volume of stools determines whether the patient will become dehydrated and how rapidly. Dehydration is the primary cause of fatality in diarrheal disease. The more liquid is the stool, the greater is the threat of dehydration. In addition to loss of fluids and electrolytes, the rapid transit time of frequent, liquid diarrhea means that few nutrients are being absorbed from the intestinal tract.
Other key signs that physicians look for include color of stool. Green is said to indicate bacterial infection; bright red is a sign of bleeding from the lower bowel or hemorrhoids. Black (sometimes referred to as "coffee-grounds" effect) is indicative of bleeding from the stomach and upper portions of the digestive tract. The blood is black because it is partially digested. The appearance of the profuse liquid stools characteristic of cholera are known as "rice water" stools. White or very light stool may be associated with hepatitis or other liver problems that impede the ability of the liver to remove the bilirubin mucous from the blood which tends to spill into the urine and stain it a darker color. Absence of stool with a small amount of bloody mucus ("currant jelly" effect) is suggestive of a telescoping of the intestine (due to severe peristalsis) or intestinal blockage (possibly by a worm mass).
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