Diarrhea is a common complication in the cancer population, occurring in 5-10% of patiens with advanced disease.

Women are more likely to have diarrhea than men after excludinggender-specific cancer. Diarrhea is also included among the top ten concequences of adverse drug reaction in hospitalized patiens with cancer. The concequenses of diarrhea can be troublesome, and include loss of water, electolytes, and albumin failureto reach nutritional goals, declining immune function, and the risk of bedsores or systemic infection. Diarrhea also brins additional work for the nursing staff or family who have to prevent maceration and bedsores. Morever, losses comfort and dignity have to be considered. Severe diarrhea, other than being debilitating, is costly complication of chemotherapy in colorectal cancer. In patiens with colorectal cancerreceiving chemotherapy, the median length of hospital stay due to diarrhea was 8 days, translating to a mean cost of $8230 per patient (Williams, 2007). Although a practical definitions lacking, diarrhea is commonly diagnosed when an abnormal increase in daily stool weight, water content, and frequncy, whether or not accompanied by urgency, perianal discomfort, or incontinence, is a present a consecuenceof incomplete absorption ofelectrolytesand waterfrom luminal content (Williams, 2007). Mechanisms From the physiopathologis point of view, different mechanisms may produce diarrhea, although is quite difficult in certain clinical condition to distinguish among mechanisms that frequently overlap (Williams, 2007). Osmotic Diarrhea The ingestion ofa poorlyabsorbable solute modifies the osmolarity of the luminal content and induces osmotic diarrhea. The proximal small bowel is highly permeable to water influx across the duodenum rapidlyadjust the osmolarityof luminal fluid toward tht of plasma, secreting water evenafter the osmolarity values between luminal contens and plasma are similar. On the contrary, the mucosa of the ileumand colon has a low permeability to sodium and solutes. However, there is and efficient active ion transport mechanism that allows the reabsorption of electrolytesand water even again electrochemical gradients (Williams, 2007). Secretory Diarrhea

Secretory diarrhea is rarcly presend as the sole mechanism . this kind of diarrhea is associated whith and abnormal ion transport in intestinal ephitelial cells, with a reduction in absorptive function or increase in the secretion of epithelial cells (Williams, 2007). Deranged motility Defective motility may reduce the contact time between luminal contents and epithelial cells. This coommonly occurs in patients with cancer with postsurgical disorder, postvagotomy, ileocecal valveresection or neoplastic and cronic diseases, such us malignant carcinoid syndrome, medullary carcinoma of the thyroid, and diabetes (Williams, 2007). As the use antibiotics in veterinary medicine has increased, so has the incidence of antibiotics-associated diarrhea can occur in any age or breed of horse. Factors that may increase the risk of antibiotic-associateddiarrhea include increasing age, underlying gastrointestinal disease (e,g. colic), a rapid change in diet, a change in the horses environment (e.g. moving to a hospital from stable or pasture), the type and route of administration of the antibiotic and the microbial sensitivity to the administered antibiotic (Jones, 2009). Diarrhea frequently complicates the course of the critically ill patient, occuring in 40% to 50% of of patients in the intensive care unit (ICU). Diarrhea is the most common nonhemorrhagic gastrointestinal (GI) complication in this patient population (1-3). Despite its high prevalence in the ICU patient population, diarrhea is frequently overlooked by physicians and the ICU team, especially when more emergant cardiovascular, respiratory, and infectious issues are present. Inattention in excessive stool output, bowever, can often result and serious perturbations of fluid and electrolyte balance, promote skin breakdown and infection, and create difficulty in the administration of proper nutritional support. In these instances, proper and immediate evaluation and management esential to prevent further complications in a critically ill patient. The evaluation of diarrhea is often limited by the patients status and practical limitations in performing diagnostic studies in the ICU setting (Harrel, 2005). The term diarrhea often carries a different meaning for patients and health care providen. Increases in stool frequency or fluidity do not necessarily inicate

the present of diarrhea. In a general patient population, an increase in daily stool weight or volume (exceeding 250 g/ml.) has been used as an objective defining criterion. In the critically ill patient, bowever accurate measurement of stool output may be difficult, if not impossible. Physician, therefore, must use their best judgment to decide wether diarrhea is present and to determinate wether it represent a clinical problem requiring attention (Harrel, 2005). Diarrhea may result from various processes or pathogens associated with disease states commonly seen in the critically ill patient . diarrhea may occur more frequently in patients who are immunosuppressed, have alternations in cardiac output and blood flow, or have various primary GI diseases (Harrel, 2005). In immunosupperssed patients, multiple infections agent may be responsible for the development of diarrhea. Cytomegalovirus (CMV) is the most common infections cause of diarrhea in this patient population. Other common infections agents causing diarrhea is the immunosuppresed patients include herpes simplex virus, Giardia, Salmonella, Shigella, Cryptosporidium, Isopora, Campylobacter, Candida and Aspergillus. Postchemotherapy or posttransplantimmunosuppresed patient can also experience diarrhea as a result of direct injury to the bowel, ranging from bowel edema to frank infarction. The cause of these changes in unclear; however, infections, direct toxic effect of chemotheraupetic agents, neutropenia, and primary intestinal injury have been postulated as initiating factors (Harrel, 2005).