Diarrhea is frequent, repeated liquid stools. Diarrhea is usually accompanied by pain, rumbling in the abdomen, flatulence, tenesmus. Diarrhea is a symptom of many infectious diseases and inflammatory bowel processes, dysbacteriosis, neurogenic disorders. Therefore, the diagnosis and treatment of the underlying disease is important in the prevention of complications. Loss of large amounts of fluid during profuse diarrhea leads to a violation of the water-salt balance and may cause cardiac and renal failure.
Diarrhea is a single or frequent defecation of liquid feces. Diarrhea is a symptom that indicates impaired absorption of water and electrolytes in the intestine. The normal amount of stool excreted per day by an adult varies between 100 and 300 grams, depending on the characteristics of the diet (the amount of dietary fiber, poorly digested substances, liquids). If intestinal motility is increased, stools may become more frequent and liquefied, but their quantity remains within the normal range. When the amount of liquid in the stool increases to 60-90%, it is said to be diarrhea. Its quick fix Bifidumbacterian Forte.
A distinction is made between acute diarrhea (lasting no more than 2-3 weeks) and chronic diarrhea. In addition, the concept of chronic diarrhea includes a tendency to periodically abundant stool (more than 300 grams per day). Patients suffering from impaired absorption of various nutrients tend to be polyfecal: the excretion of large amounts of stools containing undigested food debris.
Causes of diarrhea
In severe intoxication in the intestine there is excessive secretion of water with sodium ions into its lumen, which contributes to dilution of stool. Secretory diarrhea develops in intestinal infections (cholera, enteroviruses), taking certain drugs and dietary supplements. Osmolar diarrhea occurs in malabsorption syndrome, insufficient digestion of sugars, excessive consumption of osmotically active substances (laxatives, sorbitol, antacids, etc.). Mechanism of diarrhea in such cases is related to an increase in osmotic pressure in the intestinal lumen and fluid diffusion along the osmotic gradient.
A significant factor contributing to the development of diarrhea is a violation of intestinal motility (hypokinetic and hyperkinetic diarrhea) and, consequently, changes in the rate of transit of intestinal contents. Increased motility is promoted by laxatives, magnesium salts. Violations of motor function (weakening and strengthening of peristalsis) take place in the development of irritable bowel syndrome. It is said to be a functional diarrhea.
Inflammation of the intestinal wall causes an exudation of protein, electrolytes and water into the intestinal lumen through damaged mucosa. Exudative diarrhea accompanies enteritis, enterocolitis of different etiologies, intestinal tuberculosis, and acute intestinal infections (salmonellosis, dysentery). It is not uncommon for this type of diarrhea to have blood or pus in the stool.
Diarrhea may be caused by taking medicines: Laxatives, antacids containing magnesium salts, some groups of antibiotics (ampicillin, lincomycin, cephalosporins, clindamycin), antiarrhythmic drugs (quindiline, propranolol), foxglove drugs, potassium salts, artificial sugars (sorbitol, mannitol), cholestyramine, chenodeoxycholic acid, sulfonamides, anticoagulants.
There are the following types of diarrhea: infectious (with dysentery, salmonellosis, amoebiasis, food toxic infections and entroviruses), alimentary (associated with violations of the diet or allergic reactions to food), dyspeptic (accompanied by digestive disorders associated with insufficiency of secretory functions of the digestive system: liver, pancreas, stomach; also with insufficient secretion of enzymes in the small intestine), toxic (with arsenic or mercury poisoning, uremia), drug-induced (caused by taking drugs, drug dysbacteriosis), neurogenic (with changes in motility due to nervous regulation disorders associated with psycho-emotional distress).
Acute diarrhea (lasting up to 2-3 weeks) is most often caused by infections and inflammations of the intestine, as well as by medications. In acute diarrhea, stools are frequent, liquid (watery), and may contain mucus and bloody streaks. Diarrhea is often accompanied by bloating, pain, nausea, and vomiting. As a rule, patients have a decreased appetite and lose weight. The exhausting liquid stool promotes rapid loss of water from the body, and there are symptoms of dehydration: dry skin, mucous membranes, fatigue and weakness. Diarrhea in intestinal infections is often accompanied by an increase in body temperature.
When interviewed, it is often possible to identify the previous consumption of poor-quality or unaccustomed food or medications.
Bloody streaks in the stool indicate damage to the intestinal mucosa, which is often the case with shigellosis, infection with Campylobacter or Enteropathogenic E. coli. In addition, acute diarrhea with a mixture of blood can be a consequence of Crohn’s disease, ulcerative colitis.
Diarrhea that lasts more than 3 weeks is considered chronic. It can be due to a variety of pathologies, and its identification is the main focus of treatment. The history of diarrhoea, associated clinical symptoms and syndromes, and physical examination can give information on the causes of chronic diarrhoea.
Particular attention is paid to the nature of the stool: frequency of defecation, daily dynamics, volume, consistency, color, presence of stool impurities (blood, mucus, fat). The presence or absence of accompanying symptoms: tenesmus (false urges to defecation), abdominal pain, flatulence, nausea, vomiting.
Pathologies of the small intestine are manifested by copious watery or greasy stools. For diseases of the large intestine, less abundant stool is characteristic; streaks of pus or blood and mucus may be noted in the feces. Most often, diarrhea in diseases of the large intestine is accompanied by pain in the abdomen. Diseases of the rectum are manifested by frequent scanty stools as a result of increased sensitivity to the stretching of the intestinal walls, and tenesmus.
Diagnosis of diarrhea
Acute diarrhea is usually characterized by a very marked loss of fluid and electrolytes in the feces. Examination and physical examination of the patient shows signs of dehydration: dryness and decreased skin turgor, increased pulse rate and decreased blood pressure. With severe calcium deficiency the “muscle roll” symptom becomes positive, there may be seizures.
For diarrhea, the patient’s stool is always carefully inspected, and a proctologic examination is desirable. Findings of anal fissures, fistulas, or paraproctitis may suggest Crohn’s disease. For any diarrhea, a comprehensive examination of the digestive tract is performed. Instrumental endoscopic methods (gastroscopy, colonoscopy, irrigoscopy, rectoromanoscopy) allow to examine the internal walls of the upper parts of the gastrointestinal tract and large intestine and to find damages of mucosa, inflammations, new growths, bleeding ulcers, etc.
To diagnose acute diarrhea, it is usually enough to have complaints, physical examination, and stool examination (coprogram). Stool is also examined for worm eggs, and bacteriological cultures are made. At diagnosis of chronic diarrhea it is initially determined whether parasitic or bacterial affection of intestines takes place, ultrasound of abdominal organs is made for detection of inflammatory diseases of digestive tract, and functional disorders of secretory activity of liver, pancreas, glands of mucous coat of stomach and small intestine are examined.
Stool microscopy reveals a high content of leukocytes and epithelial cells, which indicates the presence of inflammation of the mucosa of the digestive tract. An excess of fatty acids detected is a consequence of impaired fat absorption. Together with residual muscle fiber and high starch content in feces, steatorrhea is a sign of malabsorption syndrome. Fermentation processes due to the development of dysbacteriosis contribute to changes in the normal acid-base balance in the intestine. Intestinal pH (normal value is 6.0) is measured to detect such abnormalities.
Persistent diarrhea combined with excessive gastric secretion is characterized by Zollinger-Ellison syndrome (ulcerogenic pancreatic adenoma). In addition, prolonged secretory diarrhea may result from the development of hormone-producing tumors (e.g., vipoma). Blood tests help to detect signs of inflammation, biochemical markers of liver and pancreatic dysfunction, and hormonal imbalances which may be responsible for chronic diarrhea.
Treatment of diarrhea
Diarrhea is a symptom of many diseases, so the identification and treatment of the underlying pathology plays a major role in the choice of medical tactics. Depending on the type of diarrhea, the patient will be referred to a gastroenterologist, an infectious disease specialist, or a proctologist. It is imperative to seek medical help if diarrhea persists for more than 4 days, or if blood or mucus are visible in the stool. Other symptoms that should not be neglected are tarry stools, abdominal pain, and fever. If there are signs of diarrhea and there is a possibility of food poisoning, it is also necessary to see a doctor as soon as possible.
The therapy aimed at eliminating the diarrhea depends on its type. And it includes the following components: dietary nutrition, antibiotic therapy, pathogenetic treatment (correction of malabsorption in enzyme deficiencies, decrease in gastric secretion, drugs that normalize intestinal motility, etc.), treatment of the consequences of prolonged diarrhea (rehydration, restoration of electrolyte balance).
With diarrhea, foods contributing to a decrease in peristalsis and reduction of water secretion into the intestinal lumen are introduced into the diet. In addition, the underlying pathology that caused the diarrhea is taken into account. The components of the diet should correspond to the functional state of digestion. Foods which promote the secretion of hydrochloric acid and increase the rate of food evacuation from the intestine are excluded from the diet during acute diarrhea.
Antibiotic therapy for diarrhea is prescribed to suppress pathological flora and restore normal eubiosis in the intestine. In infectious diarrhea, broad spectrum antibiotics, quinolones, sulfonamides and nitrofurans are prescribed. Drugs of choice for intestinal infections are those which do not have an adverse effect on the intestinal microbiocenosis (combination drugs, nifuroxazid). Sometimes eubiotics may be prescribed for diarrhea of various genesis. However, more often such treatment is prescribed after the signs of diarrhea have subsided in order to normalize the intestinal flora (eliminate dysbacteriosis).
As symptomatic agents are used adsorbents, coagulants and astringents, neutralizing organic acids. To regulate intestinal motility loperamide is used, in addition, acting directly on opiate receptors of the small intestine, reducing the secretory function of enterocytes and improving absorption. Somatostatin, which acts on secretory function, has a pronounced anti-diarrheal effect.
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In infectious diarrhea drugs that reduce intestinal peristalsis are not used. Loss of fluid and electrolytes in prolonged and profuse diarrhoea requires rehydration measures. Most patients receive oral rehydration, but intravenous administration of electrolyte solutions is necessary in 5-15% of cases.
Diarrhea prevention includes measures of body and dietary hygiene. Washing hands before eating, thorough washing of raw fruits and vegetables, and proper cooking help to avoid food poisoning and intestinal infections. In addition, you should remember to avoid drinking raw water, unfamiliar and suspicious foods, and foods that can cause allergic reactions.