Diarrhea (diarrhea) - rapid, repeated loose stools. Diarrhea is usually accompanied by pain, rumbling in the abdomen, flatulence, tenesmus. Diarrhea is a symptom of many infectious diseases and inflammatory processes of the intestine, dysbacteriosis, and neurogenic disorders. Therefore, the diagnosis and treatment of the underlying disease plays an important role in the prevention of complications. The loss of a large amount of fluid during profuse diarrhea leads to a violation of the water-salt balance and can cause heart and kidney failure.
Diarrhea is called a single or frequent bowel movement with liquid stools. Diarrhea is a symptom that signals a malabsorption of water and electrolytes in the intestine. Normally, the amount of feces excreted per day by an adult varies between 100-30 grams, depending on the characteristics of the diet (the amount of vegetable fiber consumed, poorly digestible substances, liquids). In the case of increased intestinal motility, the stool may become more frequent and thin, but its amount remains within the normal range. When the amount of fluid in the feces increases to 60-90%, then they talk about diarrhea.
There are acute diarrhea (lasting no more than 2-3 weeks) and chronic. In addition, the concept of chronic diarrhea includes a tendency to periodically plentiful stools (more than 30 grams per day). Patients suffering from malabsorption of various nutrients tend to polyfaeces: the excretion of large amounts of stool containing undigested food debris.
With severe intoxication in the intestine, excessive secretion of water with sodium ions into its lumen occurs, which helps to thin the stool. Secretory diarrhea develops with intestinal infections (cholera, enteroviruses), taking certain drugs and dietary supplements. Osmolar diarrhea occurs with malabsorption syndrome, insufficiency of sugar digestion, excessive consumption of osmotically active substances (laxative salts, sorbitol, antacids, etc.). The mechanism of development of diarrhea in such cases is associated with an increase in osmotic pressure in the intestinal lumen and diffusion of fluid along the osmotic gradient.
A significant factor contributing to the development of diarrhea is a violation of intestinal motility (hypokinetic and hyperkinetic diarrhea) and, as a result, a change in the rate of transit of intestinal contents. Strengthening of motility is facilitated by laxatives, magnesium salts. Disturbances in motor function (weakening and strengthening of peristalsis) occur with the development of irritable bowel syndrome. This is referred to as functional diarrhea.
Inflammation of the intestinal wall causes the exudation of protein, electrolytes and water into the intestinal lumen through the damaged mucosa. Exudative diarrhea accompanies enteritis, enterocolitis of various etiologies, intestinal tuberculosis, acute intestinal infections (salmonellosis, dysentery). Often with this type of diarrhea in the stool there is blood, pus.
Diarrhea can develop as a result of taking medications: laxatives, antacids containing magnesium salts, certain groups of antibiotics (ampicillin, lincomycin, cephalosporins, clindamycin), antiarrhythmic drugs (quindiline, propranol), digitalis preparations, potassium salts, artificial sugars (sorbitol, mannitol) , cholestyramine, chenodeoxycholic acid, sulfonamides, anticoagulants.
There are the following types of diarrhea: infectious (with dysentery, salmonellosis, amebiasis, food poisoning and entroviruses), alimentary (associated with disorders in the diet or an allergic reaction to food), dyspeptic (accompanies digestive disorders associated with insufficiency of the secretory functions of the digestive system: liver, pancreas, stomach; as well as insufficiency of secretion of enzymes in the small intestine), toxic (with arsenic or mercury poisoning, uremia), drug (caused by drugs, drug dysbacteriosis), neurogenic (with changes in motility due to impaired nervous regulation associated with psycho-emotional experiences).
In clinical practice, acute and chronic diarrhea are distinguished.
The causes of acute diarrhea (lasting up to 2-3 weeks) are most often infections and inflammations of the intestine, as well as drugs. In acute diarrhea, stools are frequent, thin (watery), and may contain mucus and bloody streaks. Diarrhea is often accompanied by bloating, pain, nausea, and vomiting. As a rule, the appetite of patients is reduced, weight loss is observed. Exhausting liquid stool contributes to the rapid loss of water by the body, while symptoms of dehydration are detected: dry skin, mucous membranes, fatigue, weakness. Diarrhea in intestinal infections is often accompanied by fever.
During the survey, it is often possible to identify the previous use of low-quality or unusual food, medicines.
Bloody streaks in the stool indicate damage to the intestinal mucosa, which is often the case with shigellosis, campylobacter infection, or enteropathogenic Escherichia coli. In addition, acute diarrhea with an admixture of blood may be a consequence of Crohn's disease, ulcerative colitis.
Diarrhea that lasts more than 3 weeks is considered chronic. It can be the result of various pathologies, the identification of which is the main task for determining treatment tactics. History data, concomitant clinical symptoms and syndromes, and physical examination can provide information about the causes of chronic diarrhea.
Particular attention is paid to the nature of the stool: the frequency of defecation, daily dynamics, volume, consistency, color, the presence of impurities in the feces (blood, mucus, fat). The survey reveals the presence or absence of concomitant symptoms: tenesmus (false urge to defecate), abdominal pain, flatulence, nausea, vomiting.
Pathologies of the small intestine are manifested by abundant watery or fatty stools. For diseases of the large intestine, less abundant stools are characteristic, streaks of pus or blood, mucus may be noted in the feces. Most often, diarrhea with lesions 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 stretching of the intestinal walls, tenesmus.
Acute diarrhea, as a rule, is characterized by a very pronounced loss of fluid and electrolytes in the feces. During examination and physical examination of the patient, signs of dehydration are noted: dryness and a decrease in skin turgor, increased heart rate and a decrease in blood pressure. With a pronounced calcium deficiency, the symptom of a "muscle roller" becomes positive, there may be convulsions.
With diarrhea, the patient's stool is always carefully examined, in addition, it is desirable to carry out a proctological examination. Identification of an anal fissure, fistula, paraproctitis may suggest the presence of Crohn's disease. With any diarrhea, a comprehensive study of the digestive tract is performed. Instrumental endoscopic techniques (gastroscopy, colonoscopy, irrigoscopy, sigmoidoscopy) allow you to examine the inner walls of the upper gastrointestinal tract and large intestine, detect mucosal damage, inflammation, neoplasms, bleeding ulcers, etc.
For the diagnosis of acute diarrhea, as a rule, complaints, data from a physical examination and a study of feces (coprogram) are sufficient. In addition, a study of feces for eggs of worms is performed, bacteriological culture is done. When diagnosing chronic diarrhea, it is initially found out whether there is a parasitic or bacterial lesion of the intestine, an ultrasound of the abdominal organs is performed to detect inflammatory diseases of the digestive tract and a study of functional disorders of the secretory activity of the liver, pancreas, glands of the mucous membrane of the stomach and small intestine.
Microscopy of feces reveals a high content of leukocytes and epithelial cells in it, which indicates the presence of inflammation of the mucous membrane of the digestive tract. The detected excess of fatty acids is a consequence of malabsorption of fats. Together with the remnants of muscle fibers and a high content of starch in the feces, steatorrhea is a sign of malabsorption syndrome. Fermentation processes due to the development of dysbacteriosis contribute to a change in the normal acid-base balance in the intestine. To identify such disorders, intestinal pH is measured (normally 6.0).
Persistent diarrhea in combination with excessive gastric secretion is characterized by Zollinger-Ellison syndrome (ulcerogenic adenoma of the pancreas). In addition, prolonged secretory diarrhea may be the result of the development of hormone-producing tumors (for example, vipoma). Laboratory blood tests are aimed at identifying signs of an inflammatory process, biochemical markers of liver and pancreas dysfunction, hormonal disorders that can be causes of chronic diarrhea.
Reception of enterosorbents - symptomatic therapy of diarrhea
Diarrhea is a symptom of many diseases, therefore, in the choice of medical tactics, the main role is played by the identification and treatment of the underlying pathology. Depending on the type of diarrhea, the patient is referred for treatment to a gastroenterologist, an infectious disease specialist or a proctologist. It is imperative to seek medical attention if you have diarrhea that lasts more than 4 days, or if you notice streaks of blood or mucus in the stool. In addition, symptoms that should not be ignored are: tarry stools, abdominal pain, fever. If there are signs of diarrhea and there is a possibility of food poisoning, it is also necessary to consult a doctor as soon as possible.
Treatment for diarrhea depends on the type of diarrhea. And it includes the following components: dietary nutrition, antibacterial therapy, pathogenetic treatment (correction of malabsorption in case of enzyme deficiencies, reduction of gastric secretion, drugs that normalize intestinal motility, etc.), treatment of the consequences of prolonged diarrhea (rehydration, restoration of electrolyte balance).
With diarrhea, foods are introduced into the diet that help reduce peristalsis, reduce the secretion of water into the intestinal lumen. In addition, the underlying pathology that caused diarrhea is taken into account. Diet components should correspond to the functional state of digestion. Products that promote the secretion of hydrochloric acid and increase the rate of evacuation of food from the intestines are excluded from the diet for the duration of acute diarrhea.
Antibiotic therapy for diarrhea is prescribed to suppress the pathological flora and restore normal eubiosis in the intestine. With infectious diarrhea, broad-spectrum antibiotics, quinolones, sulfonamides, nitrofurans are prescribed. The drugs of choice for intestinal infections are drugs that do not adversely affect the intestinal microbiocenosis (combined drugs, nifuroxazide). Sometimes, with diarrhea of various origins, eubiotics may be prescribed. However, more often such treatment is prescribed after the signs of diarrhea subside to normalize the intestinal flora (eliminate dysbacteriosis).
As symptomatic agents, adsorbents are used, enveloping and astringent agents that neutralize organic acids. To regulate intestinal motility, loperamide is used, in addition, acting directly on the opiate receptors of the small intestine, reducing the secretory function of enterocytes and improving absorption. A pronounced antidiarrheal effect is exerted by somatostatin, which affects the secretory function.
In infectious diarrhea, drugs that reduce intestinal motility are not used. Loss of fluid and electrolytes with prolonged and profuse diarrhea requires rehydration measures. Most patients are prescribed oral rehydration, but in 5-15% of cases there is a need for intravenous administration of electrolyte solutions.
Diarrhea prevention includes body hygiene and nutrition. Washing hands before eating, thoroughly washing raw vegetables and fruits, and properly cooking food help avoid food poisoning and intestinal infections. In addition, it is worth remembering the need to avoid drinking raw water, unfamiliar and suspicious food, food products that can cause an allergic reaction.