Diarrhea
(diarrhea) is a pathological condition of the body, which is not an independent disease and, as a rule, acts only as a syndrome. Diarrhea is accompanied by frequent defecation (watery stools), as well as abdominal pain.
The content of the article:
Etiology and pathogenesis of diarrhea
Classification of diarrhea (diarrhea)
Clinical features of diarrhea
Diagnosis of diarrhea
Differential diagnosis
Treatment of diarrhea
Prevention of diarrhea
Diarrhea (diarrhea)
For a healthy adult, it is considered normal to allocate 100-300 g of feces per day, depending on the food consumed and lifestyle. The appearance of a defecation disorder may indicate the presence of various diseases. In some countries with a low level of economic development, diarrhea reaches pandemic proportions and is the cause of death among infants. In countries with normal economic development, diarrhea does not have such frightening consequences and is easily eliminated. The mechanism of diarrhea development implies a violation of the absorption of water and electrolytes in the intestine and in most cases occurs due to general intoxication of the body.
Etiology and pathogenesis of diarrhea
Strong intoxication of the body contributes to increased secretion of water with sodium ions into the intestinal lumen, which in turn contributes to the dilution of stool.
According to the pathogenesis , diarrhea is divided into several types:
osmolar diarrhea: occurs when the contents of the intestine are hyperosmolar. The cause of diarrhea may be viral infections (retroviruses, rotaviruses), the presence of intracellular parasitism of coccidia or the intake of saline laxatives. The presence of viral infections provokes damage to enterocytes, as a result, membrane digestion is disrupted. An excessive amount of unfermented substances (peptides, disaccharides, etc.) is a predisposing factor to the development of this type of diarrhea. It is clinically manifested by polypecalia and steatorrhea;
invasive diarrhea: this is a pathological process that occurs in the colon. It occurs as a consequence of local inflammation of the colon after invasion of pathogenic microorganisms into its walls. A characteristic sign of amoebiasis and dysentery;
secretory diarrhea: this is a pathological process, the main localization of which is the small intestine. Most often occurs with salmonellosis and cholera. Secretory diarrhea is characterized by an increase in intracellular concentration of cAMP (cyclic adenosine monophosphate), the catalyst of which in this case is the activation of enterocyte adenylate cyclase by bacterial etherotoxin. As a consequence, there is a violation of the transport of Na + and SG ions, as well as their further accumulation in the intestinal lumen.
Such reactions in the lumen of the intestine contribute to the accumulation of water in it, which leads to the appearance of liquid stool. This form of diarrhea is extremely rare in the modern world, but if you do not take the necessary measures to dehydrate the body in time, a fatal outcome from hypovolemic shock is possible. This type of diarrhea is characterized by the appearance of liquid, non-abundant feces with impurities of mucus and blood clots.
Classification of diarrhea (diarrhea)
The clinical course of diarrhea in an adult provides for its classification into acute and chronic forms. Acute diarrhea, as a rule, is a consequence of an intestinal infection, has a bacterial, parasitic or viral nature and lasts up to 4 weeks. The chronic form of diarrhea occurs due to diseases of the digestive system and lasts more than 4 weeks.
Acute diarrhea
Acute diarrhea, quite severe, develops after pathogenic microorganisms enter the body of a healthy person due to the consumption of food and water contaminated with microorganisms (fecal-oral). The causative agents of this form of diarrhea are:
viruses (adenoviruses, rotaviruses, enteroviruses);
bacteria (salmonella, E. coli, vibrio cholerae, dysentery bacteria);
protozoa (dysentery amoeba, giardia).
The severity of the disease depends on the pathogen itself, the number of microorganisms that have penetrated the gastrointestinal tract, as well as the ability of the human body to immune defense.
Travelers’ diarrhea
Travelers’ diarrhea is also isolated, which often develops in the first two weeks in people who have left their region, it lasts about 7 days. The cause of such dyspeptic disorders may be changes in diet, climate, water quality and stress.
Chronic diarrhea
Chronic diarrhea is a sign of many diseases of the gastrointestinal tract. Chronic pancreatitis is characterized by shingling pains in the upper half of the abdomen with irradiation to the left half of the chest. The pain is accompanied by bloating, steatorrhea, fetid stools, as well as nausea and vomiting, which does not bring relief. Exacerbations of the disease appear after eating fatty, spicy, smoked food and alcohol.
Bloody diarrhea, accompanied by abdominal pain, anemia and hyperthermia, joint pain, may be a sign of ulcerative colitis, pseudomembranous colitis, Crohn’s disease, intestinal tumors. Tar-like diarrhea indicates bleeding from the upper gastrointestinal tract.
The diagnosis of “functional diarrhea” with irritable bowel syndrome is made in case of exclusion of infectious etiology and all other possible diseases. This condition can develop at a young age and manifest itself against the background of depressive states and stress. It is clinically manifested by pain, bloating, rumbling and violation of the stool by the type of pseudodiarea (the stool is frequent, the consistency of feces is framed).
Clinical features of diarrhea
It is quite simple to independently determine the signs of diarrhea. Clinically, it is manifested by sharp pains in the stomach and intestines, frequent (more than 3 times a day) liquid watery stools, sometimes accompanied by vomiting or nausea. The features of the clinical manifestations of diarrhea depend on etiological factors and the disease that provoked this syndrome. In severe forms of diarrhea caused by infectious and viral pathogens, feverish phenomena (hyperthermia, chills, convulsions) may occur. Also, patients note weakness and deterioration of the general condition.
Diagnosis of diarrhea
There are many nosological units that can manifest through this syndrome, which is an obstacle to differential diagnosis. A detailed survey of the patient will help narrow down the range of suspected diseases, among which the root cause will be determined.
Diarrhea is a sign of malabsorption
Analysis of the consistency of fecal masses and the frequency of defecation in most cases makes it possible to determine the level of lesion. For example, disinfection (copious stools) with mushy, foamy or liquid masses that are poorly washed off the toilet walls, have a clay or sour smell and are repeated 1-2 times a day, is a sign of enteral diarrhea and indicates malabsorption syndrome in the patient.
Enteral diarrhea
Confirmation of enteral diarrhea is a decrease in the severity of diarrhea when abstaining from food. Diarrhea with copious, watery discharge, continuing during fasting, may indicate increased intestinal secretion or laxative medication concealed by the patient.
Lesions of the colon
Colon lesions are characterized by stool 4-6 times a day with a small amount of fecal matter (often with an admixture of blood), while the patient complains of abdominal pain and tenesmus. Very often, the urge to defecate can end with the separation of not feces, but lumps of mucus, sometimes with an admixture of blood. When the anal sphincter is affected, patients note fecal incontinence. A variant of such dysfunction can be the appearance of fecal particles on the laundry, instead of the expected release of gases observed in malignant neoplasms of the rectum.
Inflammatory diseases
A clinical sign of inflammatory bowel diseases, infectious diarrhea, ischemic colitis, diverticulitis, malignant tumors may be hematocheesia (the presence of blood in the stool). In this case, the functional nature of diarrhea is excluded. Also, an admixture of mucus may appear in the feces, for example, with villous adenoma of the colon and colitis, but this phenomenon may be accompanied by irritable bowel syndrome, therefore differential diagnosis is very important.
The presence of undigested food particles in the feces indicates an acceleration of the transit of contents in the small and large intestines and has no significant significance for differentiation.
A very important clinical significance is the time of the appearance of diarrhea. Dyspeptic disorders provoked by an organic disease can occur at any time of the day, including at night. Irritable bowel syndrome, which is a functional dysfunction manifested by diarrhea in the morning (usually after breakfast).
Differential diagnosis
For proper differential diagnosis, it is very important to take into account the presence of other symptoms accompanying intestinal dysfunction.
Pain projected in the umbilical region is a sign of pathology of the small intestine.
Painful sensations in the right iliac region usually indicate pathological processes in the terminal part of the ileum or in the caecum.
For lesions of the sigmoid colon, cramping pains are characteristic, which increase during the act of defecation.
Changes in the rectum can be indicated by pain that increases after defecation and radiating into the sacrum.
With pancreatic cancer and chronic pancreatitis, shingles in the upper half of the abdomen are often noted.
Fever is a common sign of infectious diarrhea, also manifested in inflammatory bowel changes (ulcerative colitis, Crohn’s disease), malignant tumors, diverticulitis.
Weight loss is not characteristic of irritable bowel syndrome and functional diarrhea, and may be a sign of colorectal cancer, chronic inflammatory bowel disease or malabsorption syndrome.
With chronic adrenal insufficiency, there is a risk of hyperpigmentation of the skin and hypotension.
The presence of systemic signs of lesion (erythema nodosum, arthritis, primary sclerosing cholangitis, iridocyclitis) facilitates the differentiation of Crohn’s disease and ulcerative colitis; periodic facial hyperemia makes it possible to assume the presence of a carcinoid syndrome in the patient.
Zollinger-Edison syndrome is characterized by a combination of persistent diarrhea and frequent recurrence of gastroduodenal ulcers.
A very important factor in the differential diagnosis of diarrhea is the correct and accurate collection of the patient’s anamnesis. In most cases, these phenomena occur after errors in nutrition or ignoring hygienic principles.
Very often, diarrhea is provoked by taking medications (antibacterial, antiarrhythmic, antitumor drugs, some antidepressants and tranquilizers).
To clarify the diagnosis, a number of additional studies are performed on the patient (laboratory tests, ultrasound, endoscopic examinations, sometimes an X-ray is shown).
Treatment of diarrhea
Treatment of diarrhea requires taking into account the individual characteristics of each disease, but there are still a number of therapeutic measures that are applicable for any form of diarrhea.
Diet
The first thing to start with is a diet. Nutrition should help reduce the secretion of electrolytes and water into the intestinal lumen, as well as slow down peristalsis. The basic principle of dieting with diarrhea is the use of a mechanically and chemically sparing diet. Patients with diarrhea are usually prescribed a diet that meets this requirement, number 46, most often such a diet is used during an exacerbation.
Antibacterial drugs
If it was possible to establish that the etiological factor of the appearance of diarrhea is a bacterial pathogen, patients are shown the appointment of antibacterial agents. In the acute form of diarrhea, antibacterial drugs and antimicrobial agents from the group of quinolones, fluoroquinolones, nitrofuran derivatives, sulfonamide preparations, antiseptics are used. It is best to use means that do not disturb the balance of the intestinal microflora. Bacterial preparations (linex, enterol, bifi-form) are used as an alternative therapy. After the end of antibacterial treatment, patients are recommended to prolong the intake of bacterial agents.
Symptomatic treatment
Treatment of diarrhea does not exclude symptomatic treatment — astringents, adsorbents, neutralizing organic acids, enveloping agents (tannacomp, smecta, polyphepan).
To regulate motility, loperamide (imodium) is prescribed, which reduces intestinal tone.
To normalize the acid-base balance and eliminate electrolyte metabolism disorders, rehydration therapy is carried out. In the presence of acute intestinal infections, rehydration is performed orally, in severe conditions of the patient — by intravenous drip infusion.
Prevention of diarrhea
The basic principles of prevention of diarrhea are familiar to every person since childhood — personal hygiene, cleaning and processing of food, careful monitoring of the diet. But the main thing when symptoms of diarrhea appear is to seek medical help, especially if it lasts more than 3 days. Qualified medical care will prevent and eliminate unwanted complications.
