Chronic diarrhea – a polietiologichesky pathological state at which within 3-6 and more weeks increase of the act of defecation to 2-3 and more times a day with an otkhozhdeniye of not properly executed chair is observed. Can be followed by tenezma, swelling, rumbling, belly-aches, imperative desires and availability of pathological impurity in kalovy masses. Chronic diarrhea is diagnosed taking into account complaints, the anamnesis, data of survey, contrast radiological methods, a kolonoskopiya (it is possible – with a biopsy), analyses a calla and other diagnostic techniques. Treatment – a diet, symptomatic and pathogenetic medicamentous therapy.
Chronic diarrhea – the simptomokompleks which is shown increase in frequency of defekation with an otkhozhdeniye of not enough issued kalovy masses. Chronic diarrhea meets at infectious and noninfectious damages of intestines, some diseases of the top departments of a digestive tract, other bodies and systems, and also at the chronic intoxications and states caused by psychoemotional violations. Prevalence is unknown due to the lack of the generalized statistical data on the frequency of chronic diarrhea at various diseases and pathological states. Treatment is carried out by experts in the field of gastroenterology, a proktologiya and other branches of medicine.
Reasons of chronic diarrhea
There are several mechanisms of development of diarrhea: gipersekretorny, hyper osmotic, hyperkinetic and giperekssudativny. At gipersekretorny diarrhea more intensive is observed, than normal, secretion of water and electrolytes in an intestines gleam. Secretion can be passive or active. Chronic diarrhea as a result of increase in passive secretion comes to light at increase in hydrostatic pressure owing to right ventricular heart failure, some diseases of lymphatic system and system diseases which are followed by defeat of lymphatic vessels of this anatomic area (Whipple's disease, an amiloidoza, a lymphoma, limfangiektaziya). Some fatty acids, bilious acids, toxins emitted by pathogenic microorganisms (a cholera vibrio, colibacillus, staphylococcus), laxative medicines and peptide hormones (serotonin, a glucagon, vazointestinalny peptide) can become the reason of chronic diarrhea with intensive active secretion.
Hyper osmotic chronic diarrhea develops at disorders of digestion and absorption of nutrients in various departments of a GIT. Pancreas pathology (a tumor, chronic pancreatitis), mechanical jaundice, reduction of duration of contact of intestinal contents with a wall of a small intestine (a state after removal of a part of a small intestine, existence of an anastomoz or interintestinal fistula), the congenital and acquired disorders of absorption (a malabsorption syndrome) can provoke this type of chronic diarrhea.
Hyperkinetic chronic diarrhea results from excessive nevrogenny, hormonal or pharmacological stimulation of motor activity of intestines. Nevrogenny stimulation is observed at a syndrome of the angry intestines, functional chronic diarrhea and a diabetic enteropatiya. Hormonal stimulation comes to light at a thyrotoxicosis, Addison's disease and neuroendocrine neoplaziya. Pharmacological stimulation is noted at reception of some depletive. The last mechanism meets at sharp more often, but not at chronic diarrhea as after emergence of a diarrhea patients correct a medicine dose. At the same time, some patients abuse laxatives secretly from the doctor or even contrary to his recommendations therefore this reason of diarrhea should be excluded during differential diagnostics.
Giperekssudativny chronic diarrhea is caused by an inflammation of an intestinal wall and the increased release of exudate in a gut gleam. Chronic diarrhea with strengthening of an ekssudation is observed at inflammatory diseases of intestines (ulcer colitis, a disease Krone), chronic infections (actinomycosis, tuberculosis, syphilis), enteropatiya, an ischemic bowel disease, polyps and malignant new growths of a thick gut. Usually chronic diarrhea develops as a result of a combination of several or all listed above mechanisms.
Among the causes of chronic diarrhea researchers specify polyposes, a colorectal cancer, helminthoses, protozoan invasions and functional intestinal frustration (SRK, functional diarrhea). Besides, chronic diarrhea can be observed at a pancreatic and gastric akhiliya, a kartsinoida of a small intestine, an intestinal lipodistrofiya, a pellagra, an intestines amiloidoza, chronic exogenous intoxications, uraemia, endocrine and neuroendocrine diseases, and also specific infections (syphilis and tuberculosis of intestines).
Symptoms of chronic diarrhea
The main symptoms of this pathology are 2-3 and more acts of defecation within a day and an otkhozhdeniye insufficiently issued (watery, liquid or kashitseobrazny) a calla. Opinions of experts on duration of ponos disperse. One researchers consider that for diagnosis "chronic diarrhea" is enough violations of a chair remaining within 3 weeks others specify figure 4-6 and more weeks. Along with the listed symptoms, at patients belly-aches, rumbling, a meteorizm, tenezma, imperative desires and pathological impurity in fecal masses can be observed.
The plentiful fat or watery chair is characteristic of chronic diarrhea at pathology of a small intestine. At damage of a large intestine the volume of a chair decreases, and the quantity of defekation increases, in Calais impurity of pus, slime and blood quite often are found. Tolstokishechny chronic diarrhea often is followed by a pain syndrome (except for functional diarrhea), at tonkokishechny ponosa of pain usually are not observed. At the chronic diarrhea arising owing to diseases of the lower departments of a large intestine (at proktita and rektosigmoidita of various etiology) a chair even more poor, and defecation – even more frequent, than at colitis. Patients are disturbed by false desires.
Other symptoms are defined by the main disease which became the reason of development of chronic diarrhea. At a colorectal cancer weakness, fatigue, loss of appetite and weight reduction are observed. Development of intestinal impassability or perforation of intestines is possible. At late stages cancer intoxication, a hyperthermia and a kakheksiya are noted. Are characteristic of the inflammatory diseases of intestines which are followed by chronic diarrhea a hyperthermia of various degree of expressiveness (depending on disease severity) and extra intestinal manifestations: artralgiya, stomatitis and so forth. At endocrine and neuroendocrine frustration signs of violations of hormonal regulation are observed.
Diagnosis of chronic diarrhea
As chronic diarrhea is not an independent disease, but identification of the reason of development of ponos becomes manifestation of other pathological states, a main objective of diagnostics. In the course of inspection the doctor collects the anamnesis, finding out features of symptomatology and determining defeat level (tonkokishechny or tolstokishechny diarrhea, rectum diseases). When carrying out objective survey of the patient with chronic diarrhea the expert pays attention to existence of swelling, morbidity, asymmetry of a stomach, ascites and so forth. At survey of area of an anus the proctologist reveals the maceration centers, traces a calla, pus and slime.
The microscopic research a calla demonstrates existence of an inflammation. When carrying out a koprologichesky research with chronic diarrhea in some cases are found in patients , and . At a polypose and cancer in the course of an irrigoskopiya single or multiple defects of filling come to light. Kolonoskopiya and a rektoromanoskopiya give the chance to estimate a condition of an intestinal wall, to define quantity, the sizes and localization of ulcers, polyps and malignant tumors. If necessary during the research the endoscopist carries out a biopsy. At suspicion of diseases of endocrine system appoint consultation of the endocrinologist, in the presence of symptoms of uraemia – consultation of the nephrologist etc.
Treatment of chronic diarrhea
Treatment of chronic diarrhea can be pathogenetic and symptomatic. The plan of pathogenetic treatment is made taking into account the revealed pathology, use conservative (medicamentous and non-drug) and operational techniques is possible. To patients with chronic diarrhea appoint the special diet excluding the use of the products stimulating motility, processes of fermentation and gas generation. Recommend the wiped dishes steamed.
If necessary perform antibacterial therapy with use of the means which are not causing development of dysbacteriosis (a nifuroksazid, a tilikhinol). At chronic diarrhea against the background of dysbacteriosis use a probiotics. Apply symptomatic means of the adsorbing, enveloping and knitting action. For regulation of motility appoint loperamide, is more rare – and antagonists of calcium. The forecast is defined by the reason of development of chronic diarrhea.