Diarrhea (diarrhea) the - the speeded-up, repeated liquid chair. The diarrhea usually is followed by pain, abdominal murmur, a meteorizm, tenezma. The diarrhea is a symptom of many infectious diseases and inflammatory processes of intestines, dysbacteriosis, nevrogenny frustration. Therefore the importance in prevention of complications is played by diagnostics and treatment of the main disease. Loss of a large amount of liquid at a profuzny diarrhea leads to violation of water-salt balance and can cause a heart and renal failure.
Diarrhea call single or frequent defecation a stake of a liquid consistence. Diarrhea represents the symptom signaling about violation of absorption in intestines of water and electrolytes. The number of the kalovy masses allocated per day by the adult are normal, fluctuates within 100-300 grams depending on features of a diet (amount of the used vegetable cellulose, badly acquired substances, liquids). In case of strengthening of intestinal motility the chair can become frequent and be diluted, but its quantity remains within norm. When the amount of liquid in kalovy masses increases up to 60-90%, speak about diarrhea.
Distinguish sharp diarrhea (duration no more than 2-3 weeks) and chronic. Besides, tendency to a periodic plentiful chair gets to a concept of chronic diarrhea (more than 300 grams a day). The patients suffering from violation of absorption of various nutrients tend to polyexcrements: to allocation of a large number of the kalovy masses containing the undigested remains of food.
Etiology and pathogenesis
At the expressed intoxication in intestines there is an excess secretion in its gleam of water to sodium ions that promotes fluidifying of a chair. Sekretorny diarrhea develops at intestinal infections (cholera, enteroviruses), reception of some medicines and dietary supplements. Osmolyarny diarrhea arises at a syndrome of malabsorption, insufficiency of digestion of sugars, excess consumption of osmotically active agents (laxative salts, , antatsida, etc.). The mechanism of development of diarrhea in such cases is connected with increase in osmotic pressure in a gleam of intestines and diffusion of liquid on an osmotic gradient.
The considerable factor promoting development of diarrhea is violation of motility of intestines (hypokinetic and hyperkinetic diarrheas) and, as a result, change of speed of transit of intestinal contents. Strengthening of motility is promoted by depletive, magnesium salts. Violations of motor function (easing and strengthening of a vermicular movement) take place at development of a syndrome of the angry intestines. At the same time speak about functional diarrhea.
The inflammation of walls of intestines is the reason of an ekssudation of protein, electrolytes and waters in an intestines gleam through the damaged mucous. Ekssudativny diarrhea accompanies enterita, enterokolita of various etiology, intestines tuberculosis, sharp intestinal infections (salmonellosis, dysentery). Quite often at such type of diarrhea at a chair there is blood, pus.
Diarrhea can develop owing to reception of medicines: laxatives, the antatsid containing salts of magnesium, some groups of antibiotics (ampicillin, lincomycin, tsefalosporina, ), antiarhythmic medicines (, ), medicines of a foxglove, potassium salt, artificial sugar (, ), , henodezoksikholiyevy acid, sulfanylamides, anticoagulants.
Classification of ponos
Distinguish the following types of diarrhea: infectious (at dysentery, salmonellosis, an amebiaza, food toksikoinfektion and enteroviruses), alimentary (it is connected with violations in a diet or allergic reaction to foodstuff), dispepsichesky (accompanies the digestion violations connected with insufficiency of sekretorny functions of bodies of a gastrointestinal tract: liver, pancreas, stomach; and also at insufficiency of secretion of enzymes in a small intestine), toxic (at poisonings with arsenic or mercury, uraemia), medicamentous (caused by administration of drugs, medicinal dysbacteriosis), neurogenetic (at change of motility owing to the violation of nervous regulation connected with psycho-emotional experiences).
Clinical features of diarrhea
In clinical practice distinguish sharp and chronic diarrhea.
- Sharp diarrhea (duration is up to 2-3 weeks).
Most often infections and inflammations of intestines, and also medicines are the reasons of sharp diarrhea. At sharp diarrhea the chair frequent, liquid (watery), may contain slime and bloody streaks. Diarrhea often is followed by an abdominal distension, pain, nausea and vomiting. As a rule, appetite at patients is reduced, loss in weight is observed. The exhausting liquid chair promotes bystry loss by a water organism, at the same time dehydration symptoms are found: dryness of integuments, mucous membranes, fatigue, weakness. Diarrhea at intestinal infections often is followed by temperature increase of a body.
At poll often it is possible to reveal the previous use of low-quality or unusual food, drugs.
Bloody streaks in a chair speak about the injuries of a mucous membrane of intestines taking place that quite often happens at a shigelleza, infection with campylobacters or enteropatogenny colibacillus. Besides, sharp diarrhea with impurity of blood can be a consequence of a disease Krone, ulcer colitis.
The diarrhea proceeding more than 3 weeks is considered chronic. It can be a consequence of various pathologies which detection is the main objective for definition of tactics of treatment. The clinical symptoms and syndromes given the anamnesis, accompanying, fizikalny inspection can give information on the reasons of chronic diarrhea.
Special attention is paid to character of a chair: defecation frequency, daily dynamics, volume, consistence, color, availability of impurity in Calais (blood, slime, fat). At poll reveal existence or lack of the accompanying symptoms: tenezma (false desires to defecation), belly-ache, a meteorizm, nausea, vomiting.
Pathologies of a small intestine are shown by a plentiful watery or fat chair. Less plentiful chair is characteristic of diseases of a large intestine, in kalovy masses streaks of pus or blood, slime can be noted. Most often diarrhea at damages of a large intestine is followed by morbidity in a stomach. Diseases of a rectum are shown by a frequent poor chair as a result of hypersensibility to stretching of walls of intestines, a tenezmama.
Diagnosis of diarrhea
Sharp diarrhea is, as a rule, characterized by very expressed loss with a stake of liquid and electrolytes. At survey and fizikalny inspection of the patient note symptoms of dehydration: dryness and decrease in turgor of integuments, increase of pulse and lowering of arterial pressure. At the expressed deficiency of calcium there is positive a symptom of "the muscular roller", there can be spasms.
At diarrhea always the patient's chair carefully looks round, besides, it is desirable to carry out proktologichesky survey. Identification of an anal crack, fistula, a paraproktit the Krone is able to afford to assume the disease taking place. At any diarrhea make a complex research of bodies of a digestive tract. Tool endoscopic techniques (gastroscopy, a kolonoskopiya, an irrigoskopiya, a rektoromanoskopiya) allow to examine internal walls of the top departments of digestive tract and large intestine, to find damages mucous, inflammations, new growths, the bleeding ulcerations etc.
For diagnosing of sharp diarrhea complaints, data of fizikalny inspection and a research the calla (koprogramma), as a rule, is enough. Besides, the research a calla on eggs of worms is made, bacteriological crops become. At diagnosis of chronic diarrhea originally find out whether parasitic or bacterial damage of intestines takes place, make ultrasonography of abdominal organs regarding detection of inflammatory diseases of a digestive tract and a research of functional disorders of sekretorny activity of a liver, pancreas, glands of a mucous membrane of a stomach and small intestine.
The microscopy a calla allows to reveal the high content in it of leukocytes and epitelialny cages that speaks about existence of an inflammation of a mucous membrane of a digestive tract. The found excess of fatty acids is a consequence of violation of absorption of fats. In total from the remains of muscle fibers and high content of starch in kalovy masses is a malabsorption syndrome sign. Processes of fermentation owing to development of dysbacteriosis promote change of normal acid-base balance in intestines. For identification of such violations measure intestines (normal makes 6,0).
Persistent ponosa in combination with excess gastric secretion characterize Zollingera-Ellison's syndrome (ultserogenny adenoma of a pancreas). Besides, long sekretorny diarrhea can be result of development of gormonprodutsiruyushchy tumors (for example, vipoma). Laboratory blood tests are directed to identification of signs of inflammatory process, biochemical markers of violation of work of a liver and pancreas, the hormonal frustration able to be the reasons of chronic diarrhea.
Treatment of diarrhea
Diarrhea is a symptom of many diseases therefore in the choice of medical tactics the main role is played by identification and treatment of the main pathology. Depending on diarrhea type the patient goes for treatment to the gastroenterologist, the infectiologist or the proctologist. It is necessary to ask surely for medical care if the diarrhea proceeding more 4kh days takes place or in Calais streaks of blood or slime are noticeable. Besides, symptoms which cannot be disregarded are: tar-like chair, belly-aches, fever. If there were symptoms of diarrhea and there is a probability of food poisoning, it is also necessary to see a doctor most urgently.
The therapy directed to elimination of diarrhea depends on its type. Also includes the following components: dietary food, antibacterial therapy, pathogenetic treatment (correction of violations of absorption at fermental nedostatochnost, the decrease in gastric secretion, medicines normalizing intestinal motility, etc.), treatment of consequences of long diarrhea (a regidratation, restoration of electrolytic balance).
At diarrhea enter the products promoting reduction of a vermicular movement, decrease in secretion of water in an intestines gleam into a diet. Besides, the main pathology which caused diarrhea is considered. Components of a diet have to correspond to a functional condition of digestion. The products promoting secretion of hydrochloric acid and increase in speed of evacuation of food from intestines for the period of sharp diarrhea are excluded from a diet.
Antibiotic treatment at diarrhea is appointed for suppression of pathological flora and restoration of a normal eubioz in intestines. At infectious diarrhea appoint antibiotics of a wide range, a hinolona, sulfanylamides, nitrofurans. Choice medicines at intestinal infections are the means which are not exerting adverse impact on an intestines microbiocenosis (the combined medicines, ). At diarrheas of various genesis can sometimes appoint eubiotik. However, such treatment is more often appoint after subsiding of symptoms of diarrhea for normalization of intestinal flora (elimination of dysbacteriosis).
As symptomatic means the adsorbents enveloping and the astringents neutralizing organic acids are applied. Apply the loperamide, besides, operating directly on opiate receptors of a small intestine to regulation of intestinal motility, reducing sekretorny function of enterotsit and improving absorption. Has the expressed antidiarrheal effect , influencing sekretorny function.
At infectious diarrheas the medicines reducing an intestines vermicular movement do not apply. Loss of liquid and electrolytes at long and plentiful diarrhea demands taking measures to a regidratation. To most of patients appoint an oral regidratation, but in 5-15% of cases there is a need for intravenous administration of electrolytic solutions.
Prevention of diarrhea
Measures of respect for hygiene of a body and food belong to prevention of diarrhea. Washing of hands before food, careful washing of crude vegetables and fruit and the correct culinary processing of products promote avoiding of food poisonings and intestinal infections. Besides, it is worth remembering need to avoid the use of unboiled water, unfamiliar and suspicious food, the food able to cause allergic reaction.