Diarrhea (diarrhea)

Diarrhea (diarrhea) - frequent (more than 2 times a day) discharge of liquid stools, associated with accelerated passage of intestinal contents due to increased peristalsis, a violation of water absorption in the large intestine and secretion of a significant amount of inflammatory secretion or transudate by the intestinal wall. In most cases, diarrhea is a symptom of acute or chronic colitis, enteritis.

Infectious diarrhea is noted in dysentery, salmonellosis, food poisoning, viral diseases (viral diarrhea), amoebiasis, etc. Alimentary diarrhea can be caused by malnutrition or allergy to certain foods. Dyspeptic diarrhea is observed when digestion of food masses is impaired due to secretory deficiency of the stomach, pancreas of the liver, or inadequate secretion of certain enzymes by the small intestine. Toxic diarrhea accompanies uremia, poisoning with mercury, arsenic. Medicamentous diarrhea can be a consequence of suppression of the physiological flora of the intestine, the development of dysbiosis. Neurogenic diarrhea is observed when there is a disturbance in the nervous regulation of the motor activity of the intestine (for example, diarrhea that occurs under the influence of excitement, fear).

The frequency of the stool is different, the bowel movements are watery or mushy. The nature of the feces depends on the disease. So, with dysentery, feces have a dense consistency first, then it becomes liquid, lean, mucus and blood appear in it; When amebiasis - contains vitreous mucus and blood, sometimes the blood soaks through the mucus and the stool becomes a raspberry jelly. With diarrhea, there may be abdominal pain, a feeling of rumbling, transfusion, bloating, tenesmus. Light and non-durable diarrhea has little effect on the general condition of patients, severe and chronic leads to exhaustion, hypovitaminosis, pronounced changes in the organs.

To determine the cause of diarrhea, a coprological and bacteriological study is carried out. The severity of diarrhea can be judged from the rate of passage (progress) through the intestine of carbolen (the appearance of black stain after admission to patients with carbolenes after 2-5 h instead of normal 20-26 h) or barium sulphate during X-ray examination.

If there is a suspicion of cholera, sapmonellosis, food toxic co-infection, the ballroom is immediately hospitalized in the infectious department.

Treatment is aimed at eliminating the cause that caused diarrhea. For example, with hypovitaminosis, parenterally enter the appropriate vitamins, with stomach ailments prescribed gastric juice or its substitutes, with pancreatic insufficiency - pancreatin or panzinorm, festal, etc. With diarrhea not associated with infection, a sparing diet (restriction of carbohydrates, refractory fats of animals Origin), frequent fractional meals, thorough chewing food. Symptomatic agents include calcium carbonate, bismuth preparations, tanalbine; Decoctions from the bark of oak, herbs of St. John's wort, rhizome of serpentine, tentacle or bug, cherry fruit, bilberry infusion, aplicata of alder, chamomile flowers, tincture of belladonna, etc. With diarrhea caused by dysbacteriosis, appoint colibacterin, lactobacterin, bifikol, bifidumbacterin.

Viral diarrhea acquires a special urgency in modern medical practice. In children, the leading etiologic factor causing acute infectious diarrhea is rotavirus. Most often rotavirus diarrhea is observed in children under 2 years of age in the form of sporadic cases; Possible epidemics of rotavirus infection, more often in winter. In adults, rotavirus rarely provokes gastroenteritis and the process caused by it is erased. Acute diarrhea in adults is often caused by the Norwolk virus.

The latent period for rotavirus infection is from one to several days. The onset of viral gastroenteritis is acute with vomiting, in children pronounced; Then there are diarrhea, as well as general symptoms of infection: headaches, myalgia, fever, but these phenomena are usually moderately expressed. Abdominal pain is not characteristic of viral gastroenteritis. Edema and inflammation in the wall of the small intestine, caused by the virus, lead to a violation of secretion and absorption of a liquid rich in sodium and potassium. Diarrhea is watery, lost with diarrhea, the liquid contains little protein, but many salts. This pattern resembles secretory diarrhea caused by cholera vibrio or enterotoxins of Escherichia coli; It can lead to a massive loss of fluid, exceeding in an adult 1 liter per hour. With viral diarrhea the colon does not suffer and there are no leukocytes in the stool, viral diarrhea in adults lasts 1 to 3 days, in children - twice as much. Severe dehydration can threaten the life of the patient. Therapy is reduced mainly to the replacement of lost fluid. This substitution can be performed by infusion, with the aid of a drinking assignment containing glucose and salt (glucose stimulates sodium absorption). The liquid is administered at a rate of 1.5 liters per 1 liter of stool, but the main control is the visible filling of the vessels of the skin, mucous membranes. Antibiotic therapy with water diarrhea does not change the duration of the disease.