Diarrhea

Diarrhea is frequent (more than 2 times a day) the separation of liquid stool.
The development of diarrhea is associated with accelerated passage of intestinal contents of the intestines (due to its increased peristalsis), a violation of intake water in the colon and the release of the intestinal wall of a significant number of inflammatory secret or specimens. In most cases, diarrhea is a symptom of acute or chronic inflammation of the intestine (see Colitis, nonspecific Ulcerative colitis, Enteritis, enterocolitis).
On etiological principle distinguish the following types of diarrhea 1. Infectious diseases (dysentery, the salmonellosis, food diseases), parasitic (giardiasis, amebiasis) and invasive (ascariasis, trichocephalosis). 2. Alimentary - at the wrong diet (excessive consumption of fats, foods rich in fiber and carbohydrates) or allergies to certain foods. 3. Diarrhoea is a violation of digestion of food masses due secretory insufficiency of the stomach, pancreas, or liver. 4. Dystrophic - during prolonged fasting, beriberi (B2, PP, C and others), radiation defeat, amyloidosis, etc. 5. Toxic - by uremia, poisoning by mercury, arsenic. 6. Medical - because of the excessive and unnecessary use of antibiotics, which leads to the suppression of physiological bowel flora, in the development of pathogenic fungi and bacteria (goiter). 7. Neurogenic - violation of the nervous regulation of motor activity of the bowel (for example, diarrhea occur under the influence of excitement, fear).
Clinical symptoms of diarrhea: frequent diarrhea, bloating, rumbling, transfusion, sometimes abdominal pain. Change Kala with diarrhea associated with various diseases,see Cal, and articles dedicated to these diseases.
Light and nondurable diarrhea little effect on the General condition of the patients, a severe and chronic lead to exhaustion, avitaminosis, severe changes in organs.
To determine the cause diarrhea spend microscopic and bacteriological examination. About the severity of diarrhea can be judged by the speed of the passage (promotion) through the intestines of carbolenum (the appearance of black color of stool after taking sick of carbolenum in 2-5 hours. instead of the normal 20-26 hour.) or barium sulfate chest x-ray.
First of all it is necessary to exclude such formidable cause diarrhea as cholera (see) and severe dysentery (see). If diagnosed dysentery (severe) or cholera patients will be immediate admission to hospital. The same applies to the diarrhea caused severe food poisoning (see Foodborne diseases, Food poisoning), and dysentery light and moderate forms, if the house has no opportunity to carry out the necessary sanitary and anti-epidemic measures.
Treatment. When diarrhea is not associated with severe infection, shows a high-fiber diet (exception carbohydrates, fats), treatment should be aimed at elimination of the reasons for it. For example, during avitaminosis parenteral enter the correct vitamins, ahilii appointed gastric juice or its substitutes. At insufficiency of pancreas is assigned Pancreatin on 0.5-1 g 3 times a day before meals.
Symptomatic means at diarrheas: carbonate of calcium, bismuth or dermatol 0.5 g 2-3 times a day, tanalin or tealby 0.3-0.5 g 3-5 times a day; decoction of oak bark, grass zveroboja, roots serpentine, roots lapchatki, rhizomes of Burnet, fruit cherry, extracts of bilberry, alder stems, flowers of a camomile and others, in the most severe cases, tincture of opium. In case of dysbacteriosis helps coli-bacterin (preparation of strains of E. coli).
Warning diarrhea is in compliance with hygienic measures that prevent the penetration of the infection in the gastrointestinal tract, and normal nutritional regime.


Diarrhea is a disorder of intestinal function, manifested by frequent separation of liquid stool. Small deviations from the circadian rhythm (defecation after a day or two times a day) are just a variant of the norm. Some healthy people defecating does not happen overnight, and in two steps. Stool consistency (see also affected physiological options.
Pathogenesis Ponosov reduced to three major disorders: a) hypermotor dyskinesia thin or large intestine with the acceleration and deepening of peristaltic waves and acceleration of the entire intestinal passage, b) reduction of water absorption in the colon and C) enhanced extravasation into the lumen of the intestine, and often exudation, i.e. the allocation of inflammatory secretion in response to irritation of mucous membrane.
Accelerated passage may concern only one of the sections of the intestinal tube, such as the small intestine, while slow-down in the colon, where under normal conditions absorbed water and formed stool.
Unlike true Ponosov, when the so-called false, or stop, diarrhea is frequent allocation of scarce dense feces ("sheep Cala") or only mucus mixed with pus, blood, or gases. The nature of diarrhea allows you to define the primary localization of the disease in thin or thick intestines.
So, for enteritis typical liquid pasty defecation, frothy, acid reaction with an abundance of fermentation products for colitis is scarce, any consistency allocated after a painful desires, sometimes with tenesmus (irritation of the rectum and sigmoid colon). Diarrhea is often the main feature of intestinal diseases, less frequently a symptom of defeats of other organs.
Classification Ponosov takes into account the main etiological factor. Clarification of the etiology of diarrhea protects against the two most common causes of their incurable and protracted course: indiscriminate protivodiareynoe therapy or remains without effect, or even causes dysbacteriosis and secondary (medicinal) P., and shortcomings of a purely symptomatic of application fixing tools like chalk, bismuth, tanalbina that cause temporary constipation followed pendulum-like oscillations intestinal functions between constipation and P. Only the elucidation of the true etiology P. ensures the success of treatment.
1. Infectious diarrheas are of different etiology, proceed as in acute and chronic forms and preinfection (a consequence of sensitization of primary causative agent and increased sensitivity to the next non-specific stimuli - non-pathogenic bacteria, food substances, accidental infections, cooling of the body). On the first place on the frequency is shigellosis, then Salmonella, protozoan invasion, especially giardiasis, rarely trichomonads and the most heavy - balantidia and amoebiasis. Helminthic invasion (ascariasis, enterobiasis, trichocephalosis and others) is a common cause of diarrhea is not only children but also adults. Recently, attached is conditionally pathogenic strains of Escherichia coli type Escherichia coli, especially when diarrhea early childhood, and enteroviruses.
2. Alimentary diarrhea include three sub-groups: a) food diseases with symptoms of gastroenterocolitis; b) allergic caused by a single, or (more often) multiple antigens (group allergies); Ii. on the basis of an incorrect diet: eating, urgent food, poor eating, excessive portions, abuse rough, voluminous, greasy food, rich cold drink, physical stress immediately after eating a heavy meal, etc.
3. Diarrhea motivated dyspepsia, i.e. violations of the digestive function. Distinguish: astrogeny P. patients ahilia, coming soon after meals (pathogenesis of them due or decompensation ahilii or secondary enterocolitis); pancreatic P. with politicaly, steatorrhea, kreatora; hepatic dyspepsia with agalychnis by the chair, containing saponified oils and crystals fatty acids; finally, P. when enteritis fermentation or rotten character. Common cause of this group P. is a deficiency of digestive enzymes, among which special importance is attached to disaccharidases (the lactase, maltase and others).
4. Special group of fatty diarrhea different shapes steatorrhea: primary - both forms sprue, celiac disease, and secondary failure, liver and pancreas, Whipple's disease (intestinal lipodystrophy) with lymph vessels of a mesentery small intestines. In the etiology and pathogenesis of these steatorei combines elements of vitamins (folic acid, PP, b-complex), maxillary (gluten and gliadin cereal), malabsorption all kinds of food, endocrine failure, secondary infection.
5. Avitaminosis and dystrophic diarrhea belong to severe forms due to often irreversible anatomical changes of the wall of the small intestine with the development of atrophy, Wegener, reticulata.
6. Among drug Ponosov of particular importance are the consequences of excessive and unnecessary use of antibiotics, resulting in dysbacteriosis, suppression of physiological flora, the development of fungal infections of the intestinal and other pathogenic strains. P. can also be caused by abuse of laxatives, they quickly replaced by constipation and complicated drug colitis.
7. Neurogenic diarrhea occur either in the form of acute attacks under the influence of negative emotions or obsessions ("bear's disease), or on the background of the General neurosis and psychoneurosis. The characteristic lack of dependence on food composition, paradoxical improvements from various, even rough food and deterioration from strict sparing diet. Special syndrome are attacks of colic on the soil of Muco-membranous colitis as one of the forms of neuroses of the intestine.
8. Secondary diarrhea may be accompanied by acute infections (measles, scarlet fever, influenza, fever) or complicate abdominal surgery (resection of the stomach or intestines). After bilateral vagotomy for ulcer P. arise on the ground of gastrectasia delayed fermentation products in the stomach and periodic massive entrance in the small intestine, often simultaneously with abundant vomit food and sour juice. Currently isolated vagotomy already left surgeons and is used only in combination with piloroplasty or gastroenterostomy.
Special group of bloody diarrhea as a symptom of various diseases: dysentery, ulcerative colitis, tumors of the intestine, hemorrhoids.
Clinical course and the diagnosis of these forms of P. range from mild recurrent, non-progressive forms (most of intestinal dyspepsia, giardiasis enteritis) to grave, irreversible form, complicated by malnutrition, vitamin deficiency, atrophy or retikulez the intestinal wall. Among the most severe diarrhea is the Whipple's disease and diarrhea on the soil of the gastrocolic fistula. About the severity of diarrhea can be judged on the basis of several studies. Quick intestinal passage is determined using karmenkarina samples (the appearance of red and black color of feces through 2-5 hours instead of the normal 20-26) or x-ray method. Coprological analysis allows you to set the infectious nature of diarrhea, and also to judge the digestion and assimilation of food on the basis of steatorrhea, creatore, litterie. Morphological changes of the mucous membrane of the intestines are defined using zasypaya biopsy of the mucous membrane of the small intestine (the phenomenon of the muscle fibers with a smaller surface suction, infiltration of cellular elements, the growth of connective tissue and other).
Complications diarrhea from other organs and systems are expressed in the alimentary toxic hepatitis, anemia, amyloid principally, osteoporosis and osteomalacia, the children in the delay of the overall development and growth. In sharp dehydration come gastric tetany with convulsions and symptoms trusso and Huasteca, changes in the myocardium, as with the lack of vitamin B1.
Treatment for diarrhea as possible should be causal. Infectious and parasitic forms require specific therapy (antibiotics, sulfanilamides, Akrikhin, emetine with atrena, anteroseptal, aminohinol, furazolidone).
Nutritional therapy is indicated in all forms as a General background, or for the normalization of the disordered functions of the intestine and other digestive organs. Because most frequent dominance of fermentation processes shown courses mainly protein diet (broth, meat, fish, cheese, two-day yogurt) with a sharp restriction of carbohydrates and their gradual introduction as normalization of stool. It is also shown some days Apple cider diet (raw soeprotective apples are rich in pectin, 250 g 4 times a day); the days of dry foods (meat, cheese, white crackers); the inclusion of binding dishes (rice, strong tea). When fatty diarrhea, except restrictions fats, sometimes it helps a long gluten-free diet, with the exception of rice, wheat and rye flour, containing exellency gluten and gliadin. In the various forms of dyspepsia shown substitution therapy (hydrochloric acid, pepsin, betazed, aldol-pepsin, Pancreatin, multienzyme product abomin).
As fast securing funds used purified chalk (calcium carbonate), calcium phosphate, nitrate and bismuth carbon dioxide, dermatol, white clay, tanalin, and in particularly severe cases - opium tincture, powders or candlelight. When false desires and tenesmus appoint a lukewarm microclysters from wild camomile tincture with 0.3 g of antipyrine. Rectal diarrhea with delayed emptying shown emulsion enemas from vegetable oil with soda and water 100-200 ml before bedtime, after which on the morning comes more abundant chair. In case of dysbacteriosis, except for the exceptions of antibiotics, you can try colibacterin (dry vaccine strains of Escherichia coli) or lactobacilli (dry diet yogurt, ripening which produces antibiotic-resistant lactic acid bacteria). Among non-specific restorative means that increase the resistance of the body, applied physiotherapy, balneotherapy, and climatotherapy, Polyvitamin preparations, tonics (apilak, pantocrine, ginseng, tripoliphosphate, vitamin B15).
Prevention of diarrhea include sanitation of the oral cavity, the settlement of nutrition, work and rest, early treatment of early stages of gastrointestinal disorders.