Toxic diarrhea. Diarrhea Clinical characteristics of neurogenic diarrhea

can be of both exo- and endogenous origin.

Exogenous toxic diarrhea can occur with intoxication with arsenic, mercury, and nicotine abuse. Symptoms of elimination colitis appear (tenesmus, bloody-mucous stool). Changes in the skin, mucous membranes (arsenic melanosis), kidneys (with mercury poisoning), hypochromic anemia, and exhaustion are added. In acute poisoning, diarrhea is profuse. Anamnesis data suggest a connection between diarrhea and occupational hazards and nicotine abuse.

Diagnostics: biochemical blood tests, urine tests, chemical analysis of hair and nails (to detect arsenic) are carried out.

Allergic diarrhea (often profuse) can occur after eating certain foods (seafood, milk, strawberries, eggs, etc.). Along with diarrhea, other manifestations of allergies are possible (urticaria, Quincke's edema, allergic conjunctivitis). In some patients, large amounts of mucus are discharged, and intestinal bleeding is possible.

Diagnosis: allergic skin tests are performed to identify the allergen.

With uremia, elimination colitis occurs, sometimes with the development of ulcerative lesions.

Diagnostics: a biochemical blood test shows an increase in the level of creatinine and urea.

Diarrhea is a common side effect of many medications. The most common causes of diarrhea are: antibiotics, cytostatics and immunosuppressants, colchicine, non-steroidal anti-inflammatory drugs, digitalis, quinidine, propranolol, amiloride, triamterene, secretory laxatives (senna, buckthorn, bisacodyl), osmotic laxatives (saline, xylitol, sorbitol, mannitol, glycerin ), prostaglandin preparations, magnesium-containing antacids, bile acid preparations (cheno- and ursodeoxycholic acids), lithium, iron preparations.

Serious intestinal damage caused by taking the drug, accompanied by severe diarrhea and fever, is pseudomembranous colitis, a variant of infectious diarrhea. It occurs under the influence of Clostridium difficile microorganisms, which multiply rapidly during treatment with certain antibiotics. Diarrhea with this colitis is mixed - exudative and secretory.

Secretory diarrhea is also caused by furosemide, thiazides, misoprostol (prostaglandin E1), olsalazine (dipentum), ethanol. Cholinergic drugs (pilocarpine, muscarine, metoclopramide), cholinesterase inhibitors (neostigmine, physostigmine), erythromycin, methylxanthines (theophylline and caffeine-containing products such as chocolate) stimulate intestinal secretion and motility. Cholestyramine, which usually causes constipation, binds bile acids with long-term use, which can lead to impaired fat digestion and steatorrhea.

One of the forms of intestinal damage associated with taking NSAIDs is the so-called NSAID-associated enteropathy, which is found in many patients taking drugs in this group. The pathogenesis of NSAID-associated enteropathy includes disturbances in metabolic processes in the epithelial cells of the small intestine during the absorption of NSAIDs, as well as increased permeability of the mucous membrane. As a result, malabsorption occurs in the small intestine, some patients develop malabsorption syndrome and increased protein loss through the mucous membrane. NSAID-associated colitis occurs with abdominal pain, bloody diarrhea, and increased ESR. This form of the disease is observed mainly in older people and develops against the background of long-term (from 2 months to 5 years) use of NSAIDs.

The use of a number of other drugs (potassium chloride, cytostatics, flucytosine, D-penicillamine, gold preparations, digitalis, ergotamine, etc.) is accompanied in some cases by the development of erosive or ischemic forms of intestinal lesions, also accompanied by diarrhea.

Taking laxatives for constipation for a long time can cause diarrhea, bloating and pain in the left half of the abdomen, and weight loss in some patients. Elderly and middle-aged women are more often affected. Arthropathy, osteomalacia, liver dysfunction with pigmentation, and steatorrhea may occur.

Diagnostics: endoscopic examination of the gastrointestinal tract, including sigmoidoscopy; In a biochemical blood test, when taking certain medications, electrolyte disturbances occur in the form of hypokalemia.

V. Diarrhea caused by malnutrition and vitamin deficiencies is now rare. Diarrhea is observed in the late stages of nutritional dystrophy. In this case, there are other symptoms: disappearance of subcutaneous tissue, muscle atrophy, senile appearance, hypothermia, edema. The skin is usually pale jaundiced, dry, and flaky. Hypochromic anemia develops. Frequent complications are enterocolitis, pneumonia, and bronchitis.

VI. Diarrhea due to carbohydrate intolerance is associated with a deficiency of certain enzymes that are necessary for the absorption of carbohydrates in the intestines.

Lactose intolerance is associated with decreased activity of the lactase enzyme in digestive juice. It is manifested by watery diarrhea, bloating, rumbling and cramping pain when drinking milk. After defecation or passing a large amount of gas, the patient experiences relief. The appearance of abdominal pain at night is typical. The diagnosis is confirmed by a provocative test with lactose consumption.

Insufficient absorption of monosaccharides is manifested by watery diarrhea after consuming glucose or galactose. Patients also cannot tolerate disaccharides. Characterized by watery diarrhea with a significant increase in the daily mass of feces. Diarrhea is often accompanied by abdominal pain and increased gas formation. Intestinal peristalsis increases, which causes loud rumbling. Fructose absorption is normal in these patients.

Diagnosis is helped by prescribing a diet with fructose, determining electrolytes, and sigmoidoscopy.

VII. Functional diarrhea is one of the main variants of irritable bowel syndrome. This syndrome is defined as a functional (i.e., not associated with organic intestinal damage) disease, the main clinical manifestations of which are abdominal pain, decreasing after defecation and accompanied by flatulence, rumbling, a feeling of incomplete bowel movement or an imperative urge to defecate, as well as intestinal dysfunction - constipation, diarrhea or their alternation.

The clinical signs of functional diarrhea are varied. Characteristic is, first of all, the absence of diarrhea at night, the presence of a clear dependence of the rhythm of bowel movements on the time of day. Stool (mushy or liquid) with a frequency of 2-4 times a day is observed in patients mainly in the morning, usually after breakfast. Since increased intestinal motility, which underlies the occurrence of this form of diarrhea, is usually combined with increased gas formation, the urge to defecate in patients is often imperative, so in this case the term “morning storm syndrome” is used. The stool does not contain any admixture of blood or pus. Functional diarrhea occurs without an increase in the volume of intestinal contents, so that the weight of feces, as a rule, does not exceed 200 g/day.

When examining patients, a variety of extraintestinal manifestations are revealed: headaches, pain in the sacrum, vasospastic reactions, urination disorders, complaints of a feeling of a lump when swallowing, inability to sleep on the left side, dissatisfaction with breathing, etc. There is a clear connection between deterioration of well-being and nervousness. mental factors, a discrepancy between the abundance of complaints and the good general condition of patients, the absence of so-called anxiety symptoms (blood in the stool, fever, severe weight loss, anemia and an increase in ESR).

Functional diarrhea should be distinguished from organic diarrhea (table).

Prolonged diarrhea is dangerous. In cases where the duration of diarrhea is about three days or more, we can say that the diarrhea is prolonged. And if loose stools begin in an acute form and last for about two weeks, then this is doubly dangerous.

Consequences of prolonged diarrhea

In such cases, certain actions should be taken urgently. After all, this is dehydration, and this is a rather dangerous consequence.

With diarrhea, a person not only feels uncomfortable, but when the diarrhea drags on, mental and autonomic system disorders occur.

• Dizziness, general weakness of the body, and seizures appear. This phenomenon mainly occurs after taking antibiotics.
• In addition, prolonged diarrhea can be due to an intestinal infection, childhood anemia, or transfer to artificial formula feeding.
• Causes of severe diarrhea include bacterial infection. These are the consequences of dirty food and drinks. Food poisoning is accompanied by vomiting, diarrhea, and abdominal pain.

If treated correctly, diarrhea will go away within a few days. But if everything remains the same, then you need to consult a doctor. Based on the tests taken, the doctor will be able to find the reasons and understand why the diarrhea is prolonged.

Types of prolonged diarrhea

Daily diarrhea manifests itself in the form of liquid stool in the morning, and then during the day stool of normal consistency. It is not dangerous if one-time liquid bowel movements occur. If there is no water, blood, mucus in the stool, there is no vomiting and no pain, then the cause of such diarrhea may be poor nutrition, use of laxatives, pregnancy, as well as chronic alcoholism.

Toxic diarrhea

Toxic diarrhea can result from damage to the intestinal mucosa by various toxins. We are talking about poisoning with heavy metals, nicotine, and ethyl alcohol. When a person is poisoned by arsenic, vomiting, pain in the abdomen, severe diarrhea, and severe dehydration occur. This diagnosis is confirmed by chemical analysis of the nail plate and hair.

Diarrhea after sex

Diarrhea after sex is a consequence of anal sex. Experts are confident that anal sex does not harm the body. But you should do it correctly. Sometimes it causes diarrhea. This is due to the fact that before intercourse itself, enemas are done for cleansing. After all, the intestines may not absorb all the water, so it remains. And then he wants to go outside. In addition, if an enema is done with hot water, this can also lead to diarrhea. During anal sex, the walls of the rectum are relaxed. If a person ate heavily before the act, then there may also be diarrhea. There are products that transit through the body. Therefore, loose stools may also appear.

Differential diagnosis

If loose stools last a long time, differential diagnosis is used to identify its causes. The presence of blood in the stool is excluded. In addition, pay attention to signs of dehydration. If dehydration is suddenly observed, the person is admitted to hospital treatment. If there is no dehydration, then the disease can be treated. This generally occurs within five days.

In a conversation with the patient, the doctor finds out why the patient has diarrhea, what type of stool, what kind of diet the patient has, and whether he drinks enough fluid. The main role is given to physical examination. We are talking about things like how often a person goes to the toilet, whether there are certain impurities in the stool, and what else is accompanied by diarrhea.

The important point is whether there are disturbances in consciousness, anxiety, thirst.

Once the causes of prolonged diarrhea have been determined, treatment can be selected. The main goal is to normalize the consistency of stool. Patients are prescribed a diet and undergo therapy. Products should not burden the digestive tract; food must be processed. No raw vegetables or fruits. It is allowed to cook food in a double boiler. It is not recommended to consume foods that irritate and contribute to the formation of fermentation processes. With the help of medications, they get rid of dehydration, replenish vitamins and minerals, metabolic processes, and intestinal microflora.

General concept of diarrhea

Diarrhea is a disorder of intestinal function, which manifests itself in increased frequency of stools with a change in its consistency and quality. Diarrhea occurs with a variety of diseases of the gastrointestinal tract.

The following main factors are noted in the mechanism of their development: increased motility of the small or large intestine with increased frequency and intensification of peristaltic waves and acceleration of the entire intestinal passage, decreased absorption of water in the large intestine with increased secretion into the intestinal lumen of intercellular fluid or inflammatory exudate.

The nature of diarrhea usually makes it possible to determine the location of the intestinal lesion - large or small. However, such a division is not always possible, since many diseases, especially of an infectious nature, affect all parts of the gastrointestinal tract. Then they say that the disease proceeds as acute gastroenterocolitis, which indicates the involvement of the stomach, small intestine, and large intestine in the pathological process.

Clinical characteristics of enteric diarrhea

Enteritis

With the primary localization of the lesion in the small intestine (with enteritis), diarrhea can be of varying frequency, but the bowel movements are always copious, mushy or liquid, foamy, their reaction is acidic, there are usually remnants of undigested food substances - lumps of starch, muscle and plant fibers, saponified fats and fatty acid crystals. If such stool is present, they speak of enteric diarrhea.

Chronic enteritis can develop as a secondary disease against the background of other diseases of the digestive and other systems, for example after gastrectomy, chronic pancreatitis, hepatitis, liver cirrhosis, renal failure, various skin diseases (psoriasis, eczema).

Symptoms Chronic enteritis is manifested by moderate pain in the umbilical region, which, when exacerbated, intensifies in the afternoon, subside with the appearance of a loud rumbling. Patients note bloating and a feeling of fullness. The frequency of stool is usually 3–6 times a day, in severe cases it can reach 15 times a day. The stool is typical: stool is abundant, light yellow in color, without any admixture of blood, mucus or pus. With prolonged or severe course of chronic enteritis, symptoms of impaired absorption of substances necessary for the body are observed.

Malabsorption occurs because dystrophic changes develop in the mucous membrane, intestinal cells cease to perform their functions, and as a result, the body ceases to receive sufficient amounts of proteins, carbohydrates, fats, minerals, microelements, and vitamins.

The patient gradually develops exhaustion, weight loss, and swelling, most often of the lower extremities. All types of metabolism (protein, fat, carbohydrate, mineral) are disrupted. Characteristic signs of hypovitaminosis, iron and B 12 deficiency anemia, osteoporosis, dystrophy of internal organs, including the liver, myocardium.

There is a decreased content of potassium, calcium, magnesium, iron, and protein in the blood. A scatological examination of stool reveals undigested fats, fiber, large amounts of mucus and leukocytes. Dysbacteriosis is very often detected. X-ray examination determines the acceleration or deceleration of the passage of barium from the stomach through the small intestine, changes in the relief of the mucous membrane, and spasms of certain areas.

Enteroviral diarrhea

Among infectious diarrhea, diarrhea of ​​a viral nature has recently come to the fore. In children, the causative agent of acute enteritis is rotavirus, in adults it is more often the Norwolk virus. The onset of the disease is acute, diarrhea is preceded by nausea, and in severe cases, vomiting. General infectious manifestations (headaches, fever, muscle pain) are mild. Abdominal pain is not typical for viral enteritis. At first, the stool has a mushy fecal character, but then it becomes more and more liquid and watery. This happens because swelling and inflammation of the small intestine caused by the virus lead to impaired secretion and reabsorption of water rich in sodium and potassium salts. The fluid lost with diarrhea contains little protein, but a lot of these valuable salts. Fluid losses can be up to 1 liter per hour.

The colon does not suffer during viral diarrhea, so no leukocytes are detected in the stool. The main reason requiring immediate treatment is the threatening loss of fluid and salts. Viral diarrhea lasts 1–3 days in adults, 2 times longer in children, so it is necessary to immediately begin replacing lost fluid.

Gastric achylia

Enteric diarrhea often develops with gastritis with reduced secretion. With gastric achylia (lack of hydrochloric acid and digestive enzymes in the gastric juice), there may be several causes of diarrhea. Firstly, due to the lack of gastric digestion, undigested food remains in large quantities, especially during rapid gastric emptying, enter the intestine and cause increased peristalsis. Secondly, insufficient preliminary digestion of food in the stomach leads to the development of fermentation and putrefactive processes in the small intestine. Thirdly, with insufficient secretion of hydrochloric acid, disturbances in the secretory function of the pancreas develop, which leads to the formation of “fatty” diarrhea.

Clinical characteristics of colitic diarrhea

If the process involves predominantly the large intestine, stool with diarrhea is of a different nature. At first it has the usual consistency, but always with an admixture of mucus, visible to the eye. With the further development of the disease, the stool becomes increasingly scanty, an admixture of blood may appear, and a painful urge to defecate is usually noted - tenesmus, which occurs due to spasm of the large intestine. Sometimes the stool takes on the character of “rectal spit” - only a lump of mucus with pus or blood is released.

Dysentery

A typical example of colitic diarrhea is the well-known infectious disease dysentery. The causative agent is a bacterium of the genus Shigella. The source of infection is a sick person and a bacteria carrier. Infection occurs when food, water, or objects are contaminated directly by hands or flies. Dysenteric microbes are localized mainly in the large intestine, causing inflammation, superficial erosions and ulcers.

Symptoms The incubation period lasts from 1 to 7 days (usually 2–3 days). The disease begins acutely, with an increase in body temperature, chills, a feeling of heat, weakness, and loss of appetite. Then abdominal pain appears, initially dull, spread throughout the abdomen, later it becomes more acute, cramping. By location - lower abdomen, more often on the left, less often on the right. The pain usually intensifies before defecation. Tenesmus occurs, and false urges to descend appear. When palpating the abdomen, spasm and soreness of the colon are noted, more pronounced in the area of ​​the sigmoid colon, which is palpated in the form of a thick tourniquet. The stool is typical colitic, its frequency ranges from 2–3 times a day in mild forms of the disease to 15–20 in severe cases. The duration of the disease ranges from 1–2 to 8–9 days.

Chronic colitis

Colitic stool is also observed in chronic colitis. Chronic colitis is inflammatory, dystrophic and atrophic changes in the colon mucosa, which are accompanied by its motor and secretory disorders. Often the cause of chronic colitis is untreated dysentery and other infectious diseases. However, we cannot exclude the influence of poor nutrition, exposure to toxic substances (lead, arsenic, mercury), medications with long-term uncontrolled use of antibiotics and laxatives. A significant role in the formation and development of the disease is played by the pathology of other parts of the gastrointestinal tract (pancreatitis, gastritis).

Symptoms The main signs of chronic colitis, in addition to typical colitis, are dull, aching, cramping pain in different parts of the abdomen, sometimes without clear localization; they are always more intense after eating and weaken after defecation and the release of gas. The pain may intensify when walking, shaking, or after cleansing enemas. Patients complain of rumbling, flatulence, bloating, a feeling of incomplete bowel movement, and after eating there may be a urge to defecate. Diarrhea occurs up to 5–6 times a day, and there are streaks of mucus or blood in the stool. Pain in the anus may occur due to inflammation of the mucous membrane of the rectum and sigmoid colon. When palpating the abdomen, pain is determined along the course of the large intestine, alternating its spasmodic and dilated areas. The course of the disease is undulating: deterioration is replaced by temporary remission.

Examination of the colon during irrigation and colonoscopy allows an accurate diagnosis of chronic colitis. It is imperative to perform sigmoidoscopy - examination of the rectal mucosa with a rectoscope. If necessary, during a colonoscopy, a biopsy of the colon mucosa is taken for examination under a microscope.

A special place among diseases of the large intestine is occupied by nonspecific ulcerative colitis and Crohn's disease, which are also accompanied by specific colitic diarrhea. Nonspecific ulcerative colitis is a chronic disease of the colon with the development of ulcers in the mucous membrane and hemorrhages against the background of widespread inflammation.

The causes of ulcerative colitis are unknown, but exacerbations are provoked by physical overexertion and stressful situations. Women get sick more often. Damage to the intestine can be total - along its entire length or only in a separate area (segmental). Involvement of the rectum in the pathological process occurs almost constantly.

Patients are usually worried about a triad of complaints: diarrhea, bleeding from stool, and abdominal pain. However, the stool is typical colitic, sometimes there is an admixture of pus in the stool.

General well-being is significantly affected: loss of appetite, apathy, weight loss, temperature rises to 37.5–40 °C. The disease can be very severe, accompanied by bleeding from ulcers, perforation of the intestinal wall, peritonitis, tumors, sepsis, and degeneration of internal organs. The course of the disease is long-term and requires constant maintenance therapy.

During sigmoidoscopy and colonoscopy (endoscopic examination of the mucous membrane of the colon), swelling, redness and increased bleeding of the mucous membrane of the rectum and other parts of the colon, ulcers and pseudopolyps are detected. A mucosal biopsy confirms the diagnosis. During irrigoscopy, in advanced cases, the colon looks like a “water pipe.” Blood tests show nonspecific signs of inflammation - an increase in the number of leukocytes, an acceleration of ESR, a decrease in hemoglobin (anemia).

Crohn's disease

Crohn's disease is a specific inflammation of the intestinal wall with clear boundaries of the affected areas. The cause of the disease is also unknown. Specific inflammation is accompanied by ulceration, disintegration of the tissue of the intestinal wall, with scarring of which the intestinal lumen narrows. The painful process affects not only the mucous membrane, but also all layers of the intestinal wall, manifesting itself in the form of deep slit-shaped ulcers or cracks. The affected areas of the intestine may be located at a distance from each other - the so-called “kangaroo jumping”. Rarely, parts of the gastrointestinal tract above the intestines - the stomach, esophagus - become inflamed.

Symptoms Crohn's disease is characterized by a long-term chronic course. Patients usually complain of constant pain in various places of the abdomen, diarrhea with the passage of semi-liquid stools with a small admixture of blood and mucus, bloating and rumbling in the abdomen, weight loss, and joint pain. When the final part of the small intestine is affected (terminal ileitis), pain appears in the right iliac region, vomiting, and fever, which often leads to surgery due to suspicion of acute appendicitis. Narrowing of the lumen of the small intestine can lead to obstruction. Other complications include perforation of the intestine at the site of ulcer formation, followed by the formation of an abscess in the abdominal cavity, fistulas, and rarely peritonitis. During colonoscopy, all parts of the colon and the final part of the small intestine are necessarily examined, with a mandatory biopsy of the changed areas. A biopsy confirms the diagnosis.

Clinical characteristics of gastroenterocolitic diarrhea

When both the small and large intestines, and sometimes the stomach, are involved in the pathological process, total damage to the entire gastrointestinal tract develops - gastroenterocolitis.

With gastroenterocolitis or enterocolitis, diarrhea is of a mixed nature - feces can be copious, but mixed with mucus, less often - blood or pus.

Foodborne illnesses

A typical example of gastroenterocolitis is food poisoning. This is a group of diseases that occur when microbial agents and (or) their toxins enter the body along with food. The disease typically has an acute onset, a rapid course, symptoms of general intoxication and damage to the digestive organs. The cause of foodborne toxic infections can be a variety of bacteria: salmonella, shigella, escherichia, streptococci, spore anaerobes, spore aerobes, halophilic vibrios, staphylococcal enterotoxins types A, B, C, D, E.

The source of infection is a sick person or bacteria carrier, as well as sick animals and bacteria excretors. Microbes get on food products, mainly those that are not cooked. For example, staphylococci can multiply in milk and dairy products and release specific toxins. At the same time, the appearance and smell of the product is no different from the usual one. Often the disease can be associated with the consumption of cakes and pastries with milk or butter cream, cottage cheese. Other bacteria more often contaminate meat pates, canned fish in oil, vegetable dishes, and salads. The disease can occur in both sporadic cases and outbreaks. The incidence is recorded throughout the year, but increases slightly in warm weather.

Symptoms The incubation period is short - up to several hours, which allows us to think about the absorption of toxins already in the stomach. Chills, increased body temperature, nausea, repeated vomiting, and cramping abdominal pain, mainly in the iliac and periumbilical regions, are noted. Then comes frequent loose stools, sometimes mixed with mucus. There is no blood or pus in the stool due to food poisoning. Phenomena of general intoxication are observed: dizziness, headache, weakness, loss of appetite. The skin and visible mucous membranes are dry. The tongue is also dry, covered with a gray-white coating. The diagnosis of foodborne infectious poisoning is made on the basis of the clinical picture, epidemiological history and laboratory tests. The results of bacteriological examination of feces, vomit, and gastric lavage are of decisive importance.

Intestinal dysbiosis

In addition to food toxic infections, mixed diarrhea accompanies many other conditions and diseases of both the digestive system and other organs and systems. Often, diarrhea can be a consequence of intestinal dysbiosis. Dysbacteriosis is a disturbance in the composition of the intestinal microflora that normally populates it, and the proliferation of microbes that are normally absent. Dysbacteriosis can develop independently or accompany diseases of the gastrointestinal tract, in particular the colon. The cause of its occurrence may be disturbances in the digestion of food due to various diseases of the digestive system (gastritis with reduced secretion, pancreatitis, enterocolitis), uncontrolled or long-term use of antibiotics that suppress the growth of normal intestinal flora, and decreased immunity.

In a healthy person, the intestines are dominated by lactobacilli, anaerobic streptococci, Escherichia coli, and enterococci. They have pronounced antagonistic activity against pathogenic microorganisms entering the intestinal cavity from the external environment. With dysbiosis, both the ratio of intestinal flora and its ability to suppress the growth of pathogenic microbes are disrupted. Putrefactive and fermentative bacteria, fungi of the genus Candida develop abundantly, and pathogenic strains of Escherichia coli appear.

Patients complain of decreased appetite, unpleasant taste and odor from the mouth, nausea, bloating, diarrhea, lethargy, and general malaise. The frequency of stool varies from 2-3 times to 5-7 times a day, feces are abundant, have an unpleasant putrefactive odor, and an admixture of mucus is present. Sometimes there is an alternation of diarrhea and constipation - the so-called unstable stool. An increase in temperature to 37–38 °C is less common. With a prolonged course of the disease, hypovitaminosis, especially group B, can develop.

Clinical characteristics of diarrhea of ​​toxic-allergic origin

The intestines, like other organs, can be damaged by various allergic conditions. At the same time, allergic diarrhea develops. As a rule, their occurrence is associated with the consumption of certain types of food, the sensitivity to which is specifically increased. Very often, allergies appear in response to the entry of crayfish, strawberries, citrus fruits, greenhouse vegetables, milk, eggs and many other products into the gastrointestinal tract.

Diarrhea due to allergies is mixed, with remnants of undigested food and mucus found in the stool.

When stool microscopy, you can find a large number of cells specific for allergic reactions - eosinophils. Often, diarrhea coincides in time of appearance with other manifestations of allergies - Quincke's edema, allergic conjunctivitis, urticaria.

In such cases, the diagnosis is made on the basis of allergic skin manifestations and repeated coincidence of diarrhea with the intake of certain nutrients.

In the treatment of allergic diarrhea, antihistamines are of greatest importance - diphenhydramine, suprastin, tavegil in an age-appropriate dosage.

Toxic diarrhea can be associated with acute or chronic poisoning with various poisons (mercury, arsenic) and waste products of the body (endotoxins). The latter is most clearly manifested in uremia - the final stage of renal failure. It occurs in the stage of decompensation of chronic renal diseases - glomerulonephritis, pyelonephritis, renal amyloidosis. Self-poisoning of the body with nitrogenous wastes occurs (products of the breakdown of proteins, the excretion of which is significantly impaired in renal failure).

Diarrhea with uremia occurs up to 2-3 times a day, feces are foul-smelling and dark in color. The abdomen is swollen, symptoms of flatulence are pronounced, there may be frequent vomiting, regurgitation, the tongue is covered with a gray coating, and the smell of ammonia is clearly felt from the mouth. Treatment of such diarrhea is symptomatic; a significant improvement in the condition can only be associated with the removal of toxins using the artificial kidney apparatus.

Acute arsenic poisoning occurs as a typical gastroenteritis with vomiting, abdominal pain, profuse diarrhea and severe dehydration. However, there is a dry throat (despite drooling), as well as cramps in the calf muscles, which should immediately alert you to poisoning. Lethal outcome (death of the patient) occurs within 1–2 days due to toxic shock symptoms.

Chronic arsenic poisoning occurs more smoothly in the gastrointestinal tract, but diarrhea is still present.

These are accompanied by changes in the skin and mucous membranes, anemia, paralysis, and exhaustion. The diagnosis of arsenic poisoning is easily confirmed by chemical analysis of hair and nails. In acute cases, the diagnosis can be confirmed by the green color of the vomit and the smell of garlic.

Acute mercury poisoning occurs with frequent, black-colored stools, often mixed with blood. At first, such diarrhea is typical only when mercury is ingested through the mouth; later, specific colitis associated with the excretion of mercury through the intestinal wall occurs. Detection of mercury in blood and urine is of great value for correct diagnosis. Treatment of such poisonings should be carried out only in a hospital setting.

Many medications, in addition to antibiotics, can cause diarrhea. Diarrhea often occurs when laxatives are abused, paradoxically as it may seem. The possibility of drug-induced diarrhea should be considered in all unclear cases.

Toxic diarrhea can also occur with chronic nicotine poisoning.

Clinical characteristics of diarrhea in endocrine diseases

Diarrhea due to endocrine diseases is classified into a special group. They are believed to reflect disruption of hormonal regulation of intestinal function.

Thyrotoxicosis

Diarrhea occurs especially often with thyrotoxicosis, which is observed in diseases of the thyroid gland and is characterized by a high level of thyroid hormones (thyroid hormones) in the blood. Thyrotoxicosis is often observed in diffuse toxic and nodular goiter, toxic adenoma, and in various inflammatory processes in the gland - thyroiditis. Women get sick 10 times more often than men; they are most susceptible to these diseases between the ages of 20 and 50 years.

The causes of this pathology can be both immunity disorders due to infection, and mental trauma in individuals with a hereditary predisposition to damage to the thyroid gland, when antibodies that are aggressive to it are formed in the body.

Symptoms The main manifestations are usually an enlarged thyroid gland - goiter, as well as bulging eyes and palpitations. However, the disease can develop even when the size of the gland is normal. Tearfulness, nervousness, and insomnia appear. The appetite is very good, patients eat a lot, but at the same time lose up to 10–15 kg in weight per month.

Diarrhea is associated with increased intestinal motor function; usually food digestion is not impaired, but there may be an increased secretion of fats. The skin is moist and warm. The so-called angry look is characteristic (the palpebral slits are wide open, the eyes shine, the eyes blink rarely), pain appears in the eyeballs. Muscle weakness and fatigue develop, and patients cannot tolerate high ambient temperatures.

With typical manifestations of an enlarged thyroid gland, diagnosis is not difficult. If the size of the gland is normal, it is necessary to study its function (using radioactive iodine) and determine the level of thyroid hormones in the blood.

Hypoparathyroidism

Insufficiency of the parathyroid glands (hypoparathyroidism) is also sometimes accompanied by diarrhea, which is associated with increased excitability of the autonomic nervous system with low calcium levels in the blood.

There are also periodic diarrhea in diabetes mellitus, and they can be caused both by a specific diabetic diet (large amounts of fat and fiber, fruits and vegetables), and by the reduced enzyme-forming function of the pancreas, which is often noted in diabetes.

Diarrhea is one of the frequently observed symptoms of chronic adrenal insufficiency (Addison's disease), and complaints of gastrointestinal dysfunction often prevail in such patients. Adrenal insufficiency occurs when the adrenal cortex is damaged by Mycobacterium tuberculosis, as well as autoantibodies in the autoimmune form of the disease. As a result, the production of all cortical hormones - glucocorticoids, mineralocorticoids and androgens - decreases.

Symptoms Patients complain of fatigue, muscle weakness, weight loss, apathy, decreased or loss of appetite, and loss of interest in life. Weight loss usually correlates closely with loss of appetite and severity of gastrointestinal dysfunction. In addition to “fatty” diarrhea, peptic ulcers of the stomach and duodenum, gastritis with reduced secretion may occur.

In addition, one of the early symptoms of chronic adrenal insufficiency is persistently low blood pressure. Systolic pressure never exceeds 110 mmHg. Art., and diastolic - 70 mm Hg. Art. Addison's disease is characterized by dizziness, rapid heartbeat, and progressive weakness. A typical symptom is darkening of the skin and mucous membranes (hyperpigmentation).

In the skin, there is an increased deposition of the pigment melanin, which is responsible for the dark color of the epidermis. Areas of the body that are constantly exposed to friction by clothing darken especially strongly.

With chronic adrenal insufficiency, there is a decrease in sexual function in both men and women. In men, impotence develops; in women, the ability to bear children is impaired (spontaneous miscarriages, pregnancy pathology).

Half of patients with adrenal insufficiency have mental disorders - from mild to persistent and progressive. Apathy or irritability are common, and as the disease progresses, negativism and lack of initiative increase.

Clinical characteristics of neurogenic diarrhea

Neurogenic diarrhea is caused by a violation of the nervous regulation of the motor and secretory functions of the intestine. They can occur in the form of acute attacks under the influence of negative emotions (excitement, fear) or obsessions, which is popularly called “bear disease.” It is also possible that specific intestinal manifestations may occur against the background of general neuroticism of the body. The latter are characterized by a lack of dependence on the quality and composition of food. There may be paradoxical improvements from varied and even rough foods and deterioration while following a strict gentle diet.

Treatment of diarrhea

Treatment of enteric diarrhea using traditional methods

Chronic enteritis

It is very important to start treatment of chronic enteritis on time and prevent the development of malabsorption syndrome. The main role in therapy belongs to a strict diet. Patients with exacerbation of enteritis should eat food at least 5–7 times a day at regular intervals. All food should be served warm and pureed. It is necessary to limit the amount of animal fats. It is preferable to give vegetables and fruits in the form of puree.

Patients are advised to eat lean varieties of beef, veal, chicken, fish, eggs and cottage cheese, slimy soups, and pureed porridges. It is necessary to completely exclude milk, brown bread, carbonated drinks, prunes, grapes, cabbage, nuts, and freshly baked flour products. If dysbacteriosis is detected, biological drugs (colibacterin, bificol, bifidum-bacterin) should be taken. If a disorder of protein metabolism develops, treatment in a hospital is required with the administration of protein preparations, B vitamins, and ascorbic acid by injection. Astringents (kaolin, bismuth preparations, tanalbin) are used against frequent heavy diarrhea. For anemia, iron supplements, vitamin B 12, and folic acid are indicated.

Enteroviral diarrhea

The liquid is administered at an approximate rate of 1.5 liters per liter of stool (for children - 110 ml per kilogram of weight), however, only normalization of the condition is a sufficient criterion. Use saline solutions for rehydration: rehydron, oratil.

Gastric achylia

Diarrhea caused by gastritis with reduced secretion is not a separate disease and is treated in the same way as gastritis itself. With adequate replacement therapy with enzyme preparations and hydrochloric acid, diarrhea goes away extremely quickly.

Treatment of colitic diarrhea with traditional methods

Dysentery

Patients with dysentery can be treated both in an infectious diseases hospital and at home. Among antibiotics, tetracycline (0.2–0.3 g 4 times a day) or chloramphenicol (0.5 g 4 times a day for 6 days) has recently been used. However, sensitivity to them has decreased significantly. Nitrofuran preparations (furazolidone, furadonin, etc.) are also used, 0.1 g 4 times a day for 5–7 days. A complex of vitamins is shown. In severe forms, inpatient treatment using detoxification therapy is indicated.

Chronic colitis

Diet therapy takes a dominant place in treatment. Meals should be fractional 6-7 times a day. In case of severe exacerbation, fasting is recommended for the first 1–2 days. Then the patients are shown slimy soups, weak meat broths, pureed porridges in water, boiled meat in the form of steamed cutlets and meatballs, soft-boiled eggs, boiled river fish, jelly, sweet tea. Antibacterial therapy is prescribed in courses of 4–5 days, for mild and moderate severity - sulfonamides, if they have no effect - broad-spectrum antibiotics: tetracycline, biomycin in the usual therapeutic dosage. In severe cases, a combination of antibiotics with sulfonamides. For severe pain, you can take antispasmodics (papaverine, no-shpu, platifillin), B vitamins, ascorbic acid, preferably by injection. If the rectum is predominantly affected, therapeutic enemas are prescribed: oil enemas (sea buckthorn oil, rose hips, fish oil with the addition of 5-10 drops of vitamin A), as well as anti-inflammatory ones with hydrocortisone.

Nonspecific ulcerative colitis

Treatment of exacerbation is carried out only in a hospital setting. The patient must remain in bed. An important role is played by the diet, which includes fruits and vegetables in the form of puree, pureed mucous soups, cereal porridges in water, boiled meat (minced meat, steamed cutlets, meatballs), boiled fish. Avoid whole milk and its products. Drug treatment begins with the group of drugs sulfasalazine and salazopyridazine. In severe cases, prednisolone is prescribed, the doses are selected individually by the doctor with gradual withdrawal after a month, the duration of the course of treatment is 3–4 months.

In milder cases, you can limit yourself to drip enemas with hydrocortisone (125 mg per 200–250 ml of warm water 1–2 times a day) or microenemas with prednisolone (30–60 mg per 50 ml of warm water). You can also use suppositories with prednisolone. Astringents are indicated - bismuth with tanalbin 0.5 g 3 times a day, white clay (1-2 tsp 3 times a day). B vitamins, solutions of glucose, salts, protein preparations are administered, if necessary, by injection and dropper. If medications are ineffective, intestinal obstruction occurs, the intestinal wall is perforated, or degenerates into cancer, surgical intervention is necessary.

Crohn's disease

Treatment of Crohn's disease is similar to the treatment of ulcerative colitis. If complications develop, surgical intervention is indicated.

Treatment of gastroenterocolitic diarrhea using traditional methods

Food poisoning

To remove infected foods and their toxins in the first hours of the disease, gastric lavage is necessary. However, in case of nausea and vomiting, this procedure can be performed at a later date.

Washing is carried out with a 2% solution of sodium bicarbonate (baking soda) or a 0.1% solution of potassium permanganate until clean wash water is discharged. For the purpose of detoxification and restoration of water-salt balance, salt solutions are used: trisol, quartasol, rehydron and others.

The patient is given plenty of fluids to drink in small doses. Nutritional therapy is important. Avoid foods that can irritate the gastrointestinal tract from the diet.

Chemically and mechanically gentle food (well-cooked, pureed, non-spicy) is recommended. In order to correct and compensate for digestive insufficiency, it is necessary to use preparations of enzymes and enzyme complexes - pepsin, pancreatin, festal and others for 1-2 weeks.

To restore normal intestinal microflora, the use of colibacterin, lactobacterin, bificol, bifidum-bacterin is indicated.

Dysbacteriosis

Treatment of dysbiosis is based on the suppression of foreign flora with subsequent restoration of normal intestinal microflora. In case of dysbacteriosis resulting from irrational antibiotic therapy, the antibiotic that caused it should be discontinued. For digestive disorders, enzymes and enzyme preparations should be used. However, the dominant role should be played by the treatment of the underlying disease. Among the general strengthening agents, vitamins are indicated, especially group B. In order to normalize the microbial composition of the intestinal flora, various bacterial preparations are used - special bacteriophages, bacterial preparations such as lactobacterin, colibacterin, bifidumbacterin, bificol. In the presence of candidiasis, nystatin and levorin are prescribed in an age-appropriate dosage.

The so-called nutritional, or food, diarrhea is also of a mixed nature. They occur due to poor nutrition, gross errors in diet, and eating disorders.

Diarrhea can appear after massive overeating, haste and poor chewing of food, abuse of coarse, bulky fatty foods, copious cold drinks after meals, and even as a result of physical overexertion after a massive food load.

Treatment of diarrhea in endocrine diseases using traditional methods

Thyrotoxicosis

Treatment of diarrhea due to thyrotoxicosis depends on the treatment of the underlying disease. It is necessary to refrain from spicy foods and stimulating drinks, and smoking.

For diffuse toxic goiter, drug therapy with Mercazolil is carried out, the course of treatment is 1.5–2 years.

For large goiters, as well as drug intolerance or lack of effect, a surgical method is used. If there are contraindications to surgery, radioactive iodine is used.

Chronic adrenal insufficiency

Treatment of the disease should be aimed, on the one hand, at eliminating the pathological process that caused damage to the adrenal glands, and on the other, at replacing hormonal deficiency. Replacement therapy is carried out with synthetic analogues of glucocorticoids, mineralocorticoids and androgens. For patients, it is vital and cannot be canceled under any circumstances.

Treatment of neurogenic diarrhea using traditional methods

If there is pronounced neuroticism of the personality in combination with diarrhea that periodically occurs for no apparent reason, treatment with a psychotherapist can be recommended. In addition, in this case, acupressure or self-massage of the following points is indicated. The chi-hai point (VC 6) of the anteromedian meridian is located one and a half times the diameter of the thumb down from the navel along the midline of the abdomen. The Zhongwan point (VC12) of the anteromedian meridian is located 4 thumb diameters above the navel - between it and the xiphoid process in the midline of the abdomen. The Tianshu point of the stomach meridian (E25) is located at the level of the navel, 2 thumb diameters away from it. The yin-ling-quan point of the spleen meridian (RP9) is located under the lower edge of the tibial condyle, 2 thumb diameters below the patella. The Qu Chi point of the large intestine channel (GI11) is located between the end of the elbow fold and the most prominent bony protrusion of the elbow joint with the arm bent and closely brought to the chest. The Tzu-san-li point of the stomach channel (E36) is located at a distance equal to the width of three diameters of the thumb, below the kneecap and one finger outward from the sharp protruding bone frame of the lower leg (tibia crest). All points must be treated in a sedating (inhibiting) way. It is used when you need to calm the nervous system, ease pain, and relax spasmodic muscle groups. Within 1–2 s, find the desired point and then begin a clockwise rotational movement. With each turn, the pressure on the point increases for 5–6 seconds. Having reached the desired level, the pressure is no longer changed for 1–2 s, and then a gradual weakening occurs, accompanied by counterclockwise movements, also for 5–6 s. Returning to the original pressure force, the cycle is repeated again. The movements are reminiscent of screwing in and unscrewing a screw. You should not lift your finger from the point; the duration of the effect depends on the specific purpose. You need to do 4 cycles of “screwing in and out” per minute.

Treatment of diarrhea with unconventional methods

It is good to treat colitis during the cucumber season if you consume 100 g of cucumber pulp puree daily as your first breakfast.

Red currants perfectly soften spastic colitis. You can eat 100–150 g of it daily during the season, or you can prepare purees, jellies, decoctions, compotes and take it throughout the year.

Colitis can be treated with coltsfoot if 1/3 tsp. powder from its leaves 3 times a day, 20–30 minutes before meals, washed down with hot milk or honey water.

Dandelion infusion, which is made at the rate of 1 tbsp, helps well with colitis. l. dandelion roots or grass per 0.5 liters of boiling water. Infuse for 8–10 hours in a 0.5-liter thermos, then take 3 times a day before meals 30 minutes before meals.

It is very good for the treatment of acute and chronic diseases of the small and large intestines to use infusion, extract, and syrup of blueberries. An effective way is also to take a decoction of rose hips and fresh apples. Pectin substances contained in rose hips and apples perfectly relieve inflammation in the intestines. To treat, wash the apples well, grate them, and eat them 5–7 minutes after cooking, 4–6 times a day. Apples should be chosen that are not very hard, sour, you can add a little honey or sugar. Already on the 3rd day, signs of improvement appear, and you can switch to a vegetable diet, but continue to eat apples. The pectin substances in apples are an excellent treatment for colitis and enterocolitis in the elderly and children. However, you need to know that apples have a healing effect only until January 1st. After the New Year, it is preferable to use rose hips for treatment.

Proven folk remedy for the treatment of colitis: 1 tsp. Brew centaury, sage, chamomile in 1 cup of boiling water. Drink 1 tbsp. l. every 2 hours after meals, approximately 7–8 times a day. After 1–3 months, reduce the dose and lengthen the time intervals between doses.

Anise tea relieves pain and removes gases from the intestines during colitis. 1 tsp. Pour 1 cup of boiling water over dry or fresh green anise. It is better to cook in a teapot, cover with a linen towel, leave for 5-7 minutes. Drink little and often throughout the day. If the pain does not go away after several doses, then you need to add a pinch of dry or fresh dill to brewing fresh anise tea.

A recipe for a tincture for the treatment of colitis was proposed by the zemstvo doctor S. M. Arensky, the author of a whole collection of medicinal remedies from herbs, vegetables and fruits. Its effectiveness has been tested by several generations. It is always useful to have such a tincture in your home pharmacy.

Tincture of sunflower caps. They are collected from May to mid-June, until the heads are colored. For the course of treatment, a tincture is prepared in the following proportions: 9 tbsp. l. 96% alcohol and 50 g of finely chopped sunflower caps. Carefully place the sunflower caps into a bottle. Pour alcohol and leave for 5-6 days. Then strain through several layers of gauze. Adults drink 20–25 drops per 0.25 glass of warm boiled water, children under 14 years old - from 5 to 15 drops per the same amount of water. For severe, unbearable pain, drink 5-6 times a day, in other cases - 3 times a day 20 minutes before meals.

M.A. Nosal, compiler of a collection of folk medicines from cultivated and wild herbs, recommended making enemas from an aqueous infusion of orchis. Brew 1 tsp for children, 1 tbsp for adults. l. in a glass of boiling water. Leave until cool, strain.

An ancient and very effective method of treating diarrhea using powder from a dry film covering the stomach of a chicken. The film must first be washed well, dried, and crushed. Store in a jar. It is useful to always have this medicinal powder in the house. For one use, it is enough to pour the powder into 1 tsp on the tip of a knife. water. Take several times a day.

Green walnut shells can be used to treat diarrhea. It must be finely chopped and dried. Brew 1 tbsp. l. raw materials 1 cup of boiling water. It is better to do this in a thermos. Drink 1 tbsp. l. several times a day.

Strawberries, strawberries, sour plums, cherries (preferably dry), pears (preferably a decoction of dry ones, especially wild ones), blackberries, blueberries, and fresh green (unripe) apples are successfully used for diarrhea. They are brewed with boiling water and consumed in small portions throughout the day.

A decoction of young twigs and stalks of cherries helps well. It is worth drying up an easily accessible medicine for the winter. 1 tbsp. l. pour 1 cup of boiling water over the raw materials, it is better to use a thermos for 3-4 hours. Strain, drink a few sips every 30 minutes.

Eucalyptus leaf is brewed at the rate of 1 tbsp. l. for 1 liter of boiling water. Leave until cool, drink 0.25 cups 6-8 times a day. It is advisable to eat rice porridge on this day.

A decoction of yarrow helps a lot. It is prepared at the rate of 1 tbsp. l. for 1.5 cups of boiling water. The broth is left to cool until it cools, and a few sips are drunk 7-9 times a day.

For centuries, diarrhea has been successfully treated with rose stamens. 1 dec. l. (or 7 g) pour 1 glass of boiling water, preferably in a thermos. Drink a few sips 7-8 times a day.

A strong infusion of St. John's wort is prepared at the rate of 2 tbsp. l. for 1 cup boiling water. Leave for 20–30 minutes, strain, drink little by little throughout the day until the diarrhea stops. Recovery occurs faster if you add garlic water to this infusion: crush 1 clove of garlic or squeeze the juice into 0.5 glasses of water. Mix the infusions and drink throughout the day. At this time, eat porridge cooked only in water, or drink strong tea with crackers.

Barberry leaves and berries are good for treating diarrhea. The infusion is prepared based on the calculation of 1 tbsp. l. leaves or berries for 1.5 cups of boiling water. It is better to brew in a thermos and leave for 3 hours. Drink several sips several times.

An ancient folk and effective method is birch ash. 1 tbsp. l. pour 0.5 cups of boiling water over the ash. Let cool. Absorb this paste gradually over 3-4 hours.

For bloody diarrhea, it is good to use an infusion of plantain seeds. Brew 1 tbsp in the evening. l. raw materials 1 cup boiling water. Leave overnight in a thermos, strain, start drinking 1/3 cup every 30 minutes in the morning, with 1/3 cup of hot water (if it’s hard to tolerate hot water, you can drink it warm, but try to make it as hot as possible).

Damage to the intestinal mucous membranes by a variety of toxic substances of exogenous and endogenous nature causes the symptom of diarrhea.

An example of an exogenous infection is poisoning with heavy metals - mercury and arsenic salts, intoxication from excessive consumption of nicotine and alcohol, which is always accompanied by toxic diarrhea.

Some of the examples of toxic diarrhea in the articles:

The clinical characteristics of acute poisoning with arsenic salts correspond to the symptoms of gastroenteritis with acute pain in the abdomen, vomiting attacks, profuse diarrhea and signs of dehydration.

With excessive salivation, dry throat and convulsive spasms in the calves of the legs are observed. The latest signs indicate obvious symptoms of poisoning, which in a couple of days can result in toxic shock and, as a consequence, death.

In chronic poisoning with a chemical element, the diarrhea syndrome is less noticeable. But there are changes in the skin and mucous membranes, signs of emaciation and anemia, and paralysis is possible. To confirm the diagnosis, a laboratory test is performed by examining the victim's hair and nails. In case of acute poisoning, the green color of the vomit and the pungent garlic smell will eliminate all doubts.

The development of chronic uremia is an example of an internal infection with toxic diarrhea. The disease develops against the background of diseases of the renal system - pyelonephritis, glomerulonephritis, amyloidosis.

Symptoms

Symptoms of the pathology:

• frequent bowel movements, 3 – 4 times a day;
• stench and darkening of the color of stool;
• bloated stomach with symptoms of flatulence;
• frequent regurgitation and gag reflex;
• coated tongue and ammonia-like breath.

Treatment

Treatment to restore the functionality of the patient’s intestines is carried out using procedures to cleanse the body (plasmopheresis) and blood (hemosorption) to remove nitrogen-containing toxins.

Drugs

Sorbent agents are used to cleanse the body of toxins.

Diarrhea(diarrhea) – frequent, repeated loose stools. Diarrhea is usually accompanied by pain, rumbling in the abdomen, flatulence, and tenesmus. Diarrhea is a symptom of many infectious diseases and inflammatory processes of the intestines, dysbiosis, and neurogenic disorders. Therefore, diagnosis and treatment of the underlying disease is important in preventing complications. Loss of large amounts of fluid during profuse diarrhea leads to disruption of the water-salt balance and can cause heart and kidney failure.

General information

Diarrhea is defined as single or frequent defecation of loose stool. Diarrhea is a symptom that signals a malabsorption of water and electrolytes in the intestines. Normally, the amount of feces excreted per day by an adult varies between 100-300 grams, depending on the characteristics of the diet (the amount of plant fiber consumed, poorly digestible substances, liquids). If intestinal motility increases, stool may become more frequent and thinner, but its quantity remains within normal limits. When the amount of liquid in the stool increases to 60-90%, we speak of diarrhea.

There are acute diarrhea (lasting no more than 2-3 weeks) and chronic. In addition, the concept of chronic diarrhea includes a tendency to periodically have large stools (more than 300 grams per day). Patients suffering from malabsorption of various nutrients tend to produce polyfecal matter: the excretion of large amounts of stool containing undigested food debris.

Causes of diarrhea

With severe intoxication in the intestine, excess secretion of water with sodium ions occurs into its lumen, which helps to dilute the stool. Secretory diarrhea develops with intestinal infections (cholera, enteroviruses), taking certain medications and dietary supplements. Osmolar diarrhea occurs with malabsorption syndrome, insufficient digestion of sugars, excessive consumption of osmotically active substances (laxative salts, sorbitol, antacids, etc.). The mechanism of development of diarrhea in such cases is associated with an increase in osmotic pressure in the intestinal lumen and fluid diffusion along the osmotic gradient.

A significant factor contributing to the development of diarrhea is impaired intestinal motility (hypokinetic and hyperkinetic diarrhea) and, as a consequence, a change in the rate of transit of intestinal contents. Laxatives and magnesium salts help enhance motility. Impaired motor function (weakening and strengthening of peristalsis) occurs with the development of irritable bowel syndrome. In this case they talk about functional diarrhea.

Inflammation of the intestinal walls causes the exudation of protein, electrolytes and water into the intestinal lumen through damaged mucosa. Exudative diarrhea accompanies enteritis, enterocolitis of various etiologies, intestinal tuberculosis, acute intestinal infections (salmonellosis, dysentery). Often with this type of diarrhea there is blood and pus in the stool.

Diarrhea can develop as a result of taking medications: laxatives, antacids containing magnesium salts, certain groups of antibiotics (ampicillin, lincomycin, cephalosporins, clindamycin), antiarrhythmic drugs (quindiline, propranol), digitalis preparations, potassium salts, artificial sugars (sorbitol, mannitol) , cholestyramine, chenodeoxycholic acid, sulfonamides, anticoagulants.

Classification

The following types of diarrhea are distinguished: infectious (with dysentery, salmonellosis, amoebiasis, food toxic infections and entroviruses), nutritional (associated with dietary disorders or allergic reactions to food), dyspeptic (accompanies digestive disorders associated with insufficiency of the secretory functions of the organs of the digestive system: liver, pancreas, stomach; as well as in case of insufficiency of enzyme secretion in the small intestine), toxic (with arsenic or mercury poisoning, uremia), medicinal (caused by taking drugs, drug dysbiosis), neurogenic (with changes in motor skills due to disturbances in nervous regulation associated with psycho-emotional experiences).

Clinical features of diarrhea

In clinical practice, acute and chronic diarrhea are distinguished.

Acute diarrhea

Chronic diarrhea

Diarrhea lasting more than 3 weeks is considered chronic. It can be a consequence of various pathologies, the identification of which is the main task for determining treatment tactics. Information about the causes of chronic diarrhea can be provided by medical history, accompanying clinical symptoms and syndromes, and physical examination.

Particular attention is paid to the nature of the stool: frequency of bowel movements, daily dynamics, volume, consistency, color, presence of impurities in the stool (blood, mucus, fat). The survey reveals the presence or absence of accompanying symptoms: tenesmus (false urge to defecate), abdominal pain, flatulence, nausea, vomiting.

Pathologies of the small intestine are manifested by copious watery or fatty stools. Diseases of the large intestine are characterized by less abundant stool; streaks of pus or blood and mucus may be present in the stool. Most often, diarrhea with lesions of the large intestine is accompanied by pain in the abdomen. Diseases of the rectum are manifested by frequent, scanty stools as a result of increased sensitivity to stretching of the intestinal walls, tenesmus.

Diagnosis of diarrhea

Acute diarrhea is usually characterized by a very pronounced loss of fluid and electrolytes in the feces. During examination and physical examination of the patient, signs of dehydration are noted: dryness and decreased skin turgor, increased heart rate and decreased blood pressure. With severe calcium deficiency, the symptom of a “muscle roll” becomes positive, and convulsions may occur.

In case of diarrhea, the patient's stool is always carefully examined; in addition, it is advisable to carry out a proctological examination. Detection of anal fissure, fistula, paraproctitis may suggest Crohn's disease. For any diarrhea, a comprehensive examination of the digestive tract is performed. Instrumental endoscopic techniques (gastroscopy, colonoscopy, irrigoscopy, sigmoidoscopy) allow you to examine the internal walls of the upper gastrointestinal tract and large intestine, detect damage to the mucosa, inflammation, neoplasms, bleeding ulcerations, etc.

Fecal microscopy reveals a high content of leukocytes and epithelial cells in it, which indicates the presence of inflammation of the mucous membrane of the digestive tract. The detected excess of fatty acids is a consequence of impaired fat absorption. Together with the remains of muscle fibers and the high starch content in the feces, steatorrhea is a sign of malabsorption syndrome. Fermentation processes due to the development of dysbiosis contribute to changes in the normal acid-base balance in the intestines. To identify such disorders, intestinal pH is measured (normally 6.0).

Persistent diarrhea in combination with excessive gastric secretion is characterized by Zollinger-Ellison syndrome (ulcerogenic pancreatic adenoma). In addition, prolonged secretory diarrhea may be the result of the development of hormone-producing tumors (for example, VIPoma). Laboratory blood tests are aimed at identifying signs of the inflammatory process, biochemical markers of liver and pancreas dysfunction, and hormonal disorders that may be causes 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 the identification and treatment of the underlying pathology. Depending on the type of diarrhea, the patient is referred for treatment to a gastroenterologist, infectious disease specialist or proctologist. You should definitely seek medical help if you have diarrhea that lasts more than 4 days, or if there are streaks of blood or mucus in your stool. In addition, symptoms that cannot be ignored are: tarry stools, abdominal pain, fever. If signs of diarrhea appear and there is a possibility of food poisoning, you should also consult a doctor as soon as possible.

Therapy aimed at eliminating diarrhea depends on its type. And it includes the following components: dietary nutrition, antibacterial therapy, pathogenetic treatment (correction of malabsorption in case of enzyme deficiencies, reduction of gastric secretion, drugs that normalize intestinal motility, etc.), treatment of the consequences of prolonged diarrhea (rehydration, restoration of electrolyte balance).

In case of diarrhea, foods are introduced into the diet that help reduce peristalsis and reduce the secretion of water into the intestinal lumen. In addition, the underlying pathology that caused the diarrhea is taken into account. The components of the diet must correspond to the functional state of digestion. Products that promote the secretion of hydrochloric acid and increase the rate of evacuation of food from the intestines are excluded from the diet during acute diarrhea.

Antibiotic therapy for diarrhea is prescribed to suppress pathological flora and restore normal eubiosis in the intestines. For infectious diarrhea, broad-spectrum antibiotics, quinolones, sulfonamides, and nitrofurans are prescribed. The drugs of choice for intestinal infections are drugs that do not have an adverse effect on the intestinal microbiocenosis (combined drugs, nifuroxazide). Sometimes eubiotics can be prescribed for diarrhea of ​​various origins. However, more often such treatment is prescribed after the signs of diarrhea have subsided to normalize the intestinal flora (eliminate dysbiosis).

Adsorbents, enveloping and astringent agents that neutralize organic acids are used as symptomatic agents. Loperamide is used to regulate intestinal motility; in addition, it acts directly on the opiate receptors of the small intestine, reducing the secretory function of enterocytes and improving absorption. Somatostatin, which affects secretory function, has a pronounced antidiarrheal effect.

For infectious diarrhea, drugs that reduce intestinal motility are not used. Loss of fluid and electrolytes during prolonged and severe diarrhea requires rehydration measures. Most patients are prescribed oral rehydration, but in 5-15% of cases there is a need for intravenous administration of electrolyte solutions.

Prevention of diarrhea

Prevention of diarrhea includes measures of physical hygiene and nutrition. Washing your hands before eating, thoroughly washing raw vegetables and fruits, and properly preparing foods helps avoid food poisoning and intestinal infections. In addition, it is worth remembering the need to avoid drinking raw water, unfamiliar and suspicious food, and food that can cause an allergic reaction.