- 1) without signs of dehydration (loss of 5-9% of body weight) - distinctly increased thirst, dry mucous membrane of the oral cavity, bruises under the eyes, oliguria, orthostatic hypotension, lengthening (> 1.5-2 s) of capillary filling on the nails (the most sensitive symptom: the nail plate should be clamped in order to anemize the blood vessels, and then release the onslaught, pink color should appear within 9% of body weight or symptoms of hypovolemic shock),
- 2) symptoms of dehydration in an elderly patient - patients often do not feel thirst and consume too little fluid,
- 3) severe general condition of the patient,
- 4) conditions that do not allow the use of oral rehydration - persistent vomiting, paralytic intestinal obstruction,
- 5) the failure of oral rehydration (increased symptoms of dehydration, despite taking an adequate amount of oral rehydration solutions or difficulties with taking the required amount of fluid).
2.Rehydration - The main method for the symptomatic treatment of diarrhea. In most patients with mild to moderate dehydration (loss ≤ 9% of body weight), rehydration can be done orally on an outpatient basis or at home. For this purpose, an oral glucose - electrolyte Rehydration solution (RDP) is used, in which the concentration of sodium is ≈ 60 mmol / L, glucose 74-111 mmol / L, and osmolarity 200-250 mosm / L (Hypoosmolar RDP: Orsalit, Humana Electrolyte) . Cold RRP (chilled in the refrigerator) is better tolerated with frequent use in small portions. Rehydration therapy is carried out in 2 stages:
1) restoration of fluid deficiency (rehydration) - in the first 3-4 hours exclusively RRP is intended in an amount equal to a certain loss of body weight (the patient should drink enough to quench his thirst):
- a) if there are no signs of dehydration - up to ≈ 20 ml / kg body weight,
- b) mild dehydration - ≈ 40 ml / kg body weight,
- c) moderate dehydration - ≈ 70 ml / kg body weight,
- d) the determined volume needs to be increased depending on the current loss of fluid: an additional 5 ml / kg of body weight after each liquid feces or episode of vomiting.
Severe dehydration (loss> 9% of body weight) or shock symptoms → immediate hospitalization and iv infusion of crystalloids (Ringer's solution, 0.9% NaCl). After stabilization of the patient’s condition, a certain liquid deficiency is restored - depending on the degree of improvement - further on / in or orally in the form of PRR.
2) maintenance treatment - you should continue taking PRR in order to restore the current loss of water and electrolytes with feces and vomiting and start feeding (implementation). Additionally, the patient should drink PRR or neutral solutions (without restrictions until the thirst is quenched) in an amount equal to the daily fluid requirement (after subtracting the amount of food taken). PRR is taken until diarrhea stops.
3. Treatment of other disorders - if necessary (usually in patients with severe dehydration), metabolic acidosis, hypernatremia, hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia should be treated. The most common is isotonic dehydration. With chronic diarrhea, good nutrition is indicated, eliminating the deficiency of vitamins and trace elements.
4. Antidiarrheal drugs
1) p / o loperamide (Imodium, Loperamide, Stopoperan, Loperamide hydrochloride, Lopedium) - a derivative of opioids, slows intestinal motility, increases water absorption, reduces the number of bowel movements. It is considered as an additional tool in patients with watery diarrhea occurring without fever or with a slight fever. Well tolerated by adolescents and adults, a low risk of side effects. Treatment begins with 4 mg once p / o, and then 2 mg after each liquid feces (more than 8 mg / day - in the case of treatment only for 2 days - 16 mg / day). Contraindicated in bloody diarrhea or high body temperature. Morphine, used to treat pain, also stops diarrhea,
2) octreotide (Sandostatin) - is used for the symptomatic treatment of diarrhea associated with chemotherapy, Zollinger-Ellison syndrome, carcinoid, ileostomy, fistula, intestinal obstruction, with chronic diarrhea in patients with AIDS. Reduces visceral blood flow, reduces secretion and normalizes intestinal motility. It is prescribed in a long-term infusion of s / w, usually 300-600 mcg / day (can be mixed in a syringe with morphine, haloperidol, midazolam (Fulsed), Hyoscine).
Why diarrhea occurs in adults and children
There are many known causes of diarrhea in humans.
- Disruption of the digestive tract. First of all, this is due to intestinal motility and motility. Also, a lack of digestive enzymes disrupts the natural process, leads to rotting and fermentation in the stomach and intestines, causing an acute reaction. Functional diarrhea in babies may not be accompanied by other symptoms and occur once as a result of impaired motor skills. And, finally, ordinary overeating can provoke a desire for the stomach to clear quickly (diarrhea is accompanied by vomiting).
- Infectious diseases. An increase in the number of poisons, toxins, enteroviruses, bacterial bacilli (for example, cholera), salmonella and other parasites leads to inflammatory processes in the digestive tract and a natural acute reaction. Diarrhea in children can cause the activity of amoebic dysentery, campylobacter, rotovirus. In some cases, parasites and bacteria enter the body of a regularly traveling person. This is influenced by local food, water and general acclimatization.
- Taking medications. A number of antibiotics, potent drugs for the treatment of HIV, AIDS, antitumor drugs leads to dysbiosis. Diarrhea is also the result of taking laxatives, decoctions of some herbs and the use of an enema. Some pills in the information about possible side effects suggest an intestinal upset.
- IBS (irritable bowel syndrome). As a rule, it occurs against the background of mental disorders, stress.
- Autoimmune diseases. Diarrhea is a symptom of Crohn's disease, ulcerative colitis and other pathologies.
- Inherited intolerance to components or products. As a rule, this is expressed in the form of diseases: celiac disease, lactose deficiency, pancreatitis, cirrhosis, etc.
- An allergic reaction to certain foods.
If an adult has impurities of blood or mucus in the feces, the following pathologies and diseases with a symptom of "diarrhea" should be excluded:
- diverticulitis (inflammation of the lower intestine), common among senior citizens,
- ulcerative and erosive processes (stomach and intestinal ulcers, acute gastritis, high acidity, etc.),
- infectious diseases that are accompanied by diarrhea, hyperthermia, sharp cuts, abdominal cramps,
- lack of mobility, sedentary work, which impair motor skills,
- anal fissures, hemorrhoids (hemorrhoidal nodes become inflamed and blood clots are secreted in feces),
- oncology of the stomach and intestines is almost always accompanied by diarrhea with impurities,
- internal bleeding in the digestive tract caused by serious diseases (ulcer, cirrhosis, esophageal varicose veins, cancer, colitis, Crohn's disease).
What are the types and forms of diarrhea?
In order to accurately understand what diarrhea is, you should familiarize yourself with various types of pathology.
- Osmolar. It occurs as a result of impaired absorption of fluid and salts by the walls of the intestine. The slower the absorption, the more liquefied fecal matter with high fat content will be.
- Hyperkinetic. Some foods and dishes produce a laxative effect, due to which they quickly move through the intestines. The chair in this situation is not rich, mushy.
- Hypokinetic. Difficult to digest, coarse and fibrous food slowly moves through the intestines. There are processes of decay and fermentation, due to which liquid, non-abundant feces have a strong fetid odor.
- Hyperexudative. If water enters the lumen of an inflamed or irritated intestine, then it reacts with rapid emptying. The stool is slightly watery and may have impurities of mucus and blood.
- Hypersecretory. It is the opposite of osmolar diarrhea. Excessive absorption of fluid and salts leads to copious loose stools.
Diarrhea also differs in the form of the course. The acute form is noted up to 7-9 days. Prolonged diarrhea occurs for up to 11 weeks. In the absence of the necessary treatment and a strict diet, a chronic form may develop (duration from 3 months).
Types of damage and indigestion
Diarrhea is divided by impurities of blood, mucus or inclusions of foreign bodies. Depending on this factor, further manifestations of an intestinal disorder vary. Pathogens that affect the small intestine are isolated. This manifestation includes:
With such factors of intestinal infection, an upset stomach occurs. The bowel movement is characterized by watery stools. Impurities of blood in feces with infectious lesions are rarely found.
However, factors that affect the colon are isolated. In most cases, pathogens are classified as such. Microorganisms penetrate the intestinal mucosa. In this case, feces have impurities of mucus and blood. In this case, the diagnosis finds a large number of white blood cells.
In addition to lesions of certain parts of the intestine, some pathogens disrupt the function of all departments. In this case, the bowel movements are watery, and the patient feels manifestations of colitis.
Viral and bacterial infections
When pathogens enter the intestines, toxins are released. This helps to strengthen the contractility of the body. Such infections affect the small or large intestine. With cholera, the disease proceeds in an acute form. Infection affects only the small intestine.
Salmonellosis, which proceeds in an acute form, is isolated. Infection affects the digestive tract. Microorganisms cause a state of severe intoxication. Because of this, the whole body suffers.
The cause of acute diarrhea in adults is dysentery. At the same time, general intoxication of the body is noted. Damage to the distal colon occurs. Infection destroys the intestinal mucosa.
Enterovirus infection is similar in its damaging effect to dysentery. However, the disease destroys not only the intestinal epithelium, but other internal organs are also at risk.
If intestinal flu is detected, then loose stools in adults are rare. Diarrhea manifests itself with an additional course of dysbiosis. Sometimes patients are treated with acute diarrhea, which arose due to foodborne toxicosis. This is due to the use of products containing unacceptable to the body substances and elements. In production, this occurs due to the activity of pathogenic bacteria.
Dysbacteriosis is characterized as a change in the balance of positive and negative pathogenic organisms. The process develops due to the long use of antibacterial agents. Otherwise, the patient has reduced immunity. Especially when combining chemotherapy or radiotherapy.
If the baby has an intestinal upset, acute pain in the stomach and diarrhea, then parents should immediately call an ambulance. In most cases, a child develops diarrhea due to dysbiosis. However, there is a great risk of intestinal infections. Before the doctor arrives, you can provide first aid for diarrhea and maintain water balance.
With this disease, a violation of the production of certain enzymes occurs. In most cases, only those involved in the digestion of food. This becomes a factor in the development of acute diarrhea in adults. However, in this case, diseases of the digestive tract and adjacent organs are isolated.
The process of fermentopathy leads to:
- gall bladder stone
- lactose deficiency.
This manifestation of acute diarrhea includes pathologies in which lesions of the epithelium of the colon occur, depending on the failure in the immune system. In this case, Crohn's disease is isolated when a disorder of absorption of substances occurs. Pathology is accompanied by increased release of water. This leads to the rapid passage of feces through the intestines.
In an adult, the appearance of acute diarrhea with reduced immunity is referred to as ulcerative colitis. Such a pathology proceeds in a chronic form, and changes occur in the mucous membrane of the digestive organ epithelium. Also referred to as factors in the occurrence of acute diarrhea in violation of the immune system - enteritis and enterocolitis.
Nervous and Mental Disorders
When a disturbance in the nervous system occurs, such malfunctions lead to digestive problems. In this case, irritable bowel syndrome is isolated. Such a diagnosis of acute diarrhea is the absence of other signs and factors of the appearance of loose stools. The disorder continues for several months.
In some cases, acute diarrhea occurs due to poisoning by toxic substances. These elements include:
- heavy metals,
Toxic substances have a negative effect on the intestinal microflora. Antibacterial agents do not belong to pesticides. However, due to frequent intake, cell growth is disturbed. At the same time, the number of positive microorganisms in the intestine decreases. This leads to dysbiosis.
Cancers are sometimes found in the digestive organ. In this case, diarrhea manifests itself with a dissemination of blood and mucus in the stool. This disorder occurs due to intolerance to fatty foods. In addition, pathological changes in the epithelium of the digestive organ have a great influence. In other cases, the appearance of loose stool is associated with the manifestation of chronic diseases of the internal organs.
Symptoms of acute diarrhea
Additional signs of diarrhea depend on the occurrence factor or the individual characteristics of the body. In most cases, with the appearance of acute diarrhea in adults, the following symptoms occur:
- diarrhea at the most inopportune moment,
- frequent bowel movements,
- general malaise
- state of lethargy and drowsiness,
- burning and itching in the anus,
- decrease in urine volume
- bad smell
- no appetite.
For any reason for the occurrence of indigestion, such symptoms can intensify. It depends on the degree and severity of the pathology. When weakness and general malaise begin to manifest, the patient needs to replenish the water balance. If there are primary symptoms of dehydration, they immediately seek medical help.
However, with the main signs, you need to pay attention to dizziness or fever. Pain syndrome can be located in the navel or hypochondrium. Treatment of additional symptoms individually is prohibited.It is especially impossible to make independent decisions on the treatment of the disease. This will lead to complications. Otherwise, death will occur.
Liquid stool treatment methods
Diagnosis of acute diarrhea takes place in the form of a survey, examination and laboratory tests. The disease is determined by a proctologist or infectious disease specialist according to dry skin, vomiting, fever and pain. Diagnosis is made by patients in whom an upset stomach occurs more than 4 times a day.
As laboratory tests, general blood and stool tests are used. When a large number of leukocytes and red blood cells are found in the feces, a microbiological examination of the masses is prescribed. Otherwise, continue diagnosis using colonoscopy. This helps to identify inflammatory processes on the intestinal mucosa. A detailed picture of the disease of the digestive organ is carried out using radiography. After that, an accurate diagnosis is made. The doctor, based on the results of studies, prescribes a comprehensive treatment of acute diarrhea from drugs and diet food.
If it was diagnosed that acute diarrhea occurs due to infection, then antibiotics are prescribed. Prescribe such drugs:
If poisoning has occurred, then with acute diarrhea, sorbents are taken. Such drugs reduce the manifestation of intoxication and help to remove harmful substances. Means are used after meals.
Probiotic drugs are aimed at restoring intestinal microflora. In most cases, such therapy is prescribed for dysbiosis, and the drugs are aimed at maintaining immunity in tone. In this case, enzyme preparations are prescribed. Medicines are used for pancreatitis and exacerbation of pathology. Sometimes opioid drugs are used that act on the contractility of the digestive organ.
To eliminate discomfort, prescribe antispasmodic drugs. In this case, the patient can combine some drugs that eliminate not only acute abdominal pain, but also relieve cramps. Otherwise, anti-inflammatory drugs are prescribed. Such drugs are used for chronic diarrhea.
If you take any dishes with acute diarrhea, then this will lead to a deterioration. During the diet, dairy products should be excluded from the diet. Lactose for the patient becomes an intolerable component. In this case, you can not eat foods with caffeine and alcohol.
When using drugs that slow intestinal motility, do not take during exacerbation of colitis. Medications cause the development of intoxication.
With acute diarrhea, you can eat cottage cheese, cereals on the water, boiled dietary meat and bread crumbs.
From drinks it is allowed to drink unsweetened black tea, juice from green apples and jelly.
The occurrence of loose stool is associated with many factors. Therefore, the causes of acute diarrhea affect treatment methods and diagnostic methods. In most cases, developmental factors are associated with diseases of the stomach. If the abdominal pain intensifies, then you need to seek help from a doctor. The prescribed treatment will help stop the development of the disease or infection.
Symptoms of the disease: basic and additional
It is possible to diagnose diarrhea by a number of signs (one or a combination of them):
- frequent emptying in small portions,
- bowel incontinence,
- offensive smell
- impurities of blood, mucus, protein products,
- the presence of undigested food in feces,
- watery or thick loose stools,
- burning sensation in the anus after bowel movement.
Often along with diarrhea, additional symptoms develop, indicating an infectious or inflammatory process. This may be a violation of the digestive tract (increased bile, nausea, vomiting, high acidity), hyperthermia (38-40 ° C), acute, aching pain in the stomach, intestines or anus.
With prolonged, profuse diarrhea, dehydration occurs. To frequent emptying is added general weakness, fatigue, drying out of mucous surfaces, hypotension, tachycardia, dizziness up to a faint. In severe forms of dehydration due to diarrhea, a person regularly experiences excruciating thirst, cachexia develops.
Steps for diagnosing diarrhea in children and adults
Before starting treatment, one should reliably differentiate diarrhea from other diseases, identify hidden pathologies and underlying diseases, and identify the type and form of diarrhea.
The examination begins with a survey of the patient, the study of subjective and objective symptoms. Diarrhea is suspected if the patient reports more than 10 cases of fluid bowel movements per day. Additionally, rumbling in the stomach, colic, cramping, flatulence occurs. At this stage, the gastroenterologist finds out the patient’s menu for the last week, is interested in taking additional drugs. It is also necessary to clarify if a history of chronic diseases of the digestive tract (cholecystitis, ulcer, gastritis, enterocolitis, pancreatitis). It turns out a hereditary predisposition to diarrhea.
At the next stage, laboratory tests and analyzes are prescribed:
- blood (general analysis, biochemistry),
- feces (for the content of blood and mucous impurities, parasites),
- sowing feces (determined by bacterial microflora).
Additional, more revealing research methods.
- Coprogram. Feces are sent to research to determine the level of fat, the presence of dietary fiber and undigested elements.
- Colonoscopy A doctor uses a colonoscope to rectally examine the wall of the colon.
- Endoscopy of the digestive tract.
- CT and ultrasound of the abdominal cavity, which will determine the quality of their functioning.
- Irrigoscopy. It is an x-ray of the large intestine.
- Sigmoidoscopy. A gastroenterologist examines the rectum and sigmoid colon with an endoscope.
- Xylose (glucose) breath test. Allows you to identify excessive growth of bacterial microflora.
Treatment of diarrhea with medical methods and at home
Everyone (especially parents) should know what diarrhea is and how to treat it.
If characteristic symptoms occur, you should immediately sign up to the local doctor. To alleviate the condition, restore intestinal microflora and the digestive tract, you can take operational actions at home.
- Remove fatty foods (meat, offal, fish, dairy, sour-milk dishes), hot spices, marinades, pickles, dried fruits from the diet. From vegetables should be abandoned corn, cucumbers, legumes, peas, potatoes, radishes and all types of cabbage. It is forbidden to drink sparkling water.
- For the period of treatment, exclude physical as well as mental stress.
- After each visit, the street and toilet should be washed thoroughly with antibacterial soap.
- Wash fruits, berries and vegetables thoroughly before eating. Serve preferably in boiled and grated form.
- Good results are shown by “fixing” drinks: blueberry jelly, strong black tea, rice broth.
- If the disorder continues for several days, switch to medical diet No. 4. You can eat stale whole-grain bread, boiled chicken, white low-fat fish, cereals on the water, pasta, clear, weak broths, pilaf, 1 boiled egg per day.
If compliance with these recommendations does not help, treatment is prescribed to eliminate the cause of the pathology and symptoms.
- The patient takes anti-inflammatory (antiviral, antibacterial, anthelmintic and others) drugs that eliminate the cause of the infection.
- Medications are prescribed that stimulate intestinal motility and motility.
- You can reduce pain and cramping with anesthetics and antispasmodics.
- To cleanse the body, remove toxins and toxins, sorbents are prescribed (for example, Atoxil, white coal).
- Next, it is necessary to restore the intestinal microflora with the use of probiotics and special enzymes. The same treatment is necessary in the diagnosis of pancreatitis.
- To avoid dehydration, a special drinking regimen is prescribed to the patient. Water-electrolyte mixtures are also administered parenterally.
- If diarrhea occurs against a background of cholecystitis, a choleretic administration is prescribed.
The sooner you contact a gastroenterologist with this problem, the faster you restore intestinal motility and digestion, reducing the risk of serious consequences. Remember, if untreated, diarrhea becomes chronic and can cause dangerous dehydration.