Chronic diarrhea is a sign of serious illness. Laboratory research methods

Diarrhea (diarrhea) - frequent or single bowel movements with the release of liquid feces.

Why does diarrhea (diarrhea) occur?

Any diarrhea is a clinical manifestation of impaired absorption of water and electrolytes in the intestine. Therefore, the pathogenesis of diarrhea of ​​various etiologies has a lot in common. The ability of the small and large intestines to absorb water and electrolytes is enormous.

Every day a person consumes about 2 liters of water with food. The volume of endogenous fluid entering the intestinal cavity as part of digestive secretions reaches an average of 7 liters (saliva -1.5 liters, gastric juice - 2.5 liters, bile - 0.5 liters, pancreatic juice - 1.5 liters, intestinal juice - 1 l). From the total liquid, the volume of which reaches 9 liters, is only 100-200 ml, i.e. about 2%, excreted in the feces, the rest of the water is absorbed in the intestines. Most of the fluid (70-80%) is absorbed in the small intestine. During the day, from 1 to 2 liters of water enters the large intestine, 90% of it is absorbed, and only 100-150 ml are lost with feces. Even small changes in the amount of fluid in the stool lead to loose or harder stool than normal.

I. Secretory diarrhea (increased secretion of water and electrolytes into the intestinal lumen).

1.1. Passive secretion

1.1.1. Increase in hydrostatic pressure due to injury lymphatic vessels intestines (lymphangiectasia, lymphoma, amyloidosis, Whipple's disease)

1.1.2. Increased hydrostatic pressure due to right ventricular failure

1.2. Active secretion

1.2.1. Secretory agents associated with the activation of the adenylate cyclase - cAMP system

1.2.1.1. Bile acids

1.2.1.2. Long chain fatty acids

1.2.1.3. Bacterial enterotoxins (cholera, Escherichia coli)

1.2.2. Secretory agents associated with other intracellular secondary messengers

1.2.2.1. Laxatives (bisacodyl, phenolphthalein, castor oil).

1.2.2.2. VIP, glucagon, prostaglandins, serotonin, calcitonin, substance R.

1.2.2.3. Bacterial toxins (staphylococcus, clostridium perfringens, etc.).

II. Hyperosmolar diarrhea (decreased absorption of water and electrolytes).

2.1. Digestion and absorption disorders

2.1.1. Absorption disorders (celiac disease, ischemia small intestine, congenital defects in absorption)

2.1.2. Membrane digestion disorders (disaccharidase deficiency, etc.)

2.1.3. Disorders of cavity digestion

2.1.3.1. Pancreatic enzyme deficiency (chronic pancreatitis, pancreatic cancer)

2.1.3.2. Deficiency of bile salts (obstructive jaundice, diseases and resection of the ileum)

2.2. Insufficient time of contact of the chyme with the intestinal wall

2.2.1. Small bowel resection

2.2.2. Entero-enteroanastomosis and interintestinal fistula (Crohn's disease) III. Hyper- and hypokinetic diarrhea (increased or slowed down the rate of transit of intestinal contents). 3.1. Increased speed intestinal transit of chyme

3.1.1. Neurogenic stimulation (irritable bowel syndrome, diabetic enteropathy)

3.1.2. Hormonal stimulation(serotonin, prostaglandins, secretin, pancreozymin)

3.1.3. Pharmacological stimulation (anthroquinone laxatives, isophenine, phenolphthalein)

3.2. Slow transit speed

3.2.1. Scleroderma (combined with small intestine bacterial contamination syndrome)

3.2.2. Blind Loop Syndrome

IV. Exudative diarrhea ("discharge" of water and electrolytes into the intestinal lumen).

4.1 Inflammatory bowel disease (Crohn's disease, ulcerative colitis)

4.2. Intestinal infections with cytotoxic effects (dysentery, salmonellosis)

4.3. Ischemic disease of the small and large intestine

4.4. Protein-losing enteropathies.

The mechanism of development of diarrhea

4 mechanisms are involved in the pathogenesis of diarrhea: intestinal hypersecretion, increased osmotic pressure in the intestinal cavity, impaired transit of intestinal contents and intestinal hyperexudation.

Undoubtedly, the mechanisms of diarrhea are closely related; nevertheless, each disease is characterized by a predominant type of impairment of ion transport. This explains the features clinical manifestations different types of diarrhea.

Secretory diarrhea

Hypersecretion is the most common mechanism in the pathogenesis of diarrhea in all diseases of the small intestine. It arises from the fact that the secretion of water into the intestinal lumen prevails over absorption. Watery diarrhea occurs when the amount of water in the stool increases from 60 to 90%.

The main activators of secretion are bacterial toxins (for example, in cholera), enteropathogenic viruses, some drugs and biological active substances... Secretory diarrhea is also caused by those associated with the vital activity of microorganisms biochemical processes in the intestine: the formation of free bile acids with a decrease in the proportion of conjugated bile acids involved in lipid absorption, and as a result of this accumulation of long-chain fatty acids in the intestinal cavity. Some gastrointestinal hormones (secretin, vasoactive peptide), prostaglandins, serotonin and calcitonin, as well as laxatives containing antroglycosides (senna leaf, buckthorn bark, rhubarb) and castor oil also have the ability to increase the secretion of sodium and water into the intestinal lumen.

In case of impaired absorption of bile acids or poor contractile function gallbladder feces usually become bright yellow or green in color.

Secretory diarrhea is characterized by profuse watery stools (usually more than 1 liter), not accompanied by pain. The osmolar pressure of intestinal contents with secretory diarrhea is significantly lower than the osmolar pressure of blood plasma.

Hyperosmolar diarrhea

Hyperosmolar diarrhea develops due to an increase in the osmotic pressure of the chyme. In this case, water and substances dissolved in it remain in the intestinal lumen.

An increase in osmotic pressure in the intestinal cavity is observed:

a) with disaccharidase deficiency (for example, with hypolactasia),

b) with the syndrome of impaired absorption,

c) at increased intake into the intestine of osmotically active substances: saline laxatives containing magnesium and phosphorus ions, antacids, sorbitol, etc.

With hyperosmolar diarrhea, the stool is loose, plentiful with a large amount of undigested food debris and is not accompanied by pain. The osmotic pressure of intestinal contents is significantly higher than the osmolar pressure of blood plasma.

Hyper- and hypokinetic diarrhea

The cause of hyper- and hypokinetic diarrhea is a violation of the transit of intestinal contents.

Laxatives and antacids containing magnesium salts, as well as biologically active substances, for example, secretin, pancreosimin, gastrin, prostaglandins and serotonin, contribute to an increase in the transit speed.

The duration of transit increases in patients with scleroderma, in the presence of a blind loop in patients with enteroanastomoses. In these cases, both a violation of the transit speed and bacterial contamination of the small intestine are observed. It develops as a result of the spread of bacteria from the large intestine to the small intestine. An increase and decrease in intestinal motor activity is especially often observed in patients with irritable bowel syndrome.

With hyper- and hypokinetic diarrhea, the stool is frequent and liquid, but its daily amount does not exceed 200-300 g; its appearance is preceded by cramping pain in the abdomen. The osmotic pressure of intestinal contents approximately corresponds to the osmotic pressure of blood plasma.

Exudative diarrhea

Exudative diarrhea occurs as a result of the "discharge" of water and electrolytes into the intestinal lumen through the damaged mucous membrane and accompanies the exudation of protein into the intestinal lumen.

This type of diarrhea is observed in inflammatory bowel diseases: Crohn's disease and ulcerative colitis, bowel tuberculosis, salmonellosis, dysentery, and other acute intestinal infections. Exudative diarrhea can also occur in malignant diseases and ischemic bowel disease.

With exudative diarrhea, stool is loose, often bloody and pus; after stool, abdominal pain appears. The osmotic pressure of feces is often higher than the osmotic pressure of blood plasma.

Thus, the pathogenesis of diarrhea is complex and involves many factors. However, their role in different diseases is not the same. In patients with intestinal infections, diarrhea is associated with hypersecretion of water and electrolytes due to the fact that bacterial toxins increase the activity of adenylate cyclase in the intestinal wall with the formation of cyclic AMP. In celiac disease, the primary role is played by hyperosmotic factors caused by impaired digestion and absorption of nutrients in the small intestine. In patients who have undergone extensive resection of the small intestine, essential in the pathogenesis of diarrhea, it has a secretory factor that develops as a result of a violation of the enterohepatic circulation of bile acids and bacterial colonization of the small intestine.

Clinical features different types diarrhea

The clinical features of diarrhea largely depend on its cause, duration, severity and location of the intestinal lesion.

Distinguish between acute and chronic diarrhea.

Diarrhea is considered chronic if it persists for more than 3 weeks. Concept chronic diarrhea also includes systematically plentiful stools, the weight of which exceeds 300 g / day. However, in people who eat foods rich in plant fiber, this weight of stool may be normal.

One of the causes of chronic diarrhea can be the abuse of laxatives, including the secret use of them. The association of diarrhea with systemic disease is also often based on history. Diarrhea in patients with diabetes, other endocrinopathies and scleroderma is usually easily explained by the underlying disease, if it is already established. Difficulties arise in those rare cases when diarrhea is the first manifestation systemic disease or dominates in clinical picture... So, in patients with carcinoid syndrome the disease can manifest itself in episodes of profuse watery diarrhea. With enough large sizes tumors and the absence of metastases in the liver, diarrhea may be at a certain stage of the development of the disease the only symptom of gradually increasing small bowel obstruction. In patients with hyperthyroidism, the manifestation of the disease in the form of prolonged diarrhea is also possible, while the symptoms of thyrotoxicosis ( constant sensation fever, irritability, or weight loss, despite a good appetite, etc.) may recede into the background and not attract the attention of the patient himself.

The cause of chronic diarrhea in patients who have undergone vagotomy, resection of the stomach or intestines with the formation of a blind loop is bacterial seeding of the small intestine. This phenomenon is also often observed in patients with diabetes and scleroderma due to impaired motor function of the small intestine. In some patients, diarrhea is reduced if they eliminate foods to which tolerance is reduced. A classic example is the transition to a hypolactose diet in patients with hypolactasia.

In patients with chronic alcoholism and frequent relapses of chronic pancreatitis, as well as after surgical removal of the pancreas, a deficiency of all pancreatic enzymes develops and, as a result, diarrhea with steatorrhea. Crohn's disease with localization in the ileum or its resection leads to disruption of enterohepatic circulation of bile acids. Diarrhea and steatorrhea also appear as a result. Stool in these patients is usually profuse, foul-smelling, with floating fat. Ulcerative colitis usually presents with bloody diarrhea. Tenesmus and a small volume of diarrhea suggest that the pathological process is limited to the distal colon. A history of rectal fissure and paraproctitis also suggests Crohn's disease. Extraintestinal manifestations such as arthritis or skin lesions can be present in ulcerative colitis and Crohn's disease.

Colon and rectal tumors can also present with diarrhea; absence of others probable causes in older patients and the presence of bleeding further supports this assumption.

Irritable bowel syndrome is usually observed in younger patients, often chronic in time, patients actively seek medical help, exacerbations often intensify with stress, stools are usually frequent, after each meal, scanty and never contain blood. Weight loss in these patients, if it happens, is also associated with stress.

Physical examination of patients with chronic diarrhea is important to assess the degree of dehydration and to identify associations with systemic disease.

For example, tachycardia may be a manifestation of latent hyperthyroidism, heart murmurs characteristic of pulmonary artery or tricuspid valve stenosis may be a consequence of carcinoid syndrome, and the presence of isolated or peripheral neuropathy may be a manifestation of diabetes. Scleroderma may be suspected based on characteristic features face and skin changes in the hands. The presence of food intolerances in patients with chronic diarrhea may be due to primary or secondary disaccharidase deficiency. Organ research abdominal cavity can reveal signs of Crohn's disease in the form of a palpable infiltrate. Diseases of the perianal zone serve as its confirmation. As with acute diarrhea Stool examination and assessment of sigmoidoscopy data should be part of the physical examination.

Diagnosis, differential diagnosis of diarrhea

Diarrhea is a symptom of many diseases and the identification of its causes should be based primarily on data from history, physical examination and macro- and microscopic examination of feces.

Some forms of acute diarrhea can be caused by enteroviruses. Salient features viral enteritis are:

a) the absence of blood and inflammatory cells in the feces,

b) the ability to spontaneously recover and

c) lack of effect from antibacterial therapy... The listed features should be taken into account in the differential diagnosis between infectious and non-infectious inflammatory bowel diseases.

You should pay attention to the consistency of the mouth guard, smell, volume, presence of blood, pus, mucus, or fat in it. Occasionally, chronic diarrhea associated with malabsorption can be associated with history and physical examination. In diseases of the small intestine, stools are bulky, watery or oily. In colon disease, stools are frequent but less profuse and may contain blood, pus, and mucus. Unlike enterogenic, diarrhea associated with the pathology of the colon, in most cases is accompanied by abdominal pain. In diseases of the rectum, the latter becomes more sensitive to stretching and the stool becomes frequent and scanty, tenesmus and false urge to defecate appear. Microscopic examination feces allows you to detect signs of inflammation - the accumulation of leukocytes and desquamated epithelium, characteristic of inflammatory diseases infectious or other nature. Scatological examination makes it possible to detect excess fat (steatorrhea), muscle fibers (creatorrhea) and lumps of starch (amilorrhea), indicative of intestinal digestion disorders. The detection of eggs of worms, lamblia and amoebas is also of great importance. It is necessary to pay attention to the pH of the stool, which is normally above 6.0. The decrease in pH occurs as a result of bacterial fermentation of unabsorbed carbohydrates and proteins. An increase in stool pH is usually due to the abuse of laxatives and is detected with the help of phenolphthalein, which turns pink.

Diet changes are often helpful in establishing the diagnosis. For example, a good therapeutic effect observed after transferring a patient to an alactose diet allows a diagnosis of hypolactasia to be established without conducting a large number of invasive diagnostic studies.

How to treat diarrhea

Diarrhea is a symptom. Therefore, for etiological or pathogenetic treatment, nosological diagnosis is necessary.

A number of therapeutic approaches are common to each of the 4 types of diarrhea. These include diet, anti bacterial preparations and symptomatic agents (adsorbents, astringents and coating agents).

Diet for diarrhea

In bowel diseases accompanied by diarrhea, dietary nutrition should help inhibit peristalsis, reduce the secretion of water and electrolytes into the intestinal lumen. The set of products should correspond in composition and amount of nutrients to the enzymatic capabilities of the pathologically altered small intestine. In this regard, with diarrhea, the principle of mechanical and chemical sparing is always observed to a greater or lesser extent, depending on the severity of the process. V acute period diarrhea is largely eliminated from the diet foodstuffs that enhance the motor-evacuation and secretory function of the intestine. Diet No. 4b almost completely meets these requirements. It is prescribed during an exacerbation of diarrhea.

Diet 4c. It is prescribed for bowel diseases during remission.

The diet is similar to 46, but all meals are given unmilled. Baking in the oven is allowed. Additionally, ripe tomatoes, leafy salad with sour cream, sweet varieties of berries and raw fruits are allowed 100-200 g.

Antibacterial drugs for diarrhea

Antibiotic therapy is prescribed to restore intestinal eubiosis. For acute diarrhea of ​​bacterial etiology, antibiotics, antimicrobial agents from the group of quinolones (nitroxoline, 5-nok), fluoroquinolones (tarivid, tsifran, etc.), sulfa drugs (biseptol, sulgin, phthalazole, etc.), nitrofuran derivatives (furadonin, furazolid ) and antiseptics. Preference is given to drugs that do not disturb the balance of the microbial flora in the intestine. These include Intetrix, Ersefuril.

With intestinal amebiasis, 4 capsules are prescribed per day; the course of treatment is 10 days.

Ersefuril contains 0.2 g of nifuroxazide in one capsule. The drug is prescribed for acute diarrhea, 1 capsule 4 times a day. The course of treatment should not exceed 7 days.

Enterosediv is a combined preparation containing streptomycin, bacitracin, pectin, kaolin, sodium menadione and sodium citrate. The drug is prescribed 1 tab 2-3 times a day. Average duration treatment - 7 days.

Dependal-M is available in tablets and suspensions. One tablet contains furazolidone (0.1) and metronidazole (0.3). The suspension also includes pectin and kaolin. Dependal-M is prescribed 1 tab (or 4 teaspoons of the suspension) 3 times a day. In most patients with acute diarrhea, the effect of treatment is observed after 1-2 days, treatment continues for 2-5 days.

Bacterial drugs for diarrhea

Some bacterial medications can be prescribed for diarrhea of various origins as an alternative therapy. These include bactisubtil, linex, bifiform and enterol.

Bactisubtil is a culture of IP-5832 bacteria in the form of spores, calcium carbonate, white clay, titanium oxide and gelatin. In acute diarrhea, the drug is prescribed 1 capsule 3-6 times a day; in severe cases, the dose can be increased to 10 capsules per day. For chronic diarrhea, bactisubtil is prescribed 1 capsule 2-3 times a day. The drug should be taken 1 hour before meals.

Enterol contains a lyophilized culture of Saecharamyces doulardii.

The drug is prescribed 1-2 capsules 2-4 times a day. The course of treatment is 3-5 days.

Enterol is especially effective for diarrhea that develops after antibiotic therapy.

Other bacterial drugs (bifidumbacterin, bifiform, lactobacterin, linex, acylact, normaflor) are usually prescribed after a course of antibiotic therapy. The course of bacterial treatment can last up to 1-2 months.

Hilak-forte is a sterile concentrate of metabolic products of normal intestinal microflora: lactic acid, lactose, amino acids and fatty acids. These substances contribute to the restoration of the biological environment in the intestine, necessary for the existence of normal microflora, and inhibit the growth of pathogenic bacteria.

Khilak-forte is prescribed 40-60 drops 3 times a day. The course of treatment lasts 2-4 weeks.

Symptoms for diarrhea

This group includes adsorbents that neutralize organic acids, astringent and coating preparations. These include smecta, neointestopan; tannakp and polyphepan.

Smecta contains dioctahedral smectite - a substance natural origin, which has pronounced adsorbing properties and a protective effect on the intestinal mucosa. Being a stabilizer of the mucous barrier and possessing enveloping properties, smectite protects the mucous membrane from toxins and microorganisms. It is prescribed 3 g (1 sachet) 3 times a day 15-20 minutes before meals in the form of a talker, dissolving the contents of the sachet in 50 ml of water. Given the pronounced adsorbing properties of the drug, smecta should be taken separately from other drugs.

Neointestopan is a natural purified aluminum-magnesium silicate in colloidal form (attapulgite). Neointestopan has a high ability to adsorb pathogens and bind toxic substances, thereby contributing to the normalization of the intestinal flora. Attapulgite is not absorbed from the gastrointestinal tract and is used for acute diarrhea of ​​various origins. The initial dose for adults is 4 tablets, then after each stool there are 2 more tablets. The maximum daily dose is 14 tablets. The tablets should be swallowed without chewing with some liquid. The duration of treatment with neointestopan should not exceed 2 days.

The drug interferes with the absorption of simultaneously prescribed drugs, in particular. antibiotics and antispasmodics, so the time interval between taking neointestopan and other medicines should be several hours.

Tannacomp is a combined preparation. It contains tannin albuminate 0.5 g and ethacridine lactate 0.05 g. Tannin albuminate (tannic acid combined with protein) has an astringent and anti-inflammatory effect. Ethacridine lactate has antibacterial and antispastic effects. Tannacomp is used for the prevention and treatment of diarrhea of ​​various origins. For the prevention of tourist diarrhea, the drug is prescribed 1 tab twice a day. For treatment - 1 tab 4 times a day. The course of treatment ends with the cessation of diarrhea. In the treatment of chronic diarrhea, the drug is prescribed 2 tablets 3 times a day for 5 days.

Polycarbophil calcium is used as a symptomatic agent for non-infectious diarrhea. The drug is prescribed 2 capsules per day for 8 weeks.

Bilignin and ion-exchange resins - cholestyramine - are successfully used to treat hologenous diarrhea caused by bile acids.

Polyphepan is taken orally 1 tablespoon 3 times a day 30-40 minutes before meals, after stirring in 1 glass of water. The course of treatment is 5-7 days or more.

Cholestyramine (vazazan, questran) is prescribed 1 teaspoon 2-3 times a day for 5-7 days or more.

Motility regulators for diarrhea

For the treatment of diarrhea, or imodium is widely used, which reduces the tone and motility of the intestines, apparently due to binding to opiate receptors. Unlike other opioids, loperamide lacks central opiate-like effects, including blocking the intestinal propulsion. The antidiarrheal effect of the drug is directed to the opiate receptors of the enteric system. There is evidence that direct interaction with intestinal opiate receptors alters the function of epithelial cells, decreasing secretion and improving absorption. The antisecretory effect is accompanied by a decrease in intestinal motor function due to blockade of opiate receptors.

Imodium for acute diarrhea is prescribed 2 capsules (4 mg) or lingual tablets (on the tongue), then 1 capsule (2 mg) or a tablet is prescribed after each act of defecation in the case of loose stools until the number of bowel movements is reduced to 1-2 per day ... The maximum daily dose for adults is 8 capsules daily. If normal stool appears and there is no bowel movement within 12 hours, treatment with Imodium should be discontinued.

Somatostatin has a powerful antidiarrheal (antisecretory) effect.

Sandostatin (octreotide), a synthetic analogue of somatostatin, can be effective in refractory diarrhea in patients with malabsorption syndrome of various etiologies. It is an inhibitor of the synthesis of active secretory agents, including peptides and serotonin, and helps to reduce secretion and motor activity. Octreotide is available in 0.05 mg ampoules. The drug is administered subcutaneously at an initial dose of 0.1 mg 3 times a day. If after 5-7 days the diarrhea does not subside, the dose of the drug should be increased by 1.5-2 times.

Rehydration for diarrhea

The goal of rehydration is to eliminate dehydration and related disorders electrolyte metabolism and acid-base balance. In acute intestinal infections, rehydration should be carried out by the oral route and only 5-15% of patients require intravenous therapy.

For intravenous rehydration, polyionic crystalloid solutions are used: trisol, quartasol, chlosal, acesol. They are much more effective than saline. table salt, 5% glucose solution and Ringer's solution. Colloidal solutions (hemodez, rheopolyglucin) are used for detoxification in the absence of dehydration.

Water-electrolyte solutions are introduced at severe course acute diarrhea at a rate of 70-90 ml / min in a volume of 60-120 ml / kg, with an average severity of the disease - 60-80 ml / min in a volume of 55-75 ml / kg.

In cholera, the optimal rate of intravenous infusion can reach 70-120 ml / min, and the volume of infusion is determined by body weight and degree of dehydration. In case of shigellosis, the volumetric rate of introduction of polyionic crystalloid solutions is 50-60 ml / min.

With a low rate and less rehydration therapy, dehydration can increase, hemodynamic failure progresses, pulmonary edema, pneumonia, disseminated intravascular coagulation and anuria develop.

For oral rehydration therapy, glucosalan, rehydron and other glucose-electrolyte solutions are used. They are administered at a rate of 1 - 1.5 l / h in the same quantities as for intravenous rehydration.

Rehydration therapy is the mainstay of treatment for acute diarrheal infections.

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Do not take loperamide for invasive diarrhea (i.e., diarrhea with blood or pus).

Despite various bans and restrictions, loperamide is useful in treating a number of diarrhea:

• hyperkinetic diarrhea: irritable bowel syndrome, "bear sickness" (nervous diarrhea caused by stress - for example, at a wedding, etc.), but the doses should be minimal,
• secretory diarrhea,
• Crohn's disease,
• v complex treatment diarrhea with chemotherapy malignant tumors etc.

In other cases, it is better to avoid loperamide, or at least consult a specialist.

Loperamide is available in capsules of 2 mg... In the instructions, it is recommended to take first 2 capsules, and then 1 capsule after each loose stool. However, practice shows that in mild cases, more than 1 capsule is not required to be taken, otherwise constipation will occur for 1-3 days. The maximum permitted dose is 8 capsules per day.

Galavit for the treatment of intestinal infections

In the late 1990s, a safe and effective universal anti-inflammatory immunomodulator was created in Russia Galavit... Among the many indications for use - treating any infectious diarrhea accompanied by elevated temperature and symptoms of intoxication ( weakness, headache, dizziness, nausea, vomiting, palpitations). Galavit normalizes the activity of hyperactive macrophages, reduces excessive inflammatory response and accelerates recovery.

Galavit well compatible with other drugs (including traditional treatment intestinal infections), is well tolerated and has a minimum side effects(Allergy is occasionally possible). It's safe and legal healthy people except for pregnancy and breastfeeding... Galavit is not recommended for children under 6 years old, because they have not been tested.

Clinical studies of Galavite with diarrhea were carried out in adults and children over 12 years old with intramuscular injection according to the scheme: 200 mg once, then 100 mg 2 times a day before relief (disappearance) of symptoms of intoxication. However, taking pills is a more convenient and safer treatment.

Galavit

Dosage forms for treatment with Galavit:

• adults and children over 12 years old: 25 mg tablets, 100 mg ampoules, rectal suppositories 100 mg each;
• children 6-12 years old: ampoules of 50 mg, rectal suppositories of 50 mg, there are no tablets with a "child" dose;
• children under 6 years of age: not shown.

In acute intestinal infections, the initial dose of Galavit for adults and children over 12 years old is 2 tab. 25 mg once, then 1 table. 3-4 times a day until symptoms disappear intoxication for 3-5 days (but usually one day of admission is enough). Please note that Galavita tablets must be placed under the tongue (!) And kept there until completely dissolved (10-15 minutes). Children 6-12 years old are used intramuscular injections or rectal suppositories at a dose of 50 mg.

So, with acute diarrhea no temperature and symptoms of intoxication (weakness, nausea, vomiting, headache, palpitations, etc.) RECOMMENDED (dosage for adults):

1. 1 sachet for 0.5 glass of water 3 times a day in between meals and other medications for 2-4 days,
2. enterol 1-2 capsules in the morning and in the evening 1 hour before meals with a small volume of liquid for 7-10 days.

With diarrhea with high temperature and symptoms of intoxication to the above treatment you need add:

• necessarily - galavit under the tongue, 2 tables. once, then 1 table. 3-4 times a day until the symptoms of intoxication disappear for 3-5 days,
• optional - inside 200 mg every 6 hours for 3 days.

With large fluid losses, it is absolutely necessary rehydration:

• or dissolve in clean water according to the instructions and drink often, but little by little. However, if the patient has repeated vomiting, which does not allow the ingestion of liquid by mouth, it is necessary to induce ambulance and go to the hospital.

If you are clearly something poisoned, you feel nauseous, it is desirable before taking medications flush the stomach(drink 1 liter of warm water, then bend over and press your fingers on the root of the tongue; then the whole procedure can be repeated). If the cause of the nausea is food poisoning, after washing the stomach, you will immediately feel relief. After that, you can take enterosorbent ( smecta, polyphepan, enterosgel, atoxil, polysorb).

If after 3 days diarrhea persists, you should consult your doctor to determine the cause. Remember that diarrhea can be a sign of a fairly serious and even fatal illness (even with some forms of cancer). If chronic diarrhea(lasts over 3 weeks), you need to immediately go to the doctor, be examined and find out the cause. It is very desirable to remember after which it arose, this will help to choose the right treatment. For example, if after taking antibiotics, then it should be treated as dysbiosis.

AVOID the following drugs unnecessarily:

• Activated carbon- This is an ineffective and outdated drug;
• - relieves symptoms of diarrhea, but does not cure. In the case of intestinal infection, loperamide enhances the body's self-poisoning. It is forbidden to young children and is dangerous for infectious diarrhea. Taking loperamide is possible only for chronic diarrhea after consulting a doctor (for example, after removing the gallbladder, irritable bowel syndrome, etc.). Take it for acute diarrhea only in desperate situations or if you are well aware of what you are doing;
• antibiotics and antibacterial drugs- they should be taken as prescribed by a doctor, since they themselves can cause diarrhea due to dysbiosis. Allowed Exception - .

Diarrhea is usually treated at home. You need to see a doctor in the following cases:

• no effect from treatment for more than 3 days,
• diarrhea developed in a child under one year old or in an old (weakened) person,
• diarrhea is accompanied by a temperature above 38 ° C (the aforementioned Galavit is highly effective in these cases),
• occurrence unclear adverse reactions for treatment (allergic skin rash, irritability, sleep disturbances, yellowness of the skin and sclera, darkening of urine, etc.),
• worried about constant stomach ache,
• (!) black stool (type of tar) may indicate bleeding from the upper gastrointestinal tract,
• (!) vomiting of dark brown masses or mixed with fresh blood is possible with bleeding from the stomach or esophagus,
• (!) observed impaired consciousness or significant dehydration(dry mouth, weakness, dizziness, cold skin, little urine and it is dark with a strong odor, wrinkled skin and sunken eyes).

In the last three cases (!), You need not just consult a doctor, but call an ambulance immediately and be ready to send the patient to the hospital.

Prevention of acute intestinal infections

Wash everything: vegetables and fruits, hands after the toilet and before eating. Use clean water and fresh food.

Use the refrigerator and freezer - bacteria grow more slowly in the cold. However, there is one exception - salmonella feel great on chicken eggs in fridge.

In the home medicine cabinet, at the cottage and on long trips, have (per person):

• smecta (5 sachets),
• enterol (bottle of 30 capsules or more),
• galavit (plate for 10 tablets),
• rehydron or touring,
• loperamide (2 capsules for emergencies).

For the prevention of diarrhea when traveling or during antibiotic therapy, it is recommended to take Enterol 1-2 capsules daily in the morning during the entire trip or taking antibiotics.

Causes of prolonged diarrhea

There are several reasons for prolonged diarrhea:

The digestion process is influenced by the composition and quantitative ratio of bacteria in the intestine. Taking antibacterial drugs leads to disruption of normal microflora.

Antibiotics kill lactobacilli, colibacillus and bifidobacteria, which are directly involved in the digestion process. The cause of dysbiosis may be a lack of fresh vegetables and fruits in the diet.

The disease leads to impaired absorption of fluids and nutrients. Lack of timely treatment can lead to enterocolitis.

REASONS: One of the main causes of malfunctioning of the gastrointestinal tract is malnutrition. In addition to the quality of the consumed products themselves, the regime is also important. To improve bowel function, you need to drink a simple remedy every day ...

Prolonged diarrhea can be a sign of pancreatic disease. When the production of enzymes involved in the digestion process is greatly reduced.

The risk group includes people who are chronic alcoholics. Inflammatory process may start after consuming ethanol.

Pancreatitis is diagnosed in people who eat too much fat. Constant overeating greatly complicates the work of the pancreas. Not fully digested food enters the intestines of a sick person. As a result, the patient begins to ferment immediately after eating.

In this case, there is an active reproduction of bacteria. Pieces of poorly digested food can be seen in the patient's loose stools. This phenomenon is called creatorrhea. Steatorrhea indicates the presence of undigested neutral fat in the feces. Fat, covering the walls of the intestines, makes it slippery, and this provokes diarrhea.

Diarrhea with ulcerative colitis

Ulcerative colitis affects the tissues of the large intestine. The patient's mucous membranes not only become inflamed, but ulcers also form. Most of the patients are young people between the ages of 20 and 35. Patients complain of the following symptoms:

• clots of blood and mucus appear in the stool;
• the lower abdomen begins to hurt;
• a person feels a rumbling in the stomach and diarrhea does not go away after taking antidiarrheal drugs;
• the patient feels discomfort and bloating;
• a person is forced to go to the toilet more than 2 times a day;
• weight loss occurs.

Crohn's disease

The disease leads to inflammation of the mucous membranes. digestive system... In this case, the tissues of the small intestine are affected.

There are 3 degrees of severity of Crohn's disease:

1. The initial stage of the disease is accompanied by a slight increase in stool frequency. Blood in the patient's stool is very rare.
2. A sign of moderate severity is an increase in stool frequency up to 6 times a day. Traces of blood appear in the patient's feces.
3. The latter degree leads to more severe complications... In many patients, bleeding and fistulas can be detected.

The disease affects people under the age of 35. The patient develops characteristic symptoms:

• aching pain in the abdomen;
• the person complains of weakness;
• bloody diarrhea begins, with a frequency of up to 10 times a day.

When a worm multiplies in the body, the patient feels:

1. Cramping pains appear in the abdomen.
2. The patient (most often a child) suffers from diarrhea and flatulence;
3. Constantly growls in the stomach and diarrhea does not stop for more than a week.
4. The disease leads to increased gas production.

A distinctive feature of such diarrhea is the absence of blood and mucus in the feces.

When infected with salmonella, feces become characteristic. Salmonellosis is a dangerous intestinal infection that can lead to dehydration, infectious toxic shock, and even - to lethal outcome... Liquid gray diarrhea can be seen in patients with pancreatic pathologies.

Colonoscopy

Patient examination includes the following procedures:

1. Colonoscopy allows you to assess the surface of the patient's large intestine. Experts, based on the data obtained, draw conclusions about various diseases- ulcers, diverticula, polyps, bleeding, tumors.
2. Bacteriological culture (bacteriological examination) is used to identify pure cultures of bacteria.
3. During a proctological examination, you can find out about cracks and fistulas in the colon.
4. No less valuable information can be obtained with rectanoscopy. With the help of an endoscope, specialists examine the mucous membranes of different parts of the intestine. ...
5. If additional questions arise, the patient can be referred to undergo an irrigoscopy. The procedure consists of examining the large intestine using a radiopaque contrast agent. The method allows you to determine the condition of the mucous membranes, the presence of tumors and damage.
6. Due to the ultrasound of the abdominal cavity, inflammation can be diagnosed in a timely manner different departments digestive tract... Doctors evaluate the functioning of the pancreas, stomach, and intestines.

Treatment of prolonged diarrhea

Loose stools are not a disease. This is a syndrome, and it just indicates a disorder of the digestive system, which can occur for various reasons.

Antibiotics are used to treat diarrhea associated with infection with bacteria.

Blackberry decoction

You can get rid of diarrhea with the help of blackberry twigs. Before preparing the broth, they must be cut into small pieces. Pour st. a spoonful of raw materials with a glass of water and cook for 15 minutes. The ready-made broth can be replaced with tea. Within 3 days after you start drinking blackberry broth, you will notice an improvement in your condition.

To deal with chronic diarrhea, you can use Potentilla root. Add 100 grams of raw material to a liter of water and cook for 20 minutes over low heat. The solution helps with bloody diarrhea that does not go away for a long time.

Diarrhea itself in an adult is not separate disease, but a symptom that occurs with a wide variety of ailments. Therefore, in order to successfully normalize the stool, it is necessary to understand the causes of diarrhea in each case and, if possible, eliminate them.

What is diarrhea in adults?

Diarrhea (diarrhea) is a pathological condition when there is an increase in stool in adults more than 3 times a day, as well as a change in its consistency: it becomes watery, may be with mucus and bloody discharge... Acute diarrhea lasts up to 2 to 3 weeks. Chronic diarrhea lasts more than 21 days.

Classification of diarrhea according to the mechanism of occurrence

The accumulation of sodium and chlorine ions occurs in the intestinal lumen, which leads to an increase in osmotic pressure. High osmotic pressure causes an additional flow of water and a sharp increase in the volume of intestinal contents. Typically, this type of diarrhea is characterized by very heavy and loose stools, as well as loss of water and electrolytes.

In severe cases, without timely treatment, secretory diarrhea can be fatal due to acute fluid deficiency and the development of hypovolemic coma.

This type of diarrhea is observed in cholera, salmonellosis, viral intestinal infections, hormonally active tumors. In addition, in this way, some laxatives and prostaglandins cause increased stool frequency.

To some extent, it is similar to secretory, since in this case, increased osmotic pressure also leads to excessive accumulation of water in the intestinal lumen and an increase in the volume of feces. However, here hyperosmolarity arises not due to increased secretion of sodium and potassium ions, but due to the fact that already initially the contents of the intestine have a high osmotic pressure. This type of diarrhea usually occurs when rotavirus infection, as well as in case of an overdose of saline laxatives.

In the lower intestines, inflammation develops, due to which it worsens reverse suction water. It is observed with dysentery and amebiasis.

Liquefaction of feces occurs due to the additional release of blood, protein exudate, mucus or pus into the intestinal lumen. This type of diarrhea is typical for diseases accompanied by inflammation of the intestinal mucosa - Crohn's disease, intestinal tuberculosis, ulcerative colitis, etc.

It is characterized by the acceleration of intestinal motility. Usually observed in case of stress, functional disorder digestion, diabetic enteropathy, amyloidosis, scleroderma.

The main causes of diarrhea in adults

The leading causes of diarrhea in adults are:

• food poisoning;
• excessive consumption of "heavy" food;
• diseases of the digestive system, accompanied by inflammation of the intestinal walls (enteritis, enterocolitis);
• food allergy;
• enzyme deficiency;
• receiving some drugs(for example, synthetic sweeteners, laxatives);
• a sharp change in the style and conditions of nutrition (traveler's diarrhea);
• intestinal flu and other infections;
• poisoning with lead, mercury;
• stress.

When diarrhea is accompanied by an increase in temperature up to 380C, vomiting, or there is diarrhea with blood, diarrhea with water, it is important to urgently consult a doctor in order to receive adequate treatment and avoid the development of serious complications.

Why frequent diarrhea is dangerous

Watery and frequent stools increase the likelihood of dehydration and electrolyte loss, which can be fatal. For this reason, you should urgently see a doctor and immediately provide assistance to the sick person if the following symptoms are observed:

• dry mucous membranes;
• increased heart rate;
• cracked lips;
• rare or no urination;
• lowering blood pressure;
• the appearance of muscle cramps;
• violation of consciousness.

It is imperative to consult a doctor in the following situations:

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• diarrhea does not stop for 3 or more days;
• stool disorder arises and develops for no reason;
• in addition to diarrhea, yellowness of the sclera and skin, intense abdominal pain, sleep disturbances and high fever are observed;
• bowel movements are dark black or green and bloody.

First aid for diarrhea

If diarrhea and vomiting or diarrhea and fever are observed, it is best to consult a doctor as soon as possible, since these symptoms may indicate the development of a serious illness, for example, acute intestinal poisoning... First aid until the patient is examined by a doctor is to prevent dehydration and significant loss of minerals. In this regard, experts, in case of onset diarrhea, recommend the following:

1. Drink plenty of minerals. For this purpose, Regidron (and its analogues) is best suited. If it is absent, then you can take slightly salted water, saline solution.
2. Eat a strict diet. When diarrhea begins, it is better to abstain from 1 - 2 or more meals altogether, unless the doctor recommends otherwise. In order to relieve intestinal inflammation, you can drink tea or decoctions of anti-inflammatory herbs.

Diarrhea treatment: diet

A complete treatment for diarrhea includes the following dietary guidelines.

1. It is allowed to use such products as white crackers, slimy cereals, vegetable purees, steamed and boiled fish, lean meats, rice broth, tea.
2. It is forbidden to eat spicy, salty, sour foods, foods containing a large number of coarse fiber. In addition, milk, brown bread and everything that can cause increased gassing and "fermentation".
3. In the early days, food that stimulates the release of bile is excluded from the diet: eggs, fatty meat, butter, etc.

Gradually, the list of permitted foods expands, and the patient, as the stool normalizes, can switch to a normal diet. In situations where diarrhea is caused by enzyme deficiency or any chronic bowel disease, systematic dieting is one of the most effective means of therapy.

How to treat dehydration for acute or chronic diarrhea

As a rule, glucose-saline solutions are prescribed before stool normalization. They make up for the loss mineral salts as well as body fluids. The most famous drugs in this group are Regidron, Gastrolit, Tsitroglyukolosan. In the absence of them at hand, you can independently prepare and use the following solution: for 1 liter of water, take ½ teaspoon baking soda, salt - 1 teaspoon, potassium chloride - ¼ teaspoon, and add 4 tbsp. l. Sahara. Instead of potassium chloride, you can take a decoction of dried apricots (dried apricots).

How to treat diarrhea with drugs

The most common drugs used to treat diarrhea are:

The best prevention of diarrhea is maintaining personal hygiene, eating only high-quality foods and timely treatment of various chronic intestinal diseases.

Approximately 85% of those killed are children under the age of 2 years. The intensity of treatment for this condition depends on the diagnosis and age.

Important! Diarrhea and vomiting are part of defense mechanism aimed at ridding the body of infection and toxins.

The causes of diarrhea are manifold. She can accompany the following diseases:

• Crohn's disease;
• Nonspecific ulcerative colitis;
• Endocrine disorders, such as thyrotoxicosis;
• The presence of infectious agents (acute intestinal infections);
• The use of drugs (antibiotics, laxatives, etc.);
• Psychological factors (see Irritable Bowel Syndrome).
• Radiation sickness;
• Ingestion of chemical toxic substances;
• Diseases of the pancreas;
• Liver diseases with impaired secretion of bile acids, etc.

Why does the stool become liquid due to one reason or another? Because the inflamed intestinal mucosa is not able to normally perform its functions of digestion and absorption of substances.

There is a release of water and salts by the cells lining the intestine from the inside, the process of parietal digestion is disrupted, and due to an increase in the volume of intestinal contents, its movement throughout the intestine is reflexively accelerated.

Depending on the mechanism, the following types of diarrhea are distinguished:

1. Increased excretion (secretion) of fluid and electrolytes through the intestinal mucosa - secretory diarrhea;
2. Increased osmolarity of intestinal contents - osmotic diarrhea;
3. Increased bowel contractions - hyperkinetic diarrhea;
4. Exudative diarrhea- due to inflammation of the intestinal mucosa.

If the duration of diarrhea does not exceed 3 weeks - we are talking about acute diarrhea, and if more than 3 weeks - then about chronic.

Acute diarrhea

Among the main causes of acute diarrhea are: acute intestinal infections, parzitoses, taking medications (antibiotics, laxatives), acute ischemia intestines, stress.

The mechanism of development of the acute process is the secretory type.

The characteristic signs of diarrhea accompany the infectious nature of the disease - fever, nausea, vomiting, spastic pain in the abdomen, especially in the umbilical region, flatulence and false urge to defecate - tenesmus, which is not typical for non-inflammatory loose stools.

The appearance of loose stools when moving to other climatic zones.

The causes of chronic diarrhea:

• Gluten deficiency
• After surgery to remove the gallbladder;
• After other operations, especially if part of the intestine or stomach has been removed. Violation of the passage of intestinal contents in the form of diarrhea often accompanies the postoperative period.
• Chronic intestinal inflammation and dysbiosis can also cause chronic diarrhea.
• Increased levels of thyroid hormones;
• Chronic pancreatitis (insufficient functioning of the pancreas leads to a decrease in the number of enzymes involved in the digestion of food)

Since frequent diarrhea is only a symptom of a disease, the approach to treatment begins with a diagnosis and identification of the cause that caused this condition.

Diagnosis begins with collecting complaints and a history of the condition's development.

Such points as the frequency and amount of loose stools, color, consistency and the presence of pathological impurities are clarified, and the presence of accompanying symptoms(high fever, vomiting, exhaustion, abdominal pain, false urge to defecate, etc.)

Before the study, there is a special preparation for cleansing the intestines from feces, so that all the mucous membrane is better visible. For this, an enema may be prescribed on the eve of the event.

The endoscopic tube is inserted into the lumen of the rectum first, opening the bowel loops and moving on. At the end of this tube is a small video camera that broadcasts an image to the doctor on a monitor.

This allows you to assess the color of the mucous membrane, the structure of the large intestine, to identify the presence of neoplasms (tumors, polyps), and also to identify signs of diseases such as Crohn's disease, for example.

Of the laboratory methods, the most diagnostically significant is the sowing of feces on a microbial landscape. This will identify those aggressive microorganisms that have caused liquid diarrhea.

General and biochemical analyzes blood (blood from a finger and from a vein) is donated to detect signs of infectious inflammation in the body or allergies, to predict the severity of the condition and dehydration.

If necessary, the doctor can add or exclude other tests from the examination. This will depend on the results of the surveys carried out.

How is diarrhea treated?

Non-severe diarrhea is common and can be managed on your own. However, frequent loose stools predetermines dehydration, as the body loses a huge amount of fluids and salts. This is especially dangerous for children.

Important! Upon detection following symptoms children require immediate medical attention:

• Diarrhea in babies, especially if combined with fever and vomiting;
• Fever (above 39 degrees);
• If the child has little or almost no urination for the last three hours or more;
• If the stool is black or there is blood in the stool;
• Dry tongue, cry without tears;
• Suspiciously sleepy appearance;
• If naughty or irritable;
• Sunken appearance (confluence of the abdomen, cheeks, eyes);
• The folded skin is not smoothed.

Adults should seek immediate medical attention if they experience any of the following symptoms:

• Diarrhea lasts more than three days without relieving symptoms;
• The presence of symptoms such as thirst, dry tongue and skin, little or no urine output, severe weakness;
• Darkening of the urine;
• Severe abdominal or rectal pain
• The chair is black;
• Fever (above 39 degrees).

Staying at home and self-medicating is life-threatening if these symptoms are found!

If the diarrhea is not prolonged without an increase in body temperature and without the presence of pathological impurities in the feces, then you should start treating diarrhea as a symptom on your own, but to identify the cause, you should simultaneously consult a specialist.

While we are waiting for the doctor, we may well provide help needed yourself and your child yourself!

How to treat diarrhea before the doctor's appointment? Basic principles:

1. Fight dehydration. We carry out the prevention of dehydration by ingesting saline solutions (NOT in bulk). It could be pharmacy drug Rehydron, which is available in powders.

One sachet is diluted in a liter of drinking water and drunk within half an hour to an hour in slow sips. Children can dilute one sachet by 1.5 - 2 liters and drink them with this solution for an hour or two. This is the watering method.

If there are no special solutions, then we drink slightly salted water or at least tea. The main thing is to drink liquid.

Important! If diarrhea is accompanied by vomiting, then this method is unrealizable. Therefore, we are waiting for an ambulance or we independently apply for it to the hospital.

Since in such cases dehydration develops quickly, and it can only be dealt with by setting intravenous droppers.

2. Reception of sorbents. Enterosorbents are a popular group of drugs for diarrhea. They, falling into gastrointestinal tract, sorb its surface with all its contents with toxins, microbes, allergens, toxic substances that caused diarrhea.

It is MANDATORY to take sorbents! The most effective are Smecta, Polysorb, Enterosgel, Enterodez, Activated carbon other.

3. Reception of intestinal antiseptics for suspected food poisoning. This pharmacological group includes drugs Enterofuril, StopDiar, Alfanormix, Intetrix, Macmiror and others.

They affect pathogenic microorganisms, kill them and have almost no effect on their own beneficial lacto- and bifidobacteria.

Some of them are as safe as possible, therefore, they are recommended even during pregnancy and lactation, for example, Enterofuril. But nevertheless, it is advisable to agree on their reception with a doctor, so infectious cause diarrhea must be confirmed.

4. Taking pre- and probiotics. It is relevant for diarrhea of ​​infectious origin and for antibiotic associated diarrhea. There are countless drugs from this group. For example, Linex, Hilak forte, Bifiform, Lactofilrum, Bifido- and lactobacterins, Primadophilus and many others.

5. Nutrition for diarrhea. It is forbidden to eat foods that stimulate intestinal motility even more, containing dietary fiber. These are almost all fresh vegetables and fruits, especially apples, cabbage, legumes, prunes, grapes, etc. It is worth limiting dairy products. Avoid fatty meats, fried, smoked.