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Diarrhea (diarrhea) is a state at which there is rather frequent or single bowel emptying of the person during which the fecal mass of a liquid consistence is allocated. At the adult healthy person in days from 100 to 300 g of fecal weight are allocated. Its quantity varies depending on amount of the cellulose which is contained in food and the volume of the remained undigested substances and water. If duration of a disease remains in repartitions of two-three weeks, then in this case acute diarrhea takes place. In the presence at the person of a liquid chair within more than three weeks diarrhea passes into a chronic form. At chronic diarrhea at the patient systematically plentiful chair is also observed. At such situation weight the calla will exceed 300 g a day. Diarrhea arises when in a chair of the person the content of water — from 60 to 90% sharply increases. At the broken nutritive absorption from food polyexcrements are diagnosed for patients: it is allocated unusually many fecal masses which consist of the food remains which remained undigested. In case of disturbance of motility of intestines the chair will be very liquid and frequent, however in general its weight will not exceed 300 g a day. That is even in case of the initial analysis of features of a course of diarrhea it is possible to find out what origin of similar pathology and, therefore, to facilitate process of installation of the diagnosis and selection of the subsequent therapy.
Diarrhea of any kind represents pathological process at which there is a disturbance of absorption in intestines of water and electrolytes. So at diarrhea of any kind approximately identical picture is observed. Both the thick, and small bowel has very high ability of absorption of water. So, every day the person uses about two liters of liquid. Generally about seven liters of water taking into account saliva, a gastric juice, intestinal and pancreatic juice, bile come to intestines. At the same time with a stake only 2%, from the total amount of liquid are allocated, other is soaked up directly in intestines. Eesli amount of liquid in Calais changes even very slightly, fecal masses becomes too firm. If in a large intestine there is too much liquid, then the person has a diarrhea. This disease is shown because of frustration in the course of digestion, problems with absorption, secretion and motility of intestines. In case of diarrhea a small and large intestine are perceived as uniform physiological unit.
Types of diarrhea
At secretory diarrhea there is hypersecretion of electrolytes and water in a gut gleam. In more exceptional cases the reason of this type of diarrhea to become decrease in vsasyvatelny functions of intestines. So, secretory diarrhea is shown at cholera, an esherikhioza, a salmonellosis. But sometimes the similar state arises also at patients with some noninfectious pathologies. In the presence at sick this type of diarrhea the osmotic pressure of a blood plasma is higher, than the osmotic pressure of fecal masses. At the patient the watery and rather plentiful fecal masses, their color – green are allocated. Are origins of secretory diarrhea active process of secretion of sodium and water in a gut. Emergence of this process is provoked by bacterial toxins, enteropathogenic viruses, a number of drugs and other biologically active agents. So, fatty long-chain acids and bile free acids, laxatives which contain antraglikozida, castor oil can provoke developing of secretory diarrhea.
At hyper exudative diarrhea there is a sweating of plasma, slime, blood in a gut gleam. This state is characteristic of the patients having infectious and inflammatory diseases of intestines (a shigellosis, a salmonellosis, a campilobacteriosis, klostridioz). Also this type of diarrhea it is characteristic it is shown at noninfectious diseases, such as nonspecific ulcer colitis, a lymphoma, an illness Krone. osmotic pressure of a blood plasma is higher, than the osmotic pressure of fecal masses.
Osmotic pressure of fecal masses is lower, than the osmotic pressure of a blood plasma. Fecal masses liquid, is impurity of pus, blood, slime.
At giperosmolyarny diarrhea the patient has a malabsorption in a small bowel of certain nutrients. In an organism exchange processes are considerably broken. The similar type of diarrhea is shown at the excessive use of laxatives of salt type. Osmotic pressure of fecal masses is higher, than the osmotic pressure of a blood plasma. The liquid and plentiful chair in which parts of undigested food are found is characteristic of this state.
At hyper - and hypokinetic diarrhea at the patient disturbances of transit of contents of intestines take place. The reason of this state – is lowered or the increased motility of intestines. Very often similar state is characteristic of the people suffering from a syndrome of the angry intestines, neurosises and also of those who use too many laxatives and antacids. Osmotic pressure of fecal masses at this state same as osmotic pressure of a blood plasma. The chair is not especially plentiful, a liquid or kashitseobrazny consistence. Two last types of diarrhea occur only at patients with noninfectious illnesses.
Developing of diarrhea is influenced by the following phenomena: intestinal secretion, too high pressure in a gut cavity, intestinal exudation, disturbances in the course of transportation of contents of intestines. All these mechanisms have a certain communication, however dominance of the corresponding type of disturbance is characteristic of a certain type of an illness.
Diarrhea acute is shown at any infections, inflammations in intestines and owing to influence of certain medicines. As a rule, diarrhea is shown in combination with some other manifestations: it can be a meteorism, swelling, abdominal pains, weakness, feeling of a fever, fervescence.
Symptoms of infectious type of an illness is the febricula, displays of fever, a small appetite, vomiting. Very frequent origins of diarrhea the food, and also travel becomes low-quality (so-called diarrhea of tourists is shown). Emergence of a liquid chair with elements of blood testifies to nalichiya of damages to a mucous membrane of intestines. Their emergence is provoked by some pathogenic microbes or colibacillus with enteropathogenic properties. A state at the patient at this form of a disease heavy in view of septic symptoms and existence of pain in a stomach.
Also displays of diarrhea can provoke some medicines. Level of dehydration of an organism can be estimated already with the help surveys of the patient. If in an organism considerable loss of electrolytes and water takes place, then the xeroderma, decrease in its turgor is observed, tachycardia and hypotonia can be shown. Because of losses of calcium, notable for an organism, there can be a tendency to spasms.
At chronic diarrhea, that is the disease proceeding more than three weeks, inspection has to go first of all on clarification of the reasons of its emergence. The specialist studies data of the anamnesis, the calla conducts all corresponding researches. Important in the course of diagnosis to establish diarrhea duration, to determine what chair volume in days, the frequency and expressiveness of a vermicular movement of intestines, fluctuation of weight is. If the disease of a small bowel takes place, the chair will be volume, watery or fat. Diseases of a large intestine are accompanied by a frequent chair, however it will be less plentiful, with the content of pus, blood, slime. At pathology of a large intestine diarrhea will be followed, as a rule, by pain in a stomach.
Diagnosis of diarrhea
In the course of diagnosis usual physical examination is conducted. At the same time the specialist attentively studies a condition of excrements of the patient and conducts proctologic research. If in Calais the patient blood is found, there is a proctal crack, a paraproctitis or the svishchevy course, then it is possible to assume existence at the patient of an illness Krone. In the course of microscopic examination a calla it is important to define in it inflammatory cells, fat, existence of eggs of worms and protozoa.
By means of a method of a rektoromanoskopiya it is possible to diagnose ulcer colitis, dysentery, pseudomembranous colitis. The dl of establishment of the diagnosis "acute diarrhea" the doctor is guided first of all by complaints of the patient, the anamnesis, proctologic survey, physical inspection. To laboratories it is carried out macro - and microscopic examination of samples a calla.
If in the course of installation of the diagnosis it becomes clear that there are no inflammations in intestines, then, most likely, diarrhea in this case will be connected with absorption disturbance. In certain cases developing of acute diarrhea is provoked by enteroviruses. At suspicion on viral enteritis the doctor has to make sure whether symptoms and manifestations of this state match. So, at viral enteritis blood and inflammatory cells in Calais are absent, antibacterial therapy is inefficient in the course of treatment, the patient can spontaneously recover. The specialist surely notes all described features at differential diagnosis of diseases of any intestines.
In the course of diagnosis at chronic diarrhea, first of all, find out whether there is no communication in developing of diarrhea with infections or inflammations. For this purpose conduct researches a calla – microscopic, bacteriological, a rektoromanoskopiya. Also for an exception of inflammations it is necessary to define the pathogenetic mechanism of diarrhea. Often some period of stay on a certain diet at diarrhea helps to establish the correct diagnosis.
Treatment of diarrhea
Some approaches to treatment of diarrhea are the general at all four types of a disease. So, the diet equally effectively works at diarrhea, symptomatic medicines and drugs with antibacterial action. First of all, changes in style of food practice. So, the diet at diarrhea assumes the use of products which promote braking of a vermicular movement, reduce secretion of water and electrolytes. At the same time it is important to exclude those products which properties assume increase motor evakuatornoy and secretory functions of intestines.
Treatment of diarrhea includes purpose of antibacterial drugs which are urged to recover eubioz intestines. Patients with acute diarrhea should accept antibiotics, antimicrobic and sulfanamide drugs, antiseptic agents. The most preferable diarrhea medicine are means which do not break balance of intestinal microflora.
At diarrhea bacterial drugs, a course of treatment which proceeds about two months are considered as alternative medicine. As symptomatic means use adsorbents which neutralize organic acids, and also appoint the knitting and enveloping means.
Also treatment of diarrhea is carried out by means of means which regulate motility and reduce an intestines tone. And the regidratation is applied to elimination of a condition of dehydration of an organism. If the acute state is diagnosed for the patient, then the regidratation is carried out by an oral way, in rare instances for a regidratation crystalloid polyionic solutions intravenously join.
Diarrhea at pregnancy
Diarrhea at pregnancy is quite often shown. For emergence of such state pregnant women have a number of the reasons. So, sometimes diarrhea arises owing to diseases of intestines or gastrointestinal tract in general. In certain cases the general illnesses are the reason of diarrhea at pregnant women. However during pregnancy an organism of the woman to become especially susceptible to various infections therefore infectious diseases, local poisonings can provoke diarrhea. So, at pregnant women sensitivity to toxins is high. However disturbances in work of a nervous system, both presence of worms, and insufficient production of enzymes in an organism can become the reason of diarrhea also. Frequent the reason of display of diarrhea to become toxicosis of the pregnant woman.
In some cases the diarrhea can not constitute danger to the woman, carrying out function of a peculiar clarification of an organism before the forthcoming childbirth. However it is necessary to watch diarrhea origins accurately. If this state arose because of food or other poisoning, then it is very dangerous and for future child, and for the woman.
During pregnancy treatment of diarrhea has to be carried out only under careful control of the doctor which will surely consider all individual moments. In parallel the specialist adjusts food of the patient, appointing by her a special diet. For future mother it is very important to observe constantly the drinking mode, using enough liquid, organism dehydration – an undesirable state for a fruit and mother.
Section: Gastroenterology D