First, what is diarrhea
The frequency and amount of defecation of normal people vary widely: most people defecate 1~2 times a day, but defecate 3 times a week to 3 times a day, as long as the water content of feces does not increase significantly, it belongs to the normal range; Diarrhea refers to an obvious increase in the water content of feces. Even diluted water samples are often accompanied by an increase in the number of stools, usually three times a day and many times. Diarrhea for 3 weeks is called acute diarrhea, which is mostly caused by intestinal infection, food poisoning and other reasons. The etiology is relatively clear and the diagnosis is relatively easy. Diarrhea for 3 weeks belongs to chronic diarrhea, the cause is relatively complicated, and the diagnosis is often difficult.
Second, the common causes of diarrhea
Diarrhea is a common clinical manifestation of digestive system, and it may also be a symptom of diseases outside digestive tract. The causes of diarrhea are complicated, and the common causes are:
1, intestinal infectious inflammation:
Amoeba dysentery, bacillary dysentery, schistosomiasis, intestinal tuberculosis, parasitic diseases, fungal enteritis, enterovirus infection and flora imbalance;
2, non-infectious inflammation:
Inflammatory enteropathy, radiation enteropathy, ischemic enteropathy, diverticulitis, eosinophilic gastroenteropathy, collagen colitis, rheumatic immune diseases, nicotinic acid deficiency, uremic enteritis;
3, digestive tract tumor:
Colorectal cancer, colon adenoma, small intestinal lymphoma, intestinal endocrine cell tumor
4, small intestinal malabsorption syndrome (intestinal motor dysfunction):
Irritable bowel syndrome, subtotal gastrectomy, vagotomy, hyperthyroidism, adrenocortical hypofunction, diabetic neuropathy, anxiety and depression lead to intestinal dysfunction.
5, drug-induced diarrhea: all kinds of laxatives, antibiotics, antihypertensive drugs, lactulose, Rushan sorbitol, hypoglycemic drugs;
6, allergic diarrhea: intestinal maladjustment to special foods, allergic purpura diarrhea;
7. Congenital diseases: congenital chlorine diarrhea, congenital sodium diarrhea, etc.
Three, the common clinical manifestations of diarrhea diagnosis tips
1, frequent defecation, obvious increase in water, common in acute inflammation, intestinal endocrine cell tumor and so on.
2. Increased defecation times, decreased defecation times, mucus discharge and purulent blood often indicate chronic inflammation or tumor of colon;
3. Patients with irritable bowel syndrome often defecate after getting up or eating. Generally, they have to defecate 1.2 times with a small amount of water;
Not much;
4. Diarrhea and constipation are more common in intestinal tuberculosis, irritable bowel syndrome and diabetic autonomic neuropathy, and can also be seen in colonic diverticulitis or colon cancer;
5. If you take a kind of food that you don't often eat, especially fish, shrimp, old turtle and other foods containing foreign protein, you will have diarrhea and abdominal pain, or stop eating some foods, suggesting that diarrhea is related to food allergies;
6. If the feces are diluted water samples, the lesions are mostly in the small intestine;
7, malabsorption syndrome: sugar malabsorption can be seen as sour paste, fat malabsorption can be seen as oil paste, protein malabsorption can be seen as dirty stool;
8. Abdominal pain is common in inflammatory diarrhea: small intestinal lesions, abdominal pain and tenderness are located around the umbilicus and the right lower abdomen; Colon lesions, pain is often located in the left lower abdomen; Rectal lesions, often acute and then severe;
9. Abdominal mass: It often suggests tumor (50% of rectal cancer can be found by anal digital diagnosis) or inflammatory lesions. The location of the tumor is often the location of the diseased intestinal segment, and the tumor is sometimes caused by accumulated feces;
10, many parenteral diseases can also cause diarrhea, such as typhoid fever, hyperthyroidism crisis, sepsis and other systemic infectious diseases;
You can choose an auxiliary examination for diarrhea.
Common diarrhea, such as acute gastroenteritis and autumn diarrhea. Generally, a definite diagnosis can be made through medical history, clinical symptoms, physical examination combined with relevant laboratory examinations and auxiliary examinations, such as acute enteritis, bacillary dysentery, amebic enteropathy, intestinal tuberculosis and other diseases; According to the patient's specific situation, you can choose the corresponding auxiliary examination:
1, blood routine and biochemical examination
Can know whether there are leukocytosis, anemia, thrombocytopenia, liver and kidney dysfunction, diabetes, uremia, acid-base balance disorder, electrolyte disorder;
2. stool examination
Routine stool: you can observe the general characteristics of stool, whether there are red blood cells, white blood cells, protozoa, eggs, fat drops, fecal occult blood and so on.
Fecal culture: pathogenic bacteria can be found, which is very important for the diagnosis of infectious diarrhea. Drug sensitivity experiments can also be carried out to provide reference for clinical selection of sensitive antibiotics.
3. Colonoscopy: Fiberoptic colonoscopy combined with mucosal biopsy can definitely diagnose most colon lesions;
4.x-ray or barium enema examination: colonoscopy can be supplemented;
You can observe the functional state of the whole gastrointestinal tract and whether there are organic diseases. It is helpful for the diagnosis of Crohn's disease, ulcerative colitis, intestinal tuberculosis, intestinal tumor and some small intestinal diseases that cause malabsorption syndrome.
5. Abdominal ultrasound, CT and other examinations are helpful for the diagnosis and differential diagnosis of diarrhea.
Verb (abbreviation of verb) treatment of diarrhea
Diarrhea is a symptom of disease, and the treatment of diarrhea should be combined with etiological treatment and symptomatic treatment, especially in severe cases.
1, keep the balance of water, electrolyte and nutrition.
Correct the disorder of water, electrolyte and acid-base balance caused by diarrhea, and supplement the nutrition needed by the body. Dry mouth, less urine and yellow urine are all manifestations of lack. Encourage patients with mild symptoms to eat digestible food properly and take oral rehydration salts appropriately. Patients who are seriously dehydrated or unable to eat generally use intravenous saline, 5% 10% glucose solution and 5% 10% glucose sodium chloride solution, and those with poor nutritional status can take compound amino acids and albumin appropriately.
2, actively looking for the cause of diarrhea:
Actively seek the cause, treat the cause, keep the diet clean and hygienic, pay attention to hand hygiene, and avoid cross infection. Considering bacterial infection, antibiotics should be used appropriately;
3, symptomatic treatment:
Antidiarrheal drugs can improve symptoms, relieve patients' pain, and reduce the occurrence of water and electrolyte disorders caused by severe diarrhea, but antidiarrheal drugs can also cause bacteria and toxins to gather in the body and cover up the causes of diarrhea, so they should not be used blindly. Antidiarrheal drugs are often used for short-term symptomatic treatment of patients with functional diarrhea (mainly symptomatic treatment) and patients with clear etiology of diarrhea. Mild patients can use basic bismuth carbonate and montmorillonite, and the dosage can be adjusted according to the number of diarrhea and stool characteristics of patients. Montmorillonite can not only stop diarrhea, but also protect intestinal mucosa, adsorb and inhibit intestinal bacteria and viruses. Those with obvious diarrhea symptoms can choose: phenylethyl piperidine 1.2 tablets/time, 2 4 times /d, phenylethyl piperidine can not be used with barbiturates, otherwise it has strong central inhibitory effect; Or choose a safer and more effective drug, loperamide, with the first dose of 4 mg and the maximum dose of 8 mg/d; Use antidiarrheal drugs with caution, under the guidance of a doctor, and avoid using them for a long time. Patients with spastic abdominal pain can use anisodamine 10 mg intramuscular injection or atropine 1 mg intramuscular injection as appropriate;
4. Supplementing beneficial bacteria: Appropriate supplementation of beneficial bacteria is beneficial to the establishment of normal intestinal flora, the inhibition of pathogenic bacteria and the recovery of intestinal function;
5, drugs to inhibit intestinal peristalsis: intestinal smooth muscle activity is hyperactive during diarrhea, and anisodamine, an anticholinergic drug, can be used to inhibit excessive intestinal peristalsis, which can relieve spasmodic pain and inhibit excessive intestinal peristalsis; Pregnancy pudding has a two-way regulating effect on smooth muscle of digestive tract, can inhibit muscle contraction caused by acetylcholine, normalize excessive intestinal smooth muscle movement during diarrhea, has a good curative effect on diarrhea caused by functional dyspepsia and irritable bowel syndrome, and can also improve symptoms such as abdominal pain and abdominal distension.
Sixth, diarrhea needs to go to the hospital as soon as possible.
1, frequent diarrhea, accompanied by obvious vomiting, fatigue, dry mouth, decreased urine volume, electrolyte disorder and acid-base balance imbalance, and even changes in vital signs such as decreased blood pressure and increased pulse;
2, diarrhea with bloody stools, mucus pus and bloody stools;
3. Diarrhea with abdominal pain and mass;
4, diarrhea has parenteral manifestations, such as hepatosplenomegaly, emaciation, anemia, arthritis, rash, severe vomiting.
Seven, prevent diarrhea:
Summer and autumn are the high incidence seasons of diarrhea, among which the elderly and children are more. There are many reasons for diarrhea, among which infectious diarrhea accounts for the highest proportion in acute diarrhea. Diarrhea in summer is mostly bacterial infection, and diarrhea in autumn is mostly "from the mouth", and unclean diet is the main reason. Therefore, to prevent acute diarrhea, we must do a good job in food hygiene: don't eat cold, unclean and stale food, eat out less, take out less, and eat at home as much as possible; Eat little or no cold salad. If you want to eat cold salad, add garlic cloves, onions and vinegar.