abstract
Normal people generally defecate once a day, while individuals defecate 2-3 times a day or once every 2-3 days. Fecal properties are normal, and the average weight of feces discharged every day is 150-200 g, and the water content is 60%-75%. Diarrhea is a common symptom, which means that the frequency of defecation is obviously higher than usual, the stool is thin, the water is increased, the daily defecation volume exceeds 200g, or it contains undigested food or pus and mucus. Diarrhea is often accompanied by urgent defecation, anal discomfort, incontinence and other symptoms. Diarrhea can be divided into acute and chronic. Acute diarrhea occurs rapidly, and the course of disease is within 2 ~ 3 weeks. Chronic diarrhea refers to recurrent diarrhea with a course of more than two months or an intermittent period of 2-4 weeks.
diagnose
The diagnosis of primary disease or diarrhea mainly depends on medical history, symptoms, signs, routine examination, especially stool examination. Many sick people can often get a correct diagnosis by carefully analyzing the medical history and the preliminary results of the above examination. If the diagnosis is still unclear, X-ray barium enema, barium meal examination and/or colonoscopy can be further performed. If there is still no clear conclusion, imaging diagnosis methods such as ultrasound, CT and ERCP should be selected according to different situations to check biliary and pancreatic diseases, or small intestinal absorption function test, breath test and small intestinal mucosal biopsy should be performed to check small intestinal malabsorption. Highly suspected diseases with special treatment, such as intestinal tuberculosis and intestinal amebiasis, can be treated within a certain period of time if they cannot be diagnosed after efforts.
Treatment measures
Diarrhea is a symptom, and the fundamental treatment should be aimed at the cause. Understanding the pathogenesis of diarrhea is helpful to master the principles of treatment.
(1) Etiology treatment is self-evident. Diarrhea caused by intestinal infection needs anti-infection treatment, and antibacterial treatment for pathogens is the most ideal. Compound sulfamethoxazole, norfloxacin, ciprofloxacin and ofloxacin are effective for bacillary dysentery, salmonella or toxic Escherichia coli and helicobacter infection, while metronidazole is effective for amoeba histolytica and piriformis infection. Therefore, these drugs are often used for acute infectious diarrhea, including the prevention and treatment of so-called traveler's diarrhea. Treat diarrhea caused by lactose intolerance and mucinous celiac disease, and remove lactose or mucus from diet respectively. The treatment principle of hyperosmotic diarrhea is to stop eating or stop using food or drugs that cause hyperosmotic diarrhea. Secretory diarrhea is easy to cause severe dehydration and electrolyte loss. In addition to eliminating the cause, we should also actively supplement salt and glucose solution orally and intravenously to correct dehydration. Colonic diarrhea caused by bile salt resorption disorder can be stopped by cholestyramine adsorbing bile acid. For the treatment of fatty diarrhea caused by bile acid deficiency, medium-chain fat can be used instead of long-chain fat, because the former is absorbed directly through portal vein system without combining bile salt hydrolysis and micelle formation.
(2) When choosing drugs for symptomatic treatment, we should avoid using addictive drugs and only use them temporarily when necessary. Etiology and treatment are the main factors. Anyone with unknown etiology, although the symptoms have improved after symptomatic treatment, must not relax or cancel the due examination steps, especially for cases that have not ruled out malignant diseases.
1. Commonly used antidiarrheal drugs include activated carbon, tannic acid protein, basic bismuth carbonate, aluminum hydroxide gel, etc. Take it 3 ~ 4 times a day. Compound camphor tincture (3 ~ 5ml) and codeine (0.03g) with strong efficacy, 2 ~ 3 times a day. Because long-term use will be addictive, it is only suitable for patients with frequent diarrhea in the short term. Compound phenylephrine tincture (each tablet contains phenylephrine 2.5mg and atropine 0.025mg), each time 1 ~ 2 tablets, 2 ~ 4 tablets /d, has the function of strengthening central inhibition, so it is not suitable to be used with barbiturates and opioids. Loperamide has stronger and more lasting efficacy than compound phenylephrine, contains no atropine and has less central reaction. Take 4mg for the first time, and then adjust the dose until the number of stools is reduced to 1 ~ 2 times /d, and the daily dose should not exceed 8mg. Bifico can regulate intestinal function.
2. Spasmodic analgesics can be atropine, propofol, anisodamine, procaine and other drugs.
3. Sedatives can be diazepam, sleeping pills and phenobarbital.
4. Drugs for regulating intestinal autonomic nervous disorder can be selected from drugs such as Plant Shentiao Capsule.
etiology
(1) The course of acute diarrhea generally does not exceed 3 weeks, and the most common cause is infection.
1. Food poisoning is mostly manifested as non-inflammatory watery diarrhea, because food is contaminated by toxins such as Staphylococcus aureus, Bacillus cereus, Clostridium perfringens and botulinum.
2. Intestinal infection
(1) virus infection: when rotavirus, norwalk virus and intestinal adenovirus are infected, the small intestine may be non-inflammatory and non-diarrheal.
(2) Bacterial infection: Vibrio cholerae and toxic Escherichia coli can cause non-inflammatory watery diarrhea in small intestine. Salmonella, Shigella, Campylobacter, Yersinia coli, invasive Escherichia coli, Staphylococcus aureus, Vibrio parahaemolyticus and Clostridium difficile can cause colitis and produce purulent diarrhea.
(3) Parasitic infection: Giardia pyriformis and Cryptosporidium infection can cause non-inflammatory watery diarrhea of small intestine. Entamoeba histolytica invades colon and causes inflammation, ulcer and purulent diarrhea.
(4) Traveler's diarrhea: it is diarrhea that occurs during or after travel. Most of them are caused by infection, and the pathogens are often toxic Escherichia coli, Salmonella, Giardia pyriformis, Entamoeba histolytica and so on.
(5) Diarrhea caused by drugs: laxatives, hypertonic drugs, cholinergic drugs, antibacterial drugs and some antihypertensive or antiarrhythmic drugs will not cause diarrhea during medication.
(2) Chronic diarrhea The duration of chronic diarrhea is more than 2 months, and the cause is more complicated than acute diarrhea, so the diagnosis and treatment are sometimes difficult, which is the focus of this chapter.
1. Intestinal infectious diseases ① Chronic amebic dysentery; ② Chronic bacterial diseases; ③ Intestinal tuberculosis; ④ pyriform flagelliasis and schistosomiasis; ⑤ Intestinal candidiasis.
2. Intestinal non-infectious inflammation ① Inflammatory bowel disease (Crohn's disease and ulcerative colitis); ② Radiation enteritis; ③ Ischemic colitis; ④ diverticulitis; ⑤ Uremic enteritis.
3. Tumor ① Colorectal cancer; ② Colonic adenoma (polyp); ③ Malignant lymphoma of small intestine; ④ Amine precursor uptake decarboxylation cell tumor (APU-DOMA); Gastrinoma, carcinoid tumor, intestinal vasoactive intestinal peptide tumor (VIPoma), etc.
4. Small intestinal malabsorption
(1) Primary intestinal malabsorption.
(2) Secondary intestinal malabsorption.
1) Dyspepsia: ① Lack of digestive enzymes in pancreas, such as chronic pancreatitis, pancreatic cancer and pancreatic fistula. 2 disaccharidase deficiency, such as lactose intolerance; (3) Obstruction of bile discharge, combined with insufficient bile salts, such as extrahepatic biliary obstruction, intrahepatic cholestasis, and overlong intestinal bacteria (blind loop syndrome).
2) Decreased absorption surface of small intestine: ① Excessive small intestine resection (short bowel syndrome); ② Proximal small intestine and colon anastomosis or fistula.
3) Infiltrative diseases of small intestine: Whipple's disease, α-heavy chain disease, systemic sclerosis, etc.
5. Exercise-induced diarrhea is caused by intestinal peristalsis disorder (mostly accelerated), such as irritable bowel syndrome, subtotal gastrectomy, vagotomy, partial intestinal obstruction, hyperthyroidism, adrenocortical hypofunction, etc.
6. Drug-induced diarrhea ① cathartics such as phenolphthalein and senna; ② Antibiotics such as lincomycin, clindamycin and neomycin. ③ antihypertensive drugs such as reserpine and guanethidine; ④ Use drugs for hepatic encephalopathy, such as lactulose and Rushan pear alcohol.