diarrhea
Introduction
Introduction Normal people usually have bowel movements once a day, and individual patients take 2-3 times a day or once every 2-3 days. It is also within the normal range that the traits of the feces are not abnormal. Normal feces are generally formed, and the average weight of excreted feces per day is 150-200 g, and the moisture content is 50%-80%. Diarrhea refers to a film of undigested food, pus, blood, or shedding. It refers to diarrhea with a course of more than 2 months or intermittent period of 2-3 months. According to the course of diarrhea, it can be divided into acute diarrhea and chronic diarrhea. Patients with a course of less than 2 months are acute diarrhea. Chronic diarrhea is recurrent diarrhea within 4 weeks. Diarrhea is often accompanied by symptoms such as urgency of bowel movements, perianal discomfort, and incontinence.
Cause
Cause
Acute diarrhea
1. Bacterial infection: People may suffer from enteritis or bacillosis after eating food contaminated with bacteria such as Escherichia coli, Salmonella, Shigella, or drinking beverages contaminated with bacteria. Different degrees of abdominal pain, diarrhea, and vomiting may occur. Symptoms such as urgency, weight, and fever.
2, viral infection: the human body can cause viral diarrhea after infecting a variety of viruses through food or other means, such as: infection with rotavirus, norovirus, coxsackie virus, ecco and other viruses, abdominal pain, diarrhea, Symptoms such as nausea, vomiting, fever, and general malaise.
3. Food poisoning: It is an acute toxic disease caused by eating food contaminated with bacteria and its toxins, or eating uncooked lentils. Deteriorating foods and polluted water sources are the main sources of infection. Unclean hands, tableware and infected flies are the main routes of transmission. Patients may have acute gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain, and fever.
4, like to eat cold food, often drink ice beer, the result can lead to gastrointestinal disorders, intestinal peristalsis accelerated, causing diarrhea.
5, indigestion, eating irregular, eating too much, eating food that is not easy to digest, or food due to lack of gastric motility caused by food in the stomach, causing abdominal distension, diarrhea, nausea, vomiting, acid reflux, heartburn, suffocation (snoring), etc. symptom.
6, catching the cold: summer is hot, people like to stay in the air-conditioned room or sleep with air conditioning, the abdomen is easy to get cold, resulting in faster bowel movements leading to diarrhea.
Chronic diarrhea
The duration of chronic diarrhea is more than 2 months, and the cause is more complicated than acute, so diagnosis and treatment are sometimes difficult.
1, intestinal infectious diseases: 1 chronic amoebic dysentery; 2 chronic bacterial diseases; 3 intestinal tuberculosis; 4 pear-shaped flagellate, schistosomiasis; 5 intestinal candidiasis.
2, intestinal non-infectious inflammation: 1 inflammatory bowel disease (clonal disease and ulcerative colitis); 2 radiation enteritis; 3 ischemic colitis; 4 diverticulitis; 5 uremic enteritis.
3, tumor: 1 colorectal cancer; 2 colon adenoma (polyps); 3 small intestinal malignant lymphoma; 4 amine precursor uptake decarboxyl cell tumor, gastrinoma, carcinoid, intestinal vasoactive intestinal peptide tumor.
4, small intestinal malabsorption: 1 primary small intestinal malabsorption; 2 secondary small intestinal malabsorption.
Examine
an examination
Related inspection
Abdominal plain film abdominal perspective
Physical examination:
The examination focuses on the abdomen, and the whole body examination cannot be ignored. In addition to body temperature, pulse, respiration, blood pressure, peripheral superficial lymph nodes with or without swelling, limbs, spine, nervous system examination, rectal examination, etc. have reference value.
Laboratory inspection:
Blood routine, urine routine feces, stool examination, immunoglobulin, serum complement assay, cellular immune function test, serum antibody assay, etc., x-ray fluoroscopy, plain film, tomography, angiography (, angiography) for abdominal abdominal diseases All are necessary to check.
Diagnosis
Differential diagnosis
The disease should be differentiated from the following diseases:
Pancreatic cholera syndrome:
Also known as water diarrhea with hypokalemia gastric juice deficiency (WDHA) syndrome or Verner-Morrison syndrome. Intrinsic is very rare, mostly caused by the release of VIP from vasoactive intestinal peptide tumor (VIPoma), pancreatic adenoma or small cell lung cancer. Diagnosis relies on clinical manifestations and assays, and there is currently no specific diagnostic method. Glucocorticoid therapy can improve symptoms and is often used as a transitional measure for surgical exploration.
Irritable bowel syndrome:
It is a clinically common intestinal functional disease. It is characterized by excessive enhancement of colonic motor function or abnormal peristaltic waves. Clinically, there are often symptoms such as diarrhea, constipation, and abdominal pain. The incidence is mostly related to mental factors. Diagnosis basis: 1 clinically have diarrhea, constipation, abdominal pain and other symptoms; 2 no signs of weight loss, fever or diarrhea; 3 no positive findings in stool examination; 4X line barium meal and colonoscopy without organic changes.
Fat :
It occurs in children who call it celiac disease, and in adults it is called idiopathic steatorrhea. The patient was thin, malnourished, diarrhea, and fat. The villus and microvilli of the jejunal mucosal epithelium were significantly atrophied and the mucosal surface was flat. The mucosal lamina propria is chronically inflammatory, with lymphocytes, plasma cells, and sometimes eosinophil infiltration. If the patient's diet does not contain gluten-based foods, the above intestinal mucosal lesions can be recovered.
Gastroenteritis:
Gastroenteritis caused by intestinal bacteria such as Escherichia coli can cause diarrhea as a symptom of watery mucus and no pus and blood, and the symptoms vary.
(1) Light type: generally does not produce fever, with loss of appetite and diarrhea as the main performance. Every day, stools vary from 3 to 6 times. They are often yellow or green indigestion-like loose stools. Most of them are thin soups mixed with a small amount of foam, accompanied by abdominal distension, abdominal pain and nausea.
(2) Medium: There may be a low-heat health search. In addition to mild symptoms, there are frequent nausea, vomiting, diarrhea, frequent watery stools, mild dehydration and acidosis.
(3) Heavy: The body temperature is irregularly hot, 38 to 40 °C for several days, diarrhea 10 to 20 times a day, often yellow-green watery stool, mixed with a small amount of mucus, may have a scent or milk color or Rice soup-like, similar to cholera, mostly nausea and vomiting, infants often have convulsions. Acute renal failure can occur due to a large number of vomiting and diarrhea symptoms of dehydration and acidosis. About 30% of children with ETEG diarrhea in Bangladesh have moderate or severe dehydration. In adult cases, there are more severe dehydration, and often cannot be distinguished from cholera. If the treatment is not timely, infants and young children can die within a few days. EIEC diarrhea is similar to acute bacillary dysentery. The main symptoms of EHEC infection are bloody stools and severe abdominal pain. The diarrhea caused by EAEC is persistent (>14 days), with bloody stools and fever (38 °C) and vomiting.
Intestinal cramps:
When the colon is paralyzed, the intestinal propulsive peristalsis is weakened, causing constipation, accompanied by abdominal distension and frequent exhaustion. A small number of patients have frequent or intermittent diarrhea due to colonic dysfunction, which is very urgent. It occurs mostly before and after breakfast and dinner, and is rare at night. The feces are mushy and contain a lot of mucus. If the motor's motor function and secretion function are impaired, constipation and diarrhea alternate intermittently. In addition, patients often have symptoms of indigestion such as upper abdomen fullness, anorexia, nausea, and manifestations of autonomic imbalances such as heartbeat, shortness of breath, chest tightness, flushing, and sweating of hands and feet. Although symptoms such as abdominal pain and diarrhea seriously affect labor and life, patients generally do not have weight loss and dehydration.
In small babies, the onset of intestinal fistula is mainly characterized by persistent, difficult to appease crying. The main manifestations are crying and uneasiness, which may be accompanied by vomiting, cheek flushing, tumbling, and distortion of both lower extremities. When crying, the face is flushed, the abdomen is inflated and tense, and the legs are lifted up. The attack can be terminated by the child's exhaust or defecation. In small babies, it can be repeated and self-limited.
