Diarrhea is a dilution of (a chair can take mushy or watery character) and more frequent (more than 3 times a day) chair, accompanied by the release of more than 200 g of stool consistency modified daily.
in duration diarrhea can be severe, ongoing 7-10 days, prolonged - from 2 to 11 weeks, and chronic - 3 months or more.
mechanisms of diarrhea
1. Osmotic diarrhea is caused by malabsorption of nutrients in the gut.Nevsosavsheysya components increase oncotic pressure in the intestine, which leads to an increased flow of water into its lumen and increased fecal volume.The main causes leading to violation of nutrient digestion and absorption in the intestine, are defect cavity enzymes (peptidases), violation of the exocrine function of the pancreas, intestinal dysbiosis, cholestasis and violation of bile acid metabolism, pathology of intestinal mucosa (celiac disease, lactase or saharaznaya failure,exudative enteropathy, Crohn's disease, etc.).
2. Secretory diarrhea is caused by an excess allocatio
3. Exudative diarrhea occurs due to inflammation of the intestinal wall of the process, the outcome of which is necrosis and exfoliation of the mucous membrane of the colon.It disrupted the mucosa and intestinal lumen receives an excess amount of ions and water.As a rule, the development of exudative diarrhea causes bacterial intestinal infections - salmonellosis, shigellosis, yersiniosis, campylobacteriosis and some other, less common chronic bowel disease - idiopathic colitis, Crohn's disease, ulcerative colitis and some other intestinal ischemia.
4. Pathology of intestinal peristalsis leads to disruption of the promotion of food mass through the intestines, resulting in the emergence of unstable stool (episodes of diarrhea alternating with constipation).Lead to the development of disorders of peristalsis are chronic diseases such as diabetes mellitus, adrenal insufficiency, diffuse connective tissue disease, hyperthyroidism, parasitic infestation, neurological diseases such as Parkinson's disease, toxic diarrhea (in uremia, poisoning by mercury, arsenic) and even irritableintestine.
5. Reduction suction surface leads to a more rapid advancement of food through the intestine, and consequently to insufficient absorption of water and nutrients in the gut.Typically, reduction occurs at the suction surfaces of surgeries result - namely, extensive resection of the intestine.
6. The cause of diarrhea can be harsh nutritional disorders - "dietary overload" (the use of excessively fatty, spicy, fried foods, condiments, spices, a large amount of coarse fiber fiber), as well as nervous shock, anxiety, fear.
7. Drug diarrhea can result from long-term use of certain medications.Diarrhea can cause antibiotics, anticancer drugs, some antiarrhythmic agents (quinidine, procainamide), beta-blockers, ACE inhibitors, antidepressants (lithium preparations), tranquilizers, anticonvulsants, drugs that reduce blood cholesterol levels (lovastatin, clofibrate), antacids,H2-histamine blockers and others.
Acute diarrhea, frequent excretion of watery diarrhea is not a disease, but rather a sign of underlying disease.When food passes through the digestive system, the water is absorbed through the colon wall.Diarrhea and dehydration occurs when fluid is not absorbed but remains in the intestine and excreted with feces.Though the diarrhea usually resolves without treatment within two or three days, any dehydration caused by it is a serious problem (especially among infants and the elderly) and in need of rapid treatment.
• Food poisoning due to various reasons, including viruses or bacteria.
• Viral infection of non-food origin.
• The response to certain foods (such as citrus fruit, or beans).
• A large number of artificial sweeteners, such as sorbitol, mannitol and xylitol, which are found in foods, chewing gum and other products.
• Alcoholic beverages.
• Some medicines, including drugs for high blood pressure, for the treatment of heart disease, certain antibiotics.
• Infectious diseases such as diarrhea, occurring in travelers, typhoid fever, amoebiasis and bacillary dysentery (shigellosis).
• Emotional stress and anxiety.
• Watery stools.
• Increased bowel frequency.
• Cramping and abdominal pain.
• Signs of dehydration in young children: drowsiness;indifference;stretched skin;glazed eyes;dry, sticky mouth and tongue;constant crying.
Clinical manifestations of diseases caused by diarrhea are varied, but there are fundamental differences of infectious diarrhea of non-infectious.If the cause of diarrhea is an intestinal infection, is frequent bowel movement will be accompanied by fever, intoxication, severe dehydration, nausea, vomiting, and often the appearance of blood and mucus in the stool.
fluid losses and electrolytes (sodium and potassium chloride) is accompanied by the emergence of dizziness, severe dryness of mucous membranes, severe thirst.Severe dehydration can lead to a violation of orientation in time and space, coma and even death.
non-infectious diarrhea is accompanied by a normal condition and state of health of the patient, and only with prolonged duration can lead to weakness, weight loss and dehydration as a result of the loss of excessive amounts nevsosavsheysya water and nutrients.
However, almost always accompanied by discomfort or diarrhea, cramping abdominal pain, feeling of rumbling, flatulence, abdominal tenderness to palpation.
• Diarrhea easily identified by characteristic features.
• Laboratory analysis of stool can be carried out at constant diarrhea.
• Colonoscopy with biopsy of the rectum can help diagnose diarrhea, caused by viruses, bacteria or inflammation.
• Prevent dehydration (which is especially important for the elderly and young children), which should drink a solution of one teaspoon of salt and four teaspoons of sugar in one liter of water.Measure accurately, as too much salt can enhance dehydration.Drink 0.5 liters of solution, while continuing diarrhea.
• Do not take medications for diarrhea in the first few hours (diarrhea can rid your body of the carriers of infection or irritants).If work or other commitments require the use of drugs against diarrhea, use one that contains loperamide (eg Imodium) or bismuth subsalicylate (Pepto-Bismol).
• Reduce the intake of (or avoid), dairy products, alcohol and foods rich in dietary fiber, for recovery.What kind of folk remedies can be applied in this illness, see here.
• For young children: while diarrhea persists, do not feed them milk.Instead, give them an electrolyte solution, which is available over the counter.If the diarrhea lasts for two days, start to give milk gradually over a period of 24 hours.
diarrhea Treatment consists of symptomatic treatment, aimed at improving the general condition of the patient, and the etiological treatment aimed at eliminating the causes that led to diarrhea.
1. To eliminate the dehydration caused by the loss of fluid from the stool, apply salt solutions for oral administration: Trisol, laktasol, rehydron, yelling and other at the rate of 40-50 ml / kg body weight for 4 hours or up to 150 ml /kg of body weight per day.The volume of fluid received by adults, should be at least 3.2 liters per day.
In severe dehydration fluid intravenously, to this end, apply saline reambirin, gemodez, reopoligljukin and other solutions.Rehydration therapy to prevent severe consequences caused by dehydration.
2. In acute diarrhea is necessary to observe a light diet.Excluded from the diet fatty, fried and spicy foods, and foods that increase bowel motility.In the first 2-3 days of illness it is recommended to eat homemade biscuits from the dried white bread in the oven, with the gradual expansion of the diet: cooked cereal, mashed potatoes, vegetable soups, boiled beef.
3. In the treatment of acute infectious diarrhea antidiarrheal drugs are used: Imodium - administered in a dose of 4 mg (2 capsules) once, and then - to 2 mg after each act of defecation.The maximum dose for oral administration to an adult should not exceed 8-16 mg per day.Children older than 2 years of drug is given at the rate of 5 ml (1 capful) per 10 kg of body weight 2-3 times a day.
4. If the cause of diarrhea is an infection, for the destruction of harmful bacteria that caused it, applied antimicrobials:
• drugs nitrofuran series:
- Furazolin - acts on staphylococci, streptococci, pneumococci.Children under 1 year of drug is given 10-15 mg on reception, from 1 year to 2 years - 20 mg, from 2 to 5 years - 30 and 40 mg, from 5 to 15 years and adults - 50 mg 3-4 times a day;
- furadonin - acts on staphylococci, streptococci, pneumococci, E. coli, Proteus.The tool is available in tablets of 50 and 100 mg.Babies assigned based medicine 5-8 mg / kg per day for adults - 50-100 mg, 3-4 times a day;
- furagin - acts on staphylococci, streptococci, pneumococci, Shigella, klebsiely, Enterobacteriaceae, Salmonella.The drug is available in tablets of 50 mg.The drug is taken orally for 1-4 tablets 3 times a day after meals;
- Enterofuril - is available in a suspension and capsules of 100 mg.Children aged 2 to 6 months of 2.5 ml applied three times a day to 2 years of age - 2.5 ml 4 times a day, over 2 years - 5 ml 2-3 times a day, or 2 capsules, adults- 3-4 3-4 capsules twice a day;
- furazolidone - available in tablets of 50 mg, a single dose is calculated by 0.15 mg / kg per day, 4-6 times a day;
- intetriks - is available in capsules, an average single dose for children is 1/2 capsule, adults take 1 capsule in the reception drug is given 3 times a day, orally;
- nifuroxazide - takes the form of suspensions in vials and tablets.Babies 2-6 months prescribed by 2.5 ml 2 times a day, from 6 months to 6 years old - 5 ml
3 times a day, every 8 hours for children older than 6 years - 5 ml 4 times a day to dayevery 6 hours or 2 tablets four times a day;
• antimicrobial agents from the group of fluoroquinolones:
- norfloxacin - used in children older than 15 years.Assign inside for 1 hour before meals for 200 to 400 mg 2-3 times a day.The drug is available in tablets of 200, 400 and 800 mg;
- ciprofloxacin - available in the form of tablets of 250, 500 and 750 mg, and in solution for intravenous administration of 50 and 100 ml (100 and 200 mg, respectively).The drug is given at 125-500 mg 2 times a day;
- ofloxacin - available in the form of 200 mg tablets and solutions for intravenous administration of 100 ml (200 mg);
- gentamicin - administered intramuscularly or intravenously, newborns and children up to 2 years at the rate of 2-5 mg / kg per day in two administrations, children older than 2 years - 3-5 mg / kgday.The drug is available in bottles of 80 mg injections in ampoules of 1 and 2 ml;
- tobramycin - intramuscular or intravenous drug prescribed by 4-7.5 mg / kg per day in 2-4 reception.Means available in solutions for injections in ampoules of 1 ml and 2, as well as powder in vials of 40 mg and 80 mg;
- amikacin - agent is administered intravenously or intramuscularly in the first day at 10 mg / kg followed by 7.5 mg / kg per day in 1-2 reception.The drug is released into the powder vials for injection of 100, 250, and 500 mg capsules with a solution of 2 mL and 4;
- netromycin - agent administered intramuscularly or intravenously in premature and newborn infants under 7 days at 6 mg / kg per day in two administrations, newborns older than 7 days - by 7.5-9 mg / kg per day in two administrations, older children2 years - 6-7.5 mg / kg per day in two administrations, but is allowed a single administration of the agent;
• rarely used drugs tetracycline and chloramphenicol:
- teratsiklin - children over 8 years of drug is given at the rate of 20-25 mg / kg per day in 2-4 reception.The drug is released in the form of tablets of 50, 100 and 250 mg, and in the form of capsules, 250 mg;
- doxycycline - Children from 8 to 12 years is appointed agent at a dose of 4 mg / kg per day, over 12 years - 200 mg per day in 1-2 reception.The drug is available in the form of capsules, 50, 100 and 200 mg tablets of 100 and 200 mg, and in ampoules and vials for intramuscular injections;
- chloramphenicol - children under 3 years of drug is given at the rate of 10-15 mg / kg, from 3 to 8 years - 150-200 mg, older than 8 years - 200-300 mg 3-4 times a day.It means produced in the form of tablets of 250 and 500 mg capsules, 100, 250 and 500 mg.
5. If the cause of diarrhea is an overgrowth, then to destroy harmful bacteria used bacteriophages.By bacteriophages include:
• Intest liquid-bacteriophage - is available in bottles of 50 and 100 ml.The drug is used 3 times a day 1 hour before meals in a single dose in children up to 1 year to 5 ml, 1 to 3 years - 10 ml, over 3 years - 15 ml.One receiving the drug inside can be replaced by rectal introduction of children under 1 year - 10 ml, 1 to 3 years - 20 ml, over 3 years - 30 ml.Duration of treatment is 7-10 days.For younger children it is recommended to breed bacteriophage boiled water;
• staphylococcal bacteriophage - is available in ampoule 2 and 10 ml, in vials of 20, 50 and 100 ml, as well as pills, suppositories.The tool is used inside, 3 times a day 1 hour before meal for 7-10 days, children under the age of 6 months to 10 ml or U2 candles from 6 months to 1 year - 20 ml or U, candles, 1up to 3 years - 30 ml or 1 candle, over 3 years at 40-60 ml or 1 candle.Tonight the drug can be carried out rectally;
• piobakteriofag, strep and proteus bacteriophage - is available in 10 ml ampoules and in bottles of 20, 50 and 100 ml.Children under the age of 6 months - 10 ml or 1/2 candles from 6 months to 1 year - 20 ml or 1 / 2svechi, from 1 to 3 years - 30 ml or 1 candle, over 3 years - 40-60 ml of 1 suppository or 3 times a day.The third method can be carried out rectally;
• koliproteyny bacteriophage and bacteriophage Pseudomonas aerogenoza - takes the form of bottles of 20 and 100 ml.Is assigned as well as streptococcal bacteriophage.
After treatment bacteriophage appointed probiotics course of 1-2 months.
6. For removal of harmful substances, which produce pathogenic bacteria and also for faster securing chairs used sorbents:
• activated charcoal - is available in tablets of 250 and 500 mg.Means taken orally 1-3 tablets 3-4 times a day;
• polisorb - drug is given at the rate of 100-200 mg / kg per day in 3-4 divided doses.On average, for children weighing 10 to 15 kg, a daily dosage of 1-3 g, 20-25 kg - 2.5 g, 30-40 kg - 3.8 g, more than 50 kg - 5.12 g MediumIt is available in a powder for suspension for oral administration;
• laktofiltrum - available in tablets of 500 mg.The tool is assigned to 1-3 tablets 1-3 times a day;
• smectite - children under the age of 1 year, appoint 1 sachet per day, from 1 to 2 years - 1-2 sachets per day, or over 2 years - 2-3 sachets per day.The drug is available as a powder for suspension for the reception inside the bags containing 3 g of dry matter.Along with the influence of sorption smectite binds viruses, bacteria and bacterial toxins;