Diarrhea


First, the definition of
Stool hardness decrease (increase in water content) can be called diarrhea, generally will be accompanied by increased frequency of bowel movements and the total excretion is more than the normal average volume (about 200 g / day).

Second, and pathophysiology
Mainly via four kinds of diarrhea pathogenesis:

(A) the permeability of diarrhea (Osmotic diarrhea)
When the small intestine can not absorb too much solute, the osmotic pressure will cause the intestine of the osmotic pressure than plasma, resulting in water moving into the intestine and cause diarrhea, common reasons include: drugs (such as lactulose, magnesium                               oxide), pancreatic insufficiency, bacteria overgrowth, short                               bowel syndrome and so on. The average patient fasting, diarrhea will stop, you can diagnose this as a reference, can also be detected using permeable material contained within the stool osmotic pressure gradient to the diagnosis.

(B) of the secretory diarrhea (Secretroy diarrhea)
Some foreign substances (such as bacterial toxins, certain drugs) or intrinsic body substances (such as some hormones, bile salts, etc.) can stimulate the secretion of intestinal active diarrhea caused by water and ions, this time a large number of patients with watery diarrhea often unless it is absorbed by the bile acid or fatty acids caused by bad, or caused by oral administration of a drug, even if fasting will not stop diarrhea, and stool normally does not contain pus or blood, common reasons include: endocrine                               tumors (such as carcinoid tumor), villous adenoma of rectum, resection                               of terminal ileum and so on.

(C) of the exudative diarrhea (Exudative diarrhea)
The intestinal mucosa and submucosal tissue inflammation, it will produce liquid exudate causes diarrhea, often accompanied by intestinal material to absorb the bad, and some substances stimulate the intestinal wall and other phenomena, permeability and secretion of pathogenesis of the two also play a role at this time. Clinically, patients often suffer from abdominal pain, symptoms such as fever or bloody stool, stool examination can be found in red blood cells and white blood cells, common causes include: infections (eg salmonellosis), ulcerative                               colitis, Crohn’s disease, radiation enterocolitis and so on.

(D) motility disorders diarrhea (Deranged motility)
General increase in activity caused by the intestinal tract, the clinical, often alternating diarrhea and constipation phenomenon may also be accompanied by other neurological symptoms (such as bladder dysfunction). Common causes of irritable                               bowel syndrome, neurologic disease and so on. Can lead to slow intestinal motility intestinal bacterial growth, affect the normal absorption and cause diarrhea, so in this case the permeability is also associated with the pathogenesis of diarrhea.

Third, the differential diagnosis
Hyperdefecation: Only increased stool frequency, stool volume did not increase, the hardness is not reduced.
Fecal incontinence
Factitious diarrhea: patient self-diarrhea caused by laxative abuse

Fourth, acute diarrhea and chronic diarrhea
(A) of acute diarrhea:
Means the occurrence of less than 2 to 3 weeks who caused the reason to the most common infectious enteritis. Other causes include drugs, toxins such as chronic diarrhea may also be early.

(B) Chronic diarrhea:
Refers to the continuation of diarrhea more than 2 to 3 weeks, whilst the irritable bowel syndrome is the most common cause of chronic diarrhea may also be some of the major clinical manifestations Yanzhongjibing, so such patients should be further evaluated for their cause.

V. Diagnosis
(A) history
Shall include diarrhea onset time, frequency, stool hardness, volume, color, and diet of the relationship. Also ask whether the systemic disease, travel experiences, drug use and sexual situations.

(B) physical examination
First, note that the patient systemic conditions, dehydration situation, with or without fever, or other toxic characterization, and then observe whether the anemia, skin lesions, or goiter and so on. Note abdominal examination, abdominal tone changes have abdominal distension, tenderness, lumps or swelling of any organ. Check anal perineum, the attention for lumps, bowel obstruction or sphincter relaxation and so on.

(C) the diagnostic tests
Check the object:
1. Acute diarrhea is usually self-limiting, symptoms can be treated, without further examination. However, the following circumstances include: high fever,                               systemic toxicity, bloody diarrhea, dehydration,                               recent overseas travel, outbreak of food poisoning,                               immunocompromise, male homosexuality, recent antibiotic                               use, diagnostic tests should be done.
2. Chronic diarrhea patients from the medical history and physical examination can not determine the cause, should undergo further examination.

Check items:
1. Blood and biochemical tests, including hemoglobin, white blood cell number and classification and electrolyte concentration.
2. Stool examination should be used fresh feces include: occult blood, white blood cells, parasites, bacterial culture, lipids and so on.
3. Duodenal extracts (such as Giadia diagnosis.)
4. Endoscopy (sigmoidoscopy, colonoscopy).
5. Radiography.

Six treatment
Diarrhea patients usually do not require hospitalization, but if it is severe acute diarrhea, the patient may be due to water and electrolyte imbalance and death, requiring hospitalization for treatment. In addition, if the patient with abdominal pain or bleeding, they need to be hospitalized.                             In addition to patient hydration, electrolytes, nutrients and other supportive care, the basic cause to be treated for (Should the infection, she added with anti-microbial agents.) As mitigation for diarrhea used in their treatment, according to their mechanism of action can be divided into:
(A) of the adsorbent (Absorbents) – If kaopectate, aluminum hydroxide.
(B) of the anti-secretory agent (Antisecretory agents) – such as bismuth subsalicylate.
(C) of the opium derivative agent (Opiate derivatives) – such as opium tincture, diphenoxylate                             with atropine, loperamide.
(D) anti-cholinergic agents (Anticholinergic agents) – such as dicyclomine.

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