Diarrheal syndrome symptoms. diarrhea syndrome

Diarrheal syndrome (diarrhea) - frequent loose stools with increased intestinal peristalsis and changes in its characteristics. The basis of diarrhea is an accelerated passage of contents through the intestines, a slowdown in the absorption of fluid, as well as increased mucus formation.
To frequent stool in a healthy newborn baby can lead to:
- gross violations of the diet of a nursing mother;
- starvation of the child (hypogalactia, flat nipples, tight breasts);
- overheating;
- overfeeding;
- care defects;
- intestinal dysbiosis.
feature clinical picture yavl. the fact that the general condition of the child does not suffer, and after the elimination of the adverse factor, digestion and stool almost always normalize.
Diarrheal syndrome in the newborn not always yavl. specific for gastrointestinal diseases. The main causes may be intestinal infections, a number of somatic diseases, metabolic, toxic, hormonal and other factors that lead to inflammatory response from the gastrointestinal tract.

Acute diarrheal syndrome can occur secondarily in various non-gastrointestinal infectious and inflammatory diseases. These diseases most often include:
- otitis;
- pneumonia;
- pyelonephritis;
- purulent-inflammatory diseases, including sepsis.
Possible and prolonged diarrhea - characterized by a persistently pronounced change in the consistency and volume of the stool, a violation of its composition and frequency, lasting more than 3 weeks. Prolonged diarrhea should also include conditions in which periodically appear intestinal disorders. Their peculiarity is that they tend to heal within 3-4 weeks. Degree of expressiveness - various.
Most often, prolonged diarrhea is associated with non-infectious factors:
- malabsorption;
- maldigestion;
- hereditary metabolic disorders;
- primary immunodeficiencies(Di-George syndrome, Wiskott-Aldrich syndrome);
disease endocrine system(adrenogenital syndrome, salt-losing form).
Malabsorption - hereditary pathology associated with impaired intestinal absorption of individual or several components of food (proteins, fats, carbohydrates, and electrolytes) while maintaining their enzymatic cleavage. In the neonatal period, it occurs with:
intestinal form of cystic fibrosis; intolerance to cow's milk proteins (allergy to cow's milk, lactic enteropathy, allergic enteritis).

TICKET 10

1)Hyper and hypovitaminosis D

Vitamin D- group biologically active substances. Vitamin D 3 is synthesized under the influence of ultraviolet rays in the skin and enters the human body with food. Vitamin D 2 can only come from food.

Hypovitaminosis: rickets develops. Avitaminosis D reduces the process of calcium absorption and its release from the bones, which causes stimulation of the synthesis of parathyroid hormone by the parathyroid glands. Secondary hyperparathyroidism occurs and develops, which contributes to the leaching of calcium from the bones and the excretion of phosphate in the urine.

Manifestations of rickets in children:

1. There is a slow process of teething, closing of the fontanel.

2. Soften flat bones skulls with flattened occiput; in the region of the parietal and frontal tubercles, layers are formed ("square head", "Socrates' forehead").

3.Deformed facial skull(saddle nose, high gothic sky).

4.Distorted lower limbs, the pelvis may be deformed ("flat pelvis").

5.Shape changes chest("chicken breast").

6. Sleep disorders, sweating, irritability are observed.

Hypervitaminosis: an increase in the calcium content in the blood, calcium is transferred from bone tissue to other organs and tissues, disrupting their functions. Its deposits are observed in the arteries, heart, liver, kidneys and lungs. The exchange is disturbed, the fragility of the skeleton increases.

2)Acute rheumatic fever in children. Modern Concepts etiopathogenesis. Diagnostics. Therapy. Prevention.

ORL - This systemic disease connective tissue with a predominant localization of lesions in cardiovascular system(carditis, valvular heart disease), the development of articular (arthritis), skin (rheumatic nodules, annular erythema) and neurological (chorea) syndromes.

Etiology: group A β-hemolytic streptococcus

Clinical diagnostic criteria for ARF:

I. Large (rheumatic clinical pentad):

1) rheumatic heart disease (mainly endomyocarditis);

2) polyarthritis (mainly large joints, migratory character, without residual deformities, radiologically negative);

3) minor chorea (hypotonic-hyperkinetic syndrome due to damage to the striatum of the subcortex of the brain);

4) rheumatic nodules (periarticular subcutaneous nodular seals);

5) annular erythema (annular redness of the skin of the trunk and proximal departments limbs).

1) clinical: fever, arthralgia;

2) laboratory and instrumental: a) laboratory (SRP, SC, DFA, SM, ASLO, ASGN); b) instrumental (an increase in the PQ interval on the ECG)

Therapy: penicillins and NSAIDs; extencillin 2.4 million units once every 3 weeks.

Depending on the etiology of diarrhea, drugs from various pharmacotherapeutic groups are used to treat it:

Infectious diarrhea is treated with antibiotics such as ampicillin, gentamicin, neomycin, erythromycin, chloramphenicol, polymyxin, etc.

Sulfonamides, derivatives of nitrofurans and oxyquinolones are widely used.

Antimicrobial intestinal drugs:

1. Rifaximin (Normax) has a broad spectrum antibacterial action. It is used for acute and chronic intestinal infections with diarrheal syndrome. Method of application - inside at 10-15 mg / kg of body weight;
2. phenyl salicylate, phthalylsulfapyridazine - anti-inflammatory, antimicrobial action with diarrheal syndrome. Method of application - inside of 0.25-0.5 g 3 times a day;
3. bactisubtil is used as aid for the treatment of infectious diarrhea. It prevents the violation of the synthesis of vitamins B and P in the intestine, improves the flow of vitamins E into the blood. It normalizes the pH of the environment, prevents excessive gas formation, stimulates reparative processes in the intestine. Normalizes the microflora and restores the intestinal biocenosis. It has an immunomodulatory effect, stimulates cellular immunity, is an antioxidant. Method of application - 1 drop 3-6 times a day 1 hour before meals;
4. intetrix - incompatible with drugs containing hydroxyquinolines. Method of application - inside 4-6 capsules per day.

In the treatment of diarrheal syndrome, adsorbents are widely used:

1. Activated carbon- inside 1-3 tablets or in the form of an aqueous suspension. Water suspension is used in 20-30 g per reception;
2. attapulgite has both adsorbent and antidiarrheal effects, forming a thin film on the mucous membrane. It is taken orally at an initial dose of 4 tablets, then 2 tablets after each bowel movement;
3. Polysorb has an adsorbing, detoxifying, antimicrobial and adaptogenic effect. It is taken orally as an aqueous suspension 1 hour before meals at a dose of 2-3 g 3 times a day. In severe diarrheal syndrome, the dose may be increased to 4-6 g;
4. tannacomp is used for non-specific diarrhea due to astringent, antimicrobial, antidiarrheal action. Method of application - inside 1-2 tablets 4 times a day, for the prevention of diarrhea - 1 tablet 2 times a day;
5. smecta is an antidiarrheal agent due to its enveloping and adsorbing action. It is taken orally 1 sachet, which is diluted in 1/2 glass of water, 3-4 times a day;
6. hilak-forte normalizes the activity of the gastrointestinal intestinal tract in case of diarrhea, restores the intestinal microflora. It is taken orally before or during a meal with a small amount of liquid, 40-60 drops 3 times a day;
7. loperamide is taken orally 4 mg with a small amount of water. Daily dose - no more than 16 mg;
8. ftalazol is taken orally 1 tablet after meals.

With diarrhea associated with functional disorders of the intestinal tract, drugs are taken that regulate this activity:

1. imodium - antidiarrheal drug, which lowers the tone and motility of the smooth muscles of the intestine, increases the tone of the sphincters. It is used in diarrheal syndrome to reduce the amount and volume, as well as increase the density of the stool. Method of application - inside 2 capsules, and then 1 capsule after each liquid stool, in case of chronic diarrhea, the dose is corrected until the stool is established 1-2 times a day. No more than 6 capsules per day;
2. lopedium - antidiarrheal action is provided by the excitation of opiate receptors in the intestine. It is taken orally at first 4 mg, and then 2 mg after each episode of diarrhea;

To normalize the microflora in the case of diarrheal syndrome, the following drugs are used:

1. linex normalizes the physiological balance of the intestinal flora. Take orally 2 capsules 3 times a day with a little water;
2. flonivin BS normalizes the intestinal microflora. Take orally 4-6 capsules per day between meals;
3. Bifidumbacterin is used in violation of the intestinal biocenosis. Method of application - inside 5 doses 2-3 times a day (the contents of the vial are dissolved in 5 tsp of water);
4. bifikol - inside (1 dose is dissolved in 1 teaspoon of water) 20-30 minutes before meals;
5. colibacterin dry - inside, 1 dose dissolves in 1 tsp. Take 6-12 doses depending on the severity of dysbacteriosis;
6. acylact in suppositories - 1 suppository is applied 2 times a day;
7. to normalize the intestinal microflora, the biomass of acidophilic lactobacilli "Narine" is widely used. Method of application - inside (the contents of 1 bottle are added to a thermos with 0.5 l of boiled milk at a temperature of 40 ° C, kept at a temperature of 38 ° C for 12-18 hours in a tightly closed thermos until a homogeneous viscous ferment is formed, which is stored in the refrigerator, 2 tbsp leaven is added to 1 liter of milk, prepared as described above for leaven, and incubated for 8-12 hours). Take 1/2-3/4 cup 3 times a day 30-40 minutes before meals for 15-30 days;
8. bifiform - take 2 capsules per day.

In the treatment of diarrheal syndrome, it is important to carry out hydrating treatment, restore water-electrolyte and acid-base balance.

For these purposes, they carry out early stages diarrhea syndrome oral rehydration with:

1. rehydron: the contents of the sachet are dissolved in 1 liter of cold boiled water and taken after each loose stool, 30 ml / kg of body weight for 6-10 hours;
2. citraglucosolan (method of application, see above).

With diarrheal syndrome, drugs that improve digestion processes are also used, as a means replacement therapy with insufficient secretion of the intestinal glands, which has developed as a result of diarrhea.

This is enzyme preparations:

1. pancreatin - taken 1-2 tablets with meals 3-4 times a day;
2. panzinorm - inside during meals, 1-2 tablets;
3. mezim-forte - inside, before meals, without chewing, with plenty of water (if possible alkaline), 1-2 tablets. The dose is set individually depending on the severity of digestive disorders;
4. festal - inside 1-2 tablets 3-4 times a day with meals or immediately after meals;
5. somilase - inside during meals, 1-2 tablets 3 times a day;
6. digestal - inside, without chewing, 1-2 tablets during or immediately after a meal, washed down with a small amount of water;
7. enzistal - inside during or immediately after meals, 1-2 tablets 3 times a day.

In diarrheal syndrome, drugs are also used that remove wide range toxins, neutralize pathogenic bacteria and their decay products, suppress putrefactive processes in the intestines, have a beneficial effect on mucous membranes:

1. Filtrum - gives an effect even in small doses - 2-3 tablets per day;
2. lactofiltrum - normalizes the microbial landscape of the intestine, helps to reduce the content of histamine and better absorption of vitamins, micro- and macroelements, normalizes metabolic processes in the intestine. Well eliminates the clinical manifestations of diarrheal syndrome and dysbiosis (abdominal pain, rumbling, flatulence). Method of application - 0.5-2 tablets 3-4 times a day, depending on age and body weight.

in diarrheal syndrome caused by allergic component, bactisubtil, bifiform, linex, pregestimil, as well as desensitizing agents (calcium preparations, suprastin, claritin, diazolin, peritol, etc.) are used.

About pathogenic features, clinical manifestations and principles of pharmacotherapy of diarrheal syndrome tells Assoc. Department of Propaedeutics of Internal Diseases with a course of gastroenterology, Moscow State Medical University, Ph.D. honey. Sciences Irina Nikolaevna NIKUSHKINA.

Currently, diarrheal syndrome is understood to mean a complex various symptoms associated with a violation of the process of bowel movement, characterized by an increase in the frequency of stools (more than 3 times a day) with the release of liquid stool and more of them. Distinguish between acute and chronic diarrhea. The duration of acute diarrhea is 2-3 weeks. The diagnosis of chronic diarrhea syndrome is made with a prolonged course (more than 30 days) or with a history of episodes of recurrent diarrhea. Pathogenetically, this syndrome (as well as the syndrome of acute diarrhea) occurs as a result of indigestion, absorption, secretion and is associated mainly with a violation of the transport of water and electrolytes in the gastrointestinal tract.

There are four mechanisms in the pathogenesis of diarrhea: intestinal hypersecretion; increased osmotic pressure in the intestinal cavity; violation of the transit of intestinal contents; intestinal hyperexudation.

Certain mechanisms of the pathogenesis of diarrhea are a response to the influence of various etiological factors.

Intestinal hypersecretion is the most general mechanism diarrhea caused by a violation of electrolyte transport in the intestine, which is characterized by an increase in the content of water and sodium in the intestinal lumen. These processes are triggered and regulated by neuroendocrine mediators, bile acids, hormones released in the body or locally in the intestine. Bacterial exotoxins and viruses play a significant role in their occurrence. Secretory diarrhea is characterized by the fact that the osmolarity of the feces corresponds to the osmolarity of the blood plasma, and fasting (up to 72 hours) does not lead to its termination.

A typical example of this type of diarrhea is cholera. Hypersecretory diarrhea is observed with salmonellosis, terminal ileitis, dysfunction of the sphincter of Oddi (postcholecystectomy syndrome).

Characteristic signs of secretory diarrhea: polyfecalia (copious liquid watery stools), greenish color of feces, steatorrhea (due to fatty acids with a long carbon chain), large losses of sodium, potassium, chlorine with feces, metabolic acidosis, high pH of feces.

Hyperosmolar diarrhea is caused by an increase in the osmotic pressure of the chyme, which leads to water retention in the intestinal lumen. The causes of this type of diarrhea can be: increased intake of osmotically active substances into the intestine (salt laxatives, sorbitol, some antacids, etc.); violation of digestion and absorption of carbohydrates (most often lactase deficiency); malabsorption syndrome.

Accumulation of unabsorbed osmotically active particles in the intestinal lumen, disruption of the digestive transport conveyor - all this leads to an increase in the osmolarity of chyme and feces. Since the mucous membrane small intestine freely permeable to water and electrolytes, an osmotic balance is established between the contents of the small intestine and plasma. A similar mechanism of diarrhea is observed when taking laxatives, some antacids, and is also characteristic of patients with organic lesions of the small intestine (gluten enteropathy, lactase deficiency, Whipple's disease, etc.), pancreatic diseases ( chronic pancreatitis, tumors, cystic fibrosis), liver diseases, accompanied by impaired excretion of bile acids. This type of diarrhea is characterized by loose stools, polyfecal matter, high osmolarity of chyme and feces, an increase in the fecal concentration of short-chain fatty acids and lactic acid, slight losses of electrolytes with feces, and low fecal pH.

At the heart of hyper- and hypokinetic diarrhea are violations of the transit of intestinal contents (increase or decrease motor function intestines).

Its characteristic feature is the weakening of retrograde motor activity, and stimulation of secretory processes in the intestine can play a certain role.

Often this species diarrhea develops with bacterial colonization of the small intestine, as well as with irritable bowel syndrome.

Acceleration of the transit of intestinal contents occurs as a result of hormonal and physiological stimulation of transit (serotonin, prostaglandins, secretin, pancreozymin, gastrin, motilin), neurogenic stimulation of transit, and an increase in intra-intestinal pressure.

Laxatives and some antacids. The osmotic pressure of feces in hyper- and hypokinetic diarrhea, as a rule, corresponds to the osmotic pressure of blood plasma.

An increase in the rate of transit through the intestines is most often characterized by liquid or mushy, not plentiful stools, sometimes with an admixture of mucus, mainly in the morning or after a meal. characteristic feature This form of diarrheal syndrome are cramping pains in the abdomen (like intestinal colic) before the stool, weakening after it. The severity of the pain syndrome is sometimes such that patients, in some cases, are forced to refuse food to prevent diarrhea that occurs in response to eating. Often, morning diarrhea after waking up, the so-called wake-up diarrhea, can also be observed.

Hyperexudative diarrhea often develops with inflammatory changes in the intestinal mucosa (nonspecific ulcerative colitis, Crohn's disease, intestinal tuberculosis, lymphoma, acute intestinal infections), as well as tumor and ischemic processes. In the pathogenesis of hyperexudative diarrhea in all the diseases considered, there is sweating into the intestinal lumen of plasma, blood, mucous secretions of intestinal cells and glands. It is characterized by frequent spotting, often mixed with mucus or with an admixture of pus; moderate volume or in the form of a "spit". There is an increase in the fecal concentration of sodium and chlorine, lactic acid, a decrease in potassium losses with feces, low level stool pH.

At the heart of any diarrhea are several mechanisms at the same time: an imbalance between the secretion and absorption of water and electrolytes, an increase in the osmolarity of intestinal contents, and an acceleration of transit. However, in various diseases, one of them is predominant.

It is generally accepted that diarrhea is most common in developing countries, but recent WHO studies have shown that diarrheal syndrome is no less relevant for economically developed countries, while in the structure of morbidity and in etiological factors there are certain differences in the absence of a difference in age.

In the treatment of any disease, preference is given to the selection of etiotropic therapy. To establish the etiological causes of diarrhea, a lot of time is required, which the doctor diagnosing diarrheal syndrome does not have.

In this regard, the treatment of any type of diarrhea includes a number of steps:

1. symptomatic treatment aimed at stopping the main manifestations of diarrheal syndrome (frequent and copious stools, pain syndrome, dehydration, intoxication);
2. selection of etiotropic therapy;
3. rehabilitative and preventive therapy.

Modern symptomatic therapy of acute diarrhea is based on the following principles:

the appointment of antibiotic therapy is carried out only after laboratory verification of the causative agent of the disease. In other cases, especially with the so-called traveler's diarrhea, the use antimicrobials not shown and may cause unwanted effect(the emergence of antibiotic-resistant strains of microorganisms, superinfection associated with eradication normal microflora antibacterial agents);

preferably the use of funds symptomatic therapy not absorbed in the intestines and not addictive;

Primarily, treatment should be aimed at preventing dehydration and associated arterial hypotension against the background of intoxication and compensation for fluid loss. In 85-95% of patients with acute intestinal infections accompanied by diarrhea, rehydration therapy is carried out by the oral route, only in 5-15% of patients with clinical signs severe dehydration is shown intravenous administration replacement solutions. For intravenous rehydration, isotonic polyionic crystalloid solutions are used: trisol, quartasol, acesol. Colloidal solutions (hemodez, reopoliglyukin, refortan) for detoxification are administered in cases of severe hypotension and only in the absence of signs of dehydration. For oral rehydration therapy, solutions recommended by WHO are used - rehydron, citroglucosalan, gastrolith. AT recent times recommend solutions of the II generation, which, in addition to salts, include amino acids, dipeptides, maltodextrin and cereals. On average, the amount of fluid drunk should be 1.5 times higher than its loss during urination and defecation.

The duration and severity of the diarrheal syndrome are reduced by taking absorbent drugs, which not only prevent the absorption of toxins, but also help to remove them from the intestines. So, with symptoms of intoxication, damage to the intestinal wall and flatulence, the means of choice primarily include sorbents, astringents and enveloping means. Bismuth subsalicylate (desmol) and diosmectite (smecta) most meet all the above requirements. These drugs have not only a pronounced adsorbing effect, but also membrane-stabilizing properties, they are protectors of the mucous membrane of the gastrointestinal tract, protecting it from exposure to bacterial and viral irritants. The adult dose is 2-3 sachets per day; children under 1 year old - 1 sachet per day, from 1 to 2 years old - 1-2 sachets, over 2 years old - 2-3 sachets. Among the adsorbents is the drug attapulgite (neointestopan), which is a natural mixture of aluminum and magnesium silicate hydrates, which is similar in composition to white clay. The advantage of the drug is not only that it adsorbs toxins, pathogenic bacteria and promotes their faster elimination, but also normalizes the bacterial landscape of the colon, prevents the development of dysbacteriosis and chronic diarrhea. When choosing therapy in patients with irritable bowel syndrome with diarrhea, the drug has significant advantages, because. has an anti-inflammatory effect, relieves irritation of the colon, reduces spastic activity, thereby stopping the pain syndrome. For adults, the drug is usually prescribed in the initial dose - 4 tablets, then 2 tablets. after each liquid stool, maximum dose- 14 tablets / day. Shown to children from 6 years. The drug is recommended in the initial dose - 2 tablets, then 1 table. after each liquid stool, the maximum dose is 7 tablets / day. Total duration taking the drug should not exceed 2 days. In addition to these drugs, it is possible to use drugs such as activated charcoal in the form of tablets or an aqueous suspension in daily dose 20-30 g in two or three doses; polyphepan in the form of a powder in a daily dose of 20-50 g in two or three doses; polysorb; tanacomb, etc.

Symptomatic treatment of diarrheal syndrome includes taking drugs that regulate intestinal tone and motility. Most often, drugs that bind to opiate or serotonin receptors are used for this purpose. When prescribing antidiarrheal agents, it should be remembered that their use in case of intoxication is not desirable, because. they do not contribute to the elimination of toxins, and the intoxication itself persists for a longer period. With absence high fever, signs of intoxication and dehydration, loperamide hydrochloride (imodium) 4 mg once, then 2 mg after each act of defecation, but not more than 8 mg per day, is widely used. Currently, the method of choice is the appointment of the lingual form of imodium, when taken (2 tablets per tongue), the effect is achieved already within the first hour, as well as a new dosage form Imodium Plus is a combination of loperamide hydrochloride and simethicone. The addition of simethicone, which adsorbs gases and removes them from the intestine, helps to eliminate flatulence and more quickly stop the diarrheal syndrome. The drug is also prescribed in a single dose of 2 tablets. at the reception and then 1 tab. after each act of defecation liquid stool. The daily dose is 4 tablets. It is recommended to select the dose of the drug individually in each case, because. abrupt slowing of stool can lead to intestinal obstruction. The drug is contraindicated in patients with nonspecific ulcerative and pseudomembranous colitis.

With intestinal hypermotility of a neurogenic nature (neurosis), sedatives are indicated. Well established for the treatment of such diarrhea bromazepam.

In order to weaken the motility of the gastrointestinal tract, calcium channel blockers (verapamil, etc.) can also be prescribed. It should be remembered that they are able to have a systemic effect on the body as a whole.

Somatostatin and its synthetic analogue, octreotide, have a pronounced antisecretory effect. The drugs are used for secretory and osmotic diarrhea. For carcinoid tumors with diarrheal syndrome, extensive distal resections accompanied by copious water stools, the purpose of this medicinal product is the therapy of choice.

Choice of anti bacterial preparations and the duration of treatment of diarrhea caused by intestinal infections, accompanied by fever, vomiting, stools mixed with blood or pus, is determined by the type of pathogen. So, for example, in shigellosis infection, preference is given to fluoroquinolones, alternative drugs are sulfonamides and nitrofuran derivatives. Macrolides have proven themselves in the treatment of diarrhea caused by Campylobacter infection. For antibacterial treatment, bacteriophages can be used, the appointment of which does not lead to the development of dysbacteriosis.

Of particular importance at all stages of therapy of patients with diarrheal syndrome is given to the correction of intestinal microbiocenosis, which is carried out with the help of probiotics. Recently, it has been established that early administration of high doses of bifidumbacterin forte is advisable (50 doses 3 times every 2 hours on the first day of admission, then, according to indications, maintenance intake of 30 doses per day for 6 days). The appointment of large doses of bacterial preparations provides a high local colonization of the intestinal mucosa and a pronounced antagonistic effect against pathogenic and opportunistic microorganisms. Currently, among probiotics prepared on the basis of microorganisms of the genus Bacillus, biosporin is the drug of choice. In addition to the pronounced antibacterial and antitoxic effects, the drug has an immunomodulatory effect, induces the synthesis of endogenous interferon, stimulates the activity of blood leukocytes, and the synthesis of immunoglobulins. Biosporin is prescribed 2 doses 2-3 times a day for 5-7 days. With the predominance of the enteric syndrome, enterol is recommended at a dose of 250 mg 2 times a day for 5 days. To stabilize the intestinal microbiocenosis and homeostatic processes, especially after a course of treatment antibacterial drugs, it is advisable to use drugs of obligate flora - bifidumbacterin forte, bifikol, linex, acylac, normoflor, etc. Drugs are prescribed in the usual dosage, for 1.5-2 months. The course ends with the appointment of probiotics (Hilak forte 30-60 drops 2-3 times a day for 1 month).

To improve digestion processes in diarrheal syndrome, enzymatic preparations with an enteric coating (creon, pancitrate) are prescribed in a daily dose (in terms of lipase content) from 30,000 to 150,000 units, in short courses for 2 weeks. However, in some diseases of the small intestine (gluten enteropathy, short bowel syndrome), long repeated courses are carried out.

In the process of rehabilitation after diarrhea, especially accompanied by a protracted course and severe intoxication, restorative therapy with hepatoprotectors is necessary, primarily to maintain the function of the liver and other organs involved in detoxification of the body. The most preferred use of hepatoprotectors on plant-based, which have not only a hepatoprotective effect, but also an anti-inflammatory, antioxidant and diuretic effect, which contributes to the elimination of toxic substances from the body. It should be emphasized that many of the hepatoprotective drugs can have a slight laxative effect due to choleretic action. However, against the background of the use of astringent adsorbents, negative point applications of which is to delay emptying, unwanted manifestation hepatoprotectors is leveled.

Treatment of diarrhea should be built on a comprehensive differentiated approach to each stage of therapy.

diarrheal syndrome- this is a symptom complex of disorders associated with digestion, bowel movement, characterized by an increase in stool and a change in its consistency (liquid unformed feces).

Liquid unformed feces refers to a violation of defecation. People of various age groups there is a difference in the number of bowel movements. For example, in newborns, the number of bowel movements corresponds to the number of feedings, in an adult, one trip to the toilet is considered the norm, in older people, bowel movements are normal once every few days.

According to duration, the syndrome is classified into acute and chronic form diseases. Acute diarrhea is a consequence acute infections intestines (viruses, bacteria, etc.), diet disorders, allergic intolerance to medicines or food, etc. The duration of the acute process does not exceed 30 days. If the condition lasts longer, then they talk about a chronic course. In this condition, parietal digestion, fluid absorption, as well as the transport of water and electrolytes are disturbed.

The criteria for diarrhea are: increased fluid content in feces from 65 to 90%, as well as an increase in stool weight of more than 200 grams. Gastroenterologists classify diarrhea as stool types 6 and 7 (see Figure 1).

Rice. one - bristol scale chair ratings.

Diarrhea can occur with various manifestations. Some patients seek medical help in time due to the fact that their diarrhea is accompanied by:

• bloating;
• severe pain;
• frequent bowel movements as thick as a pencil (more than 4 times);
• general weakness, etc.

Others, on the contrary, do not turn to a specialist due to the absence of the above symptoms, since they are only concerned about the disorder after overeating or a slight poisoning.

Types of diarrhea syndrome

Pathogenetically, with diarrhea, 4 main aspects are determined: an increase in intestinal secretion, changes in osmotic pressure, changes in the nature of chyme transport, and hyperexudation in the intestinal cavity. Therefore, there are several types of diarrhea pathogenetically (see table 1)

Table 1. Classification of types of diarrhea.

Possible reasons

• infectious diseases - salmonellosis, cholera, dysentery, shigellosis, clostridium, viruses, protozoa;
• oncological diseases - lymphoma, intestinal carcinoma, etc .;
• non-communicable diseases - diseases of the pancreas, conditions after removal of the gallbladder, helminths.

Diagnostics

Collection of anamnesis

To determine the causes of diarrheal syndrome, the doctor needs to collect a detailed history of the disease:

For differential diagnosis apply basic and additional research.

Basic research methods

• collecting anamnesis of the disease;
• physical examination (examination of the patient by palpation, percussion, auscultation, review skin etc.);
• examination of the rectum, esophagus, stomach, 12 duodenal ulcer(cm. );
• laboratory research(blood, urine, feces)
• consultations of a gynecologist for women and a urologist for men, etc.

Additional research methods

Additional studies are used if there is a question about clarifying the diagnosis or type of diarrheal syndrome. These include:

• a detailed analysis of blood and other biomaterial;
• study of pancreatic and thyroid hormones;
• biopsy of the intestinal mucosa or stomach;
• x-ray of the gastrointestinal tract with a radiopaque substance;
• other.

Treatment

Treatment involves a set of measures aimed at eliminating symptoms, treating causes and preventing re-development diarrhea syndrome.

In what cases should you see a doctor?

You should definitely contact if diarrhea lasts more than 24 hours with more than 4 trips to the toilet. Symptoms of weakness, abdominal pain, thirst, etc. are manifested in everyone in one way or another, so you need to focus on the number of bowel movements (more than 200 g), as well as the frequency, duration and consistency of the stool.

Factors that require a referral:

Possible consequences

If there is diarrhea with a black color and the abundance of feces of the corresponding color increases, this is a sign of progressive internal bleeding, which can subsequently lead to profuse blood loss, hemorrhagic shock and death.

Prolonged and profuse diarrhea (as in dysentery) is fraught with dehydration of the body, which is called dehydration and, as a result, also ends in death.

Do not ignore stool disorders lasting more than 24 hours in order to prevent possible negative consequences.