Diarrhea: Causes, Diagnosis & Treatments
Diarrhea is defined as a condition in which the number of bowel movements is more than four times a day and the amount of feces is more than 200 g per day. In cases of diarrhea, chronic diarrhea lasting more than 4 weeks and acute diarrhea less than 1 to 2 weeks are defined as diarrhea.
There are caustic diarrhea and fecal incontinence which should be distinguished from diarrhea. Caustic diarrhea defecates more than 3 ~ 4 times a day, but total defecation is in the normal range. It is caused by irritable bowel syndrome, rectalitis and hyperthyroidism.
Fecal incontinence can not be controlled voluntarily due to anomalous rectal or pelvic muscle abnormalities, so the bowel movement itself will not exceed 200g, regardless of the patient's intent.
The most common causes of acute diarrhea are infections and drugs caused by pathogenic organisms. The causes of chronic diarrhea are very diverse and include irritable bowel syndrome, drug-induced diarrhea, inflammatory bowel disease, post-operative diarrhea, And diarrhea caused by.
The mechanism of diarrhea is divided into osmotic diarrhea, secretory diarrhea, mucosal injury, increased filtration, and intestinal obstruction.
The osmotic diarrhea is caused by the ingestion of substances that are difficult or impossible to absorb in the intestinal tract into the intestinal tract, which increases the concentration of these substances in the intestinal tract, thereby increasing the osmotic pressure and causing diarrhea to migrate into the intestinal tract. Therefore, when monosaccharides are ingested in the presence of a congenital disease that interferes with the absorption of monosaccharides, such as sulphate, phosphate, magnesium salt, lactulose, sorbitol, etc., Of the carbohydrate absorption disorder group. Clinically, diarrhea is stopped by fasting and there is a large difference in osmotic pressure of feces.
Secretory diarrhea is a diarrhea caused by bacterial toxins, humoral factors, bile acids, fatty acids, diarrhea and the like resulting in increased intestinal water and electrolyte secretion. Therefore, even if fasting is continued, more than 1L per day, a large amount of feces, there is less difference in osmotic pressure. Bacterial toxins include cholera toxin, ETEC toxin, and humoral factors such as VIP, Secretin, and PG.
In the case of mucosal damage, diarrhea accompanied by intestinal exudation of the blood component as well as water and electrolytic absorptive disorder is caused by structural damage of the mucous membrane, which is caused by IBD, salmonella, dysentery, EPEC, and protozoan infection. The clinical picture is similar to secretory diarrhea, but it is characterized by the presence of inflammatory cells or blood in the stool.
The clinical symptoms of diarrhea vary according to the toxicity of the pathogen in case of infection. In case of Rota and Norwalk virus, vomiting with diarrhea, severe diarrhea such as cholera or ETEC in case of diarrhea, And so on.
Diagnosis is usually normal in acute diarrhea within a few days, so it is not necessary to try to find the cause by using several test methods. If a diarrhea comes, first distinguish acute and chronic diarrhea and identify the cause of diarrhea. The lesion of the left colon is characterized by frequent bowel movements, low fecal weight, and abdominal pain when there is a dislocation. On the other hand, the right bowel or ascending colon lesions have a low number of bowel movements, a large amount of bowel movement at one time, It is characterized by sinking after bowel movement. Next, the causes of diarrhea should be identified as osmotic, secretory, or mucosal injury, and other factors such as occurrence, travel force, food intake, medication use, fever and weight loss should be identified. It is important to understand the state of water and electrolytes in physical examination. Hypotension and reduction of skin elasticity mean dehydration. In hyperventilation, metabolic acidosis due to dehydration can be suspected. Other cases of chronic diarrhea can be identified in the lower abdomen mass. Laboratory tests for stools are important. It is necessary to suspicion of inflammatory diseases and infectious diseases through the examination of leukocyte and occult blood in the stool. If necessary, it is necessary to check the infectious source through parasite test and bacterial culture test. In the case of colonoscopy, the colonoscopy should not be performed before the examination. If the colonoscopy is infectious, the findings may be very similar. Antibiotic-associated colitis can be easily diagnosed by showing a pale yellow film on the mucous membrane.
In the case of dehydration, water and electrolyte replenishment should be the first priority and should be replenished within 12 hours. If you are suspected of having infectious diarrhea, such as fever or bloody diarrhea, you should not use it because it can aggravate the disease. If you suspect an infection or suspect infection, you should use antibiotics. In the case of chronic diarrhea, the goal is to treat underlying diseases.
There are caustic diarrhea and fecal incontinence which should be distinguished from diarrhea. Caustic diarrhea defecates more than 3 ~ 4 times a day, but total defecation is in the normal range. It is caused by irritable bowel syndrome, rectalitis and hyperthyroidism.
Fecal incontinence can not be controlled voluntarily due to anomalous rectal or pelvic muscle abnormalities, so the bowel movement itself will not exceed 200g, regardless of the patient's intent.
The most common causes of acute diarrhea are infections and drugs caused by pathogenic organisms. The causes of chronic diarrhea are very diverse and include irritable bowel syndrome, drug-induced diarrhea, inflammatory bowel disease, post-operative diarrhea, And diarrhea caused by.
The mechanism of diarrhea is divided into osmotic diarrhea, secretory diarrhea, mucosal injury, increased filtration, and intestinal obstruction.
The osmotic diarrhea is caused by the ingestion of substances that are difficult or impossible to absorb in the intestinal tract into the intestinal tract, which increases the concentration of these substances in the intestinal tract, thereby increasing the osmotic pressure and causing diarrhea to migrate into the intestinal tract. Therefore, when monosaccharides are ingested in the presence of a congenital disease that interferes with the absorption of monosaccharides, such as sulphate, phosphate, magnesium salt, lactulose, sorbitol, etc., Of the carbohydrate absorption disorder group. Clinically, diarrhea is stopped by fasting and there is a large difference in osmotic pressure of feces.
Secretory diarrhea is a diarrhea caused by bacterial toxins, humoral factors, bile acids, fatty acids, diarrhea and the like resulting in increased intestinal water and electrolyte secretion. Therefore, even if fasting is continued, more than 1L per day, a large amount of feces, there is less difference in osmotic pressure. Bacterial toxins include cholera toxin, ETEC toxin, and humoral factors such as VIP, Secretin, and PG.
In the case of mucosal damage, diarrhea accompanied by intestinal exudation of the blood component as well as water and electrolytic absorptive disorder is caused by structural damage of the mucous membrane, which is caused by IBD, salmonella, dysentery, EPEC, and protozoan infection. The clinical picture is similar to secretory diarrhea, but it is characterized by the presence of inflammatory cells or blood in the stool.
The clinical symptoms of diarrhea vary according to the toxicity of the pathogen in case of infection. In case of Rota and Norwalk virus, vomiting with diarrhea, severe diarrhea such as cholera or ETEC in case of diarrhea, And so on.
Diagnosis is usually normal in acute diarrhea within a few days, so it is not necessary to try to find the cause by using several test methods. If a diarrhea comes, first distinguish acute and chronic diarrhea and identify the cause of diarrhea. The lesion of the left colon is characterized by frequent bowel movements, low fecal weight, and abdominal pain when there is a dislocation. On the other hand, the right bowel or ascending colon lesions have a low number of bowel movements, a large amount of bowel movement at one time, It is characterized by sinking after bowel movement. Next, the causes of diarrhea should be identified as osmotic, secretory, or mucosal injury, and other factors such as occurrence, travel force, food intake, medication use, fever and weight loss should be identified. It is important to understand the state of water and electrolytes in physical examination. Hypotension and reduction of skin elasticity mean dehydration. In hyperventilation, metabolic acidosis due to dehydration can be suspected. Other cases of chronic diarrhea can be identified in the lower abdomen mass. Laboratory tests for stools are important. It is necessary to suspicion of inflammatory diseases and infectious diseases through the examination of leukocyte and occult blood in the stool. If necessary, it is necessary to check the infectious source through parasite test and bacterial culture test. In the case of colonoscopy, the colonoscopy should not be performed before the examination. If the colonoscopy is infectious, the findings may be very similar. Antibiotic-associated colitis can be easily diagnosed by showing a pale yellow film on the mucous membrane.
In the case of dehydration, water and electrolyte replenishment should be the first priority and should be replenished within 12 hours. If you are suspected of having infectious diarrhea, such as fever or bloody diarrhea, you should not use it because it can aggravate the disease. If you suspect an infection or suspect infection, you should use antibiotics. In the case of chronic diarrhea, the goal is to treat underlying diseases.
