Acute diarrhea is a polyetiological syndrome accompanying the course of a number of infectious and non–communicable diseases, characterized by frequent loose stools. With acute diarrhea, the stool becomes profuse, watery or mushy, it may contain impurities of undigested food, mucus; its frequency is more than three times a day. To determine the causes of the disorder, complaints and anamnesis are collected, a general analysis of blood and feces, the removal of stool, as well as instrumental studies: colonoscopy and irrigoscopy. Treatment includes diet therapy, the appointment of antibacterial drugs, antidiarrheal agents, eubiotics, as well as rehydration therapy.
A09 Diarrhea and gastroenteritis of presumably infectious origin
Acute diarrhea is a pathological syndrome that is clinically manifested by unformed or loose stools more than 3 times a day; at the same time, the relaxation of the stool persists for no more than three weeks. If diarrhea lasts longer than 21 days, it is said to be chronic. Most often, diarrhea is caused by bacterial, viral and parasitic factors. Every year, more than 2 billion new cases of acute diarrhea are registered in the world. Thus, this is a very common manifestation of various pathological processes in clinical infectology, gastroenterology and proctology. At the same time, acute diarrhea is mainly characterized by a favorable course, in which there are practically no fatal outcomes. If diarrhea was caused by an acute intestinal infection, then treatment of such patients should be carried out in an infectious hospital.
Acute diarrhea can develop under the influence of many etiofactors against the background of various pathological processes. The main causes of this condition are infectious agents, the action of toxins, taking medications, ischemic or inflammatory bowel pathology, as well as acute diseases of the pelvic organs. In developed countries, acute diarrhea most often occurs against the background of a viral infection, the causative agents of which are rotaviruses and adenoviruses. In addition to viruses, the development of the syndrome can be provoked by strains of various bacteria that produce enterotoxins, for example, salmonella, E. coli, shigella, campylobacter and so on. In some cases, the cause of diarrhea is the simplest microorganisms (giardia, blastocysts and others) and intestinal worms (pathogens of strongyloidosis, schistosomiasis and angiostrongylosis).
Acute diarrhea sometimes occurs against the background of taking various medications, being a side effect of their action on the body. The appearance of diarrhea may be associated with treatment with antibiotics, magnesium-containing drugs, antiserotonin preparations, digitalis, anticoagulants and henodeoxycholic acid. In addition, acute diarrhea occurs with an overdose and improper use of laxatives, while stool disorder can develop both immediately after taking a certain drug, and with an increase in its dosage.
A separate form is travelers diarrhea, which is observed in people when moving from regions with a high sanitary level to countries with a low level of sanitation. The cause of diarrheal syndrome in this case is an enteropathogenic strain of E. coli. Acute diarrhea can also develop in patients with AIDS or other forms of immunodeficiency. Depending on the mechanisms of pathogenesis, secretory, osmolar and exudative, hyperkinetic and hypokinetic forms of acute diarrhea are distinguished.
Clinical manifestations of the disease depend on the predominance of one or another form of intestinal disorders. In the secretory form, the pathological process is accompanied by a painless copious liquid stool, the volume of which exceeds 1 liter per day. This symptom is caused by increased secretion of water and electrolytes in the intestine against the background of exposure to pathogenic toxins on the mucosa. Manifestations of secretory diarrhea do not depend on the nature of nutrition, and therefore do not pass against the background of fasting.
The osmolar form of acute diarrhea is manifested by an increase in the total amount of feces, which is due to the presence of osmotically active components in the intestine that disrupt the absorption of fluid and electrolytes, so the stool contains a large volume of undigested food residues. Osmolar diarrhea is observed when taking laxatives or with maldigestion. Accordingly, the symptoms of this form of acute diarrhea often pass after the withdrawal of laxatives or against the background of fasting.
The exudative form of acute diarrhea is characterized by loose stools, in which there is a large amount of bloody and purulent discharge. Symptoms are the result of increased intake of trace elements and water into the intestine in the form of inflammatory exudate, which can be observed in pathology of the colon mucosa or increased pressure in the lymphatic vessels of the abdominal cavity. This form of acute diarrhea is noted with nonspecific ulcerative colitis, diverticulitis, dysentery, Crohn’s disease, and so on.
Hyperkinetic form is caused by neurogenic and hormonal factors. The main symptom of hyperkinetic acute diarrhea is frequent stools of a liquid or mushy nature. With this form, the daily amount of feces does not exceed 300 g. As a rule, these symptoms are observed with irritable bowel syndrome.
The hypokinetic form of diarrhea is observed in caecum syndrome or scleroderma, when the transit of intestinal contents is disrupted. As a result, excessive bacterial growth is noted, against which the malabsorption of fats and increased mucus formation in the intestine progress. A symptom of hypokinetic acute diarrhea is a liquid fetid stool with the presence of undigested fats.
Acute diarrhea is often accompanied by general nonspecific intestinal symptoms, such as abdominal pain, fever, nausea and vomiting. Also, with frequent copious stools, symptoms of dehydration may occur in the form of dry skin, decreased blood pressure and tachycardia. In addition, there may be impurities in the feces that are characteristic of the lesion of a certain part of the intestine. For example, acute diarrhea caused by a lesion of the small intestine is accompanied by the presence of undigested food residues in the feces. The chair at the same time often has a greenish tint and emits an unpleasant smell. With the development of a pathological process in the large intestine, spotting and an increased amount of mucus may occur.
An important factor that allows you to determine the nature of acute diarrhea is a complete collection of complaints and anamnesis. At the same time, it is important for the patient to find out the frequency and consistency of stool, the presence of various impurities or blood in the feces. The severity of the pathological process is indicated by symptoms such as abdominal pain, vomiting, dry skin and high fever. These clinical manifestations require either an infectious disease specialist or a proctologist to quickly prescribe appropriate therapy. When talking to a patient, the specialist clarifies which medications he has taken recently, since this factor can also lead to the development of acute diarrhea. The diagnostic criterion for acute diarrhea is the appearance of loose stools more than 3 times a day with a duration of intestinal disorders of no more than three weeks.
To diagnose acute diarrhea, laboratory methods are used, such as a general blood and stool test. These studies allow us to confirm the inflammatory genesis of the process. In particular, the coprogram determines the concentration of leukocytes and erythrocytes, which makes it possible to differentiate inflammatory and non-inflammatory diarrhea. In the absence of signs of inflammation, fecal back-sowing is not carried out. In case of detection of a large number of leukocytes and erythrocytes in the stool, a microbiological examination of feces is mandatory. This method allows you to identify pathogenic bacteria that have caused the development of acute diarrhea. However, in some cases, microbiological examination of feces does not give results, since diarrhea is caused by other factors.
Of the instrumental methods, colonoscopy is used to determine the cause of acute diarrhea. This study makes it possible to identify inflammatory changes in the intestinal mucosa, as well as the presence of ulcers and erosions of the intestinal wall. Intestinal endoscopy allows you to diagnose colitis, Crohn’s disease, diverticulitis and other diseases that could cause acute diarrhea. An informative instrumental method of investigation is contrast radiography of the intestine (irrigoscopy). This technique makes it possible to determine the speed of passage through the intestine and suspect inflammatory changes in the mucosa.
Regardless of the cause that caused the stool disorder, all patients are prescribed a special diet, eubiotics, as well as astringents and adsorbing agents. The diet for diarrhea is used to reduce intestinal motility and reduce the secretion of fluid into the intestinal lumen. It is very important to exclude products that can lead to irritation and damage to the mucous membrane.
With a pronounced loss of fluid and electrolytes with feces, rehydration therapy is performed. With a mild degree of dehydration, oral therapy is prescribed – special salt-containing solutions. In severe forms of diarrhea, there is a significant loss of fluid and electrolytes. In such cases, parenteral rehydration is used, which provides intravenous administration of balanced saline solutions. Antibacterial drugs are prescribed only in cases when diarrhea syndrome is caused by pathogenic bacteria. At the same time, the duration of the course of antibiotic therapy can vary from several days to a month.
In the treatment of acute diarrhea, drugs that inhibit intestinal motility play an important role. They reduce the secretion of fluid into the lumen of the intestine, thereby slowing down the contractions of smooth muscles. Loperamide is an effective antidiarrheal drug, but it is not recommended to prescribe it for the inflammatory genesis of diarrhea. It is also mandatory to use eubiotics to restore normal intestinal flora.
Prognosis and prevention
To prevent acute diarrhea, it is necessary to observe the rules of personal hygiene and store food products correctly. In addition, meat, fish and eggs must be subjected to thorough heat treatment. With timely complex treatment, the prognosis for this pathological condition is favorable.