Chronic diarrhea Diarrhea is defined as a bowel movement that is significantly more frequent than usual, with thin stools, more than 200 g of feces per day, or containing undigested food or pus and blood. Chronic diarrhea refers to diarrhea with a duration of more than two months or recurrent diarrhea with an interval of 2-4 weeks. 1, symptoms 2, the correct understanding of chronic diarrhea 3, the difference between chronic diarrhea and common diarrhea 4, chronic diarrhea need to do what examination disease overview What is chronic diarrhea chronic diarrhea: belongs to functional diarrhea, refers to intestinal dysfunction caused by diarrhea, including colonic allergy, emotional, indigestion caused by diarrhea. Symptoms include abdominal pain and flatulence, pain that disappears after exhaustion and defecation, and alternating thin and hard stools. Chinese medicine will be accompanied by abdominal cold, the limbs are not hot, intolerant of cold stimulation, as well as at dawn that is abdominal pain and diarrhea called spleen and kidney deficiency cold diarrhea; accompanied by poor appetite, indigestion, abdominal distension and sagging feeling, limbs heavy and weak called spleen and stomach qi deficiency diarrhea; depressed spirit that is painful diarrhea, diarrhea after pain relief is called liver wang grams spleen diarrhea. Chronic diarrhea is prolonged and recurrent, and can last for several months or years. Classification Chronic diarrhea is a common symptom of digestive system diseases, which is due to the secretion, digestion (digestion food) absorption and motor (motor food) dysfunction of the gastrointestinal tract, resulting in thin stools and increased frequency, and the duration of the disease is more than 2 months, called chronic diarrhea. Clinically, according to the anatomical site combined with the etiology: 1, gastrogenic diarrhea, including diarrhea caused by gastric diseases and the return of intestinal contents or bile into the stomach; 2, enterogenic diarrhea, including various inflammatory diseases of the intestinal tract such as bacillary dysentery, clonor, incomplete intestinal obstruction, tumors, dyspepsia, dysbiosis, allergy to fish, shrimp, food poisoning and certain diarrheal drugs, antihypertensive drugs caused by diarrhea; 3, endocrine disorders diarrhea, such as 4, functional diarrhea, such as emotional diarrhea, irritable bowel syndrome. Among the above causes of diarrhea, the most common are various intestinal infections, colon and rectal cancer, food poisoning caused by grape (grape food) enterotoxin and irritable bowel syndrome. Etiology Etiology Pathology In a domestic group of 433 cases of chronic diarrhea etiology analysis, intestinal infectious diseases accounted for 36.7%, intestinal tumors 29.6%, the cause is not known 20.6%, small intestine malabsorption 6.4%, non-infectious inflammation 3.3%, other rare. 1, infectious diseases of the intestine; 2, tumors; 3, small intestine malabsorption; 4, non-infectious inflammation; 5, functional diarrhea; 6, pharmacogenic diarrhea. According to pathophysiology, there are four categories: 1, hyperosmolar diarrhea caused by increased osmotic pressure in the intestinal lumen exceeding plasma osmolality; 2, impaired absorption diarrhea caused by absorption dysfunction; 3, secretory diarrhea caused by increased intestinal secretion; 4, motility diarrhea caused by intestinal dysfunction and hyperperistalsis. Causes of induced chronic diarrhea There are many causes of chronic diarrhea, and it is complex, not necessarily caused by intestinal inflammation. The early manifestations of some other diseases are atypical and can sometimes manifest only as chronic diarrhea. Systemic diseases 1. Diabetes mellitus: Diabetes mellitus causes diarrhea associated with its resulting gastrointestinal phytonecrosis. Diarrhea is persistent, intermittent, the attack can be a few days to a few weeks; intermittent period can be weeks to months, diarrhea can occur day and night, about 5% of patients with diarrhea at the same time have steatorrhea. 2, hyperthyroidism: hyperthyroidism patients due to rapid intestinal peristalsis, digestion and malabsorption and frequent stools and even diarrhea, stools are generally mushy, containing more undigested food. 3.Uremia 4.Systemic lupus erythematosus Liver, biliary tract and pancreatic diseases 1.Hepatocellular carcinoma. It is not uncommon for liver cancer to have diarrhea as the first symptom. The liver detoxification function of liver cancer patients decreases, and the intestinal mucosa produces intestinal toxins under the stimulation of harmful chemicals, prompting mast cells to proliferate and release histamine, causing the intestinal mucosa to become degenerative and edematous, increasing permeability and reducing water reabsorption, resulting in a large amount of water discharged into the intestinal cavity and causing some diarrhea. 2, chronic hepatitis, cirrhosis 3, chronic pancreatitis, pancreatic cancer Gastrointestinal diseases 1, colorectal cancer: most colorectal cancers occur after middle age, and those located in the left colon are often ring-shaped growth, accompanied by changes in defecation habits. When the tumor has erosion, ulcer and necrosis, it can be manifested as diarrhea, bloody stool and shortness of breath, especially if the tumor is located in the rectum, it mainly manifests as bloody stool, increased number of bowel movements, poor defecation and shortness of breath. 2, clonorchiasis: also known as segmental enteritis, the age of onset is mainly in 20-40 years old, the onset of disease is slow, starting with abdominal pain, diarrhea, gradually aggravated, stool is thin or watery, often without pus and blood. Inflammation, increased peristalsis and secondary intestinal malabsorption of the diseased intestinal segment are the main causes of diarrhea. Mostly intermittent episodes, the late course of the disease is persistent. 3, ulcerative colitis: more women than men, the onset can be acute or slow, symptoms vary in severity, diarrhea is stimulated by inflammation, increased intestinal peristalsis and intestinal lumen water, sodium absorption disorders. In mild cases, the bowel movements are 3-4 times a day, or alternating between diarrhea and constipation; in severe cases, the bowel movements are frequent and the stools are mostly paste-like, mixed with mucus and pus and blood. The disease can have nodular erythema, iridocyclitis, arthritis and other extraintestinal manifestations. 4, irritable bowel syndrome 5, gastric cancer, atrophic gastritis 6, other: there are many other causes of chronic diarrhea, such as intestinal tuberculosis, intestinal fungal infections, chronic bacterial dysentery, drugs, etc.. When diarrhea appears, if the performance of the primary disease is more typical, it is easier to diagnose; if the performance of the primary disease is not typical, it is easier to misdiagnose, and sometimes the misdiagnosis can last for months or years. Therefore, the appearance of chronic diarrhea should not be taken lightly, but should be carefully examined, and only when the cause is identified can chronic diarrhea be properly treated. Conversely, symptomatic treatment of chronic diarrhea is often less effective and can even delay the disease and lose the time for treatment. Identifying diarrhea lesions from defecation The defecation, fecal appearance and the nature of abdominal pain can often reflect where the lesions are located in the intestine. Patients with lesions in the rectum or sigmoid colon have frequent bowel movements and urgency, a small amount of stool each time, or only a small amount of gas and mucus, dark feces, mostly in the form of mucous jelly, which can be mixed with pus and blood, and abdominal pain located in the lower abdomen or left lower abdomen, which can be slightly relieved after the stool. 2, small intestinal lesions of diarrhea each defecation more, diarrhea times relatively less, no urgency after heavy, stool thin and liquid-like, lighter color, abdominal pain is located in the umbilicus, mostly intermittent paroxysmal colic with hyperactive intestinal sounds. 3, small intestine malabsorption, stool is greasy, foamy, containing food residues, with bad odor. 4, chronic dysentery, schistosomiasis, ulcerative colitis, rectal cancer and other diseases caused by diarrhea, the daily number of bowel movements is not much, stool often with pus and blood. 5, intestinal tuberculosis often have alternating diarrhea and constipation. 6, stool volume greater than 5 liters per day, should be considered cholera (rice-like stool) or endocrine tumor induced diarrhea in Catania. Clinical manifestations chronic diarrhea is a common clinical symptom. It is manifested by an increase in the number of stools thin, even with mucous jelly and pus and blood, lasting more than two months. Small intestine lesions cause diarrhea is characterized by abdominal discomfort, mostly located around the umbilicus, and intensify after meals or before the stool, without urgency, stool volume, light color, the number of times can be more or less; colon lesions cause diarrhea is characterized by abdominal discomfort, located on both sides of the abdomen or lower abdomen, often relieved or alleviated after the stool, the number of bowel movements and urgent, stool volume is small, often containing blood and mucus; rectal lesions are often accompanied by urgency after the weight. Diarrhea: Patients with lesions in the rectum or sigmoid colon have frequent bowel movements and shortness of breath. 2, diarrhea accompanying symptoms: depending on the cause, accompanied by abdominal pain, fever, wasting, abdominal masses or peptic ulcers, etc. Laboratory examination 1, stool examination: bleeding, pus cells, protozoa, worm eggs, fat droplets, etc. 2.Small intestine absorption function measurement: show intestinal malabsorption. 3.X-ray and endoscopy to detect lesion location, motor function status, gallstone, etc. 4.Ultrasound. 5.Small intestine mucosal biopsy. The diagnosis of chronic diarrhea mainly relies on medical history, physical signs, rectal finger examination, stool examination, and then further sigmoidoscopy and X-ray examination if there is difficulty, and if it still cannot be solved, then consider fiber colonoscopy or small intestine microscopy, and if necessary, various functional tests, such as small intestine absorption function test (glucose tolerance test, dextrose test, radionuclide labeled vitamin B12 test) and pancreatic Functional tests. 1, clinical appearance of diarrhea; 2, abnormal fecal examination; 3, X-ray and endoscopic detection of the location of the lesion. Chronic diarrhea complications 1, malnutrition and vitamin deficiencies: diarrhea is a long course, such as fasting for too long or long-term caloric deficiency, can often cause malnutrition and various vitamin deficiencies. Indigestion and malnutrition can be the cause and effect of each other, often resulting in a vicious circle, leading to adverse consequences. Vitamin A deficiency can cause dry eye and corneal softening disease; vitamin D deficiency can cause hand and foot twitching disease. 2, infection: common otitis media, stomatitis, upper respiratory tract infection, bronchitis, pneumonia, boils, sepsis, urinary tract infection and phlebitis. Various infections may be the cause of diarrhea, but there are also secondary infections that occur after diarrhea due to a decrease in systemic resistance. Children with prolonged diarrhea or pre-existing malnutrition are prone to complications of fungal infections, such as thrush, fungal enteritis, and even systemic fungal disease. 3, toxic hepatitis: heavy diarrhea may appear jaundice, commonly in malnourished and seriously septic children, the prognosis is poor, so toxic hepatitis is one of the serious complications of diarrhea. 4, other: such as acute renal failure, diffuse intravascular coagulation, infectious shock, toxic encephalopathy, etc., such as improper handling can also occur acute heart failure, hyperkalemia, toxic intestinal paralysis, intestinal hemorrhage, intussusception, etc., occasionally seen intestinal perforation and peritonitis. Common complications 1, malnutrition and vitamin deficiencies: diarrhea longer course, such as fasting for too long or long-term caloric deficiency, often can cause malnutrition and various vitamin deficiencies. Indigestion and malnutrition can be the cause and effect of each other, often resulting in a vicious circle, leading to adverse consequences. Vitamin A deficiency can cause dry eye and corneal softening disease; vitamin D deficiency can cause hand and foot convulsions. 2, infection Commonly, there are otitis media, stomatitis, upper respiratory tract infection, bronchitis, pneumonia, boils, sepsis, urinary tract infection and phlebitis. Various infections may be the cause of diarrhea, but there are also secondary infections that occur after diarrhea due to a decrease in systemic resistance. Children with prolonged diarrhea or original malnutrition are prone to complications of fungal infections, such as thrush, fungal enteritis, and even systemic fungal disease. 3, toxic hepatitis severe diarrhea may appear jaundice, commonly in malnourished and seriously septic children, the prognosis is poor, so toxic hepatitis is one of the serious complications of diarrhea. 4, other such as acute renal failure, diffuse intravascular coagulation, infectious shock, toxic encephalopathy, etc., such as improper treatment can also occur acute heart failure, hyperkalemia, toxic intestinal paralysis, intestinal hemorrhage, intussusception, etc., occasionally see intestinal perforation and peritonitis. Treatment Treatment principles 1, etiological treatment: for different types of diarrhea to take the appropriate treatment 2, symptomatic treatment: try to avoid the choice of addictive drugs; and should be applied after a clear cause. Antidiarrheal drugs: activated charcoal, aluminum hydroxide gel, codeine, etc. 3, antispasmodic and analgesic drugs: atropine, scopolamine. Understand the medication of chronic diarrhea – Emmenagogue neurological antidiarrheal drugs, through enhancing the tension of intestinal smooth muscle, inhibit the propulsive peristalsis of the intestine, prolong the residence time of its contents and play an antidiarrheal role, applicable to diarrhea caused by sympathetic excitation or chronic diarrhea. Because of the exact efficacy, many people take this medicine as soon as they have diarrhea. In fact, if you simply use Emmenthal, it is not conducive to the reduction of inflammation, and should not be used when watery diarrhea and accompanied by bloating, fever and other symptoms of bacterial infection. Food therapy principles 1, low-fat less slag diet: about 40g of fat per day, too much is not easy to digest and increase the burden on the gastrointestinal tract, stimulating gastrointestinal peristalsis aggravate diarrhea. Therefore, vegetable oil should also be limited, and pay attention to cooking methods, mainly steaming, boiling, blanching, braising, burning, etc., prohibit oil frying, stir-frying, slippery, etc.. Available foods are lean meat, chicken, shrimp, fish, soy products, etc. Pay attention to less slag, coarse fiber food can stimulate intestinal peristalsis, so that diarrhea aggravated, when the number of diarrhea is better to temporarily do not eat or eat as little as possible vegetables and fruits, can give fresh juice, tomato juice to supplement vitamins: less slag diet can reduce intestinal peristalsis, reduce diarrhea, so it is appropriate to eat fine noodles, porridge, rotten rice, etc.. 2, high protein and high caloric energy: chronic diarrhea is long and often recurrent, affecting the digestion and absorption of food, and causing the consumption of stored caloric energy in the body. In order to improve the nutritional status, a high-protein, high-calorie diet should be given, with a gradual increase in the amount of methods, such as increasing too quickly, nutrients can not be completely absorbed, but may increase the burden on the gastrointestinal tract. Can supply protein 100g / d or so, caloric energy 2500 ~ 300 kcal. 3, forbidden food: such as coarse grains, raw and cold fruits and vegetables, leeks, celery, squash, etc., which contain a lot of crude fiber; hard and indigestible meat such as ham, sausage, cured meat, etc.; stimulating food such as chili, spirits, mustard, chili powder, and fatty meat, crispy snacks and other high-fat food. Three meals a day reference Chronic diarrhea breakfast: fine noodles, eggs, such as: fine noodles, half boiled eggs, a glass of fresh orange juice; lunch: rice, tofu, lean minced meat, tomatoes, such as: rotten rice, minced meat and tofu, a glass of thick tomato juice; snack: rice porridge; dinner: rice, shrimp, such as: rotten rice, boiled shrimp. Chinese medicine diagnosis and treatment Chronic diarrhea is mainly treated for its causes. If the diarrhea is severe and weak non-infectious diarrhea, symptomatic treatment with antidiarrheal agents is commonly used to reduce the number of diarrhea. Chinese medicine believes that this disease is most closely related to spleen deficiency. If the spleen is deficient in transportation, the water and grain do not turn into essence, and the turbidity is generated internally, so the grain becomes stagnant and the water becomes wet. If the spleen and stomach are usually weak, and due to emotional and mental disorders, the liver becomes depressed, and the spleen is crossed by the rebellion, and the transportation and transformation are not in order, diarrhea can also be formed. However, diarrhea caused by the liver and kidney, also mostly on the basis of spleen deficiency, so the cloud “the origin of diarrhea, all due to the spleen and stomach.” Self-medication precautions 1.Find the cause of diarrhea and try to avoid it. 2, emotional stability, conducive to the adjustment of gastrointestinal function. 3, diet should be easy to digest, less dregs, and avoid eating cold food. 4, avoid eating raw garlic. The pungency of garlic will stimulate the intestinal wall and aggravate diarrhea. 5, red dates, Chinese yam, chestnuts, lentils, glutinous rice, lotus seed meat has a spleen thick intestinal anti-diarrheal effect, may wish to eat more points. Apple can stop diarrhea, cooked can also eat more. 6, reduce intercourse, so that the spleen and kidney essence to nourish. Prevention 1, the root cause of acute diarrhea; 2, pay attention to dietary hygiene, do not eat spoiled food, do not overeat, do not crave greasy cold; 3, regular life, avoid fatigue, cold, especially abdominal warmth; 4, relaxed mood, optimism and open-mindedness; 5, abdominal health care massage; 6, appropriate activities and exercise to enhance physical fitness; 7, choose some spleen anti-diarrhea food, such as coix seeds, yam, jujube, lotus meat (remove the core), chestnut, gorgonian, flat. Chestnuts, gravy, lentils, tea, garlic, vinegar, etc.; 8, eat less food that can easily cause diarrhea, such as honey, bananas, figs, sesame seeds, sesame oil, peanut kernels, melon seeds, walnut meat, etc. Pediatric chronic diarrhea Pediatric chronic diarrhea how to do Chronic diarrhea is now more common, but children suffering from chronic diarrhea is also very dangerous. Chronic diarrhea in children often leads to malnutrition, which in turn causes death. It kills about 5 million children worldwide each year, making it the number one cause of death in children. In our country, chronic diarrhea in children is mainly caused by Salmonella and is accompanied by intestinal dysfunction. Acute bacillary dysentery into chronic bacillary dysentery accounts for about 10%-15%, chronic bacillary dysentery in children is much less than in adults, the acute to slow change in less than 1%, treatment The treatment of chronic diarrhea in children is: 1, first of all, bacterial culture and stool routine examination, to clarify the cause of diarrhea, targeted antibacterial treatment. 2, adjust the diet. In children with diarrhea, most of them have a decrease in biosaccharidase intercalation. At this time, if fasting, can reduce diarrhea but hunger more malnutrition; if not control the diet, will aggravate diarrhea. At this time, there is a need for a dietary adjustment phase, giving the child a “special diet”, which we call “diet therapy”. For most of the sick children, the effect is very obvious. The diet is prepared mainly with skimmed milk, rice soup and dried cake powder. 3, strengthen the whole body and intestinal local resistance, improve the body’s immune function. The content of immunoglobulin A in the intestinal mucosa and stool of children with chronic diarrhea is significantly reduced, which is the reason for the chronicity of diarrhea. Immunomodulators such as thymidine are often used, fresh blood transfusions are given when necessary, and attention is paid to calcium and potassium supplementation. For small children with diarrhea, a detailed evaluation and examination should be done and treatment should be done as early as possible to avoid complications. At the same time, with proper care and diet, babies with diarrhea can recover faster and maintain good nutrition and growth. Early replacement of lost water The first thing to do is to determine whether your baby is mildly dehydrated. Symptoms of mild dehydration: a sense of thirst, slightly dry lips, less urine than usual, yellowish color, and showing irritability and crying. You can choose one of the following two methods of rehydration: 1. Use homemade sugar saline rehydration: use homemade rice soup with salt liquid rehydration, i.e. add refined table salt inside warm boiled water. 2, rehydration with oral rehydration salt prescribed by the doctor: ORS rehydration salt is a dry powder that has been prepared, and can be prepared as a liquid according to the instructions when used. Then, give the liquid per kilogram of the baby’s body weight for the first 4 hours. After that, drink as much as you can orally at any time; babies under 2 years old can be fed a small spoonful every 1 to 2 minutes, while older babies can drink from a small cup. If the baby vomits, wait 10 minutes before feeding slowly; once the baby’s eyelids are puffy, it indicates that the rehydration is a bit too much, so you should temporarily drink plain water or breast milk instead.