DIARRHEA, causes, diagnosis, solutions
Diarrhea is the evacuation of liquid stools with increased stool frequency; in persistent cases can lead to severe dehydration.
Diarrhea is not in itself a disease, but only a symptom that can respond to different causes. It is one of the most common disorders in the course of many intestinal diseases, but may also be a consequence of diseases not localized in the digestive system. Diarrhea can be defined as a series of rapid bowel movements that are too liquid; the accelerated passage of food through the intestine prevents its total digestion and also prevents, totally or partially, the absorption of nutritional principles.
Diarrhea is caused by a series of irritating chemical, bacterial, mechanical or nervous stimuli that give rise to an acceleration of normal bowel motility and consequently to a faster transit. The chemical stimuli are usually run by toxic substances, which can be produced inside the digestive tract or from other parts of the body, and then eliminated by the intestinal route.
However, diarrhea does not always respond to toxic causes; in many cases an insufficient gastric digestion or lack of digestive intestinal secretions, by not allowing the complete digestion of food, results in an increase of the transit speed of an insufficiently elaborated material and consequently to diarrhea. Depending on the duration of diarrhea, acute forms, which last a few days, and chronic forms are distinguished, in which the disorder is daily or almost daily for long periods. In general the causes of the acute forms reside in infectious or toxi-infectious processes located in the digestive tract. Ingestion of bacteria or products of their metabolism, called toxins, results in an irritant or inflammatory state of the intestinal mucosa, followed by an increase in intestinal motility.
Other times toxic substances are contained in foods due to poor conservation of the same, and therefore do not come from germs.
The causes of chronic diarrhea are included in general illness or in the digestive tract (stomach, small intestine, colon), liver, biliary tract and pancreas.
WHAT TO DO
The distinction between acute forms and chronic forms is also convenient from the therapeutic point of view. In acute forms and in the acute stages of chronic diarrhea, the physician’s concern should focus on the consequences of the loss of water and salts that is recorded as a result of numerous depositions of liquid feces.
In these cases, the first objective of the therapy is to restore the water and saline patrimony of the organism, for which the intravenous administration of water and salts is used. In less severe cases it is advisable to institute a dietary treatment: fasting for at least 24 hours, followed by administration of diluted tea, grated raw apples, carrot puree, boiled rice and cream of rice with lightly salted vegetable stock. The administration of water and other liquids should be done with caution during the first 24 hours; then, if they are well tolerated, their administration will be increased to rehydrate the organism.
After an acute episode of diarrhea, in diarrheal colitis and other colonic infections (ulcerative colitis, diverticulosis), as well as in chronic diarrhea during the waiting phase imposed by diagnostic tests, diet poor in residues (see table). The purpose of this diet is to eliminate from food those substances that can not be properly digested and absorbed in the intestine, while ensuring adequate nutrition. Said diet contains a modest quantity of indigestible material, represented essentially by the cellulose and the fiber contained in the vegetables; is indicated not only in the circumstances mentioned above, but also in all cases where food intake is followed by an abnormal formation of gas in the stomach and intestine (meteorism) and after surgical operations of the abdomen.
Vegetables with low fiber and therefore desirable: asparagus (tips), beets, cauliflower, onion, watercress, endives, lettuce, potatoes, peas, tomatoes, celery, spinach, squash, zucchini.
Vegetables not allowed: artichokes, cabbage, Brussels sprouts, green beans, beans, lentils, dried peas, peppers.
Recommended fruit: apricots, pineapple, oranges, banana, cherries, apples, melon, peach, grapefruit.
Fruit not allowed: nuts, grapes, dates, dried figs, strawberries, raspberries, pears.
Treatment of diarrhea, coupled with the specific treatment of causative factors (antibiotic or sulphamidic of intestinal action), requires the administration of intestinal astringents (subnitrate or bismuth carbonate, tannic acid or acetylanthine), antispasmodic (derived from belladonna and opium) and, even better, synthetic antidiarrheals which, in addition to decreasing intestinal motility, increase water resorption.
In the forms with severe dehydration the administration of physiological or glucose solutions by venoclisis or hypodermoclisis and of cardiovascular analeptics is indicated. In children, the treatment of diarrhea is to regulate feeding so that meals are infrequent and that the administration of liquids is never below 150 milliliters per kilo of body weight in 24 hours.