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Abnormal bowel movements

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The frequency of defecation is abnormally manifested as diarrhea or constipation. Normal people usually have bowel movements once a day. Individuals have 2 or 3 bowel movements per day or once every 2 to 3 days. The characteristics of feces are normal. The average weight of feces per day is 150-200g, and the water content is 60%-75%. . Diarrhea is a common symptom. It means that the frequency of bowel movements is significantly higher than the frequency of usual habits. The faeces are thin and the water is increased. The daily defecation is more than 200g, or contains undigested food or pus and mucus. Diarrhea is often accompanied by symptoms such as urgency of bowel movements, anal discomfort, and incontinence. Diarrhea is divided into acute and chronic. The incidence of acute diarrhea is acute, and the course of disease is within 2 to 3 weeks. Chronic diarrhea refers to recurrent diarrhea with a course of disease of more than two months or intermittent within 2 to 4 weeks.

Cause

Cause

(1) Causes of the disease

1. Causes of acute diarrhea: Intestinal infections, including food poisoning, are the most common cause of acute diarrhea and can be divided into:

(1) bacterial infection:

1 Bacterial dysentery: more acute onset, often chills, fever, abdominal pain, diarrhea and urgency, can be accompanied by nausea and vomiting. Diarrhea is characterized by mucus pus and blood, varying in number of times per day. Under the microscope, it is found that a large amount of red blood cells and white blood cells are contained in the stool, and dysentery bacilli can be found in stool culture.

2 Salmonella infection: a history of unclean diet, often bloating, abdominal pain and diarrhea. The stool is mainly loose or watery, with less pus and blood, and the stool varies from 3 to 5 times a day. In the stool culture, pathogenic bacteria (Salmonella or Salmonella typhimurium, etc.) can be found.

3 Escherichia coli enteritis: often have a history of unclean diet. The onset is more urgent, and there may be symptoms such as chills, fever, abdominal pain, diarrhea, etc., which may be accompanied by vomiting. Most of the diarrhea is watery stools, but also mucus and pus. Stool culture can detect pathogenic bacteria.

4 Campylobacter intestinal infection: the symptoms are generally mild, manifested as pain in the upper abdomen accompanied by diarrhea, with loose stools or watery stools as the main performance, antibiotic treatment.

5 small intestine, Yersinia colon infection: clinical manifestations and Campylobacter infection are similar, diarrhea and other symptoms are often mild.

6 intestinal Staphylococcus aureus infection: onset more acute, may have chills, fever, abdominal pain and diarrhea and other symptoms. Diarrhea is mainly caused by loose stools, and may be accompanied by a small amount of mucus pus and blood. The stool culture can establish a diagnosis. The disease often occurs after the use of broad-spectrum antibiotics, hormones, or major surgery. Staphylococcus aureus can be found in stool culture.

7 acute hemorrhagic necrotizing enterocolitis: now considered to be associated with Clostridium perfringens or Clostridium perfringens infection. The onset is more urgent, abdominal pain, diarrhea and other symptoms are generally heavier, abdominal pain is more severe and can spread throughout the abdomen, may be persistent pain or paroxysmal aggravation. Early diarrhea can be loose stools or watery stools, more than 10 times a day, and then can bring blood, heavy can be bloody, often accompanied by symptoms such as chills, fever, nausea and vomiting. The disease is more common in adolescents.

8 pseudomembranous colitis: occurs after long-term use of antibiotics in large quantities, and can also occur in patients with low immune function. Due to the infection of the intestine secondary to Clostridium difficile, the toxin of the bacteria has a damaging effect on the intestinal mucosa. The clinical features are more frequent stools, and the weight can reach more than 20 times a day. The feces can have mucus pus and blood, and even bloody water samples, sometimes can discharge the pseudomembrane of egg pattern, often accompanied by fever, palpitations, dehydration, electrolyte imbalance. , low blood pressure and other symptoms of systemic poisoning. When the stool is used for anaerobic culture, pathogenic bacteria can be found. Metronidazole, vancomycin and other treatments are effective. 9 Cholera: caused by Vibrio cholerae infection. Clinical manifestations vary in severity, mild symptoms are mild, often watery diarrhea, several times a day, may be accompanied by nausea, vomiting, abdominal pain and other symptoms; severe cases of stool more frequent, large rice soup-like, patients often There are systemic poisoning manifestations such as fever, dehydration, and hypotension. Stool culture can find pathogenic bacteria.

(2) Protozoal and parasitic infections:

1 amoebic dysentery: onset is generally more urgent, often have fever, abdominal pain and diarrhea and other symptoms, diarrhea several times a day to more than 10 times, stool with mucus pus and blood, sometimes stool is dark red or jam-like, the amount is more, Stinks. Fresh stool examinations can be diagnosed if amebic trophozoites are found. Metronidazole or tinidazole is effective.

2 acute schistosomiasis: generally occurs in the first time infected with a large number of cercariae cercariae, often chills, fever, bloating, cough, abdominal pain and diarrhea and other symptoms, diarrhea is not serious, ranging from 3 to 5 times a day, can be loose stools or With mucus. Increased eosinophils in peripheral blood. If the patient is repeatedly infected, it is often accompanied by hepatosplenomegaly and other manifestations.

3 Piriformis infection: 3 to 5 times a day, mostly watery stools or loose stools, less mucus. A flagellate can be found in the stool to confirm the diagnosis. Metronidazole is effective.

4 trichomoniasis infection: Intestinal trichomoniasis infection can also cause diarrhea, stools vary from several times a day, mainly to loose stools, with mucus. (3) Viral infection: more common in intestinal rotavirus infection, intestinal adenovirus infection, clinical symptoms are generally mild, may have abdominal pain, diarrhea, etc., diarrhea varies from several times a day, mainly to loose stools or watery stools .

(4) fungal infection: long-term application of antibiotics, hormones or chronically consuming diseases in the middle and late stages, the patient's intestines may develop fungal infections, causing intestinal mucosal congestion, edema, erosion and ulceration leading to diarrhea, manifested as increased stool frequency Light is soft and can be accompanied by mucus, several times a day, sometimes stools are egg-like performance; heavy ones can be mucus pus. A routine diagnosis of stool can be used to identify or culture a fungus that is pathogenic.

(5) Food poisoning:

1 After eating food contaminated with Staphylococcus aureus, Salmonella, Halophilicus or Botox, symptoms such as fever, abdominal pain, vomiting, diarrhea and dehydration may occur, which is called food poisoning. Patients can be loose or watery stools, often accompanied by mucus, and a few may have pus.

2 taking poisonous mites, puffer fish, larger fish gallbladder and other toxic chemical poisons, such as poisonous rat drugs, pesticides, etc. can occur diarrhea. Diarrhea is mainly due to loose stools or watery stools, and there are few pus and blood, which may be accompanied by symptoms such as vomiting and abdominal pain. In addition to diarrhea, the above various poisons have their own special symptoms.

(6) Allergic reactions: such as food allergies (milk, fish, shrimp, seafood products, etc.) can cause abdominal pain, diarrhea; allergic purpura and other diseases can be accompanied by increased intestinal peristalsis and diarrhea. The characteristics of diarrhea are often dominated by dilute watery stools, often accompanied by abdominal pain.

(7) drugs: a variety of drugs can cause diarrhea, such as erythromycin, magnesium hydroxide, neomycin, lincomycin, magnesium sulfate, sorbitol, mannitol, 5-fluorourea pyridine, lishepine ( Resveratrol, propranolol, etc., these drugs cause different mechanisms of diarrhea; some chemicals such as phosphorus, arsenic, mercury and alcoholism can cause acute diarrhea. Diarrhea is often dominated by loose stools and watery stools, often without mucus pus.

2. The cause of chronic diarrhea: There are many causes of chronic diarrhea. In general, it can be divided into the following seven aspects. Clinically, chronic diarrhea is more common, so the characteristics of the disease are briefly described for identification.

(1) Intestinal infection: It is the most common cause of chronic diarrhea.

1 bacterial infection:

A. Chronic bacillary dysentery: acute bacillary dysentery can not be completely cured, can be evolved into chronic, can also be acute on the basis of chronic, manifested as 3 to 5 times a day stool, may be accompanied by mucus, pus and blood, more urgency and heavy feeling A small number of patients have pain in the left lower abdomen. When the chronic bacillary dysentery, the positive rate of stool culture is low, generally only 15% to 30%, so it is necessary to repeatedly find the pathogenic bacteria.

B. Intestinal tuberculosis: more common in adolescents and young adults, more women than men. The predilection of this disease is the end of the ileum or the right colon. Diarrhea is the main symptom of ulcerative intestinal tuberculosis, often alternating with constipation. The characteristic of diarrhea is that the feces are mushy or watery, ranging from 3 to 5 times a day, and severe cases can reach more than 10 times, often accompanied by symptoms of tuberculosis such as fever and night sweats. X-ray barium enema or colonoscopy can confirm the diagnosis.

2 protozoal and parasitic infections:

A. Chronic amoebic dysentery (also known as slow-acting amoebic enteritis): 3 to 5 times a day, the stool is mushy and sparse, may be accompanied by mucus or blood, and typical jam-like stools are rare in chronic cases. The course of the disease can be prolonged for several months and several years. Repeated acute attacks can occur during the course of the disease. Amoebic trophozoites can often be found in fresh feces.

B. Chronic schistosomiasis: Chronic schistosomiasis can occur diarrhea, 3 to 5 times a day, mostly loose stools, may be accompanied by mucus or pus and blood, patients often have schistosomiasis liver fibrosis. The diagnosis depends on serum antibody determination and fecal or rectal mucosal biopsy to find eggs.

C. Piriformis or Trichomonas infection: Chronic people can have stools several times a day, often for loose stools or watery stools, sometimes with mucus. A diagnosis can be made when Piriformis or Trichomonas is found in the stool.

3 chronic fungal enteritis: often occurs after long-term use of antibiotics, hormones, but also prone to the late stage of chronic wasting disease, manifested as diarrhea, severe with mucus or pus and can be repeated. A fungus can be found in the stool to confirm the diagnosis.

(2) Intestinal non-specific inflammation or non-infectious inflammation:

1 Chronic non-specific ulcerative colitis: It is considered to be an autoimmune disease. In recent years, there has been an increasing trend in China, which is more common in young and middle-aged people. The lesion mainly invades the rectum, sigmoid colon and descending colon, and can also invade the right colon. It can be divided into light, heavy and outbreak type 3. Most often seen in light weight. The lighter stools are 3 to 4 times a day, and the heavy ones can reach more than 10 times. The stool is mushy or loose, often mixed with mucus pus and blood, and the severe ones only discharge mucus pus and no fecal matter. Often accompanied by abdominal pain, urgency and other symptoms, a small number of cases may have joint pain and other extraintestinal symptoms. X-ray barium enema and colonoscopy are helpful for diagnosis. In the onset of symptoms, the disease can generally be controlled after treatment, so that the disease is in a remission period, and if it is not maintained, it can relapse.

2Crohn disease (Crohn's disease): It is also an autoimmune disease. China is far less common in Europe and America, and it is more common in young adults. The lesion can invade the whole digestive tract, but it is more common at the end of the ileum and its adjacent cecum and ascending colon. The characteristics of diarrhea are 3 to 6 times of stool per day, mostly mushy or loose stools, and few mucus pus and blood; There is often tenderness in the right lower abdomen, sometimes the lower right abdomen can be licked and mass, and a small number of patients may have extraintestinal manifestations such as arthritis. X-ray barium enema and colonoscopy are helpful for diagnosis. The disease also has the characteristics of symptom onset and relief, and the disease can be delayed for many years.

3 chronic radiation enteritis: patients with cervical cancer or pelvic malignant tumors, if diarrhea occurs within weeks or months after receiving radiation therapy, the possibility of radiation enteritis should be considered. Mainly manifested as mucus and bloody stools, often accompanied by urgency and heavy weight, local pain in the rectum. At the time of colonoscopy, the lesion mucosa (the mucosa damaged after radiotherapy) showed hyperemia, erosion, or oozing. The disease can last for many years without healing.

(3) Absorptive syndrome: The classification of malabsorption syndrome is very complicated. Malabsorption can be caused by stomach and small bowel diseases, but also by liver and gallbladder and pancreatic diseases.

1 primary malabsorption:

A. Tropical steatorrhea: also known as tropical inflammatory diarrhea, occurs in the tropics, the cause is still unknown, and is generally thought to be related to protein, folic acid and B vitamin deficiency. Diarrhea is characterized by a large amount of feces and stench, and about one-third of patients present with steatorrhea.

B. Nontropic steatorrhea: also known as gliadinal bowel disease, primary steatorrhea or celiac disease. The patient's intestinal mucosa lacks a peptide-degrading enzyme, so it can not decompose the toxic alpha-gliadin. The alpha-glycoprotein has a detrimental effect on intestinal villi and intestinal epithelial cells, eventually leading to malabsorption (barley, wheat and oats). Both contain alpha gliadin). The diarrhea is characterized by steatorrhea, the amount of feces is oily, stinking, and stools vary from several times a day.

2 secondary malabsorption:

A. After gastrectomy: more common after total gastrectomy and Piro II surgery. As food quickly enters the small intestine, causing insufficient secretion of enterokinase, pancreatic digestive enzymes and bile, or insufficient mixing of pancreatic juice and food with food, it can cause malabsorption and cause diarrhea. In addition, such as gastrointestinal surgery, causing bacterial overgrowth (blindness syndrome), due to bacterial decomposition combined with bile salts affect the formation of micelles, can lead to steatorrhea.

B. Chronic hepatobiliary diseases: such as chronic hepatitis, cirrhosis and intrahepatic bile duct obstruction, etc., due to the lack of bile salts, fat can not be emulsified and transported, it can lead to steatorrhea.

C. Intestinal disease: excessive small intestine resection (such as short bowel syndrome when the small intestine is removed more than 75% of the total length or only 120cm remaining), stomach, colon fistula or stomach, ileal fistula can be due to the absorption area of the small intestine Decrease, or food that passes through the small intestine or jejunum and through the fistula to the colon, can eventually lead to diarrhea.

D. Chronic pancreatic diseases: such as chronic pancreatitis, pancreatic cancer, etc., can cause diarrhea caused by insufficient secretion of pancreatic juice and lack of pancreatic enzyme to cause digestion and absorption of fat and protein.

E. Small intestinal mucosal diffuse lesions: such as small intestinal malignant lymphoma, Whipple disease, etc., due to intestinal mucosal damage and lymphatic vessel dilatation or obstruction and other factors leading to steatorrhea; scleroderma, due to gastrointestinal mucosa and submucosa Atrophy can eventually cause digestive dysfunction and lead to diarrhea.

(4) Endocrine diseases: Many endocrine diseases are associated with symptoms of diarrhea. Patients may sometimes be diagnosed in the Department of Gastroenterology due to diarrhea, so they must be identified.

1 hyperthyroidism: 10% to 15% of patients with hyperthyroidism have diarrhea, but diarrhea is generally not serious, several times a day, mostly soft stool or watery stool, no mucus pus and blood, less abdominal pain, patients often have more Sweat, palpitations, weight loss, thyroid enlargement and exophthalmos.

2 Diabetes: The cause of diarrhea is related to pancreatic exocrine dysfunction and intestinal motility dysfunction. The diarrhea can be soft stool or watery stool, or it can be steatorrhea, often no mucus pus and blood, several times a day. A small number of patients can present with intractable diarrhea.

3 hypoparathyroidism and medullary thyroid tumor: the former may cause neuro-muscle stress-induced diarrhea due to hypocalcemia, but diarrhea is generally not serious, ranging from 2 to 3 times a day. The latter is caused by diarrhea caused by the release of calcitonin from the tumor.

4 adrenal insufficiency: when the adrenal cortical function is low, it can cause the secretion of gastric acid and pepsin, and often accompanied by intestinal absorption dysfunction, it can occur diarrhea, often mushy, not many times.

5 pancreatic cholera syndrome (also known as Verner-Morrison syndrome, WDHA syndrome, watery diarrhea - hypokalemia - no gastric acid syndrome or vasoactive intestinal peptide tumor, namely Vipoma): this disease is rare, there are scattered cases reported in the country, This disease is caused by abnormal secretion of vasoactive intestinal peptide (VIP) by tumor cells. Some people think that adult patients' VIPs are mostly from islet cell tumors, while children's VIPs are mostly from ganglion neuroma or ganglion neuroblastoma. The clinical features of this disease are watery diarrhea, low potassium and true no gastric acid (reported cases have normal gastric acid secretion). The diagnosis depends on the VIP measurement, B-ultrasound, CT or MRI examination to find the tumor.

6 gastrinoma (Zollinger-Ellison syndrome, Zhuo-Ehrlich syndrome): due to the secretion of a large number of gastrin from islet non--cell tumor, a large number of gastrin stimulated parietal cells to secrete a large amount of gastric acid, diarrhea and a large number Gastric acid and gastric juice secretion are related. The disease is often accompanied by multiple ulcers of the stomach and duodenum. The diagnosis depends on gastric juice analysis, gastrin level determination and B-ultrasound, CT or MRI. The tumor is mostly located in the pancreatic tissue, and a few are located in the abdominal cavity. Part).

(5) Neoplastic diseases: There are the following benign or malignant tumors.

1 Gastrointestinal malignant lymphoma: The most invasive part of gastrointestinal lymphoma is the ileum, which is less affected by the colon. In addition to diarrhea, often accompanied by abdominal pain or abdominal mass, a small number of patients can be the main manifestation of bloody stools.

Type 2 cancer syndrome: diarrhea is associated with a large number of vasoactive substances such as serotonin, bradykinin and serotonin secreted by carcinoid cells. The carcinogenesis site is most common with appendix, and other parts of the intestine can also occur. In addition to diarrhea, patients often have paroxysmal redness in the face or neck or upper body (also known as "redness"), and a few are accompanied by bronchi. Asthma symptoms.

3 colon cancer: middle and late rectum or sigmoid colon cancer may have mucus pus and bloody stools, accompanied by pain in the left lower abdomen and urgency. Diarrhea is an important symptom of right colon cancer, often manifested as loose stools or mushy stools, no obvious mucus pus and blood (but often red blood cells, pus cells under the microscope). Patients are often accompanied by abdominal pain, weight loss and anemia. Left colon cancer is the main manifestation of constipation or chronic intestinal obstruction, but if there is infection or cancer rupture, it can be expressed as pus and blood. 4 intestinal adenomatous polyps or polyposis: can cause secretory diarrhea due to bleeding, erosion or ulceration on the surface of polyps. In addition to diarrhea, blood is also one of the important symptoms of intestinal polyps.

(6) Gastrointestinal dysfunction disease: irritable bowel syndrome (IBS). IBS is a group of intestinal dysfunction syndrome consisting of abdominal discomfort or abdominal pain accompanied by abnormal bowel movements. The patient's intestinal tract does not have any organic disease or abnormal biochemical indicators. Previously referred to as mucinous colitis, irritating colon or allergic colitis are now collectively referred to as IBS, the occurrence of this disease often has a more important relationship with mental stress and emotional agitation, that is, mental and psychological factors have an important impact on the onset. . In addition, stress and/or intestinal infections (such as dysentery, enteritis, etc.) are often an important cause of IBS. In recent years, there has been a more in-depth study on the onset of IBS, which suggests that IBS has visceral paresthesia, and the sensitivity of the colon to stimulation is increased to cause abnormal bowel movements (diarrhea or constipation or diarrhea constipation). In 2000, the latest diagnostic standard for IBS, the Rome II standard, was promulgated internationally. The main points are:

1 diagnosis: This disease first needs to rule out the explanation of the symptoms of tissue structure or biochemical abnormalities.

At least 3 months in 21 years, there are repeated abdominal pain or abdominal discomfort accompanied by 2 of the following 3 bowel movement abnormalities.

A. The abdominal pain is relieved or relieved after the operation.

B. Abnormal frequency of defecation

C. Abnormal shape of the bowel movement (lean or dry hard knot). The Rome II standard is gradually being accepted by multinational digestive doctors. Patients with diarrhea-type IBS often develop diarrhea after abdominal pain or discomfort, and relieve or relieve abdominal pain or discomfort after the stool. The stool is characterized by loose stools and soft stools, and a few are watery stools. The number of times varies from day to day, often 3 times. Above, feces do not have pus and blood, a few may be accompanied by mucus. The diagnosis of Chinese medicine is five diarrhea, which can be considered as a manifestation of IBS. Patients often have abdominal pain or abdominal discomfort before dawn. Most of them have bowel sounds, and the pain is relieved or relieved after abdominal pain. Diarrhea 2 to 3 times before breakfast, and diarrhea can often stop after breakfast. A small number of patients are prone to abdominal pain and diarrhea after each meal. This is because the stomach-colon reflex is caused by eating, that is, after the stomach contains food, it causes colonic hyperstimulation, and the patient has a pain or discomfort in the abdomen. This performance should also be considered to be caused by colonic dysfunction.

(7) Other factors:

1 intestinal flora imbalance: diarrhea due to long-term application of broad-spectrum antibiotics, resulting in a disorder of the normal flora of the intestine, severe cases can induce pseudomembranous colitis.

2 uremia: diarrhea caused by uremic enteritis, stool 3 to 5 times a day, mostly paste or watery stool.

(two) pathogenesis

The mechanism that causes diarrhea is complex, and a diarrheal disease often involves multiple factors. The pathogenesis of diarrhea is generally classified into the following four categories according to pathophysiology.

1. Abnormal secretion function: Diarrhea caused by abnormal secretion function is also called secretory diarrhea or exudative diarrhea. Normal intestinal mucosa has the function of secretion and absorption, and regulates the absorption function of water, nutrients and electrolytes, so that the water lost from the feces remains basically stable. When the secretory function of the intestine exceeds its absorption function, it will inevitably lead to diarrhea. . A large amount of watery diarrhea caused by Escherichia coli endotoxin, Vibrio cholerae or Clostridium difficile endotoxin is a typical representative of intestinal secretory or exudative diarrhea. The mechanism is that endotoxin binds to receptors on the brush border of epithelial cells, which in turn activates adenylyl cyclase in intestinal mucosal cells, allowing intracellular second messenger cAMP (cyclic adenosine monophosphate), cGMP (cyclic phosphate). The increase in guanosine and calcium ions, in turn, increases the intracellular secretion of water and chlorine into the intestinal lumen, reaching 1 to 2 L per hour. Clostridium difficile infection causes secretory diarrhea through an increase in Ca. A large amount of liquid can not be absorbed by the small intestine and large intestine mucosa, which will inevitably lead to diarrhea, other diseases such as gastrinoma (Zollinger-Ellison syndrome), vasoactive intestinal peptide tumor (Vipoma), pancreatic cholera syndrome and other diarrhea It is also a secretory diarrhea. In addition, infective and non-infectious inflammation of the intestine (such as dysentery bacilli, Salmonella, Mycobacterium tuberculosis, amoeba, Yersinia and virus, fungal infections, non-specific ulcerative colitis and Crohn's disease, Radiation-induced intestinal damage, etc.) are diarrhea caused by increased intestinal secretion.

2. Increased osmotic pressure: Diarrhea due to increased osmotic pressure in the intestinal lumen is also called osmotic diarrhea or hypertonic diarrhea. In normal people, food decomposition products, such as sugars, fats, proteins and electrolytes, have been absorbed or diluted under the action of chylomicrons, intestinal kinase and various pancreatic enzymes, so the contents of empty and ileum are presented. Seepage state. If the contents of the empty and ileum are hypertonic, that is, the osmotic pressure in the intestinal lumen is increased, the osmotic pressure between the plasma and the contents of the intestinal cavity may be different. When the osmotic pressure difference between the two increases, Maintaining the osmotic pressure gradient, the water in the plasma will quickly enter the intestinal lumen through the intestinal mucosa until the contents of the intestinal lumen are diluted to isotonic, and a large amount of fluid in the intestinal lumen can cause diarrhea.

When pancreatic lesions (such as chronic pancreatitis, pancreatic cancer, pancreatic cystic fibrosis, etc.) or hepatobiliary lesions (chronic hepatitis, cirrhosis, liver cancer, biliary calculi, biliary tract inflammation, and biliary tract tumors), due to lack of digestion Emulsification disorders of enzymes or fats can cause digestion and absorption of sugars, fats and proteins in the air and ileum, and the contents of the intestinal cavity are in a hypertonic state, which inevitably leads to diarrhea. In a few cases, severe atrophic gastritis or invasive gastric cancer is reduced by gastric juice and gastric acid secretion. The digestion of food in the stomach is weakened, and food will enter the small intestine directly, resulting in an increase in intestinal osmotic pressure, which may also cause diarrhea. Lactose malabsorption caused by congenital lactase deficiency is not uncommon in China. Among them, about 60% of patients lack enzymes, and can develop symptoms such as diarrhea and abdominal pain after eating milk or dairy products. Such patients are intolerant to lactose, and the undigested lactose in the intestine is enzymatically hydrolyzed by the intestines to produce a large amount of gas such as carbon dioxide. The decomposed lactic acid and other short-chain organic acids cause an increase in intestinal osmotic pressure, thus causing The diarrhea is also hyperosmolar diarrhea. In addition, diarrhea caused by taking certain drugs, such as magnesium sulfate, magnesium oxide, mannitol, sorbitol and lactulose, is also hyperosmotic diarrhea.

3. Absorption dysfunction: diarrhea caused by malabsorption of nutrients is also called malabsorption diarrhea, and various diseases that cause intestinal mucosal damage or reduced absorption area can cause diarrhea; intestinal infectious and non-infectious diseases It can cause damage to the intestinal mucosa, that is, the microvilli on the surface of the small intestine mucosa can be destroyed, resulting in a decrease in the absorption area and diarrhea; the absorption area of most of the intestine can be reduced to cause diarrhea; pediatric celiac disease, tropical and non-tropical Sexual steatorrhea (micidal intestinal disease), etc. are due to the reduction and atrophy of the small intestine microvilli, resulting in decreased absorption area and diarrhea. In addition, mesenteric vascular or lymphatic lesions (such as obstruction, reflux obstruction, etc.) can also cause absorption. Poor diarrhea; suffering from portal hypertension (causal hypertensive gastric mucosal lesions), right heart dysfunction or constrictive pericarditis, if not treated promptly, can cause gastrointestinal mucosal congestion, resulting in intestinal mucosa Absorption disorder leads to diarrhea; in addition, under normal circumstances, combined bile salts are reabsorbed at the end of the ileum and reach the liver (intestinal hepatic circulation), such as the ileum There are serious lesions at the end, such as intestinal tuberculosis, Crohn's disease, tumor or extensive resection of the distal ileum, combined with reduced absorption of bile salts, and the bound bile salts entering the colon are significantly increased, which can be decomposed into bischolic acid by colonic bacteria. It stimulates the secretion of colonic mucosa, and the absorption of water and salt decreases, leading to diarrhea.

4. Gastrointestinal motor dysfunction: Diarrhea due to gastrointestinal dysfunction is also called abnormal motor function diarrhea, functional diarrhea or hyperkinetic diarrhea. When the gastrointestinal tract peristalsis increases, the residence time of the chyme and water in the gastrointestinal tract is shortened, resulting in incomplete absorption and diarrhea; intestinal inflammation, infectious lesions can stimulate the intestinal wall, causing the intestinal peristalsis to increase and aggravate diarrhea. Some patients have abdominal pain and diarrhea while having anxiety and emotional stress, commonly known as irritable bowel syndrome (IBS). The main cause of diarrhea is intestinal dysfunction or hypertrophy of the stomach-colon. In addition, some endocrine diseases such as hyperthyroidism, diabetes, etc. can also occur diarrhea, the cause is also related to intestinal hyperfunction; when the peristalsis is too slow, the chyme stays in the intestine for too long, such as causing excessive bacteria Breeding can also cause diarrhea. In addition, some drugs such as propranolol and mosapride can cause diarrhea when the intestinal peristalsis increases.

Examine

an examination

Related inspection

Sigmoidoscopy for rectal examination of fiberoptic colonoscopy

Clinical manifestation

1. Gastrointestinal symptoms: frequent intentions, each time the amount of feces is not much and there is a sensation in the urgency, the lesions are mostly in the rectum or sigmoid colon; small intestinal lesions are not in a hurry and then feel heavy. Abdominal pain in the lower abdomen or left lower abdomen, abdominal pain can be relieved after defecation, often sigmoid colon or rectal lesions. Small bowel lesions, diarrhea, pain in the umbilical cord, pain after bowel movements are not relieved. Secretory diarrhea often has no symptoms of abdominal pain.

2. The number of diarrhea and fecal traits: acute diarrhea can be more than 10 times a day, the stool is thin, such as bacterial infection (bacterial dysentery) often with blood and pus. If it is syrup or jam-like stool, the suggestion may be amoebic dysentery. Thin water samples are common in food poisoning. Hemorrhagic necrotic enteritis discharges bloody bloody stools with a foul smell.

3. Accompanying symptoms

(1) people with fever can be seen in acute bacterial dysentery, typhoid or paratyphoid fever, intestinal tuberculosis, colon cancer, small intestinal lymphoma, Crohn's disease, acute exacerbation of non-specific ulcerative colitis, sepsis, viral enteritis, Thyroid crisis and so on.

(2) with obvious wasting can be seen in gastrointestinal malignant tumors and malabsorption syndrome.

(3) with rash or subcutaneous hemorrhage seen in sepsis, typhoid or paratyphoid, measles, allergic purpura, pellagra and so on.

(4) with joint pain or swelling found in Crohn's disease, chronic non-specific ulcerative colitis, lupus erythematosus, intestinal tuberculosis, Whipple's disease.

(5) with abdominal mass in the gastrointestinal malignant tumor, intestinal tuberculosis, Crohn's disease and schistosomiasis granuloma.

(6) Commonly associated with severe dehydration, secretory diarrhea such as cholera and bacterial food poisoning, also seen in uremia.

diagnosis

Most patients with acute or chronic diarrhea need only be diagnosed based on their medical history, physical signs, and necessary laboratory tests, such as stool routine and culture. When a diagnosis cannot be made after a general routine examination, further examination should be considered, but since there are many items available for examination, it is necessary to make a choice in combination with the characteristics of each patient's diarrhea. For example, when it is judged that the patient's diarrhea is likely to be caused by small bowel disease, an examination that is helpful for the diagnosis of small bowel disease should be selected; if diarrhea is caused by a large bowel disease, an examination that is helpful for the diagnosis of large bowel disease should be selected.

1. History and clinical manifestations: A detailed understanding of the history and clinical manifestations is important for the diagnosis of acute or chronic diarrhea, and can initially estimate the cause of diarrhea or the location of the lesion. The site of abdominal pain or the site of the sputum and mass often indicates the location of the lesion. For example, pain, tenderness or sputum and mass in the right lower quadrant should be considered for intestinal tuberculosis, Crohn's disease, amoebic granulomatosis or right colon. The possibility of cancer.

2. Digital rectal examination: rectal examination is extremely valuable for the diagnosis of rectal lesions such as rectal cancer, ulcerative proctitis, and rectal polyps. For stools with mucus and pus, the digital rectal examination should be listed as the preferred routine examination.

Diagnosis

Differential diagnosis

Defecation time is too long: In life, many people like to read a book while sitting on the toilet. It is half an hour. Experts believe that this habit is very bad. Generally, the defecation time is normal in 5 to 10 minutes. Reading while reading the toilet, the defecation time is too long, the energy is scattered, and it is easy to cause anorectal diseases such as hemorrhoids and constipation. The defecation time is too long, the energy is scattered, and it is easy to cause anorectal diseases such as hemorrhoids and constipation.

Defecation is not enough: Many people have the feeling that the bowel movements are not clean, and the stool is not formed, and the bowel movements are not comfortable and uncomfortable. In fact, most of the feelings of defecation are caused by chronic enteritis. Chronic enteritis can be caused by prolonged or recurrent episodes of acute enteritis, and the course of disease is more than 2 months. Long-term fatigue, emotional excitement, excessive mental stress, and malnutrition can all be the cause of chronic enteritis. It can also be secondary to diseases such as chewing disorders, gastric acid deficiency, subtotal gastrectomy, and intestinal parasitic diseases. According to the increase in the number and frequency of clinical diarrhea, feces are thin, even watery stools, accompanied by bowel, but no urgency, nutritional disorders, combined with recurrent episodes or the cause of chronic enteritis, the diagnosis is generally not difficult.

Defecation disorder: mainly refers to the disorder of discharge of feces caused by pelvic floor muscle coordination disorder or difficulty in stool. This type can also be called outlet obstruction constipation, often because the pelvic floor muscles and anal sphincters can not coordinate the activities during defecation. Or caused by abnormalities. Anal digital examination is a basic and simple examination that can exclude organic diseases such as hemorrhoids, anal stenosis, and blood in the stool. An assessment of the strength and coordination of the anorectal muscles was examined by examining the patient's simulated bowel movements and tightening of the anus. Anorectal manometry is one of the most commonly used tests to determine the function of the internal and external sphincters of the anus, as well as the sensory function and compliance of the rectal wall. include:

(1) resting pressure, maximum systolic pressure, and systolic time limit of the anal sphincter,

(2) length of the anal sphincter,

(3) anorectal inhibition of reflexes,

(4) Simulating pressure changes during defecation,

(5) rectal sensory function,

(6) Rectal compliance and the like.