Diarrhea

　　Diarrhea is divided into acute diarrhea and chronic diarrhea, and the causes are also not the same. The specific details are as follows:

　　First, the course of acute diarrhea usually does not exceed 3 weeks, intestinal infection, including food poisoning, is the most common cause of acute diarrhea, and can be divided into:

　　1, Bacterial infections: Common pathogens include Shigella, Escherichia coli, Salmonella, Campylobacter jejuni, Yersinia enterocolitica, Staphylococcus aureus in the intestines, Clostridium perfringens, Clostridium welchii, Clostridium difficile, and Vibrio cholerae.

　　2, Protozoa and parasitic infections: Including amebas, schistosomes, trichomonas, and giardia.

　　3, Viral infections: Most common in enteric rotavirus infection and enteric adenovirus infection.

　　4, Fungal infections: There are many fungi that can cause diarrhea, such as mold in expired food.

　　5, Food poisoning: Common pathogenic bacteria include Staphylococcus aureus, Salmonella, halophilic bacteria, Bacillus cereus, Clostridium perfringens, Clostridium botulinum, or botulism; poisonous mushrooms, fugu, large fish bile, and other toxic chemicals such as rodenticides and pesticides.

　　6, Allergic reactions: Food allergies (such as milk, fish, shrimp, seafood products, etc.) can cause abdominal pain and diarrhea; diseases such as allergic purpura can be accompanied by increased intestinal peristalsis and diarrhea.

　　7, Medications: Various drugs can cause diarrhea, such as erythromycin, magnesium hydroxide, neomycin, lincomycin, magnesium sulfate, sorbitol, mannitol, 5-fluorouracil, reserpine (reserpine), propranolol (Propranolol), and others. The mechanisms by which these drugs cause diarrhea are not the same; certain chemicals such as phosphorus, arsenic, mercury, and alcohol poisoning can also cause acute diarrhea.

　　Secondly, the disease period of chronic diarrhea is more than 2 months, and the etiology is more complex than that of acute diarrhea, making diagnosis and treatment sometimes difficult. There are many causes of chronic diarrhea, including:

　　1. Intestinal infection: It is the most common cause of chronic diarrhea, including bacterial infections, protozoan and parasitic infections, and fungi.

　　2. Non-specific intestinal inflammation or non-infectious inflammation: Autoimmune diseases, autoimmune diseases, enteritis caused by radiotherapy, malabsorption syndrome, etc.

　　3. Malabsorption syndrome: The classification of malabsorption syndrome is very complex. Malabsorption can be caused by diseases of the stomach and small intestine, as well as diseases of the liver, gallbladder, and pancreas.

　　4. Endocrine diseases: Many endocrine diseases are accompanied by diarrhea symptoms, such as hyperthyroidism, diabetes, hypoparathyroidism and thyroid medullary tumor, adrenal cortical insufficiency, cholera syndrome, WDHA syndrome, watery diarrhea-hypokalemia-achlorhydria syndrome, or vasoactive intestinal peptide tumor, gastrinoma.

　　5. Tumor diseases: Gastrointestinal malignant lymphoma, carcinoid syndrome, colorectal cancer, intestinal adenomatous polyps or polyposis.

　　6. Gastrointestinal dysfunction diseases: Irritable bowel syndrome includes mucous colitis, irritable colon, or allergic colitis.

　　7. Other factors: intestinal flora imbalance, uremia.

　　In daily life, we may experience diarrhea without realizing it. Most people do not pay attention to it, but in fact, if diarrhea is not treated in a timely manner, it can lead to the following complications:

　　1. Acute viral myocarditis

　　Viral myocarditis is one of the most dangerous complications of diarrhea. Some diarrhea can be caused by viruses, and the most common virus to cause myocarditis is a type of enterovirus called Coxsackie virus, which can directly enter myocardial cells and cause damage, or produce certain harmful substances that damage myocardial cells, leading to myocardial degeneration. It can also affect the pericardium and endocardium. If it invades the cardiac pacemaker system, it will threaten life.

　　2. Cardiovascular and cerebrovascular accidents

　　During diarrhea, a large amount of water and sodium, potassium, calcium, and magnesium ions are excreted in the feces. The loss of water puts the body in a state of dehydration, reducing blood volume, increasing blood viscosity, slowing blood flow, and easily forming thrombi that block blood vessels, causing coronary artery blockage leading to angina pectoris and myocardial infarction, and cerebral vascular blockage causing ischemic stroke. Sodium, potassium, calcium, and magnesium are important cations in the body. In addition to maintaining acid-base balance in the blood, they play a crucial role in maintaining nerve conduction function and heartbeat rhythm. Deficiency can cause severe arrhythmias and sudden death.

　　3. Hypoglycemia

　　During diarrhea, appetite usually decreases, leading to insufficient food intake. At this time, the body needs to break down stored glycogen to maintain blood glucose stability. However, the elderly do not have enough glycogen stores to convert into blood glucose, and when blood glucose levels drop, the elderly are prone to symptoms such as fatigue, sweating, palpitations, pale complexion, and fainting, which are a series of symptoms of hypoglycemia.

　　4. Dehydration and acidosis

　　It is the main cause of death in acute diarrhea. Normally, carbon dioxide produced by metabolism in the body is exhaled through respiration, and the rest of the waste needs to be transported by water through the kidneys and excreted from the body as urine. During dehydration, urine output decreases due to water loss in the body, and in severe cases, there may be no urine. This will reduce the excretion of waste produced by metabolism in the body and accumulate in the body, causing toxic symptoms in the body. The clinical manifestations, in addition to respiratory changes, can also appear fatigue, weakness, and neurological symptoms, etc.

　　In addition, after the recurrence of gastric disease, diarrhea leads to a gradual decrease in human digestive function and a weakening of intestinal resistance, increasing the burden on gastrointestinal function, which often leads to the recurrence of gastric disease.

　　Diarrhea is a common symptom, commonly known as 'diarrhea', referring to symptoms such as an increase in defecation frequency, thin stools, and increased water content, etc. In order to help everyone better understand diarrhea, the following will be introduced specifically:

　　First, gastrointestinal symptoms

　　Diarrhea is characterized by frequent defecation, with little stool each time and a sense of urgency. The lesion is often in the rectum or sigmoid colon; there is no sense of urgency in the small intestine. Abdominal pain is in the lower abdomen or left lower abdomen, and the pain may subside after defecation, which is often a sigmoid colon or rectal lesion. In small intestinal lesions, the pain is often around the umbilicus, and the pain does not usually subside after defecation. Secretory diarrhea often has no abdominal pain symptoms.

　　Acute diarrhea can cause more than 10 bowel movements a day, with loose stools. If it is caused by bacterial infection (bacterial dysentery), it often contains blood and pus. If it is like syrup or jam, it may indicate amebic dysentery. Thin watery stools are common in food poisoning. Hemorrhagic necrotizing enteritis excretes bloody stools resembling washwater, with a foul smell.

　　Second, accompanying symptoms

　　1. Fever: Visible in acute bacterial dysentery, typhoid or paratyphoid fever, intestinal tuberculosis, colon cancer, small intestinal malignant lymphoma, Crohn's disease, acute onset of non-specific ulcerative colitis, sepsis, viral enteritis, thyroid crisis, and others.

　　2. Significant weight loss: Visible in gastrointestinal malignant tumors and malabsorption syndrome.

　　3. Rash or subcutaneous hemorrhage: Seen in sepsis, typhoid or paratyphoid fever, measles, allergic purpura, pellagra, and others.

　　4. Joint pain or swelling: Seen in Crohn's disease, chronic non-specific ulcerative colitis, lupus erythematosus, intestinal tuberculosis, Whipple's disease, and others.

　　5. Abdominal mass: Seen in gastrointestinal malignant tumors, intestinal tuberculosis, Crohn's disease, and schistosomiasis granuloma.

　　6. Severe dehydration: Common in secretory diarrhea such as cholera and bacterial food poisoning, also seen in uremia and other conditions.

　　Diarrhea is often caused by our neglect of diet, so the key to prevention is to prevent 'disease from the mouth'. It is recommended to pay attention to the following points:

　　1. Wash your hands before and after meals

　　Wash your hands before and after meals to avoid eating pathogens after hand contact.

　　2. Buy less cooked meat in summer

　　Try not to buy cooked meat products in summer, and if consumed, they should be disinfected at high temperature before eating.

　　3. Ensure the freshness of food

　　Eat fresh food and do not buy expired or deteriorated food, especially in summer when high temperatures are easy to cause deterioration of meat, seafood, dairy products, and soy products. When purchasing, be sure to check the expiration and preservation date of the food.

　　4. Eat less leftover rice and vegetables

　　Try to avoid eating leftover rice and vegetables, and after-dinner food should be thoroughly heated before eating. Cold dishes should be eaten immediately after mixing, and it is best to add some rice vinegar and garlic to kill bacteria. Moreover, cold dishes should be cut with special knives and boards to avoid mixing raw and cooked foods.

　　Diarrhea can be caused by various reasons, and common examinations include:

　　1. Fecal examination

　　Fecal examination includes routine feces, fecal culture, and egg examination. If the feces show a paste-like, loose, or watery consistency, are abundant in quantity or have a bad smell, and do not contain mucus, pus, or only contain fat, it often suggests small intestinal diarrhea or diarrhea due to low function of liver, bile, and pancreas; if the feces are less in quantity and contain mucus or pus, it often suggests colonic diarrhea; if protozoa, parasites, or eggs are found in the feces and other causes can be excluded, it can suggest protozoan or parasitic diarrhea; fecal culture can isolate various pathogenic bacteria, which is of great value for diagnosis.

　　2. Pancreatic exocrine function test

　　If diarrhea is suspected to be caused by pancreatic disease, pancreatic exocrine function tests should be performed, such as meal test (Lundh test), benzoyl-tyrosine-p-aminobenzoic acid test (PABA test), and secretin test, etc.

　　3. Small intestine absorption function test

　　Determination of fat globules, nitrogen content, muscle fibers, and trypsin content in feces: When the number of fat globules is over 100 under high-power microscopic observation ( Sudan III staining method), malabsorption of fat can be considered; when the nitrogen content in feces increases, it suggests malabsorption of sugars; when the muscle fibers in feces increase and the trypsin content decreases, it indicates malabsorption of the small intestine.

　　Dextrose xylose test: In patients with poor absorption of dextrose, the excretion of D-xylose in urine is often reduced. Radioactive isotope-labeled vitamin B12 absorption test (Schilling test): In patients with impaired absorption of vitamin B12, the concentration of radioactive isotopes in urine is significantly lower than normal.

　　4. Breath test

　　Mostly 14C-triacylglycerol breath test. In patients with malabsorption of fat, after taking oral 14C-labeled triacylglycerol, the amount of 14C-labeled CO2 exhaled from the lungs decreases, while the amount of 14C-labeled CO2 excreted in feces increases. In recent years, the 13C breath test, which has been widely conducted, can observe the absorption of sugars and has important diagnostic value for lactose malabsorption. In addition, there are also methods such as 14C-glycine breath test.

　　5. X-ray examination

　　Barium meal or barium enema examination can understand the functional state and peristalsis of the gastrointestinal tract, and is of great diagnostic value for malabsorption of the small intestine, tuberculosis, Crohn's disease, ulcerative colitis, lymphoma, and colon cancer.

　　6. Ultrasound, CT, or MRI examination

　　Observation of liver, bile duct, pancreas and other organs can determine whether there are any lesions related to diarrhea. It can also provide evidence for intestinal tumor lesions. Therefore, ultrasound, CT, and MRI examinations have auxiliary diagnostic value for malabsorption diarrhea and tumor diarrhea.

　　7. Colonoscopy

　　Colonoscopy has important diagnostic value for lesions at the distal ileum, such as intestinal tuberculosis, Crohn's disease, other ulcerative lesions, and colonic lesions such as ulcerative colitis, colorectal polyps, cancer, chronic schistosomiasis intestinal disease, etc.

　　8. Retrograde cholangiopancreatography

　　It has important diagnostic value for bile duct and pancreatic lesions.

　　9. Enteroscopy

　　Although enteroscopy has not been widely carried out, it has important diagnostic significance for malabsorption of the small intestine and Whipple's disease. Under direct vision of enteroscopy, the condition of the small intestinal mucosa can be observed, and histopathological examination of living tissue can judge the changes of microvilli and glands, etc.

　　Both patients with acute diarrhea onset and chronic diarrhea need to pay attention to dietary adjustment. On the one hand, do not increase the burden on the gastrointestinal tract, and on the other hand, ensure the body's nutrition. Next, I will specifically introduce the dietary principles for diarrhea patients.

　　1. Acute stage fasting

　　During the acute watery diarrhea period, temporary fasting is required to allow the intestines to rest completely. Intravenous infusion may be necessary if necessary to prevent excessive water loss and dehydration.

　　2. Light fluid diet

　　For those who do not need to fast, light fluid diet should be given in the early stage of the disease. Such as protein water, fruit juice, rice gruel, thin flour soup, etc., with salt as the main flavor. Early fasting of milk and sucrose, which are easy to produce gas, should be avoided. Some patients may not tolerate milk, and taking milk often aggravates diarrhea.

　　3. Adjust diet according to the condition

　　After the frequency of defecation decreases and the symptoms are relieved, switch to low-fat liquid diet or low-fat, low-fiber, fine and easily digestible semi-liquid diet, such as rice porridge, lotus root starch, soft noodles, noodles, etc.

　　4. Dietary selection

　　After the diarrhea basically stops, low-fat, low-fiber semi-liquid or soft food can be provided. Eat in small portions but more frequently to facilitate digestion, such as noodles, congee, steamed buns, rice porridge, minced lean meat, etc. It is still appropriate to limit vegetables and fruits with high fiber, and gradually transition to regular food later.

　　5. Vitamin supplement

　　Pay attention to the supplement of vitamin B and vitamin C, such as fresh orange juice, fruit juice, tomato juice, vegetable soup, etc.

　　6. Dietary taboos

　　Abstain from alcohol, fatty meat, hard and fibrous vegetables, raw and cold fruits and vegetables, pastries and cold drinks with high oil content, etc.