Preparations for irritable bowel syndrome with diarrhea


Diarrhea (diarrhea)- rapid or single emptying of the intestine with the release of liquid feces (usually more than 200-300 g per day).

At the heart of diarrhea may be an increase in active secretion of the intestinal sodium and water, an increase in osmotic pressure in the intestinal cavity (decreased water and electrolyte absorption), intestinal peristalsis, increased exudation of water and electrolytes in the lumen intestines. Excessive secretion in the small intestine develops when it is infested with pathogenic microorganisms (for example, cholera vibrio, enteropathogenic viruses), tumors that release peptide hormones, Zollinger-Ellison syndrome (due to increased production gastrin). Excessive secretion in the large intestine is possible if there is a violation of absorption in the small intestine of fatty acids with long chains, bile acids (for example, with dysbacteriosis).

Hyperosmolar diarrhea develops with malabsorption (for example, celiac disease), deficiency of pancreatic enzymes (with chronic

pancreatitis, cancer of the pancreas) and bile salts (with mechanical jaundice), under the influence of osmotic laxatives (magnesium sulfate, lacta-vines).

Violations of intestinal peristalsis are possible with irritable bowel syndrome, under the influence of some laxatives (senna extract, bisacodyl, castor oil). An increase in the exudation of water and electrolytes accompanies exudation of the protein in the lumen of the gut through the damaged mucosa - with Crohn's disease, ulcerative colitis, intestinal tuberculosis, intestinal infections (dysentery, salmonellosis), malignant tumors and ischemic diseases intestines.

The frequency of the stool is different, the bowel movements are watery or mushy. With hypersecretory diarrhea, the stool is plentiful, watery, with hyperosmolar - polyphealic prevalence (increase in the number of feces due to undigested remnants), with motor diarrhea there is a nevolnoe frequent liquid stool, with hyperexcudative stool liquid, sometimes with an admixture of pus and blood. The nature of the bowel movements depends on the disease.

So, the presence of fresh or altered blood in the feces indicates a pathology of the colon, the appearance of pus and mucus - on the inflammatory process. In particular, with dysentery, feces have a dense consistency first, then it becomes liquid, lean, mucus appears in it and blood; with amoebiasis - contains vitreous mucus and blood, sometimes blood impregnates the mucus and the bowel movements acquire the appearance of a crimson jelly.

In diseases of the pancreas, fatty feces are noted (after washing off the stool, drops of fat remain on the toilet bowl).

Distinguish diarrhea is acute (duration less than 2-3 weeks) and chronic(lasting more than 3 weeks). The causes of acute diarrhea are most often infectious (dysentery, salmonellosis, etc.) and other inflammatory diseases intestines (ulcerative colitis, Crohn's disease), taking medicines (laxatives, antibiotics, containing magnesium salts of antacids and etc.).

For acute infectious diarrhea, signs of intoxication, fever, anorexia, and sometimes vomiting are characteristic. The cause of diarrhea, which continues after acute gastroenteritis, can be persistent infection (giardiasis, iersenioz), acquired laccaseemia, irritable bowel syndrome, as well as an unrecognized disease (eg, celiac disease, ulcerative colitis).

Chronic diarrhea can be a manifestation of functional disorders or organic bowel disease, including irritable bowel syndrome, intestinal tumors, ulcerative colitis, Crohn's disease, malabsorption syndrome and etc. Pain in the hypogastrium can accompany diarrhea in diseases of the colon (diverticulosis, Crohn's disease, syndrome irritated colon, intestinal tumors), in the upper half of the abdomen - with pancreatitis, syndrome Zollinger-Ellison. Ulcerative colitis and dysbacteriosis are often manifested by diarrhea without pain syndrome. The fetid smell of stool, the presence of undigested residues in them, the feeling of rumbling, transfusion, bloating - are non-specific signs that occur in many diseases.

Light and non-durable diarrhea has little effect on the general condition of patients, severe and chronic dehydration, loss of electrolytes (potassium, sodium, magnesium), exhaustion, hypovitaminosis, marked changes in bodies. To establish the cause of diarrhea, a cop-rlogic and bacteriological study is carried out.

The treatment is aimed, first of all, at eliminating the cause that caused diarrhea.For example, with pancreatic insufficiency, enzymatic preparations are shown - creon, festal, mezim forte, etc. A mechanically and chemically sparing diet is shown with the exception of products that enhance motor-evacuator and secretory function. Antibacterial agents are used to restore eubiosis, preference is given to drugs that do not disturb the balance of the microbial flora in the intestine - inte- trix, nifuroxazide (ersefu-rilu) and others. Bacterial preparations are used - bifidumbacterin, bifikol, lactobacterin, bakti-subtil, linex, enterol, flonivine BS, etc. as well as hilak forte.

Symptomatic agents include calcium carbonate, bismuth preparations, tanalbine; decoctions of the bark of oak, grass St. John's wort, rhizome of serpentine, tentacle or bug, cherry fruit, bilberry infusion, aplicata of alder, chamomile flowers, belladonna tincture and other Apply adsorbing, astringent, enveloping agents (smecta, tanna-comp, etc.).

To slow the intestinal peristalsis use antispasmodics (no-spa, papaverine, bacus-copan).

Antidiarrheal destroys possesses loperamide (imodium), which reduces tone and intestinal motility due to influence on opiate receptors. The drug is used in acute gastroenteritis, motor disorders, appointed at a dose of 4 mg orally after the first liquid stool, then 2 mg after each defecation. With the development of dehydration, infusion therapy or rehydration solutions (citroglucosolane, regidron, and gastrolit) are administered for oral administration.



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