Patients with secretory diarrheal syndrome are a frequent and at the same time complex problem in the practice of a gastroenterologist. It is not always possible to correctly determine the cause of the disease, respectively, in a timely and competent way to choose a course of treatment. The term "diarrhea" means frequent bowel movements with the release of liquid feces. Secretory diarrhea differs from other types in that there is an increased secretion of water and electrolytes with a painless secretion of intestinal contents.
Symptomatology
The main symptoms of secretory diarrhea include:
- increase in body temperature to 37-37.8 degrees;
- weak intoxication of the body is observed;
- spastic pain is minimal;
- no false urge to defecate; electrolyte balance is disturbed (detected during laboratory tests);
- there is an admixture of greenery in the feces, odorless watery stools.
Pathogenesis
The pathological process accumulates in the small intestine. Due to the activation of enterocyte adenylate cyclase by enterotoxins, an increase in intracellular cyclic adenosine monophosphate occurs. As a result of this process, the transportation of sodium and calcium ions is disrupted, followed by their accumulation in the lumen of the intestine, after which there is an accumulation of water, therefore, the appearance of abundant loose stools. The pathogenesis of secretory diarrhea is similar to the pathological process of salmonellosis and cholera.
Diagnostics
Initially, doctors determine the type of diarrhea by asking the patient about the frequency of bowel movements and the consistency of feces. This information allows you to determine the level and etiology of the lesion. The second step in the diagnosis is to collect an anamnesis. The results of the tests will determine the concomitant diseases, especially the patient’s nutrition, the presence of intolerance to dairy products, taking medications, as well as operations on the gastrointestinal tract.
Laboratory studies of secretory diarrhea in children and adults begin by determining the number of leukocytes and red blood cells in the feces. Bacteriological studies of feces and sigmoidoscopy are also carried out, due to which it is possible to establish a connection between the disease and parasitic invasion, non-specific intestinal inflammation and various infections.
Consequences of the disease
Due to the secretory type of diarrhea, dehydration occurs due to a violation of homeostatic regulation of water volume. There is also a failure in the exchange of electrolytes, acidosis, hypokalemia and hyponatremia develop (rapid loss of potassium and sodium by the body). With diarrhea, mild malabsorption (malabsorption in the small intestine) and dilution of digestive enzymes are observed.
The causes of the disease
Secretory diarrhea occurs due to an increase in the number of bacterial toxins, bile acid, pathogenic viruses, prostaglandins and other biologically active substances. Depending on the nature of the appearance, the causes of the disease are divided into two types:
- Infectious.
- Non-infectious.
The causes of non-infectious secretory diarrhea can be:
- Hereditary predisposition to increase the level of sodium secretion. This phenomenon occurs due to the fact that a gene mutation occurs that is directly responsible for the creation of a brush border of enterocytes. Quite often, this can be observed in women during multiple pregnancy.
- Tumors that contribute to the production of hormones that upset the balance of secretion.
- Taking laxatives with a strong effect.
- Increased levels of arsenic salts, toxins and fungi in the body.
- Pancreatic cholera, which promotes the growth of tumors of the pancreas and intestinal mucosa of the malignant type. This pathology causes high hypochlorhydria, which slows down the production of hydrochloric acid in the organs of the gastrointestinal tract.
- Modular carcinoma of the thyroid gland, due to which there is a violation of the secretion of water and salts by enterocides.
- Hereditary chloride diarrhea.
- Carcinoid syndrome, which affects the tissues of the bronchi and intestines. This pathology appears due to the release of a large amount of serotonin and bradykinin.
Infectious sector diarrhea occurs as a result of cholera. In this case, the daily volume of feces increases to 10 liters during bowel movements. This leads to water-electrolyte imbalance.
Treating Secretory Diarrhea
To alleviate the condition of the patient, doctors use:
- enzyme therapy, that is, poly- and mono-enzymes are prescribed in cases of symptoms of secondary fermentopathy;
- phage therapy - the use of bacteriophages with the constant allocation of UPM from feces;
- probiotic therapy - the use of probiotic preparations for violations of microbiocenosis;
- herbal medicine as an option of auxiliary treatment (prescribed decoctions of St. John's wort, calendula, sage, plantain or lingonberry, cabbage juice, a decoction of nettle and a string);
- vitamin therapy - taking a vitamin and mineral complex.
Treatment of secretory diarrhea after surgery involves bed rest for the entire rehabilitation period, followed by a transition to semi-bed. To restore the water-electrolyte balance, rehydration is carried out using saline solutions for oral administration. In severe diarrhea, accompanied by constant vomiting, parenteral administration of drugs is used.
Diet
In addition to medication for secretory diarrhea, you should follow simple nutritional rules to speed up the healing process:
- Limit the use of spicy and spicy dishes, smoked meats, as well as food from coarse fiber.
- Milk sugar - lactose - is completely excluded from the daily diet. In this case, patients can take lactose-free mixtures.
- Patients should eat cereals cooked with vegetable broth, as well as more vegetable foods, such as potatoes, cauliflower or zucchini.
- If necessary, and only after consulting a doctor, dietary supplements (lysozyme, bifidumbacterin) are introduced into the diet.
- The following foods should be completely excluded from the diet: garlic, onions, plums, melons, spinach, sorrel, turnips, radishes, wheat and pearl barley, white cabbage, beets, mushrooms, apricots.
Pediatricians recommend the use of sour-milk mixtures for children, for example, acidophilic and propionic acidophilus milk, kefir, etc. With secretory diarrhea, children should limit the use of spicy, smoked and fried foods, as well as from obligate allergens. Depending on the form of the disease, the frequency of feeding can increase up to 6-10 times a day, depending on age.
Secretory diarrhea in children
Diarrhea is considered a widespread pediatric disease, due to which up to 1.5 million people die annually. With diarrhea in children, liquid and watery bowel movements are observed. An upset stomach is accompanied by anorexia, rapid weight loss, vomiting, pain in the stomach, bleeding and fever due to fever. The disease manifests itself much harder than in adults.
Alarm symptoms in children can be considered:
- bloody stools;
- vomiting with bile;
- pallor;
- tachycardia;
- physical inactivity;
- bloating.
Treatment of diarrhea in children is aimed at eliminating specific signs of the disease. Oral rehydration with a solution that contains complex carbohydrates or glucose is mandatory. Such solutions do not include juices, carbonated and sports and energy drinks. You can purchase special solutions in a pharmacy without a doctor’s prescription. The medicinal solution is used by children in small amounts up to 5 times a day. Gradually, the volume of the drink increases depending on tolerance.
Before proceeding with the treatment of the pathological process, you should consult a doctor. With the independent selection of ineffective drug therapy, health conditions can significantly deteriorate.