What is this?

Diarrhea is defined as the emission of stools that are too fast, too abundant and too liquid.

There are four types of diarrhea

This is a common symptom.

Causes and risk factors

Osmotic diarrhea is caused by the presence in the intestine of substances causing water in the small bowel or bowel.

Diarrhea by invasive bacteria

These are ions (salts) present in certain osmotic or antacid laxatives, nonabsorbable carbohydrates (lactulose, Duphalac) or malabsorbed (enzymatic deficiencies). The malabsorption of these sugars at the level of the small intestine will cause a considerable bacterial fermentation on their arrival in the colon, resulting in the production of volatile fatty acids and lactic acid, themselves having a powerful osmotic power. This explains why the pH of the stools is low (pH at 5 or 6)

Acute diarrhea of ​​viral origin

Traveler's diarrhea (turista)

Other causes of acute diarrhea

Processing

Secretory diarrhea is caused by excessive losses of water and electrolytes secondary to stimulation of secretion and / or inhibition of absorption at the level of the small bowel or colon.

Diarrhea caused by intestinal tract disorders group two distinct mechanisms.

These motorized diarrhea are characterized by stools of moderate volume but a high number of exemptions with urgent need, especially after meals. Fasting and transit brake suppress diarrhea.

Diarrhea due to alteration of the mucosa is caused by lesions which may range from the isolated destruction of the brush border of the intestinal cell (by viral involvement), abrasion of the intestinal wall with inflammation, ulcerations (necrotizing enteritis And colitis), by way of complete villous atrophy (celiac disease).

During diarrhea with colitis (recto-colitis haemorrhagic, Crohn, ischemic colitis, parasitic or bacterial colitis), stools are numerous but scanty with mucus, blood and pus.

During diarrhea with villous atrophy, malabsorption syndrome is clear with fatty stools (steatorrhea).

These are usually hydro-electrolytic diarrhea, most often of secretory origin, sometimes motor.

The big risk is dehydration all the more serious as it affects children, old people and sick people.

Acute bacterial diarrhea are classified into two groups

These bacteria penetrate and multiply in the enterocytes (intestinal cells), causing localized lesions to the colon that loses its capacity for absorption and is the site of hypersecretion. It's a dysentery. Dysentery syndrome includes severe abdominal pain, frequent feces without fecal matter but with mucus and blood.

The bacteria involved are of several types

Bacillary dysentery, due to Shiga bacillus, results in severe abdominal pain (colic), very high fever, vomiting and dysentery syndrome (very frequent rectal evacuations, afecal, muco-bleeding). This typical form is no longer seen in Europe where it is mainly feverish diarrhea dysenteriformes, or diarrhea of ​​more banal appearance, falling within the usual framework of "summer diarrhea".
All varieties of Shigella can be seen and are recognized for coproculture.

Man is the reservoir of germs. Transmission is made either through contaminated water (fruits, vegetables, raw vegetables ...) or directly by the man (dirty hands).

The treatment of severe forms is based on antibiotics (Bactrim, ampicillin) or others according to the antibiogram.

This germ meets more and more often

Three clinical pictures are frequent

The endoscopic examination (sigmoidoscopy) can reveal in the adult lesions evoking ulcerative colitis. The cure is spontaneous but it is faster with antibiotics (macrolides).

Contamination is by contaminated food. The reservoirs of germs are sick, healthy carriers and some domestic animals.

There are more than a thousand different kinds of salmonella.

The disorders they provoke fall within two frameworks

Treatment of intense febrile diarrhea is based on antibiotics (fluoroquinolones, cotrimoxazole ...).

Moderate or discrete forms do not require antibiotics.

Clinical disorders are dominated by pains in the right iliac fossa with fever or diarrhea. Sepsis, scarlatiniform fever, erythema nodosum, arthralgia or arthritis may occur.

Atypical forms are of difficult diagnosis: forms evoking appendicitis, Crohn's disease ...

Diagnosis is based on coproculture and serology.

Treatment is based on antibiotics: tetracyclines or chloramphenicol.

Bacterial diarrhea producing enterotoxins

These bacteria multiply on the surface of the intestinal mucosa and produce a toxin responsible for hydroelectrolytic hypersecretion.

Incubation is very short (1 to 4 hours). These infections are caused by the ingestion of food containing the germ following an unfortunate manipulation by a subject bearing a staphylococcal cutaneous (panaris) or rhino-pharyngeal. Diarrhea is abundant, painful with vomiting but without fever. Signs of shock can be seen.

These bacteria currently play an important role in the causes of acute diarrhea in adults, particularly in travelers' diarrhea ("turista"). They belong to different groups, the invasive and enterotoxigenic characters can be carried by the same strain.

It can cause diarrhea 10 to 12 hours after ingestion. The contamination is by means of meat prepared, cooled and consumed later. The evolution is generally benign and does not require treatment.

However, massive necrosis of the hail is possible (Hamburg disease: sometimes bloody liquid diarrhea, vomiting, pain, collapse, paralytic ileus). The treatment combines antibiotics (penicillin) and sulfonamides

Viral gastroenteritis results in diarrhea, fever, vomiting, abdominal pain, headache, muscle pain and sometimes ENT catarrh

The rapidly regressive development of these diarrhea does not generally justify complex and costly explorations.

In the event of a slowing of the transit, there is a chronic bacterial multiplication leading to several harmful effects: In case of accelerated transit, motor diarrhea is usually due to functional colopathy or endocrine and nerve causes.

Diarrhea by invasive bacteria, Diarrhea by bacteria producing toxins.

febrile diarrhea with abdominal pain for 15 days preceded by a prodromal phase 3 to 5 days; Acute abdomen simulating appendicitis or peritonitis in infants table can evoke an intussusception

The turista is not due to the changes of regime and climate, the spices or the fatigue of the trip.