Disease diagnosis of acute diarrhea

1. Medical history In acute diarrhea, especially infectious diarrhea, a detailed and accurate medical history is very helpful for a definite diagnosis. For example, intestinal infectious diarrhea, if the patient has a history of eating unclean food, and most people with the same food get sick, can be initially judged as food poisoning.

2. Age and sex: Bacillary dysentery occurs in all ages, but it is more common in children and young adults, amoebic dysentery is more common in adult males, rotavirus gastroenteritis and pathogenic Escherichia coli enteritis are more common in infants, disaccharidase deficiency, intestinal tuberculosis, intestinal parasitic diseases, Crohn's disease and ulcerative colitis are more common in young adults, and colon cancer and pancreatic head cancer are mainly common in middle-aged and elderly people. Ischemic diarrhea of large intestine caused by arteriosclerosis is mainly seen in the elderly, while irritable bowel syndrome is mainly seen in middle-aged women.

3. Incidence and course of disease: Acute diarrhea is mostly contagious, so it is necessary to ask about the epidemic history. Acute bacillary dysentery often has a history of contact with dysentery patients or unclean diet. Cholera is common in coastal areas. In a short time, it is a water-based or food-based outbreak, which can spread along the traffic line. Inland patients often have a history of traveling to coastal areas and eating seafood. Acute bacterial food poisoning often occurs within 2 ~ 24 hours after eating, and often occurs among people who eat together. Tourists' diarrhea mostly occurs when traveling in tropical developing countries, and it can appear within 2 ~ 3 weeks after arriving at the tourist destination. The poisoned person has a history of taking poison. Aids often takes diarrhea and emaciation as the first symptoms, so it is necessary to ask about the history of sex and drug abuse in detail. If the diet changes, such as diarrhea after eating milk, lactase deficiency should be considered, and people who take drugs can also cause diarrhea. Postoperative, elderly or shock patients, especially after receiving broad-spectrum antibiotic treatment, should consider the possibility of antibiotic-associated diarrhea or pseudomembranous enteritis.

Acute onset, short course of disease, persistent rather than intermittent diarrhea, night diarrhea, accompanied by weight loss, anemia, accelerated ESR, mostly organic diarrhea. On the contrary, intestinal functional diarrhea is more likely, such as irritable bowel syndrome. There is still diarrhea after fasting, which often suggests that the mechanism of diarrhea is excessive intestinal secretion or inflammatory exudation; Diarrhea stops after fasting, suggesting that it is osmotic diarrhea caused by some ingredients in food, such as lactase deficiency. Diarrhea may be caused by amebic dysentery or ulcerative colitis.

4. Characteristics of stool: Diarrhea caused by small intestine is frequent and few, while diarrhea caused by large intestine is frequent and few, often accompanied by mucus or blood. Acute bacillary dysentery first has loose stools, then purulent bloody stools, accompanied by acute diarrhea, and then severe diarrhea; Enteritis caused by Campylobacter jejuni, yersinia enterocolitica and invasive Escherichia coli can also have the same manifestations. In addition, acute amoebic dysentery, schistosomiasis and malignant malaria in gastrointestinal tract should be excluded. Typical amebic dysentery has a deep red jam-like stool. Feces are as thin as water, accompanied by obvious stench and vomiting, which are more common in food poisoning infection. Those that occur 2 to 5 hours after eating are mostly food poisoning caused by Staphylococcus aureus and Bacillus cereus. If it happens 6-24 hours after eating, it is more likely to be caused by salmonella, Proteus and Clostridium perfringens type A. Diarrhea vomit is rice swill-like, and the water loss is serious, so cholera should be considered. Acute hemorrhagic necrotizing enteritis has a foul smell in the stool, which is purple bloody stool. Uremia can also lead to bloody stools.

Blood-based diarrhea should consider small intestinal lymphoma, intestinal tuberculosis, colon cancer, malignant histiocytosis and ischemic bowel disease. Fatty diarrhea, due to the stimulation of fatty acids and hydroxyl fatty acids on intestinal mucosa, increases the secretion of water and electrolytes, which is characterized by watery diarrhea, greasy stool, large amount, unbearable smell and difficulty in flushing urinals, such as pancreatic lesions and celiac disease. People with sugar malabsorption often have bowel sounds, bloating, foaming in the stool and sour smell. In addition to fatty diarrhea, people with dirty stools also suggest that unabsorbed amino acids are decomposed by bacteria, which can be seen in protein's gastrointestinal diseases caused by small intestinal lymphatic dilatation.

A large number of stools are watery, suggesting secretory diarrhea, such as bile acid deficiency, VIP tumor, gastrinoma or intestinal fistula, small bowel resection and so on. It is often irritable bowel syndrome that only mucus is seen in feces without purulent blood. There is a lot of mucus, suggesting a villous adenoma of the colon.