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Diareea cronica la adult

Dr Alecse Valerian Ditoiu, Spitalul Fundeni

7 iulie 2014

Diarrhea (engl)

Ce inseamna diaree?

Prin diaree se intelege existenta a mai mult de trei scaune pe zi, de obicei apoase, dar nu obligatoriu.

Statistic, un adult are de obicei cel putin 5 episoade de diaree pe an, iar un copil mic cel putin 15 episoade anual.

Asta inseamna ca daca ai un scaun moale, intr-o zi, nu inseamna ca ai diaree, conform definitiei medicale.

Ce inseamna diaree cronica?

In terminologie medicala curenta, diareea cu durata de cel putin patru saptamani este definita ca fiind diaree cronica

Diareea, simptome insotitoare

Existenta mai multor scaune diareice pe perioade lungi, poate sa fie insotita de unele simptome, cele mai frecvente fiind:

  • Diminuarea cantitatii de urina eliminate
  • Urina inchisa la culoare
  • Ameteli
  • Scaderea tensiunii arteriale
  • Uscarea pielii su mucoasei bucale
  • Oboseala musculara
  • Crampe abdominale
  • Bolboroseli intestinale
  • Greata
  • Varsaturi alimentare
  • Lipsa poftei de mancare
  • Uneori scaune cu sange, mucus, puroi, paraziti, etc
  • Semne de deshidratare:
  • Scadere in greutate

Tinand seama de faptul ca prin diaree nu se pierde numaiapa ci si substante nutritive, in diareea cronica poate sa apara o scadere semnificativa a imunitatii care sa favorizeze aparitia altor boli – vezi schema

Cauze de diaree cronica

Diareea cronica care de obicei dureaza perioade mai lungi de timp, in general peste 4 saptamani, si poate fi data de diferite boli unele serioase, printre,  care:

  • Boli inflamatorii intestinale (boala Crohn, rectocolita ulcero-hemoragica)
  • Colita – inclusiv colita de iradiere-
  • Colonul iritabil
  • Tumori de colon sau intestin subtire
  • Pancreatita acuta sau cronica
  • Sindrom de malabsorbtie
  • Parazitoze digestive
  • Intoleranta la anumite alimente (lactoza, gluten, etc)
  • Diaree dupa antibiotice, prin dezechilibrarea florei intestinale
  • Clisme frecvente sau laxative frecvente cu dezechilibrarea florei intestinale
  • Diarreea dupa preparate cu magneziu, medicamente de tensiune, etc
  • Solutii de “curatire” a colonului sau.. organismului
  • Rezectii de stomac
  • Vagotomie
  • Colecistectomia (scoaterea veziculei biliare)
  • Operatii pe colon cu scurtarea sau san anastomoze
  • Tuberculoza intestinala
  • Hipertiroidie
  • Diabet zaharat (prin afectarea nervilor intestinali)
  • Alcoolismul cronic
  • SIDA

Diareea cronica, diagnostic cauzal

Diagnosticul cauzal al diareei cronice se pune prin:

  • Prezenta scaunelor frecvente si moi
  • Examinare de medicul de familie, internist, gastronterolog sau infectionist
  • Examene de scaun
    • Coproparazitologic
    • Coprocultura/coprocitograma
    • Alte examinari in functie de presupusa cauza a diareei
  • Analize de sange – pentru a depista cauza diareei si efectele sale – in special asupra ionogramei, albuminei sanguine, proteinelor sanguine, hemoglobinei
  • Sigmoidoscopia sau colonoscopia

Diareea cronica – tratament

Diareea cronica se trateaza, tratand de fapt cauza sa – mentionata anterior, si regim alimentar similar ca la diareea acuta, dar personalizat pentru fiecare pacient.

Frecvent sunt necesare administrari de perfuzii de reechilibrare hidrica si electrolitica sau pentru hranire.

Sunt situatii in care poate fi necesara repopularea intestinala prin transplant de materii fecale

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