Diarrhea is not an independent disease, but a common manifestation of many diseases, it can be accompanied by vomiting, fever, abdominal pain, abdominal distension, mucus stool, blood stool and other symptoms. Diarrhea with fever, abdominal pain, vomiting and other often suggest acute infection; With blood in stool, anemia, emaciation, etc., it is necessary to be alert to bowel cancer; With abdominal distension, poor appetite and other often need to be vigilant for liver cancer; Beware of vibrio cholerae infection in watery stool.
If combined with the patient’s history, symptoms, signs and other manifestations, it can be helpful to further speculate the cause of diarrhea.
From the analysis of age: children diarrhea is mostly rotavirus infection, disaccharide esterase deficiency, congenital chlorosis, mesenteric lymphatic tuberculosis and pancreatic fibrocystic changes; The diarrhea of young adults is mostly functional diarrhea and ulcerative intestinal tuberculosis. Middle age or old age diarrhea is often colon cancer.
Analysis by gender: functional diarrhea caused by hyperthyroidism is more common in women, while colonic diverticulum and colon cancer are more common in men.
Analysis from native place and occupation: farmers and fishermen living in the middle and lower reaches of the Yangtze River, frequent contact with the infected water, diarrhea should consider the possibility of schistosomiasis infection.
From the onset and course of analysis: the onset, short duration and frequent diarrhea, diarrhea due to a variety of causes should be considered, such as rotavirus infection, salmonella infection, bacterial dysentery, deputy hemolytic vibrio infections, staphylococcus aureus enterotoxin food poisoning, amoebiasis, im allergic disease, and drug and chemical poisoning, etc. If the history of more than 2 years, colon cancer is less likely to cause; If the history of several years to decades, common in functional diarrhea, schistosomiasis, ulcerative colitis and cloning disease; If diarrhea is intermittent, common in functional diarrhea, malabsorption syndrome and colonic diverticulitis.
Analysis of gastrointestinal symptoms: From the patient’s present gastrointestinal symptoms, especially diarrhea, it can be inferred that the lesion is in the small intestine or colon. Meaning is frequent, such as patients have tenesmus feeling, every time defecation quantity is little, sometimes even only some gas or a small amount of mucus discharge without dung, excrement and urine color is deeper, hot glue the frozen samples, or do not contain visible blood, odor is not heavy, with lower abdomen or left abdomen persistent pain, abdominal pain in the toilet can be a little relief, the diarrhea lesions located in rectum and sigmoid colon (or).
If there are no tenesmus symptoms when diarrhea, feces pale, large, watery, foamy or greasy, foul odor, no visible blood and pus, but contain indigestion of food residues, accompanied by umbilical cord or limited to the right lower abdomen intermittent colic, hyperactive bowel sounds, this diarrhea lesion is located in the small intestine.
If the number of defecation in 24 hours is more than 10 times, even up to dozens of acute diarrhea, common in acute infection caused by secretory diarrhea, such as cholera and exudative diarrhea such as bacterial dysentery. The chronic diarrhea that defecates several times a day can be seen in many diseases, such as chronic bacterial dysentery, chronic amoeba enteropathy, schistosomiasis, ulcerative colitis, rectal and colon cancer, and intestinal irritability syndrome.
If diarrhoea and constipation occur alternately, the habit person that can see at ulcerative sex bowel tuberculosis, colonic cancer, incomplete bowel obstruction, colonic diverticulitis, constipation and the bowel that have take laxative and irritable syndrome, the latter is when constipation, defecate is like “cow dung” sample, take mucous and without pus blood.
If diarrhea is related to eating, fasting can stop diarrhea, which is often seen in increased osmotic pressure of intestinal contents, abnormal mucosal permeability, and accelerated peristalsis.
If diarrhea occurs early in the morning or after meals, it is commonly seen in irritable bowel syndrome; If the diarrhea at night, so that the patient from sleep, often prompted by organic disease.
Analysis from systemic symptom: if diarrhea is accompanied by febrile person, should consider all sorts of reasons that cause enteric infection above all, also should except ulcerative colitis, clone disease reach canceration of late enteric tract. If the patient is significantly wasted or malnourished, it is more common in intestinal diarrhea, such as pancreatic diarrhea, gastrointestinal short circuit formation or other absorption defects, and less common in colonic diarrhea, but colon cancer can be cachexia, should be an exception. If diarrhea is accompanied by insomnia, forgetfulness, inattention, etc., and the symptoms often shift with mood and can be temporarily alleviated by hints, this kind of diarrhea is common in intestinal irritability syndrome.
Abdominal signs: Patients with chronic diarrhea, such as palpable abdominal masses, often suggest a tumor or inflammatory disease. If the mass is located in the lower left abdomen, fecal accumulation due to left semicolon cancer, diverticulitis of the sigmoid colon, or narrowing of the lumen should be suspected. If the mass is located in the right lower abdomen, the right semicolon, amoeba or schistosomiasis granuloma, intestinal tuberculosis, clonosis, and intestinal actinomycosis should be suspected. Colitis and pericolitis form masses that are softer and more tender than cancers. Colon spasm may be palpable, but it is infrequent and can be distinguished from masses of organic disease. If abdominal tenderness is obvious, see in clone disease, colonic diverticulitis and pelvic cavity or appendix abscess. If abdominal distention accompanies bowel sound hyperactivity, often suggest the presence of intestinal obstruction.
Digital rectal examination analysis: digital rectal examination is simple and easy to do, can find whether the anal lesions and rectal stenosis, cancer or bezoar, so digital rectal examination for rectal cancer caused diarrhea patients, have an important value in direct diagnosis. When the finger touches a hard, immovable, nodular mass, the glove is stained with blood, often indicating rectal cancer.