Průjem

Průjem – Definice

Diarrhea is more than three loose, liquid stools in a single day. It depletes your body of fluids and electrolytes. Diarrhea can be:

• Acute — occurring suddenly and lasting briefly
• Chronic — long-term
• Recurring — coming and going

If you lose too much fluid, můžete se dehydratovat. Dehydration is especially dangerous for babies, malé děti, a starší lidé.

Průjem – Příčiny

Příčiny mohou zahrnovat:

• Food intolerance, such as lactose intolerance
• Léky, včetně:
  • Antibiotika
  • Magnesium-containing antacids
  • High blood pressure medications
  • Chinin
  • Chemoterapie rakoviny
  • Laxatives
• Syndrom dráždivého tračníku (episodes of diarrhea often alternate with periods of constipation)
• Injury to the bowel after radiation treatments for cancer
• Malabsorpční syndromy, jako:
  • Celiakie
  • Tropical sprue
  • Short bowel syndrome
  • Whippleova nemoc
  • Intestinal lymphangiectasia
• Diseases of the pancreas and/or gallbladder
• Zánětlivá onemocnění střev ( ulcerative colitis, Crohnova nemoc)
• Chronická onemocnění, jako:
  • Nemoc jater
  • Diabetes
  • Hypertyreóza
  • Addison’s disease
  • Pellagra
  • Sklerodermie
  • Amyloidóza
  • AIDS
  • Rakovina tlustého střeva
• Intestinal surgery
• Infekce, including food poisoning, jako:
  • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, a Escherichia coli
  • Viral: rotavirus, Norwalk virus, cytomegaloviru, herpes simplex virus, and viral hepatitis
  • Parasitic: Giardia lamblia, Entamoeba histolytica, Cryptosporidium, tapeworm, roundworm, flukes
  • Fungal: Candida (yeast)

Průjem – Rizikové faktory

Mezi rizikové faktory patří:

• Traveling to a developing country where the water and food supply may be contaminated
• Having a severely weakened immune system, such as with AIDS or after an organ transplant
• Užívání určitých léků

Průjem – Příznaky

Příznaky mohou zahrnovat:

• Časté, loose, liquid stools
• Bolest břicha, spojování sponou
• Urgent need to defecate
• Blood and/or mucus in stool
• Horečka
• Dehydratace
• Nevolnost, zvracení
• Muscle aches and pains
• Hubnutí
• Podvýživa

Průjem – Kdy mám zavolat svému lékaři?

Pokud ano, zavolejte svému lékaři:

• Have diarrhea that lasts longer than three days
• Are not able to eat or drink to stay hydrated
• Have a fever

Call the doctor if your young child:

• Has diarrhea lasting longer than a day
• Has pus in stool
• Is dehydrated (no wet diapers in three hours, sucho v ústech, crying without tears, skin that stays up after being pinched)
• Is sleepy or irritable
• Has a fever

Kdy mám okamžitě zavolat lékařskou pomoc?

Call for medical help or go to the emergency room right away if you or your child:

• Has severe abdominal pain and cramping
• Has bloody or black stool

Průjem – Diagnóza

Lékař se vás zeptá na vaše příznaky a anamnézu. Bude provedena fyzická zkouška. To determine the cause of your diarrhea, the doctor will ask questions, jako:

• Does anyone else in your family have diarrhea?
• What kinds of food have you eaten recently?
• Do you drink well water?
• Do your children attend daycare?
• Have you traveled recently?
• Do you use laxatives?
• What medicines do you take?
• Do you have any symptoms other than diarrhea (Např, horečka, zbrklý, aching joints)?
• What is your sexual history?
• Have you ever had abdominal surgery?

Testy mohou zahrnovat:

• Laboratory analysis of a stool sample
• Krevní testy
• Fasting or food elimination tests
• Digitální rektální vyšetření — vyšetření konečníku s prstem v rukavici zasunutým do vašeho konečníku
• Flexibilní sigmoidoskopie — tenká, osvětlená trubice zavedená do konečníku pro vyšetření konečníku a dolního tlustého střeva.
• Kolonoskopie — tenká, osvětlená trubice zavedená přes konečník a do tlustého střeva, aby se prozkoumala výstelka tlustého střeva
• Biopsie — odebrání vzorku tkáně tlustého střeva pro testování (may be done as part of a flexible sigmoidoscopy or colonoscopy)
• Upper Gastrointestinal (GI) Series — a series of x-rays of the upper digestive system taken after drinking a barium solution
• Barium enema — insertion of fluid into the rectum that makes the lining of your colon show up on an x-ray

Průjem – Léčba

Treating the underlying condition may help to relieve the diarrhea.

General recommendations for treating diarrhea include:

Drink Lots of Fluids

Plain water will not replace the electrolytes lost through diarrhea. For adults and children, look for age specific oral rehydration solutions. Avoid fruit juices and soda. For young children, continue with breastfeeding or formula feeding.

Ask Your Doctor What You Should Eat

Doctors differ in their approach to treating diarrhea. Například, Váš lékař Vám to může doporučit:

• Drink only clear fluids during severe phases of diarrhea.
• Avoid certain foods, jako: very spicy foods, fatty foods, greasy foods, high-fiber foods, dairy products in large amounts, caffeinated drinks.
• Eat certain foods, jako: complex carbohydrates (Např, těstoviny, rýže), yogurt, fruits and vegetables, lean meats.

Ask your doctor which dietary guidelines you should follow. As your diarrhea subsides, your usual healthy foods can be reintroduced.

Treat Abdominal Pain With Heat

Use a hot water bottle or heating pad on your abdomen to relieve cramps and pain.

Léky

Your doctor may recommend medicines, jako:

• Antidiarrheal medicine (Např, bismuth subsalicylate, loperamide hydrochloride)
• Antibiotics — may be needed if a bacterial infection is causing diarrhea
• Probiotika (Např, Lactobacillus casei, Enterococcus faecium, Saccharomyces boulardii) — may be beneficial in some cases
• Zinc supplementation — may be recommended in some cases

Children should not be given medicine unless specifically recommended by the doctor.

Hospitalizace

Diarrhea can cause severe dehydration. You may need to be hospitalized. Fluids will be delivered through an IV.

Průjem – Prevence

To reduce your chance of getting diarrhea:

• Practice good handwashing.
• Practice safe food preparation and food storage.
• If you have diarrhea, do not prepare food for others.
• If you are traveling:
  • Pijte balenou vodu.
  • Use bottled water when brushing your teeth.
  • Avoid drinks that contain ice.
  • Do not eat food purchased from street vendors.
  • Do not eat raw vegetables or fruits. (All produce should be peeled and/or cooked.)
  • Make sure meats are cooked thoroughly.
  • Eat only pasteurized dairy products.
  • If you eat seafood, make sure it is very hot.

Rotavirus is a common cause of diarrhea in children under five years of age. There is a vaccine to prevent rotavirus. The first dose is given at age two months. Make sure your infant has received this vaccine.