=Definition.=—A diffuse inflammation involving the entire intestinal
tract to a greater or less degree. Usually the seat of disease is found
in the small intestine and the upper part of the large bowel.
=Osteopathic Etiology= and =Pathology=.—Acute diarrhea may be caused
by overeating, drinking impure water, unripe fruits, and poisons
produced in decomposed and fermented milk and other articles of food.
This sometimes takes place in perfectly harmless substances in an
inexplicable manner. Milk and ice cream may produce intestinal catarrh.
Dr. Still often referred to the harm resulting from iced drinks.
Changes in the weather, tending to weaken the system, often cause
diarrhea; hot weather favors this, although a chilling of the system by
a sudden fall in the temperature may produce the disorder. Dr. Still
was of the opinion that sitting on the cold ground (a common habit of
children) is a frequent source of intestinal derangements. Changes in
the quantity and quality of the secretions also induce the disorder;
thus the bile, if in too great a quantity, increases the peristalsis
to such a degree that diarrhea is produced; if diminished, it favors
the fermentation and decomposition of the food. Pancreatic diseases may
be a cause of diarrhea. Infectious diseases, through their specific
poisons, such as cholera, dysentery and typhoid fever; inflammation,
extending into the bowels from adjacent parts; inflammation caused by
peritonitis and intestinal obstructions, as invagination and hernia;
hyperemia, secondary to diseases of the liver, heart and lungs;
cachectic states met with in Addison’s disease; the last stages of
Bright’s disease; cancer and marked anemia are all among the causes of
diarrhea.
As in constipation, diarrhea is oftentimes simply a symptom of various
disorders; still, it may be the only symptom manifested. Lesions are
found in various regions of the body, but chiefly in the lower dorsal
and lumbar vertebræ and the lower ribs at either side. Also lesions
may be found to the vagi, thus increasing the peristalsis or affecting
the blood supply of the intestines. The lesions to the splanchnics may
involve the motor, vasomotor or secretory fibers to the intestines.
Oftentimes the innervation to the liver is disturbed, affecting the
secretion of the bile. The left side of the spinal column is involved
more often that the right side, by vertebral, rib and muscular lesions.
=Nervous Diarrhea= frequently follows fright and other causes of
nervous excitement, and is often found in hysterical women. There is
simply an increase in the peristalsis and secretion of the bowel, due
to a vasomotor paresis of the intestinal vessels, producing an outflow
of the serum.
The intestinal condition is one of hyperemia. The secretory glands
are frequently inflamed. In decided cases the mucous membrane may be
red and injected, but more often it is pale and covered with a layer
of mucus. Sometimes the solitary follicles are considerably enlarged.
These enlargements may become filled with pus, forming abscesses which
rupture, leaving an ulcer. Peyer’s patches may also be involved.
=Symptoms.=—The diarrhea is the important, and often the only, symptom
of enteritis; the stools are frequent, varying from two or three to
fifteen or more a day; they are thin and watery, varying in color
according to the amount of bile they contain. They are usually of a
yellowish or greenish color. They contain undigested food, mucus,
columnar epithelium and mucous cells, micro-organisms and triple
phosphate. The reaction of the discharge is either acid or neutral.
There are colicky pains in the abdomen, rumbling noises or borborygmi,
intense thirst, dry and coated tongue, with loss of appetite, and,
rarely, a fever. When fever is pronounced care should be taken that
some infectious disease is not the cause. =Chronic catarrhal diarrhea=
may follow the acute form. If the stools contain much undigested food
the inflammation is in the upper bowel; if thin, watery and containing
mucus, the lower bowel is involved. In prolonged cases the general
health is affected. Definite tender areas along the spine and deep
muscular contractions are invariably important etiologic and diagnostic
clues.
=Diagnosis.=—This is ordinarily made easy by giving attention to the
above symptoms. In distinguishing as to whether the large or small
intestines are involved the following is important: In catarrh of the
=small intestines=, diarrhea is not so well marked; there is much
undigested food, but very little mucus; and there is usually pain of a
colicky nature in the middle or inferior part of the abdomen. When the
=large intestine= is involved there may be no pain; when present, it
is intense and usually in the upper and lateral parts of the abdomen;
there are borborygmi and thin, soupy stools, mixed with much mucus.
If the lower portion of the bowel is involved there may be marked
tenesmus, with marked contraction of the muscles over the sacral
foramina.
=Duodenitis= is often associated with acute gastritis. Placing the
patient in the knee-chest position one may be able to palpate the
duodenum. If the inflammation involves the bile duct, there is
jaundice; in these cases the urine may be bile-stained.
=Prognosis.=—Commonly favorable if early and prompt treatment is
employed; though it should be remembered that some infections, or
constitutional disease, or intestinal ulcer may be an underlying cause.
=Treatment.=—Many cases of acute diarrhea will recover by restricting
the diet, with rest. Where improper food and water are the causes, an
entire change of diet should be considered. Withdrawal of all food and
the substitution of boiled milk will be of great aid. The bowels should
never be confined if there is reason to suspect that all irritating
matters have not been removed; and when fermentation and irritation
exist in the lower bowel, an enema will often be beneficial. The spinal
column should be examined, especially on the left side, from the fifth
dorsal down to the coccyx. The vertebræ may become displaced and cause
diarrhea, by derangement of the vasomotor nerves.
Either an increased blood supply through the intestines, or an
affection of the motor nerves will produce an increased peristalsis.
An active condition of Meissner’s plexuses may be produced
sympathetically, resulting in increased secretion of intestinal juice
and thus in diarrhea. The ribs may become displaced and be a source of
irritation to the nerves of the intestines. The muscles of the spine
are apt to become contracted by colds, injuries, strains, etc., and
stimulate or inhibit the action of certain centers in the cord and
produce disordered intestines. Conversely the muscles of the back may
be thrown into a contracted condition by irritating substances in
the bowels acting as a stimulus to the centers in the cord, and thus
reflexly to the muscles. Trouble may arise in the colon and rectum by
lumbar lesions, the slipping of an innominate, a dislocated coccyx, or
contracted muscles over the sacrum. In a word, thorough inhibition,
relaxing contracted muscles and correcting abnormal vertebræ and ribs
are the osteopathic essentials of treatment for diarrhea. Inhibition
of the lower dorsal and lumbar is very effective; it dilates the
mesenteric vessels by way of vasomotor fibers, and thus controls
secretions and lessens peristalsis. This has been clearly proven in the
osteopathic experimental work of Burns and Pearce.
Hot fomentations over the dorsal and lumbar spine will frequently,
through the nervous reciprocal relationship, be of decided value.
Direct treatment over the mesenteric circulation, i. e., through the
abdomen anteriorly, will be helpful in some cases. It relaxes tissues,
removes irritations and frees the circulation generally about the
mesenteric vessels and intestines. When giving this treatment one
should be certain of the underlying pathology. The liver should be
kept active. Treatment of the vagus nerves is important, as they help
to control the blood supply and the motor nerve force through the
intestines. Daily hot baths and increased activity of the skin and
kidneys are beneficial.