It called persistent diarrhea that diarrhea of persumed infection caused that start acutely but unusully persist for more then 14 days.3 to 20% of acute diarrhea become persistent.
Causes:
-sugar intolerance(lactose intolerance).The infection cause the destruction of brush of intestinal vili and this lead to deficiency of disaccharidases(lactase deficiency),this leading to malabsorption of lactose and osmotic diarrhea.Fermentation of sugars by intestinal flora cause formation of organic acids which can also induce diarrhea.The treatment is the administration of lactose-free formula.
-cow milk protein allergy.Intestinal allergy cause damage of intestinal cells of continuos diarrhea.In this case the stool contains mucous and blood and as treatment is has to be administarted soya protein based formula.
-overgrowth of bacteria in upper intestine.The acute diarrhea cause colonic bacteria(fecal bacterias:anerobes and E-coli) can ascend and invade the upper small intestine which is sterile under normal condition and lead to mucosal demage by direct bacterial invasion or toxins production and this cause persist diarrhea.
Why diarrhea persist?
The continuation of diarrhea and the presence of offending agents(milk protein and bacteria) will lead to continuos intestinal mucosal injury and atrophy in prologed cases causing impaired digestion and absorption,this leading to the persistence of diarrhea and vicious cicle.
Characteristics:
Diarrhea with or without dehydration.
Complications:malnutrition,intercurrent infection.
Treatment:
-Prevention and treatment of water and electrolyte disturbance
-Proper nutrition management should continue for long time after stoppage of diarrhea,to give time for regeneration of intestinal mucosa.So remove the offending agent from diet,administrate vitamins,especially vitamin A in the recovery period.
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