Duodenitis is based on dystrophic, inflammatory, degenerative changes in the mucous membrane (CO) of the duodenum (duodenum) , accompanied by a structural reorganization of the glandular apparatus with the development of metaplasia and atrophy. The following types of duodenitis are distinguished. In the affected area:
- Duodenitis of the proximal region, in which the duodenal bulb is affected mainly ( Bulbit ),
- Duodenitis of the distal section in which the bulb is almost unchanged ,
- Diffuse (total),
- Local (limited) duodenitis, including papillitis (inflammation of the large duodenal papilla).
According to morphological changes:
- Superficial ( Interstitial, without atrophy of the glands) ,
- Duodenitis with atrophy (Atrophic ).
Chronic duodenitis (CD) is often combined with gastritis, gastric ulcer and duodenal ulcer , chronic cholecystitis, pancreatitis, enteritis and colitis. Bulbitis is almost always associated with antral gastritis and duodenal ulcer.
Classification of diseases of the duodenum.
- Functional diseases of the duodenum associated with impaired motor-kinematic function: dyskinesia, duodenostasis .
- Organic diseases of the duodenum, which is based on violations of the morphological structures of the mucous membrane: Duodenitis, Duodenal obstruction.
- Rare pathologies, developmental anomalies:
Etiopathogenesis. Similar to peptic ulcer: exposure to the mucous membrane of the duodenum with proteolytic enzymes of gastric juice, impaired motor-evacuation function (in the mucous membrane of the duodenum, the release of protective functions is reduced ), microcirculation and trophic disturbance .
The clinic appears in 4 forms.
1st form. Ulcer-like form. Reminds peptic ulcer, can be combined with peptic ulcer . If it does not combine with peptic ulcer , the pain goes along the entire epigastrium, there is no point localization, the pain radiates along both costal arches, a symptom of food jam . Common symptoms: adynamia, lethargy, drowsiness, headache. These symptoms subside after eating. Objectively: a somewhat sensitive pyloroduodenal zone is palpated . With a long course, it can lead to an erosive form. 2nd form. Cholecystic form. It develops with the localization of duodenitis in the descending section. Through the papila fatheri, the bile duct and pancreatic duct enter the surface of the division . They can run separately. With inflammation, an inflammatory narrowing of the veined nipple occurs. Differential diagnosis: endoscopy, clinical manifestations of dyskinesia, sonography. 3rd form. Gastritis-like form. Small symptoms: dyspepsia (bloating immediately after eating in the epigastrium, heaviness, belching). Differential diagnosis: with the exclusion of other diseases. 4th form. Mixed form. Differential diagnosis : endoscopy with biopsy taking.
TREATMENT OF DUODENITIS.
- The treatment of Helicobacter pylori duodenitis is carried out according to the same scheme as the treatment of chronic active antral gastritis associated with Helicobakter Pylori (HP). Apply: Triple therapy : de-nol, 240 mg 2 times a day + metronidazole 250 mg 4 times a day + antibiotic (tetracycline 500 mg 4 times a day , oxacillin 500 mg 4 times a day or amoxacillin 500 mg 4 once a day ).
- In case of an ulcer- like form, if the patient also has high acidity, then it is advisable to apply: Dual therapy ( ranitidine or famotidine + antibiotic, omeprazole or lansoprazole + antibiotic, gastrocepin with denol + antibiotic). Also physiotherapy in use with anticholinergics, inductothermy, applications. Sanatorium treatment taking into account the allocated secret.
- When duodenitis associated with microbial contamination of the duodenum, along with the treatment of underlying disease, requires the elimination of microbial contamination in the upper parts of the digestive tract courses of antibiotic therapy .
- When lyamblioznoy and helminth duodenitis is necessary to carry out the appropriate treatment.
- If the cholecystic form, then antacids, antispasmodics, anticholinergics, anti – inflammatory drugs , choleretic are needed . Of prokinetics give d omperodon ( Motilium and other synonyms).
- In neurasthenic syndrome, often associated with HD , sedatives are prescribed (tincture or valerian extract ) and tranquilizers (elenium, tazepam, seduxen) .
DUODENAL STAZ (Wilkie’s disease).
This is a functional disease. This is a chronic duodenal obstruction (Wilkie’s disease). The basis is a violation of the motor-evacuation function of the duodenum. The leading causes are the presence in the tissues and lymphatic apparatus, adjacent organs of the inflammatory process. 1st form. The development of proximal periduodenitis. 2nd form. The development of distal periduodenitis. 3rd form. The development of proximal periuenitis. 4th form. The development of total periduodenitis.
Pain is the result of hyperperistalsis, increased pressure inside the body. It begins, intensifies after eating after 5-15 minutes. Relief occurs only after vomiting. Vomiting can be single, multiple, daily. Objectively. In severe forms, depletion, slight peristalsis in the epigastrium, in the upper right quadrant of the abdomen, splash noise with balanced palpation are observed . The diagnosis is made after x-ray with confidence. With stasis, barium masses are delayed here for 40 seconds.
TREATMENT OF DUODENAL STAGE.
Treatment with moderate severity in a hospital. Easily digestible, frequent, fractional, if taken per os. If the condition is serious, the food should be liquid and introduced through a probe into the jejunum.
- Broad- spectrum antibiotics for 7-8 days
- Enzymes (festival, panzinorm, digestal , etc.),
- Drugs that regulate motor-evacuation function (cerucal, motilium),
- Parenteral nutrition: pp glucose, fat emulsions (Lipofundin) salt p-ry (Disol, Trisol).
- Thiamine – 2ml daily. IM 20 days.
- Rinse with soda or mineral water. It is introduced with a probe of 100-150 ml, then it is aspirated by a probe so that there is no stagnation.
Acute erosion and ulcers of the stomach and duodenum .
For peptic ulcer disease is sometimes referred sharp ulcer and erosion. The acute form of ulcer, apparently, is rarely diagnosed , only with the development of complications (bleeding, perforation). An acute onset can later go into a chronic cyclic form.
Acute gastroduodenal ulceration (ulcers, erosion).
- With extensive burns ( Carling ulcers ),
- With damage to the central nervous system (Cushing’s ulcer),
- Under stress
- As a result of taking medications (aspirin, indomethacin , etc. ), alcohol and other toxic substances,
- In elderly patients (“senile ulcers”),
- In patients with a recurrent course of peptic ulcer and active gastroduodenitis associated with Helicobacter Pilory,
- In patients with severe somatic diseases, endogenous and exogenous intoxications, after severe injuries and operations that cause cheeks, collapse, hypovolemia, hypoxemia, renal and hepatic insufficiency, severe infections, and bleeding disorders.
In substantially distinguish three kinds of lesions of the mucous membranes (CO) Stomach and Duodenum CO (KDP), which are like the successive stages of one pathological process – Hemorrhages in CO, varying from:
- Small petechiae to vast areas,
Acute ulcers and erosion are more often localized in the area of the bottom and body of the stomach, much less often in the pyloric section of the W and duodenum.
Uncomplicated acute erosion and ulcers, as a rule, is almost asymptomatic. Some patients with their appearance is accompanied by heartburn, pain in the epigastric pain and discomfort, nausea, belching. The initial symptoms of bleeding include: nausea, dizziness, “flashing flies in front of the eyes,” dry mouth, weakness, tachycardia, arterial hypotension, etc.
TREATMENT OF EROSION AND ACUTE ULCERS.
Take Antisecretory drugs: H2-blockers, Omeprazole, Pantoprazole, Misoprastol, Sucralfate .
With hemorrhagic gastritis.
With hemorrhagic gastritis, which developed against the background of shock, the high effectiveness of Sucralfate (10-15 g per day) and Omeprazole (40-60 mg per day) has been proved . The initial dose of Omeprazole is 40 mg iv , Sucralfate is 6.0 g orally. With continued bleeding, an additional 4.0 g is prescribed with a possible daily dose up to 15.0 g. Omeprazole is subsequently taken orally at 20 mg 2 times a day. This technique provides a quick stop of bleeding, saves the patient from surgery and even from a blood transfusion .
With Mallory-Weiss Syndrome.
In this syndrome arises bleeding caused by discontinuities CO cardia of the stomach. Sometimes, the immediate cause of cracking is repeated forced vomiting, due to increased intragastric and intra-abdominal pressure, and spasms of cardioesophageal pulp. Fissures are located along the longitudinal axis of the stomach, affecting, as a rule, only CO, less often submucosal and muscle layers. Manifested by bloody vomiting. The treatment is the same as with other bleeding with peptic ulcer disease.
Gastrinoma Ulcerogenic ( Zollinger-Ellison Syndrome ).
Gastrin-secreting neuroendocrine tumor, manifested by recurrent duodenal ulceration and diarrhea, which is associated with excessive secretion of hydrochloric acid and inactivation of pancreatic lipase. The main diagnostic symptom is ulcers of the duodenal ulcer, continuously recurring, often complicated by bleeding and perforation. Treatment includes the appointment of Omeprazole 40 mg per day or Ranitidine 450-600 mg per day, or Famotidine 60-80 mg per day. The level of gastrin in the background receiving anti-secretory drugs interpreted impossible.