Enteritis is the most typical and frequent manifestation of damage to the small intestine . The intestine consists of two anatomically and functionally different departments: small and large intestines. The small intestine begins with the duodenum. The duodenum passes into the skinny, and the last without sharp boundaries into the ileum. This section ends with the small intestines, followed by the large intestines.
Physiology of the intestines.
The intestine performs 2 main functions:
1) Digestive, 2) Motor
Digestive function is carried out mainly in the duodenum (duodenum) and other parts of the small intestine. Digestive disorders are associated mainly with the pathology of the small intestine. The motor function is predominantly thick. Violations of motor and motor function are associated mainly with pathology of the large intestine. In the small intestine there is a certain motility peristalsis, which contribute to the mixing of food and advancement to other departments (pendulum-like movements). This is necessary so that the food is in better contact with the mucosa of the small intestine. Here the movement is slow. Movement of the colon is carried out by the muscle layer. Here, too, slow motion. Characteristic only for the colon: 1 ) antiperistalsis; 2) defecation. Digestive function is carried out using the following factors: Secretory function – the secretion of intestinal juice, which reaches 3 liters per day, containing enzymes. The maximum amount of intestinal juice is excreted 4-5 hours after a meal. The secretion of intestinal juice increases under the influence of HCI, enzymes. Digestion consists of 2 processes: 1) Abdominal digestion , when the initial rough breakdown of food components occurs . 2) Membrane digestion , resulting in the preparation of nutrients for absorption processes. Occurs with a brush border of microvilli. Absorption is closely related to cavity and membrane digestion, thanks to the villous apparatus. Absorption occurs due to diffusion, active transport. The breakdown products, proteins, fats, carbohydrates are absorbed in the duodenum and other parts of the small intestine. In 1-2 minutes, a number of monosaccharides can be absorbed. Amino acids, fatty acids are absorbed more slowly. At the level of the ileum, B vitamins and bile salts are absorbed.
In the colon, absorption processes are completed. Water is mainly absorbed. Residual water also breaks down under the influence of colon bacteria.
In the colon, the decay of carbohydrates can be influenced by bacteria, with the formation of organic acids that are not broken down in the small intestine ( fermentative dyspepsia ), carbohydrates are further broken down, and the medium becomes acidic.
And putrefactive dyspepsia is the accumulation of a large number of unsplit proteins, the medium becomes alkaline, rotting occurs, and ammonia forms.
Small Intestine Diseases include
- Enteritis (Gastroenteritis, Enterocolitis, Gastroenterocolitis).
- Intestinal Enzymopathies ( Celiac disease, Disaccharidase deficiency ),
- Diverticulosis, Crohn’s disease (this is a lesion of the entire intestine),
- Whipple’s disease.
Enteritis (from the Greek. Enteros – gut) – inflammation of the mucous membrane (Qatar) of the small intestines. Isolated lesions of the small intestines are extremely rare. Typically, the process proceeds in the form of simultaneous inflammation of the mucous membrane of the small and large intestines (enterocolitis), or the stomach and small intestines (gastroenteritis), or the entire gastrointestinal tract (gastroenterocolitis).
Etiological factors. Exogenous causes:
- infections (salmonellosis, dysentery, viruses, staphylococci, clostridia, helikobakter pilory.)
- parasitic diseases (lamblia, roundworm)
- ionizing radiation;
- exposure to poisons (arsenic, phosphorus, lead);
- medicines (prolonged action of salicylates, cytostatics, antibiotics, tuberculostatics);
- post-resection enteritis.
- diseases of neighboring organs,
- skin diseases
- gastroduodenitis with low HCI,
- Crohn’s disease,
- chronic hepatitis, viral hepatitis,
- collagenoses, malignant diseases.
There are Acute and Chronic Enteritis (and enterocolitis).
Acute Enteritis (and enterocolitis) is often characterized by a sudden onset – diarrhea, pain, mainly in the middle of the abdomen, vomiting (especially with gastritis at the same time). Sometimes these symptoms are preceded by malaise, loss of appetite, nausea, fever. With a predominant lesion of the small intestines, bowel movements can be plentiful, first gruel-like, then watery, frothy, sometimes with an acidic odor, stool frequency 4-7 times a day, with no significant pain. With a predominant lesion of the colon, diarrhea increases up to 10-15 times a day, accompanied by cramping pains; there is a lot of mucus in the stool, and sometimes there is blood; tenesmus are characteristic. In severe cases of Enteritis (and enterocolitis) from vomiting and diarrhea, dehydration may occur (dry mouth, thirst, dry skin, decreased amount of urine), decreased cardiac activity, decreased temperature, general intoxication, and convulsions. With proper treatment, Acute Enteritis (and enterocolitis) disappears within 3-5 weeks, sometimes lasting up to 2-3 weeks. With an unfavorable outcome, complications are possible (inflammation of the biliary tract with jaundice, inflammation of the bladder, kidneys, etc.) and the transition to Chronic Enteritis.
In Chronic enteritis , structural changes in the mucous membrane of the small intestine (atrophy, dystrophy, inflammation) occur with periodic or permanent impairment of organ function. For the occurrence of histopathological changes characteristic of chronic enteritis, a violation of the regeneration of the mucous membrane of the small intestine is essential. Chronic enteritis is characterized by diarrhea that occurs in the morning and soon after a meal, rumbling and transfusion in the intestines, mild abdominal pain. Diarrhea can be replaced by constipation, often there is nausea, belching. Patients usually lose weight, are pale, irritable, complain of weakness, fatigue. With proper and timely treatment, Chronic Enteritis, even in severe cases, can end in complete recovery.
Clinical signs include 2 major syndromes.
- Local enteric syndrome.
- Enteral coprological syndrome.
The basis of the Local Enteral Syndrome is a violation of the process of splitting the substances of membrane cavity digestion, digestion is incomplete.
Complaints are pain in the umbilical zone, to the left of the navel, flatulence, rumbling, transfusion, more often in the afternoon, during the most active time. Over time, symptoms of lactase deficiency are noted. If the disease is complicated by mesidonitis or ganglionitis, the pains become permanent, persistent, localized around the navel, the pain is associated with movements, worse after running, shaking, bowel movements, enemas. Appetite can both decrease and increase.
Enteral coprological syndrome. With chronic enteritis, frequent diarrhea (up to 10 times a day). Feces contain undigested foods. The volume of feces interes increase to 2 kg. In the feces there may be gas bubbles, a fetid odor, have a golden color due to bilirubin, has a clay appearance due to fat. Microscopically there are unsplit fibers, crystals of fatty acids, neutral fats, mucus. The main symptom of the common enteric syndrome — Malabsorption syndrome (lack of absorption). The main clinical manifestation: weight loss by 25-30 kg, general weakness, malaise, decreased performance. Insufficiency of absorption leads to a deficiency of protein, fat, electrolyte, carbohydrate, vitamin, microelement metabolism. This is manifested by an abundance of clinical symptoms: signs of polyhypovitaminosis (dryness, peeling of the skin, brittle nails, hair loss and brittleness, polyneuritis, impaired twilight vision, impaired Ca-metabolism, fragility of the bone apparatus, vitamin D deficiency). All processes are inhibited. Patients develop progressive anemia of a secondary nature. Pituitary insufficiency occurs – a picture of diabetes insipidus, there may be adrenal insufficiency, impaired sexual function: in men – impotence, in women – amenorrhea. Objectively. Depletion, pain on palpation at the Porges Point (2 cm to the left and above the navel, the site of attachment of the mesentery) and the umbilical zone, the abdomen is swollen, has a domed shape due to gases. At the site of transition of the jejunum into the ileum, splashing noise is noted in the cecal area. The course of the disease. Usually, the acute phase replaces the remission phase. Enteritis 1 degree: Mostly local symptoms appear. Enteritis of the 2nd degree: Often expressed local intestinal symptoms and mild symptoms of metabolic disturbance. Enteritis 3 degree: Severe metabolic changes.
Diagnosis of enteritis.
- An accurate indicator of mucosal tissue damage is the study of its biopsy specimens from the jejunum and the identification of biopsy specimens indicating enteritis.
- X – ray – in moderate cases, hyperemia, swelling of the folds is visible, in severe cases – smoothing of the folds due to atrophy.
- The content of intestinal juice is determined, an increase in active enterokinase and alkaline phosphatase is determined for mild to moderate severity, and a decrease in enzymes for severe enteritis. Parietal digestion is studied using carbohydrate loads.
- Bacteriological examination of feces to exclude infection.
- Coprological examination of feces for helminths.
- Blood analysis. An increase in ESR, C-reactive protein indicates an inflammatory process. Of great importance is the study of the level of albumin, immunoglobulins with diarrhea.
TREATMENT OF CHRONIC ENTERITIS.
Treatment of Chronic Enteritis with severe pathological changes in the phase of exacerbation should be in a hospital. 1. Unloading of the affected organ, thanks to the appropriate therapeutic nutrition.
- Diet. Fractional nutrition up to 6-7 times a day, in less severe cases 4-5 times.
- Regulation of motor activity of the small intestine.
Food should be mashed, hot. It is necessary to exclude coarse fiber, brown bread, fresh milk, sour cream, carbonated drinks, as much as possible to exclude fruits, vegetables, fresh juices, fresh vegetables
- Introduction of products requiring minimal motility. Prescribe boiled meat, fish, rice, jelly, white crackers, you can baked apple, boiled vegetables, potatoes. With a pronounced exacerbation of chronic enteritis, it is necessary to put on hunger for 3-4 days, but no more.
2. Parenteral nutrition. During this period, a daily solution of 5% Glucose, 200 ml Amino acid mixtures are introduced ( aminone, aminokrovin, aminopeptide, albumin, levamine). In the future, the patient is gradually transferred to the Diet (130-150 g of protein, 60-70-80 g of fat, 300-400 g of carbohydrates). If fermentative dyspepsia prevails, then carbohydrates should be excluded, and if more putrid, proteins should be limited. 3. Astringents and Envelopes.
- Codeine phosphate – is the first appointment to reduce the frequency of stool. 30-60 mg per day.
- Bismuth nitrate 1 g 4-5 times a day (powders).
- Tannalbin 0.3 with bismuth subpitrin 0.5 3-4 times a day (powders)
- Calcium carbonate 1 g 4-6 times a day.
- Caopectat on 1 table. spoon 4-8 times a day, preferably after loose stool.
- Astringent tea: mix 3 parts of cherry fruit 2 parts of blueberries, pour 2 tablespoons, pour 2 cups of water, boil for 20 minutes, insist, strain, take 1/4, 1/2 cup 3-4 times a day. St. John’s wort or alder cones; Hemophilus -15 g of herb per 200 ml of water, take 1 table. spoon 5-6 times a day.
- Immodium (Loperamide) – prescribed for diarrhea, if there is no infection. Take after each loose stool. After the 1st loose stool, 4 mg, and then 2 mg after each loose stool. If there is no diarrhea, then stop. But if there is an infection, then it will not help.
4. Enzymatic treatment. Panzinorm, festal, triferment, pancreatin, catazine, zymoplex (with a slight increase in acidity). Enzymes are used during remission, with exacerbation they can not be used.
In Severe Disease , the following is required: 5. Antibacterial therapy . Begin with a group of Eubiotocs: Intestopan, Enteroseptol, Mexase (both enzymatic and antibacterial drugs) 1 t 3 times a day, 7 days. Nitrofuran preparations – furagin, furozolidol, ricriden, nifurdin.
6. Corticosteroids are indicated for severe enteritis, they contribute to improved regeneration, the average initial dose of 30-40 mg, 60 mg, according to the usual scheme. That is, we give this dose a week, every 5-6 days they reduce by 1 tab. Hormonal drugs are prescribed only after a clear exclusion of the tumor and TBC.
7. In the restoration of exchange in-in. Vitamins
- Riboflamin 0.01 + Folic acid 0.002 + Sugar 0.2 (powders). 1 powder 3 times a day.
- Ca preparations . You can use eggshell, crushed in a mortar. Add 1 teaspoon of lemon juice to 1 shell, take 1 teaspoon 3 times a day.
- Multivitamins (vitamin C 0.1-0.2 – folic acid 0.02 – nicotinic acid 0.02 – riboflavin 0.02 – thiamine bromide 0.02 – rutin 0.02. ), in powder form. Mix everything, take 3 times a day after meals for 3-4 weeks, then take a break for 1 month, and again take 3 weeks. And so 4 courses. It is advisable to repeat these courses in the spring and autumn months.
If the patient’s condition does not allow to be taken orally, Parenteral Vitamin therapy can be prescribed according to the following scheme:
1st day. Vitamin B1 1.0, Nicotinic acid – 1% 1.0 or 3.0 v / m. 2nd day. Nicotinic acid 1.0, Vitamin B12 1 00mg 1.0, Vitamin C 5% 2.0 IM 3 day. Vitamin B6 5% 1.0 im 4 days. Repeat first. The course of treatment is 30 days. All with separate syringes.