Duodenit – an inflammation of a mucous membrane of a duodenum. At defeats of the top departments symptoms of a disease remind stomach ulcer of a stomach, and duodenit the lower departments causes the symptoms similar to pancreatitis or cholecystitis. The disease is followed by the general weakness, pains in a stomach, heartburn, an eructation, nausea, vomiting. Sharp duodenit at observance of the sparing diet (sometimes starvations) usually comes to an end in several days. Repeated diseases pass into the chronic form complicated by intestinal bleedings, perforation of a wall of a gut, development of sharp pancreatitis.
Duodenit – an inflammatory disease of a mucous membrane of a wall of a duodenal kishika (DPK). Distinguish sharp and chronic forms. Sharp duodenit it is characterized by the expressed symptoms of an acute inflammation which completely abate after the carried-out therapy and do not leave noticeable structural changes in mucous. Chronic duodenit – the disease of a long recidivous current which is characterized by development of the centers of an inflammation in mucous with the subsequent pathological reorganization of its structure.
Duodenit – the most widespread of duodenum diseases. 94% of all inflammatory processes in DPK get a chronic current. Chronic duodenit more than twice arises at men more often, than at women.
Classification of duodenit
Chronic duodenit is classified by several signs.
- by origin (primary and secondary);
- on localization of the centers of an inflammation (bulbarny, postbulbarny, local or diffusion);
- on an endoscopic picture (eritematozny, hemorrhagic, atrophic, erosive, nodular);
- on extent of structural changes (superficial, interstitsialny, atrophic);
- special forms (specific duodenita: tubercular, at Whipple's disease, immunodeficient, fungal, at an intestines amiloidoza, at a disease Krone, etc.).
- chronic atsidopepticheskiya bulbit, usually combined with gastritis of type B;
- chronic duodenit in combination with enteritis and any enteropatiya;
- duodenit as result of a duodenostaz;
- local duodenit (okolososochkovy divertikulit, a nipple inflammation).
Etiology and pathogenesis of duodenit
Are the reasons of primary duodenit:
- violations of food, the use of the products irritating mucous with a GIT (sour, smoked, sharp, fried);
- alcohol, smoking, abuse of coffee;
The mechanism of development of an inflammation of DPK is connected with damage of a mucous wall of a gut by the giperatsidny juice arriving from a stomach. The increased acidity in total with decrease in protective properties of a wall of a duodenum lead to irritation, and then and an inflammation of mucous. If the acute inflammation proceeds without pronounced symptomatology, then it develops into chronic process, gets a cyclic recidivous current, in a wall of a gut degenerate and atrophic processes begin.
Clinical cases of primary duodenit meet much more less than duodenit secondary (developed as a result of other pathology).
Reasons of a secondary duodenit:
- infection of DPK Helicobacter Pylori,
- chronic gastritises of various etiology;
- stomach ulcer of DPK;
- violations of blood supply of a duodenum, deterioration traffic, innervations and tissue respiration in a gut wall;
- chronic diseases of intestines and digestive bodies: liver, pancreas (colitis, hepatitis and cirrhosis, sharp and chronic pancreatitis of various etiology, inflammatory diseases of a bryzheyka, etc.);
In case of a secondary duodenit the main pathogenetic link of development of a disease is – a consequence of functional disorders of digestion, an insufficient vermicular movement, adhesive processes, compression impassability of DPK.
Chronic diseases of a liver, gall bladder and pancreas cause violations of fermental balance that causes change of a homeostasis of the internal environment of intestines, reducing protective properties of an epithelium of mucous. Chronic inflammatory process turns out to be consequence.
The inflammation of a dudenalny nipple, as a rule, is result of pathological processes in bilious channels.
Symptoms of a duodenit
The symptomatology of a chronic duodenit differs for various clinical forms of a disease. Atsidopeptichesky duodenit, associated with antralny bacterial gastritis quite often accompanies stomach ulcer of a stomach and a duodenum that causes existence of a yazvopodobny syndrome – the expressed morbidity in an epigastriya on a hungry stomach, at night or in a couple of hours after meal.
Duodenit, combined with enteritis it is shown first of all by intestinal symptoms (digestion violation, dyspepsia, an absorption violation syndrome). At a duodenostaza the expressed pain syndrome – pristupoobrazny, the holding apart and twisting character, pain in epigastralny area, or in the right half of a stomach, feeling of swelling, abdominal murmur, a bitter eructation, nausea and vomiting with bile is characteristic.
At a local duodenit bile outflow is broken, the symptomatology of dyskinesia of bilious ways results. Morbidity in the field of a projection of DPK can irradiate in the right or left podreberye, gain the surrounding character. Development of symptoms of jaundice, easy yellowness of skin (the brownish shade) and the skler clarified up to white (is characteristic of holestatichesky jaundice at a full obturation of biliary tract) a chair is characteristic. In blood – a bilirubinemiya.
Violation of synthesis of a sekretin, enkefalin and other gastrointerstitsialny enzymes is characteristic of a long chronic duodenit. It is connected with decrease in sekretorny properties of an epithelium mucous owing to her dystrophy. These peptides are extremely important in digestive activity, and their insufficiency leads to deep frustration not only bodies of a digestive tract, but also other systems of an organism, up to violations from vegetative and the central nervous system.
- Yazvennopodobny ("night" and "hungry" pain in an epigastriya or in the field of a projection of DPK of the pulling character without irradiation. It is stopped meal and reception of antatsidny medicines and gastroprotektor. Often there is heartburn and a bitter eructation.).
- Gastritopodobny form (pain practically in 15-20 minutes after meal, a dispepsichesky syndrome – nausea, vomiting, an eructation, muttering in a stomach, a diarrhea, a meteorizm, lack of appetite).
- Holetsistopodobny and pankreatopodobny forms (the acute pain expressed settles down in the right or left podreberye, is inclined to irradiation, proceeds as bilious colic, there are signs of a holestaz, dispepsichesky frustration).
- Neuro and vegetative form (into the forefront vegetative astenonevrotichesky frustration, a deping-syndrome – consequences of duodenal hormonal insufficiency act).
- The mixed form (combines signs of different clinical forms of duodenit).
- Asymptomatic form (as a rule at elderly people – comes to light at functional methods of diagnostics at inspection concerning other pathologies).
Diagnostics of a duodenit
To diagnose duodenit it is possible on the basis of an endoscopic picture at gastroscopy. Additional methods of diagnostics are:
- X-ray analysis of a stomach and duodenum;
- research of gastric juice – biochemical and definition ;
- duodenal sounding;
- biochemical blood test;
At suspicion on an ozlokachestvleniye of affected areas of mucous conduct a research of a bioptat.
Treatment of a duodenit
Treatment of chronic duodenit differs depending on their clinical form.
Atsidopeptichesky chronic duodenit
Treatment means complex action in three directions:
- eradikation of helikobakteriya;
- protection of mucous: decrease in secretion of hydrochloric acid (blockers of a proton pomp, H2 blockers, an antatsida) and the gastroprotektion (enveloping medicines);
- restoration of digestion by means of fermental medicines.
Duodenit with enteritis
Treatment of an aggravation first of all is directed to an exception of a diet of products which badly are digested (first of all milk, cereals), use of fermental medicines for restoration of digestive function of intestines, normalization of intestinal flora. During the periods of remission the healthy balanced nutrition is shown.
Treatment-and-prophylactic actions have to be carried out taking into account clinical option of a chronic duodenit and the nature of associated diseases.
Duodenit against the background of a duodenostaz
Treatment of a duodenostaz is always directed to eradication of the reason of impassability of a duodenum. Functional treat conservatively – frequent food in the small portions with an exception of the products promoting bile secretions, the medicines connecting the bile, medicines promoting regulation of motility of intestines. Effectively duodenal sounding with washing of DPK.
In cases of resistant obturation as a result of the expressed solderings, mechanical barriers, and also at the functional impassability resistant to therapeutic treatment, operation is shown. Treatment of duodenal impassability is carried always out in stationary conditions to warn possible heavy complications.
Prevention and the forecast at a duodenita
Primary prevention of duodenit is the healthy balanced nutrition, refusal of smoking and moderation in alcohol intake. Timely identification and treatment of diseases of a GIT, use of medicines strictly to destination. Prevention of a recurrence at patients with a chronic duodenit consists in regular observation and annual out-patient inspection, sanatorium treatment.
The forecast at regular observation and timely treatment is favorable, at the duodenit caused the duodenostazy ambassador of the actions directed to stagnation elimination there is a stukhaniye of inflammatory symptomatology and, as a rule, treatment.