Enteritis – the inflammatory process in a small intestine which is followed by violation of its functions and dystrophic changes of a mucous membrane. It is characterized by symptoms of frustration of a chair which gains liquid or mazevidny character, an abdominal distension, rumbling, pains in a navel. The general health is broken, the patient grows thin. In hard cases dystrophic changes, hypovitaminosis, nadpochechnikovy insufficiency can develop.
Enterita is the whole group of inflammatory diseases of a mucous membrane of a small intestine.
Enterita as a result of infection of intestines with bacteria, the elementary parasites, helminths, influences of aggressive chemical agents, alimentary violations most often develop. Enteritis differs on character of a current on sharp and chronic. In most cases chronic enteritis is a consequence of uncured or lechenny insufficiently sharp enteritis. Besides the factors which are directly irritating an intestinal wall in pathogenesis of inflammatory processes of a small intestine various functional disorders of digestive organs and violation of enzymatic system, a disease of exchange and autoimmune states can play a role.
Reasons of development of enterit
As the causes of sharp enteritis sharp intestinal infection of a bacterial or virus origin (cholera, salmonellosis, a typhoid), poisoning with toxic substance (arsenic, corrosive sublimate) or poisonous products (a pale toadstool, kostochkovy fruits, bodies and parts of some fishes, inedible berries etc.), an overeating of spicy, spicy, greasy food, the use of strong alcohol), an allergy to foodstuff or medicinal substances can serve.
Chronic enterita can develop as a result of settling of intestines protozoa or helminths, harmful eating habits (tendency to rough, spicy food, alcohol), chronic poisoning with heavy metals, caustic substances. Enteritis can become result of long reception of medicines, develop at radiation sickness.
The factors promoting developing of enteritis is smoking, a renal failure, atherosclerosis, tendency to allergies, autoimmune processes, enzimopatiya, an inflammation of vessels of a bryzheyka. Enteritis can join others a disease of bodies of a GIT, be a consequence of genetically caused violations of absorption, surgeries on intestines and a stomach.
Classification of enterit
On the cause distinguish infectious, parasitic, toxic, medicamentous, alimentary, postoperative, radiation enterit, enteritis at congenital anomaly of intestines or an enzimopatiya, at insufficiency of a big duodenal nipple and the ileotsekalny valve, secondary enterita.
On localization distinguish an inflammation of a lean gut (eyunit) also a podvzdoshny gut (ileitis), and also allocate total enteritis when the inflammation mentioned all departments. Depending on the nature of morphological changes distinguish enteritis without atrophy, with a moderate partial and subtotal atrophy . Enteritis can proceed in easy, moderate severity and in a severe form, chronic enteritis can stay in a phase of an aggravation or remission.
Also note the nature of functional violations of work of a small intestine: existence of a syndrome of malabsorption, maldigestiya, enteralny insufficiency, ekssudativny enteropatiya. If the mucous membrane of a large intestine is involved in process, then speak about enteritis with the accompanying colitis. And also note the accompanying extra intestinal pathologies.
Sharp enteritis begins usually a diarrhea, nausea and vomiting, developing of belly-ache. Temperature increase, a headache can be noted. The chair happens till 10-15 once a day, plentiful, watery. General state: weakness, pallor, dryness of skin, a white raid in language. The stomach is blown up, muttering in intestines is noted.
At long ponosa the clinical picture of dehydration, in hard cases develops up to developing of muscular spasms, a syndrome of disseminirovanny intra vascular folding. Symptoms of hemorrhagic diathesis (the raised bleeding, tendency to a tromboobrazovaniye) can be noted. Chronic enteritis is characterized by enteralny and extra intestinal manifestations.
Carry diarrhea, a meteorizm, pain of skhvatkoobrazny character in the top part of a stomach to enteralny symptomatology, around a navel, rumbling, a swirling in a stomach. The symptomatology is usually more expressed in the period of the greatest activity of a gastrointestinal tract – in the second half of day.
The chair at chronic enteritis the liquid or kashitseobrazny, containing undigested remains of food, with a frequency about 5 times a day, defecation, as a rule, is followed by weakness emergence, a debilitation. After that can sharp falling of arterial pressure, tachycardia, dizziness, a tremor of extremities (is noted up to development of a collapse).
The painful, followed by a swirling and spasms in a stomach desires to defecation, with allocation of greenish color of a watery poor chair are sometimes noted. Language at enteritis is laid over by a white raid, prints of teeth are at the edges visible. The stomach is blown up, the palpation the blind person of a gut responds noise and splash (Obraztsov's symptom).
Extra intestinal displays of chronic enteritis are connected with development of a syndrome of malabsorption – violations of absorption of nutrients in a small intestine. It is long the existing lack of the substances coming to an organism leads to numerous hypovitaminoses, nedostatochnost of mineral components (iron deficiency anemia, osteoporosis owing to insufficiency of calcium, etc.), to proteinaceous starvation. Decrease in body weight, dystrophy progresses.
Diagnosis of enteritis
Careful poll and collecting the anamnesis of the patient gives the gastroenterologist enough information for statement of primary diagnosis, additional confirmation are given the general survey, a palpation and percussion of a belly wall.
As laboratory methods of diagnostics apply a koprogramma, at a macroscopic research note a consistence, color, a smell. The microscopic research shows presence of large amounts of muscle fibers (), starch (), fat (). Usually the acid-base indicator changes.
Functional tests for diagnostics of violations of absorption in a small intestine (absorbing tests): definition in blood, urine, saliva of the carbohydrates and other substances accepted before the analysis (test with D-ksilozoy, yodo-potassium). The technique of an eyunoperfuziya helps to reveal violations of intestinal digestion at the cellular and molecular level.
The bacteriological research a calla is conducted for detection of dysbacteriosis or intestinal infection. In blood find symptoms of anemia (iron deficiency, B12-scarce mixed), , sometimes - , the accelerated SOE. Biochemical blood test it is long the proceeding chronic enteritis allows to note malabsorption syndrome signs.
The endoscopic research of a small intestine presents considerable difficulty. Only terminal departments have availability to introduction of the endoscope: postbulbarny part of a duodenum and regional site of podvzdoshny. When carrying out endoscopic inspection take a bioptat mucous for the histologic analysis. As a rule, note the dystrophic and atrophic phenomena from epitelialny cages and intestinal .
Radiological inspection of intestines with introduction of contrast substance allows to note change of folded structure, to reveal segmentary defeats and tumoral educations, ulcers. Also there is an opportunity to estimate a condition of motor function of intestines.
At chronic enteritis carry out differential diagnostics with the diseases proceeding with persistent ponosa and leading to exhaustion. Endocrine diseases with similar clinic: thyrotoxicosis, diabetes, Addison and Simmonds's diseases.
Persistent diarrhea can arise at other pathologies of intestines: nonspecific ulcer colitis, disease Krone, malignancies and amiloidoza of intestines. It is also necessary to exclude an abdominal syndrome at insufficiency of blood supply of a bryzheyka of a small intestine (ischemia). Gormonprodutsiruyushchy tumors, pathologies of a stomach, liver and pancreas can cause violations of digestion in a small intestine.
Treatment of enterit
Sharp enteritis treat in a hospital. Sharp toxic enteritis treat in offices of gastroenterology, infectious enterita are the indication for hospitalization to the infectious box. The patient appoint a bed rest, dietary food (mechanically and chemically sparing food, restriction of content of carbohydrates and fats), plentiful drink (in need of a measure of hydration therapy), the symptomatic and all-strengthening treatment.
At development of heavy dysbacteriosis make medicamentous correction of intestinal flora, stop diarrhea astringents. In case of violation of proteinaceous exchange make introduction of polypeptide solutions. Treatment of sharp enteritis, as a rule, takes about a week, the extract from a hospital is carried out after subsiding of sharp symptoms.
Patients with heavy enteritis, and also enteritis of a toxic origin (which further course is difficult to define during the first hours diseases) surely are hospitalized. Patients with infectious enterita are hospitalized in infectious diseases hospitals.
Exacerbation of chronic enteritis it is expedient to treat in the conditions of a hospital. To patients the bed rest and dietary food (diet No. 4) is appointed. During the sharp period food has to be most protein-rich, it is better to limit fats and carbohydrates. It is necessary to refuse rough food, sharp, sour, products capable to damage mucous a digestive tract. Exclude the products containing a large amount of cellulose, milk. Amount of fats and carbohydrates gradually increase.
During remission the balanced diet containing all necessary substances, vitamins and minerals in enough is recommended. Correction of insufficiency of digestive enzymes is carried out by the help of fermental medicines: Pancreatinum, pan-citrate, festat. Stimulate absorption by the medicines containing nitrates, it is desirable long action. Protective means (essentsialny phospholipids, extract of fruits of a thistle) help to restore functionality of cellular membranes of an intestinal epithelium.
Loperamide is appointed for suppression of excess propulsive motility of intestines. The astringents enveloping and adsorbing medicines, antiseptics are recommended to patients with heavy diarrhea. It is possible to apply phytotherapy (broths of a camomile, a sage, St. John's Wort, bird cherry and fruits of bilberry, alder cones) to these purposes.
Dysbacteriosis is corrected by means of probiotics and eubiotik. Intravenous infusion of solutions of amino acids appoint at the expressed violations of absorption with heavy proteinaceous deficiency. At development of symptoms of enteritis against the background of new growths of a small intestine (polyps, diverticulums), their surgical removal is necessary.
Forecast and prevention
The easy and medium-weight course of sharp enteritis at adequate medical actions comes to an end with treatment within several days. The heavy current which is badly giving in to treatment can lead to development of the complications (bleeding, perforation, to heavy dehydration, emergence of sites of a necrosis) demanding acceptance of emergency measures.
Chronic enteritis proceeds with alternation of aggravations and the periods of remission, gradually progressing (the inflammation is aggravated, extends on digestive tract, malabsorption signs amplify). In the absence of due medical measures the long course of enteritis threatens with a lethal outcome from heavy violations of an internal homeostasis and exhaustion. Also uncured chronic enteritis is fraught with development of life-threatening complications, accession of infections.
At slight and medium-weight enteritis working capacity usually remains, difficulties are caused by heavy physical activity and frequent psycho-emotional stresses. The heavy current leads to decrease and disability.
Prevention of inflammations of a small intestine includes a balanced diet, observance of hygienic recommendations, careful processing of foodstuff, avoiding of consumption of possible toxic products (inedible mushrooms, berries), careful reception of medicines strictly according to indications. Also measures of the prevention of enterit is timely identification and treatment of diseases of digestive tract, exchange frustration, endocrine violations.