The gastroenteritis is the disease which is characterized by inflammatory process in a stomach and a small intestine which cause virus or protozoan defeat, action of chemical and physical factors, development of allergic reactions can be bacterial (including helikobakterny). The leading clinical signs – a dispepsichesky, pain syndrome, at a sharp infectious gastroenteritis – dehydration. Diagnostics consists in studying of the anamnesis of a disease, an epidemiological situation, identification of the activator, carrying out endoscopic and other additional methods of a research. Treatment is conservative, is defined by a pathology form.
Gastroenteritis – the inflammatory process which is localized in a mucous membrane of a stomach and a small intestine which leads to violation of sekretorny, digestive and transport function, secondary immune and metabolic changes. The disease can proceed in two forms – sharp and chronic which have fundamental differences in an etiology, manifestations and methods of treatment. Prevalence is very high: in structure of infectious diseases the sharp gastroenteritis takes the second place after respiratory infections, and chronic occurs more than at a half of school students and faces of the senior age groups. Relevance of this pathology is caused by continuous emergence of new strains of activators, development of resistance to antibiotics, prevalence of such risk factors as irrational food, alcohol intake and smoking, and also extremely frequent cases of self-treatment.
Infection with bacteria, viruses, protozoa (shigellas, salmonellas, colibacillus, enterotropny viruses, amoebas, etc.), and also action on a mucous membrane of a stomach and a small intestine of the chemical or physical damaging factors is the main reason for development of a sharp gastroenteritis (alcohol, some medicines, aggressive chemicals, the ionizing radiation). Less often the sharp form develops as a result of unbalanced food (the use of too spicy, greasy food) or individual intolerance of certain food (an allergic form). Most often the infectious sharp gastroenteritis at which there is a hit of pathogenic flora in a GIT, adhesion and an invasion of microorganisms, production them enterotoksin meets. These processes are followed by increase in osmotic pressure of contents of intestines and secretion in its gleam of a large amount of water and electrolytes. The probability of a sharp infectious gastroenteritis increases at violation of a microbiocenosis of intestines and the lowered acidity of gastric juice.
The chronic gastroenteritis can arise as a complication and continuation of the postponed sharp process, but in most cases Helicobacter pylori infection is its reason. Helikobakteriya are the acid resisting microorganisms which are possessing a tropnost to epitelialny tissue of a stomach and having the protective mechanisms allowing to exist in hostile acidic environment. Development of these bacteria leads to increase in acid-forming function, and as a result of constant action on mucous a small intestine of sour contents of a stomach – a metaplaziya of an intestinal epithelium which is transformed to gastric. At the same time mucous gains favorable properties for settling of helikobakteriya. Chronic inflammatory process leads to insufficient production of digestive juice and oppression of local immune mechanisms.
The chronic gastroenteritis often arises at alcoholism. At the same time atrophic changes in a mucous membrane of digestive tract with the expressed violations of digestion of food and absorption of valuable nutrients take place.
Classification of a gastroenteritis
The gastroenteritis is classified depending on a form (sharp or chronic), an etiologichesky factor and the prevailing clinical syndrome. During a sharp gastroenteritis mark out three severity. The first is characterized by infrequent diarrhea and vomiting, preservation of normal body temperature and lack of symptoms of dehydration. Moderate severity is defined by vomiting and diarrhea to ten times a day, symptoms of slight dehydration and temperature increase to 38,5º. The heavy current is followed by the expressed dehydration, fever, consciousness violations.
The chronic gastroenteritis is classified by etiologichesky factors (infectious, alimentary, caused by physical or chemical factors, diseases of a liver and pancreas) and to the prevailing functional changes (violation of membrane digestion, vsasyvatelny or motor function). Depending on anatomo-morphological changes distinguish a superficial gastroenteritis with damage of epitelialny cages, chronic process without atrophy, a chronic inflammation with an atrophy . During a chronic form allocate aggravations and remissions.
The clinical picture depends on a disease form. Sharp process develops violently, because of frequent and plentiful diarrhea and vomiting within several hours the condition of the patient can significantly worsen. If infectious process is the reason of pathology, the incubatory period can last from 3-4 hours to several days. Most often the first symptom – diarrhea, is possible nausea and vomiting. Expressiveness of manifestations of a sharp gastroenteritis differs depending on specific accessory of the activator.
At a bacterial gastroenteritis a current usually heavier, than at virus, the hyperthermia and an intoksikatsionny syndrome are characteristic. Feature is damage of cages of an epithelium by toxins therefore in most cases the bacterial gastroenteritis is followed by the expressed spastic pains on the intestines course. Virus defeat extremely seldom is followed by belly-ache, at small children the disease can quickly lead to considerable dehydration. The virus gastroenteritis often proceeds with symptoms of a respiratory infection.
At a sharp gastroenteritis the leading clinical syndrome demanding early correction is dehydration. Dehydration can reach considerable degree when the patient loses liquid in number of 10% of body weight and more. At the same time spasms, consciousness violation, the expressed weakness, tachycardia, a lowering of arterial pressure are possible. Patients feel strong thirst; integuments are dry, turgor is reduced. At considerable dehydration body temperature goes down to 35 º, the amount of the emitted urine up to an anury decreases.
The chronic gastroenteritis is followed by the general symptoms and signs of local damage of a mucous membrane. The general manifestations are characterized by weakness, astenisation, weight reduction owing to the broken absorption of nutrients, irritability, sleeplessness. At the most part of patients the trophic changes of nails (exfoliating, fragile nails), a hair (the fragile, splitting hair), skin and mucous are observed. Violation of absorption of calcium can lead to paresteziya, spasms of small muscles. Pain at a chronic gastroenteritis arises in 1-2 hours after food, is followed by nausea, an eructation, is more rare – vomiting. Diarrhea, polyexcrements, an abdominal distension, rumbling belong to intestinal displays of a disease.
In clinic of a chronic gastroduodenit the periods of aggravations and remissions are replaced. Aggravations have autumn and spring seasonality, they are provoked by violations of a diet and associated diseases. At adequate therapy symptoms regress approximately in ten days.
Diagnostics of a gastroenteritis
In case of a sharp form of a gastroenteritis the leading role in diagnostics is assigned to studying of complaints and the anamnesis of a disease, an epidemiological situation in the region, risk factors, and also to methods of identification of the activator. The nature of changes of excrements and degree of dehydration allow to decide on an initiation of treatment. The exact diagnosis is exposed after identification of the activator, however these researches demand a long time (7-10 days).
At survey dryness of integuments and decrease in their turgor, morbidity of a stomach at a palpation is defined. Language dry, is laid over by a grayish or white raid. The hyperthermia, consciousness violation is possible, at the expressed dehydration – a hypothermia and spasms.
The Koprologichesky research (koprogramma) reveals in excrements of impurity of slime, pus, blood, undigested cellulose, muscle fibers, starch and fats. In clinical blood test is defined and acceleration of SOE, and in case of dehydration – haemo concentration signs (reduction of a liquid component of blood). Identification of the activator is carried out by bacteriological and virologic methods. Excrements, the emetic masses, blood and urine are investigated. Serological diagnostics – a quadruple gain of a caption of specific antibodies in pair serums is most informative.
For verification of a chronic gastroenteritis additional researches GITs are conducted. At an ezofagogastroduodenoskopiya the condition of a mucous membrane of a stomach and initial departments of a small intestine is estimated, the biopsy of the changed sites mucous for the subsequent histologic analysis is carried out. It allows to find an atrophy, a metaplaziya or a giperplaziya. The antroduodenalny manometriya is applied to identification of violation of motility. The intragastric rn-metriya as the lowered and increased acidity demand various approach to treatment is surely carried out. For the purpose of identification of Helicobacter pylori PTsR-diagnostics, the respiratory ureazny test and a morphological research of bioptat is performed. For assessment of a condition of a liver and a pancreas ultrasonography of abdominal organs is carried out.
Treatment of a gastroenteritis
At a sharp gastroenteritis treatment can be carried out in out-patient conditions or in an infectious hospital, at chronic – in office of gastroenterology. A therapy basis at a sharp form is the regidratation, a dietotherapy, in certain cases – application of antibiotics and supportive applications.
Any severity of a sharp infectious gastroenteritis demands the early beginning of oral rehydration therapy. Especially it concerns small children at whom dehydration develops very quickly. Even if there are no signs of an eksikoz, plentiful drink is required. With thirst, dryness of skin, decrease in volume of urine special oral salt solutions are applied. The patient has to drink liquid in the volume exceeding losses by one and a half times. If thirst decreases and the diuresis increases, so dehydration is compensated enough. At considerable losses of water and electrolytes the infusional regidratation is carried out by salt solutions.
Antibiotics in case of a sharp gastroenteritis are shown only at its bacterial etiology (availability of slime, pus and the blood in excrements expressed to a hyperthermia). At virus defeat antibacterial therapy is contraindicated. For reduction of diarrhea and removal of toxins enterosorbents are appointed: absorbent carbon, dioctahedral smektit, and others. For the purpose of normalization of intestinal flora a probiotics and eubiotik is applied.
Treatment of a chronic gastroenteritis is defined by its form. In case of the increased acidity antatsida, inhibitors of a proton pomp are applied. Detection of helikobakteriya demands obligatory performing specific therapy: antibiotics, medicines of bismuth and inhibitors of the proton pump are appointed. At the reduced acidity natural gastric juice, enzymatic and reparative medicines is used. Intestinal microflora restoration is also surely carried out. At the expressed pain syndrome, especially with the phenomena of a solyarit, the physical therapy is effective: an electrophoresis with anesthetics, magnetotherapy.
At a sharp and chronic form of a gastroenteritis observance of a diet is obligatory. Food has to be chemically and mechanically sparing, extractive substances, fat and hot dishes are excluded. For the purpose of decrease in risk of a retsidivirovaniye patients are recommended to exclude smoking, alcohol intake, coffee and carbonated drinks. During remission sanatorium treatment is carried out. Therapy of a gastroenteritis should not be conducted by patients independently – irrational application of symptomatic means only reduces manifestations, but does not lead to treatment.
Forecast and prevention of a gastroenteritis
At timely treatment at the gastroenterologist, observance of a diet the forecast favorable. At the same time independent treatment of a sharp gastroenteritis can lead to process synchronization. With risk factors (age up to 6 months and after 65 years, the accompanying renal, cardiovascular and neurologic diseases, diabetes, oncological pathology) the sharp gastroenteritis can proceed in a severe form, at the same time a lethality rather high.
At a chronic gastroenteritis medical examination and regular inspection is obligatory. Preventive measures include respect for personal hygiene (washing of hands after visit of bathrooms and before meal), careful washing of the vegetables used in the raw, greens, sufficient heat treatment of products, detailed inspection of employees of the food industry with discharge from production at identification of sharp infectious process.