Intestinal enteritis medicinal. Enteritis in adults - symptoms, diagnosis and treatment. When you need a doctor's help

For diseases gastrointestinal tract the patient constantly feels discomfort. In addition, there is a need for a special diet menu from which to remove junk food. The patient must adhere to many prohibitions in order to prevent the occurrence of complications. One of the diseases of the digestive system is enteritis. The disease can occur in both acute and chronic forms. The occurrence of enteritis is characteristic of the small intestine, in which, due to inflammation, the normal functioning. The mucous membrane changes, as a result of which the synthesis of intestinal juice and its barrier function are disturbed. Therefore, patients should, if possible, refuse products for which mechanical (in particular, various additives) and chemical methods processing.

In an enlarged form, the disease is enteritis.

Description

The disease can appear in patients of any age, and in children appears acute stage, and in the older generation - chronic, which is associated with other diseases. The chronic stage develops when there was no treatment for the acute form.

In the acute form, the symptomatic series is brightly pronounced, and in the chronic form it is not always manifested. According to statistics, every person in his life suffered from an acute form of enteritis, and a quarter of the world's population has a chronic form of the disease.

If the patient has an acute form of enteritis, then concomitant diseases are gastritis, or colitis. The chronic form is characterized by concomitant diseases of the pancreas, bile ducts, metabolic disorders or autoimmune system. It is necessary to start treating the disease on time so that complications do not appear.

Kinds

Depending on certain characteristics, several classifications of enteritis are distinguished. According to the place of distribution of inflammatory processes, there are:

• isolated form;
• combined with the defeat of the stomach gastroenteritis;
• enterocolitis, which is combined with pathologies of the large intestine;
• gastroenterocolitis, in which the stomach and entire intestine become inflamed.

According to the level of spread of inflammatory processes:

• duodenitis form, in which the duodenum becomes inflamed;
• eunitic, when the jejunum is affected;
• ileitis, if the patient suffers from the ileum.

According to the factors influencing the development of the disease, there are:

In addition, there are:

• primary enteritis, which can occur on its own;
• secondary, which appears as a complication of another disease.

Causes

Causes of enteritis can be very different, and for each form of the disease there are different factors.

In patients with acute enteritis, annoying factors can be:

• infection, among which salmonella, staphylococcus aureus, dysentery bacillus and various viruses are isolated;
• allergic reactions to certain foods;
• side effects after taking medications;
• presence in the diet a large number fatty, spicy, salty and sour foods;
• use alcoholic beverages in large quantities;
• food poisoning, most often due to berries or mushrooms;
• poisoning with chemical components both at home and at work.

With enteritis in a chronic form, there are such causes of appearance as:

• hereditary diseases;
• operations or trauma to the intestinal environment;
• too much long time medication use;
• alcohol abuse, smoking;
• damage to the body by worms;
• frequent overeating;
• exposure and poisoning at work;
• autoimmune diseases.

The primary factors that influence the appearance of each of the forms are bad habits, absence active image life, problems with the circulatory system and the development of adhesions.

Symptoms

Signs of enteritis appear differently at each stage of development. acute form always appears unexpectedly and has a sufficiently pronounced symptomatic range, which includes:

• the appearance of loose stools up to 20 times a day, and sometimes more;
• nausea appears, vomiting begins;
• severe pain in the abdomen;
• feeling of bloating in the abdomen, rumbling;
• body temperature rises to 39 degrees;
• feeling unwell, constant headaches;
• tongue coating.

In especially severe cases the patient may begin dehydration, accompanied by dryness of the tongue and mucous membranes, a sharp weight loss. The patient may begin to have convulsions, clotting is disturbed, and as a result, a state of shock appears, which can end in a coma.

Symptoms of enteritis chronic stage may be varied, although they do not have acute manifestations but may take several months. At this stage, symptoms such as:

• the appearance of diarrhea after almost every meal;
• liquid stool appears more than 10 times a day, has a watery texture, yellow color and food impurities;
• slight pain in the navel;
• rumbling and bloating;
• when emptying the small intestine, there is a feeling of discomfort, pressure decreases;
• due to impaired absorption of a complex of vitamins and minerals, a person may develop anemia or osteoporosis;
• a white coating appears on the tongue;
• hypovitaminosis appears;
• the patient gradually loses weight, development of dystrophy is possible.

Diagnostics

It is important that the patient, at the first symptoms, contact a specialist who will conduct a series of studies. The examination begins with a study of the patient's medical history, complaints. It is necessary to find out whether there were diseases of the gastrointestinal tract before.

• conducting and the liver to determine whether the disease is the result of inflammatory processes in these organs;
• examination of feces for intestinal infections, conducting a coprogram;
• abdominal x-ray;
• complete blood count to determine the presence infectious manifestations, leukocytosis;
• biochemical blood test;
• study of feces for available carbohydrates.

Enteritis is a group of inflammatory diseases of the small intestine.

Chronic enteritis- a disease of the small intestine, characterized by a violation of its functions (digestion and absorption) against the background of dystrophic and regenerative (restorative) changes, culminating in the development of inflammation, atrophy and sclerosis of the mucous membrane of the small intestine.

Acute enteritis- infectious diseases that often develop as a result of food poisoning and are clinically manifested by gastroenteritis with symptoms of general intoxication, fever, severe diarrhea. The causative agents of acute gastroenteritis: salmonella, typhoid paratyphoid group, vibrio cholera.

Chronic enteritis is a multi-causal disease.

The disease can result in:

Acute inflammatory process

Be primarily chronic.

The primary factor is considered- Yersinia, Helicobacter, Proteus, Pseudomonas aeruginosa, rotaviruses, protozoa and helminths. Nutritional factors are no less important in the development of chronic enteritis: overeating, eating dry food, the predominant use of carbohydrates, the abuse of spices, and food allergies. Also contribute to the development of enteritis, some drugs - salicylates, indomethacin, corticosteroids, immunosuppressants, cytostatics, antibiotics with their long-term use.

Often enteritis accompanies diffuse diseases connective tissue, tuberculosis, chronic pancreatitis, cirrhosis of the liver, chronic renal failure. Functional and structural changes in the mucous membrane of the small intestine are promoted by congenital and acquired metabolic diseases, dysfunction of the digestive glands and immunological homeostasis, changes in intestinal motility, and microcirculatory circulatory disorders.

Of great importance in the mechanism of development of enteritis are changes in the intestinal microflora against the background of a decrease in local and general immunity. Changes immune status- a decrease in the content of secretory immunoglobulin A, an increase in the level of IgE, a decrease in the reaction of blast transformation of lymphocytes, inhibition of the reaction of migration of leukocytes lead to colonization of the small intestine conditionally pathogenic microflora(escherichia, enterococci, staphylococcus aureus), a decrease in normal anaerobic flora (intestinal microbes living in anoxic conditions).

Bacterial colonization of the small intestine enhances intestinal secretion of epitheliocytes (epithelial cells), which leads to an increase in intestinal permeability and, ultimately, to water and electrolyte disorders. Under the influence of microbial flora, the enterohepatic circulation of bile is disturbed. Under the influence of metabolic disorders fat soluble vitamins the content of trace elements in the blood decreases.

Prolonged dysbacteriosis contributes to sensitization (increased sensitivity) to microbial and food antigens, causes immunological inflammation of the mucous membrane. The increased permeability of the mucous barrier is accompanied by resorption (absorption) of non-split protein macromolecules, which acquire the properties of allergens, they cause the release of biologically active substances(histamine, serotonin, prostaglandins), which change the function of enterocytes, and inhibition of carbohydrate-splitting (lactase, then maltase and sucrase) activity.

At dystrophic changes epitheliocytes (epithelial cells), the synthesis of enzymes and their sorption (settlement) on the membranes of epithelial cells decreases, which causes disturbances in both membrane and cavity digestion, which becomes the basis of malabsorption syndrome. Disorders of lipid (fat) metabolism develop, associated with a decrease in fat absorption, its loss with feces, and changes in the intestinal phase of the enterogenous circulation of bile.

Violation of bile metabolism leads to a violation of lipid metabolism, the structure and functions change cell membranes, the synthesis of steroids (hormones) and the function of endocrine glands. Morphologically, chronic enteritis is manifested by inflammatory and dysregenerative changes in the mucous membrane of the small intestine, atrophy and sclerosis.

SYMPTOMS

The phases of enteritis are exacerbation and improvement.

Complications: solaritis (inflammation of the solar nerve plexus), nonspecific mesadenitis (inflammation of the inter-intestinal lymph nodes). The clinic consists of general and local manifestations. Local enteral syndrome is associated with a violation of the processes of parietal (membrane) digestion and abdominal digestion (maldigestion).

General enteral syndrome is associated with malabsorption, leading to a disorder of all types of metabolism. With local enteral (small intestinal) syndrome, patients complain of flatulence, pain in the middle part of the abdomen, mainly in the navel, bloating in the form of a cap, loud rumbling, diarrhea, constipation, or their alternation.

When palpated, pain is detected in the mesogastrium, on the left and above the navel ( positive symptom Porges), splashing noise in the region of the caecum (obraztsov's symptom). The feces have a clayey appearance, polyfecalia is characteristic (an increased amount of feces). There are no pathological changes (blood, pus) in the feces. Intestinal manifestations often occur in the afternoon at the height of the intestinal phase of digestion. Often, against the background of a feeling of fullness in the abdomen, palpitations, pain in the heart, headaches appear.

General enteral syndrome is manifested by metabolic disorders, primarily protein, which is accompanied by weight loss. Changes in carbohydrate metabolism are less pronounced (bloating, rumbling in the abdomen, increased diarrhea while taking dairy products). Changes in lipid metabolism are associated with impaired metabolism of fat-soluble vitamins.

Specific signs of calcium deficiency: a positive symptom of a muscle roller, convulsions, periodic bone fractures, osteoporosis; swelling of the face, lips, glossitis, irritability, poor sleep. Violations of the water-electrolyte balance are clinically manifested general weakness, physical inactivity, muscle hypotension, nausea, vomiting, changes in the central nervous system.

Dominated intestinal symptoms at mild form chronic enteritis. The combination of local and general metabolic disorders in moderate, and in severe forms, distinct metabolic disorders dominate with often irreversible changes in the functions of internal organs.

Symptoms of polyhypovitaminosis are bleeding gums, nosebleeds, bruising (vitamin C deficiency); accompanied by pallor of the skin, inflammation of the tongue, irritability, poor twilight vision, dry skin and mucous membranes - deficiency of vitamins A, D, E, K, drowsiness, loss of appetite, dermatitis, impaired food passage - deficiency of B vitamins.

At severe forms chronic enteritis, there are symptoms of endocrine dysfunction, hypocorticism (decreased function of the adrenal cortex - arterial hypotension- low blood pressure, arrhythmia, skin pigmentation).

In case of violations metabolic processes nonspecific reactive hepatitis develops - a feeling of heaviness in the right hypochondrium, there are pigment metabolism disorders, a moderate enlargement of the liver.

DIAGNOSTICS

Spend general analysis blood. Micro- and macrocytic anemia is found in it. Increased ESR, in severe cases - lympho- and eosinopenia.

In a coprological study, steatorrhea is detected, mainly due to fatty acids and soaps (intestinal type of steatorrhea), the daily weight of feces increases significantly - more than 500-1000 g.

Bacteriological examination of feces reveals dysbacteriosis of varying degrees. In chronic enteritis, the small intestine is colonized by microorganisms from distal departments intestines, the nature of the microflora in it resembles that in the large intestine. In severe cases, bacteremia develops, followed by infection of the biliary and urinary tract.

In chronic enteritis, testing for HIV infection is mandatory. In a biochemical blood test: hypoproteinemia, hypoalbuminemia, hypocalcemia, a decrease in magnesium levels, a decrease in potassium and sodium levels. The activity of transaminases may increase, hyperbilirubinemia may appear, the level of cholesterol and phospholipids decreases.

Functional research methods make it possible to assess the degree of enteral insufficiency: changes in the absorption of carbohydrates according to the test with B-xylose. The lactase loading test reveals a "flat" curve.

Clarifies the motor function of the small intestine, the relief of the mucosa - X-ray examination. In a mild form of the disease, dystonic and dyskinetic changes are observed in the form of a slowdown or acceleration of the passage of a suspension of barium sulfate through the small intestine, the relief of the mucous membrane retains its pinnate structure; in the moderate form, in addition to impaired motor skills, there are changes in the relief of the mucous membrane in the form of uneven thickening, deformation and smoothing of the folds.

The severe form of chronic Enteritis is characterized by the accumulation of fluid and gas in the small intestine. Osteoporosis is revealed. Gastroduodenoscopy reveals signs of atrophic gastritis and duodenitis, while intestinoscopy reveals dystrophic, dysregenerative and atrophic changes mucous membrane, its inflammatory infiltration.

Endoscopy allows to differentiate chronic enteritis from other diseases of the small intestine, to clarify the prevalence, severity of the process.

In chronic enteritis, differential diagnosis is carried out with celiac enteropathy, Crohn's disease, Whipple's disease, intestinal amyloidosis, diverticular disease, lymphoma, tumors of the small intestine. Common to all the listed states are clinical symptoms digestive disorders, absorption and dysbacteriosis.

The final diagnosis is confirmed by morphological examination of the mucous membrane of the small intestine. The basis of diagnosis is instrumental and specific diagnostic tests.

In the treatment of important means that affect ethological factors, pathogenic mechanisms, as well as local and general symptoms diseases. In the treatment of chronic enteritis, the main thing is an integrated approach.

Diet Forms the basis of treatment. It helps to reduce the increased osmotic pressure in the intestine, reduces secretion, and normalizes the passage of intestinal contents. During the period of exacerbation, a table No. 4 and 4a is assigned; after 4-5 days the patient is transferred to a full, rich in protein and a balanced diet in terms of fats and carbohydrates, exclude foods containing coarse vegetable fiber ( raw vegetables, fruit, Rye bread, nuts).

Butter dough, canned food, spices, spicy dishes, Whole milk, beer, kvass, carbonated and alcoholic drinks, limit salt. Also, during the period of exacerbation, soups from mucous decoctions of cereals are recommended on a weak meat broth, pureed or well-boiled porridges from rice, oatmeal, pearl barley, buckwheat on water with the addition of a small amount butter, boiled vegetables, lean meats, fish, soft-boiled eggs, steam omelettes, cheese, low-fat cottage cheese, curdled milk, dried White bread, fruit jelly, mousses, kissels, compotes, baked apples, blueberry, blackcurrant, quince, pear, marshmallow, marmalade, marshmallow, non-sour jam juices. Eating should be fractional, up to 5-6 times a day. Table No. 46 is prescribed for 4–6 weeks until the stool is completely normalized. This diet can be followed for a long time.

During the period of remission, some vegetables and fruits are added to the diet, up to 100–200 g per day. You can also eat lettuce, ripe peeled tomatoes, soft pears, sweet apples, oranges, tangerines, raspberries, strawberries. Food should be boiled or steamed.

Taking into account the data of the analysis of feces for dysbacteriosis, etiotropic treatment is carried out.

With dysbacteriosis of 2-4 degrees, drugs are recommended antibacterial action: metronidazole (0.5 g 3 times a day), clindamycin (0.5 g 4 times a day), cephalexin (0.5 g 2 times a day), biseptol (0.48 g 2 times a day day), sulgin (1 g 3-4 times a day), furazolidone (0.1 g 4 times a day). Antibacterial therapy lasts 8-10 days. Detection of pathogenic fungi requires the appointment of nystatin 5000 IU 3-4 times a day for 10-14 days. If campillobacteria are isolated during stool culture, erythromycin, gentamicin, tetracycline, clarithromycin are prescribed.

After the use of antibacterial drugs, eubiotics are prescribed - bifidumbacterin or bifikol 5 doses 3 times a day 30 minutes before meals, coli-bacterin or lactobacterin 3 doses 3 times a day before meals, hilak-forte 40 drops 3 times a day before meals. food, which is dissolved in a small amount of liquid. Long-term treatment with bacterial preparations - 3 courses for 3 months during the year.

With staphylococcal dysbacteriosis, an antistaphylococcal bacteriophage is prescribed 20 ml 3 times a day for 15–20 days, with proteus dysbacteriosis - coli-proteus bacteriophage inside 20 ml 3 times a day, the course of treatment is 2–3 weeks. As an antidiarrheal symptomatic agent, imodium (loperamide) is prescribed 1 capsule 2-3 times a day before meals for 3-5 days.

In this case, decoctions and infusions of alder cones are used, oak bark, pomegranate peels, burnet rhizomes, tansy flowers, St. John's wort, sorrel, plantain, knotweed, sage, marshmallow root, blackcurrant leaves, bird cherry and blueberries.

To improve the process of digestion, it is recommended to use enzymatic agents: pancreatin, panzinorm forte, festal, digestal, pankurmen, mezim forte, trienzyme, the doses of which are selected individually (from 1 tablet 3 times a day to 3-4 tablets 4 times a day) and which are prescribed immediately before or during meals for 2-3 months, possibly longer.

To normalize abdominal digestion, choleretics are prescribed: lyobil, allochol, cholenzym, berberine in generally accepted dosages. The use of saline laxatives in chronic enteritis is contraindicated. At severe flatulence appoint carminatives: infusions and decoctions of chamomile flowers, mint leaves, valerian root, dill seeds, parsley, cumin, calamus rhizomes, oregano herbs, centaury.

With simultaneous damage to the small and large intestines, microclysters are prescribed with protargol, Shestakovsky's balm, fish oil, antipyrine, decoctions of chamomile and eucalyptus. Transduodenal and rectal bowel lavages are approached carefully to avoid exacerbation of abdominal pain and diarrhea.

Within 4–5 weeks, vitamin therapy is carried out; with steatorrhea, parenteral administration of vitamin B12 in combination with fat-soluble vitamins is indicated. With severe protein deficiency, amino acids, protein preparations are prescribed, along with a protein diet, anabolic hormones and fat mixtures. The appointment of steroids is indicated only with significant protein deficiency, adrenal insufficiency. They are also prescribed for allergic manifestations.

Mandatory correction of water and electrolyte disorders intravenous administration saline solutions. At iron deficiency anemia prescribe iron supplements, but you need to remember about the development of dyspepsia and loose stools. Iron preparations are taken for a long time - 3-6 months. With eosinophilic allergic enteritis against the background of intestinal helminths, with food and drug allergy use antihistamines.

In chronic enteritis, mineral water should be prescribed in the absence of diarrhea. Low-mineralized waters are recommended: "Slavyanovskaya", "Smirnovskaya", "Essentuki", "Izhevskaya", "Narzan" in a warm form, without gas, no more than 1/4 cup per reception. The time of drinking mineral water depends on secretory function stomach: at decreased secretion for 15-20 minutes, with normal - 40-45 minutes, with increased - 1.5 hours before meals.

Unfavorable signs are a continuously relapsing course of the disease, a sharp significant weight loss, anemia, endocrine disorders syndrome, HIV infection. In most cases, the prognosis for life and working capacity is favorable.

Enteritis is it sharp or chronic illness, which is based on inflammatory processes in the wall of the small intestine, with a violation of intra-intestinal and parietal digestion, as well as absorption, excretory and motor functions of the small intestine, leading to a deterioration in metabolism.

Types of enteritis

Enteritis is subdivided according to the duration of the course:

1. Acute enteritis proceeds rapidly and for a short time, up to a maximum of a month. Very similar to poisoning. Almost everyone has experienced symptoms of acute enteritis.
2. Chronic enteritis can last for months, give various complications and requires mandatory treatment.

Inevitably, enteritis will occur with inflammation of other organs of the digestive system - the stomach, liver, pancreas. Then they talk about secondary enteritis.

According to localization, enteritis is divided:

• Enteritis - when only the small intestine is affected;
• Gastroenteritis - occurs when not only the small intestine is affected, but also the stomach;
• Enterocolitis - with additional damage to the colon;
• Gastroenterocolitis - with damage to the stomach, small and large intestines.

Causes of enteritis

• Infections - cholera, salmonellosis, typhoid fever. Such enteritis is the most difficult, very dangerous;
• Viruses - respiratory infection combined with intestinal damage (enterovirus infection), influenza;
• Errors in food - overeating, preference for fatty and spicy food in combination with alcohol, nicotine;
• Poisoning toxic substances, poisons, fungi of a non-bacterial nature;
• Allergic enteritis (with intolerance individual products or if you are allergic to medications)
• Worm infestations, lamblia;
• Intestinal damage due to long-term medication (hormones, antipsychotics, and others);
• autoimmune diseases;
• Congenital deficiency of intestinal enzymes;
• Diseases of other organs of the gastrointestinal tract, operations on the intestine.

Symptoms of the disease

The inflammatory process can be widespread throughout the small intestine or be limited. Main clinical manifestations enteritis are diarrhea, increase in the amount of feces, flatulence, abdominal pain. It is known that the processes of digestion in the small intestine are not just the sum of individual reactions, but the result of their complex interaction. Violation of the processes of splitting and absorption of food particles create conditions for the reproduction of microorganisms that are not characteristic of a healthy intestine. Special meaning has a state of the body's immune system - this is important for suppressing harmful bacteria.

Intestinal symptoms: the stomach swells, gases are tormented - this is characteristics enteritis. Normally, up to 200 ml of gases leave, the rest are absorbed into the blood. In case of illness, the absorption of gases is disturbed, they accumulate in the intestines, and can cause pain, sometimes unbearable. Peristalsis becomes loud, intensified. Significant relief comes after the passage of gases.

The abdomen is painful, when it is probed, a splash is determined, a feeling of a stretched rumbling body is created. The appearance of this symptom indicates an overload of the intestine with undigested carbohydrate residues, the predominance of fermentation processes. Such violations lead to the accumulation of fluid in the intestinal lumen, colonization by unnecessary microorganisms, and dysbacteriosis appears. A sick person can excrete up to 2-3 liters of a fetid brown liquid.

Metabolism is disturbed. Lack of absorption leads to weight loss.

Symptoms of insufficient absorption are divided into 3 stages:

1. First stage- working capacity is slightly reduced, mild hypovitaminosis, weight loss 5-7 kg The process of fat absorption is sharply disrupted, a lot of it remains in the feces, the absorption of glucose, fat-soluble vitamins (A, E, D, K, B, nicotinic acid) is impaired.
2. Second stage- all the symptoms of the first stage are accompanied by a decrease in the function of the gonads (menstrual disorders in women, impotence in men). Body weight deficit of 10 kg or more.
3. Third stage- pronounced symptoms of hypovitaminosis, anemia, trophic disorders of the limbs, edema, decreased protein in the blood.

Ultimately, malabsorption leads to metabolic disorders.

Diagnosis of enteritis

The first diagnostic criteria are characteristic complaints, examination of the patient and palpation of the abdomen. Further, feces, blood tests are examined in more detail, endoscopic methods are carried out:

• Coprogram ( hidden blood, detection of dysbacteriosis, the presence of fat, carbohydrates)
• Blood test - detection of anemia, leukocytosis, ESR, biochemistry;
• Endoscopy primary departments intestines;
• Computed and magnetic resonance imaging
• Video capsular endoscopy.
• Biopsy of the intestinal mucosa.

Treatment of enteritis

Therapeutic measures depend on the type and stage of the disease. They usually include:

Diet therapy is based on the use of special tables (diets) with the exclusion of milk and carbohydrates from food. Unacceptable errors: alcohol, nicotine. Negatively affect the condition of the intestine: caffeine, fiber. Meals should be fractional and frequent (up to 6 times a day).

Adsorbents are used to eliminate diarrhea and astringents.

Antibiotic therapy is carried out in case of reproduction pathogenic microbes. Signs can be diarrhea mixed with blood, pus, mucus, fever. In these cases, antibiotics of the cephalosporin group have proven themselves well.

Enzyme replacement therapy is almost always prescribed. It will improve absorption and reduce gas formation, reduce stool frequency and relieve abdominal pain. When combined with pathology of the pancreas enzyme preparations appointed for life. Admission desired various groups: pepsidil, panzinorm forte, enzistal, solisim, oraza, Kirchner's pankreal, lactraz. These are enzymes of various organs involved in digestion. They complement each other and are relevant in the treatment of the disease.

Treatment is combined with the normalization of intestinal biocenosis. These include drugs containing beneficial microorganisms. They help to reduce all symptoms of enteritis.

The prognosis for the treatment of acute enteritis is favorable. In the treatment of the chronic form, the prognosis depends on the cause of the disease and the elimination of negative factors.

Prevention

You need to pay serious attention to your diet. In mild forms of the disease, dieting may be the only and effective method of treatment.

Normalization of the work of other digestive organs easily removes the symptoms of enteritis. Timely and proper treatment acute enteritis will dramatically reduce the likelihood of its transition to a chronic form.

This is an inflammation of the lining of the small intestine. Usually a large area of ​​the intestine is affected (diffuse enteritis), although in some patients pathological changes are limited to its separate departments (duodenitis, regional enteritis, regional ileitis).

In its activities, the general practitioner diagnoses acute enteritis relatively rarely, since inflammation of the small intestine is rarely isolated, in most cases it occurs with simultaneous inflammation of the colon (colitis) and stomach (gastritis), called gastroenterocolitis. However, both acute and chronic enteritis have a number of characteristic features, which allows diagnosing enteritis as an independent nosological unit, and in combination with other diseases of the digestive system.

In etiology and pathogenesis acute enteritis highest value have infections (typhoid fever, cholera, influenza, viral hepatitis). It can be caused by exposure to various toxic and chemical compounds that enter the mucous membrane of the small intestine. matters and allergic factor, in particular, idiosyncrasy to certain foods (eggs, crabs, strawberries) and medicines (iodine, novocaine, sulfa drugs, antibiotics).

First, hyperemia and edema of the mucous membrane of the small intestine develop, then hemorrhages and ulcerations. In severe cases, mucosal necrosis and perforation may develop. There are local (intestinal) and general symptoms:

• local
  • diarrhea,
  • rumbling in the stomach, a feeling of transfusion in it,
  • moderate soreness (rarely severe cutting pain) in the umbilical region,
  • nausea and vomiting,
  • belching, persistent hiccups,
  • stools are initially excessive, mushy, later they become liquid, watery, acquire a dirty green hue, without significant impurities of mucus (with colitis, mucus and blood are found in the feces);
• general
  • rapidly increasing general weakness,
  • dizziness,
  • in severe cases, a collaptoid state develops:
    • increase in body temperature up to 38.5-39 ° C,
    • the skin is pale, the tongue is dry, coated with a gray or yellow-gray coating,
    • the pulse is usually accelerated, in severe cases - insufficient filling (due to a decrease in blood pressure),
    • heart sounds in most patients are weakened,
    • the abdomen is initially swollen, subsequently becomes retracted, sunken, palpation is determined by soreness in the umbilical region, a sensitive terminal segment of the small intestine, rumbling is heard in the large intestine.

The disease usually lasts 1-2 days, sometimes - a week. If colitis joins, then the disease lasts longer. Severe course acute enteritis in children and the elderly. Basically, acute enteritis ends in complete recovery in 1-2 weeks.

Etiology and pathogenesis chronic duodenitis not studied enough. It is believed that its cause is Helicobacter pylori and other infectious agents that can enter the duodenum from the tonsils, prostate, carious teeth, nasopharynx, paranasal sinuses, appendix, gallbladder. Due to the reflux of acidic gastric contents into the duodenum, metaplasia of the gastric epithelium occurs here, which supports Helicobacter pylori infection. A significant role is played by violations of the nature and diet, the quality and quantity of food, irregular meals, the use of very hot or cold dishes, the abuse of alcohol, spicy foods. An important role in the occurrence of chronic duodenitis is played by smoking, especially on an empty stomach.

The leading symptom of chronic duodenitis is a dull aching pain in epigastric region, less often xiphoid process. Sometimes it is a sharp and severe pain, as in peptic ulcer. It is determined constantly, may decrease slightly immediately after eating and intensify 2-3 hours after eating. The pain radiates along both costal arches. Sometimes patients complain of a feeling of being stuck behind the sternum, regardless of the nature of the food and its consistency - a symptom of Hubergrits. Patients complain of heartburn, nausea, vomiting, which does not bring improvement. The tongue is covered with a white coating, along the edges the imprints of the teeth stand out well. Superficial palpation reveals resistance in upper section right side of the abdomen. At deep palpation pyloroduodenal zone, you can find the so-called muscle roller, which disappears in the position on the left side.

There is no seasonality, which is characteristic of duodenal ulcer.

According to the clinical course, four forms of chronic duodenitis are distinguished:

• ulcer-like - manifested pain syndrome, which is subsequently joined by dyspeptic phenomena, usually the pain is expressed on an empty stomach and at night, it is unlimitedly localized (as is the case with duodenal ulcer), more often spilled, defined throughout the epigastric region;
• gastritis-like - accompanied by leading signs of dyspepsia (nausea, heartburn, sour belching, a feeling of heaviness under the xiphoid process);
• cholecystic-like - patients complain of pain in the upper part of the right half of the abdomen, which is caused or intensified after consumption fatty foods, irradiates transversely along both costal arches;
• latent - asymptomatic, detected by chance, for example, during fibroesophagogastroduodenoscopy.

Chronic enteritis- This is a disease of the small intestine, characterized by structural changes in the mucous membrane (dystrophy, inflammation, atrophy) with periodic or permanent dysfunction of the small intestine. In the occurrence of pathomorphological changes, a violation of the normal regeneration of the mucous membrane of the small intestine is essential. The pathological reaction of the mucous membrane of the small intestine is the same, regardless of etiological factor. Among the exogenous causes of chronic enteritis, the most important are:

• infection (shigella, staphylococcus, salmonella, enteroviruses),
• invasion of protozoa (giardiasis, opisthorchiasis, ascariasis, etc.),
• the influence of radionuclides, industrial hazards (arsenic, phosphorus, lead),
• the influence of medicines (salicylates, cytostatic agents, antibiotics).
• surgical interventions - gastric resection, gastroenteroanastomosis, vagotomy operation.

Among the endogenous factors:

• chronic renal failure,
• skin diseases (psoriasis, eczema),
• chronic gastritis with secretory insufficiency,
• chronic pancreatitis,
• chronic hepatitis (cirrhosis of the liver),
• cancer of various localization.

In implementation numerous reasons In the development of chronic enteritis, the peculiarities (congenital and acquired) of metabolism in the intestinal wall and dysregulation of regeneration processes are essential, which contribute to the continuous renewal of the mucous membrane of the small intestine.

Clinical signs of chronic enteritis are caused by functional disorders due to structural changes in the mucous membrane of the small intestine (inflammation, dystrophy, atrophy). Ciliary atrophy causes a decrease in the total surface area of ​​the small intestine. Dystrophy and changes in the ultrastructure of the ciliary cells of the surface epithelium lead, on the one hand, to disruption of hydrolysis processes in the small intestine (maldigestion syndrome - a violation of parietal digestion), and on the other hand, to a decrease in the intensity of the absorption process (malabsorption syndrome). Moreover, with the insufficiency of hydrolysis, symptoms are associated, which are combined into the so-called local enteral syndrome. Signs of malabsorption (malabsorption) are combined into a common enteral syndrome.

Incomplete hydrolysis nutrients leads to the fact that undigested products change osmotic pressure in the cavity of the small intestine. It increases the level of the so-called highly toxic osmotic content. Its liquid part is not absorbed enough, which leads to "osmotic diarrhea". The stool becomes excessive (4-6 times a day), with high content water, stool light yellow color, acid reaction, there are often impurities of undigested fat (steatorrhea), but pus, blood, mucus are not found in the feces.

Important clinical signs local enteral syndrome is bloating (flatulence), increased flatulence, rumbling in the abdomen, nausea. Flatulence is manifested by a feeling of heaviness, and sometimes pain (cramping, sometimes quite intense). Symptoms of local enteral syndrome are most pronounced after drinking raw milk (against the background of lactase enzyme deficiency).

Signs of the general enteral syndrome is a decrease in body weight, which can constantly progress and reach 25-30 kg. Lack of absorption of nutrients leads to hypoproteinemia and is accompanied by edema. Hypochromic anemia develops due to insufficient absorption of iron. Less common is B12-deficiency hyperchromic anemia. Mineral and vitamin metabolism is also disturbed.

How to treat enteritis?

Treatment of enteritis is a complex process in many respects similar to the tactics of treating colitis and other inflammatory processes of the gastrointestinal tract localization.

Vitamins - A, group B, C are administered parenterally. In the infectious nature of the disease, taking into account the nature of the pathogen, short courses of antibiotic therapy (levomycetin, erythromycin) are prescribed. You can also prescribe sulfanilamide drugs, in particular sulgin, and nitrofuran drugs, such as furazolidone. Oxyquinoline derivatives have positively proven themselves: enteroseptol, mexaform or. Detoxification therapy is carried out with a 5% glucose solution, which is administered intravenously, after adding 6-8 IU of insulin.

For diarrhea, astringents are prescribed: bismuth nitrate basic, bismuth gallate (deomatol, tanalbin) and calcium carbonate and white clay that hold the stool together.

Drug treatment is supplemented with the use of phytopreparations and traditional medicine.

Treatment of enteritis consists not only in taking medications and carrying out certain procedures, but also in observing the regimen and therapeutic nutrition.

Treatment of chronic duodenitis is complex and consists of prescribing diet No. 1a, No. 16 (1 week), No. 1 (1 month or longer), antispasmodics (platifilina hydrotartrate, papaverine hydrochloride), antacids and H2-receptor blockers (in case of existing gastric hypersecretion ) and reparant (means that promote recovery processes - solcoseryl, oxyferriscorbone).

During the period of remission, physiotherapeutic procedures are prescribed for the epigastric region: ozocerite applications, inductothermy, diathermy, solux, electrophoresis of novocaine or papaverine hydrochloride.

What diseases can be associated

Acute enteritis is associated with the penetration of an infectious agent into the intestine (, viral hepatitis, any other microorganisms that can cause food poisoning) and the development of an allergic process.

The infection that provoked the manifestation of enteritis can earlier be localized in the most remote areas - tonsils, prostate gland, carious teeth, nasopharynx, paranasal sinuses, appendix, gallbladder.

• skin diseases (, ),
• diffuse diseases of the connective tissue,
• different localization.

Acute enteritis tends to become chronic, and chronic, in the absence of the necessary treatment, develops into:

• solarite,
• nonspecific mesadenitis.

In the predominant number of cases with chronic enteritis, there is:

• maldigestion syndrome - violation of parietal digestion,
• malabsorption syndrome - a decrease in the intensity of the absorption process.

Treatment of enteritis at home

Treatment of enteritis successfully carried out at home. It consists in compliance with medical prescriptions, as well as in the conduct healthy lifestyle life and rational nutrition.

First, diet No. 4 is prescribed for 2-5 days or, in the case of fermentation processes in the intestines, diet No. 4a. Subsequently, they switch to a more complete "enteric" diet, which provides for the introduction increased amount proteins (up to 130-150 g). At least half should be animal proteins (meat, fish, eggs, cheese). As for fats, they use those that are easily digested ( butter, vegetable oils). The amount of carbohydrates can reach 400 grams per day. Salt is limited. It is recommended to consume a lot of vitamins.

Raw vegetables and fruits, black bread, milk, spicy and salty foods, carbonated drinks are excluded from the diet, cold food, pork, lamb, nuts, kvass, beer and other alcoholic drinks.

Allow boiled, pureed porridge from rice, oats, buckwheat. Consume boiled vegetables, and fish and meat - in the form of a soufflé, steamed cutlets. Cottage cheese, lean meat, kefir, acidophilus milk, dried white bread, fruit and berry jelly are well tolerated. It is recommended to eat in small portions, 5-6 times a day with warm food.

During the period of remission, such patients are referred for Spa treatment- to Morshyn, Truskavets, Mirgorod, Berezovsky mineral water, sanatoriums in Transcarpathia and the Satanovskaya resort area.

What drugs to treat enteritis?

Parenterally administered vitamins:

• A - 10000-20000 IU (3-6 mg) 3 times a day inside,
• B1 - in the form of a 6% solution of 0.5-1 ml intramuscularly,
• B2 - in the form of a 5% solution of 1 ml intramuscularly,
• B6 - in the form of a 6% solution of 1 ml intramuscularly,
• B12 - 100-200 mcg every other day intramuscularly,
• C - inside 0.1-0.3 g up to 3 times a day or in the form of a 5% or 10% solution of 1-5 ml intravenously.

In the case of the infectious nature of enteritis, the following are prescribed:

• - 0.5 g 1-2 times a day inside,
• - 200,000 IU 4 times a day,
• - 1-2 g 4-6 times a day inside,
• - 0.1 g 4 times a day inside after meals,
• enteroseptol - 1-2 tablets 3 times a day for 10-12 days,
• mexaform or mexaz - 1-2 tablets 3 times a day for a month,

Suitable detoxification therapy:

• 5% glucose solution - 500-1000 ml per day intravenously (sometimes 6-8 units of insulin are added).

Astringents:

• - 0.5 g 3-4 times a day inside,
• tanalbin - 0.5 g 3-4 times a day inside,
• - 0.5-1 g 3-6 times a day inside,
• white clay - 30-50 g per day, internally,
• - 15 mg 3 times a day inside,
• - 2 mg 3-4 times a day.

Painkillers:

• - in the form of a 0.1% solution of 0.5-1 ml subcutaneously,
• - in the form of a 2% solution of 1 ml intramuscularly,
• - 40 mg 3 times a day orally or 2 ml intramuscularly.

Treatment of enteritis folk methods

At treatment of enteritis has proven itself and ethnoscience, but the choice medicinal extract It's best to discuss with your doctor. Purpose treatment course might look like this:

• St. John's wort - 1 tbsp. brew herbs with a glass of boiling water, strain after 45 minutes, take ½ cup 3-4 times a day inside,
• blueberries - 1 tbsp. dried fruits brew blueberries with a glass of boiling water, strain after 45 minutes, take ½ cup 2-3 times a day,
• herb kvass in the form of infusion - 1 tbsp. brew herbs with a glass of boiling water, strain after 45 minutes, take 1 tbsp. decoction 3-4 times a day inside.

Treatment of enteritis during pregnancy

Treatment of enteritis during pregnancy largely repeats the standard scheme. Medications are selected by a gastroenterologist who is aware of the situation of a woman. Percussive antibacterials may be excluded, but if a viral agent is present, alternative but safer medications will be considered.

The effect of phytopreparations and medicinal herbs is positively assessed. Many of them are used within symptomatic therapy, have anti-inflammatory, bactericidal and soothing action on the mucous membrane.

Compliance with the daily routine, diet, minimizing stress and a positive mood can alleviate the course of the disease. Considerable attention is paid to the normalization of the stool and the elimination of pain.

Which doctors to contact if you have enteritis

At acute enteritis in the blood, leukocytosis, an increase in ESR are detected, in the urine - moderate proteinuria.

The diagnosis of chronic duodenitis is established using X-ray and endoscopic research, use hypotonic duodenography (when an X-ray examination of the duodenum is performed after parenteral administration 0.1% solution of atropine sulfate).

An objective examination of a patient with chronic enteritis determines the pallor and dryness of the skin, signs of exhaustion and hypovitaminosis (brittle nails, bleeding gums). The abdomen is somewhat swollen, painful on palpation, especially in the umbilical region on the left. Palpation of the caecum is accompanied by rumbling. When involved in the pathological process serous membrane small intestine with superficial palpation of the abdomen, local resistance of the anterior abdominal wall and skin hyperesthesia on the left above the navel (Zakharyin-Ged zone). With deep palpation, it is possible to examine the terminal segment of the small intestine in the right iliac region.

Palpation terminal department small intestine should be carried out perpendicular to the length of its axis. In this case, the doctor's right hand is located at an obtuse angle to the caecum, four curved fingers move towards the posterior abdominal wall and slide from the inside outward, while rolling over the terminal segment of the small intestine. When the terminal segment of the small intestine is involved in the pathological process during deep palpation, its soreness is determined, it is spasmodic, less often stretched or in the form of a dense roller. In the abdominal region on the left above the navel, with lesions of the small intestine, one can find a zone of severe pain - a symptom of Porges. Loud rumbling during palpation of the caecum indicates that it is filled with gas and liquid contents that are not absorbed in the small intestine and have moved into the caecum. Data scatological research testify to typical signs digestive disorders in the small intestine.

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and how to treat it, contact your doctor. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal.

Enteritis - inflammatory disease small intestine, resulting in a violation of the functions of absorption and breakdown of nutrients.

Classification

According to the course of pathology, enteritis is divided into:

• spicy;
• chronic.

According to the place of spread of the disease:

• jejunitis - the inflammatory process affected only the jejunum;
• ileitis - a disease of the ileum;
• total enteritis - inflammation has spread to the entire intestine.

By localization:

• isolated enteritis - the inflammatory process captured only the small intestine;
• enterocolitis - the pathology has spread to the large intestine;
• gastroenteritis - inflammation of the stomach and small intestine;
• gastroenterocolitis - the entire intestine and stomach were affected.

Due to occurrence:

The main reason for the development of acute enteritis are diseases of a viral or bacterial nature that affect the mucous membrane of the small intestine. These include:

• typhoid fever;
• salmonellosis;
• cholera;
• staphylococci;
• enteroviruses;
• rotoviruses.

In addition, acute enteritis can be the result of:

• poisoning with mushrooms, berries;
• eating fatty, spicy and spicy foods;
• poisoning with toxic substances (sublimate, arsenic);
• abuse of alcoholic beverages;
• allergic reactions to foods or drugs.

Chronic enteritis can develop against the background of:

• worms;
• hereditary factors;
• alcohol intake in large quantities;
• drug use;
• impact chemical substances, heavy metals;
• taking certain medicines;
• performed operations on the intestines or stomach;
• autoimmune pathologies.

Also, acute and chronic enteritis can be a consequence of diseases of the gastrointestinal tract, vascular inflammation, kidney failure, enzymopathies.

How is it manifested?

Acute enteritis manifests itself very quickly and is accompanied by:

• frequent (up to 10-15 times), watery, profuse diarrhea;
• pain in the abdomen;
• nausea, vomiting;
• an increase in body temperature (up to 39⁰ and more);
• rumbling, bloating;
• white coating on the tongue;
• headache;
• weakness of the whole body;
• dryness, pallor of the skin.

In cases where diarrhea is protracted, enteritis becomes more severe and manifests itself:

• severe dehydration of the body;
• the appearance of seizures;
• bleeding disorders (increased bleeding).

If the patient is not helped in time, then the above symptoms will lead to shock of the body, and then to coma.

Chronic inflammation is characterized by a longer course of the disease (from 2 to 6 months). The symptoms of enteritis are as follows:

• bloating, especially after eating;
• pain at the navel;
• cramping pain in the upper abdomen;
• mushy or loose stools (up to 5 times a day);
• bubbling in the stomach;
• discomfort during bowel movements;
• feces yellow, watery, with undigested particles of food;
• language white color for a long time;
• signs of hypovitaminosis;
• significant weight loss;
• dizziness;
• lowering blood pressure;
• tachycardia;
• tremor of the limbs.

Chronic enteritis can cause the development of osteoporosis, hypovitaminosis, protein starvation or anemia, since during the disease the absorption of nutrients and minerals through the intestinal mucosa stops. During palpation of the caecum, Obraztsov's symptom appears - noise, splashing. Also, with chronic enteritis, there are frequent urges to defecation, with the release of a small amount of stool of a liquid green consistency.

Diagnostics

The primary diagnosis of the disease is based on the patient's complaints and on palpation of the abdomen. To confirm the diagnosis, it is necessary to perform many procedures.

Complete blood count - shows the presence of anemia, infection, increase in ESR and leukocytes.

Blood biochemistry - detection of malabsorption - insufficiency of absorption of nutrients in the small intestine. Shows a deficiency of trace elements, protein starvation.

X-ray of the intestine with contrast - allows you to identify the presence of ulcers, tumors, changes in structure, segmental lesions.

Endoscopy of the small intestine with mucosal biopsy. Reveal atrophic and dystrophic phenomena of intestinal villi, epithelial cells.

A bacteriological study of feces is performed to detect an intestinal infection or an imbalance of useful and harmful microorganisms intestines.

Absorption tests help detect the presence of carbohydrates in the blood, saliva, and urine.

To exclude pathologies that are also accompanied by severe diarrhea, differential diagnosis performed using computer technology. Such diseases include:

• diabetes;
• nonspecific ulcerative colitis;
• thyrotoxicosis;
• Crohn's disease;
• chronic pancreatitis;
• tuberculous ileotiflitis;
• celiac enteropathy;
• intestinal amyloidosis;
• Addison's disease;
• malignant formations.

Treatment

Treatment of acute and chronic enteritis is different.

Acute enteritis

Acute enteritis is treated in a hospital setting. If the pathology was provoked by any infection, then the patient is hospitalized in the infectious diseases department in a separate isolated box. With toxic enteritis, treatment is carried out in the department of gastroenterology.

With a microbial intestinal infection, antibiotics and a corrective diet are necessary to treat the disease. In cases where intestinal infection was caused by a virus, treatment will be based on the elimination of symptoms.

Diet. In acute enteritis, the patient is prescribed a diet. He should eat only pureed boiled food, which will not irritate the walls of the stomach and intestines. It is also necessary to limit the intake of fats, carbohydrates, and increase the amount of water you drink.

To stop diarrhea caused by enteritis, fixing therapy is performed. Sorbing agents are prescribed - Activated carbon, smecta, rice decoction, enterosgel.

If enteritis is accompanied by dysbacteriosis, therapy is performed aimed at restoring the intestinal flora. For this, hilak forte, linex, bifidumbacterin, and other drugs containing beneficial bacteria are prescribed.

If the patient is dehydrated, procedures are performed to infuse sodium chloride and glucose. In case of violation of protein metabolism, polypeptide solutions are introduced into the patient's body.

In severe forms of pathology and with obvious signs of an inflammatory process (pus, mucus or blood in the feces), broad-spectrum antibiotics (ofloxacin, norfloxacin) are prescribed.

Chronic enteritis

The main treatment for exacerbation of chronic enteritis is to prescribe diet table No. 4. The patient should stop using:

• sour;
• acute;
• coarse food that can damage the digestive tract;
• fats;
• carbohydrates;
• fiber;
• whole milk.

You need to eat small portions of food with a high content of minerals, vitamins and protein.

When enteritis is allowed to use:

• cottage cheese;
• lean meats;
• fish;
• bananas;
• soybeans (contains easily digestible protein);
• cheeses;
• raisins, dried apricots;
• fermented milk products (kefir, yogurt).

Animal fats are subject to restriction.

Enzyme preparations are also prescribed. These include:

• festal;
• pancitrate;
• pancreatin;
• mezim;
• Creon.

With excessive work of intestinal motility, accompanied by seething and bloating, imodium is prescribed. Correction of dysbacteriosis is performed by the appointment of eubiotics and probiotics, which will help normalize the work of digestion and absorption of nutrients.

To stimulate better absorption into the intestines useful elements preparations containing nitrates are recommended positive action. It can be: nitrong, sustak.

Patients with severe diarrhea are prescribed adsorbents and antiseptics. It is also possible to use herbal medicine (sage, chamomile, St. John's wort, alder cones).

Surgical intervention is performed when diagnosing formations on small intestine- diverticulum or polyps.

Chronic enteritis during exacerbations is treated in a hospital.

Prevention

Prevention of enteritis is:

• food processing before consumption;
• avoiding poisoning with food poisons (mushrooms, berries);
• proper nutrition;
• taking medications according to strict indications;
• timely treatment of gastrointestinal diseases.

Prognosis and consequences of the disease

Acute enteritis of the mild and moderate it is quite possible to cure in 4-5 days, with the appointment essential medicines and dieting. Pathology that does not respond to treatment during this time can lead to.