is a change in the morphology and functional abilities of the small intestine of inflammatory and non-inflammatory origin. Acute illness, especially of infectious origin, occurs quickly and without serious consequences. Chronic damage to the small intestine leads to severe disorders all types of metabolism (mineral, lipid, carbohydrate, protein), significantly reduces the patient’s quality of life.
The classification of this disease is based on several principles:
- preferential localization of the pathological process;
- probable cause of the disease;
- the nature of the occurring morphological and functional changes;
- the severity of the patient's condition;
- phase of the disease (remission or exacerbation).
Downstream
- acute enteritis (duration less than 3 months);
- chronic enteritis (duration of clinical symptoms exceeds 6 months).
By localization
In some cases, it is possible to determine the predominant localization of the pathological process:
- (defeat duodenum);
- (changes in the jejunum);
- (pathology of the ileum).
For the reason that caused the disease
The most important component of the classification is the etiology of enteritis, that is, the reasons that provoked the development of clinical symptoms:
Often there is a combined lesion of the digestive canal, that is, damage not only to the small intestine, but also to the large intestine. In accordance with the localization of the pathological process, the following are distinguished:
- (changes inside the stomach and intestines);
- (combined damage to the small and large intestines).
Issues of classification of enteritis are important, since strictly defined therapeutic tactics are used in the treatment of various types of this disease.
Symptoms
Clinical symptoms acute and chronic enteritis differs significantly not only in duration, but also in severity metabolic disorders.
Signs of acute enteritis
As a rule, acute enteritis has an infectious etiology, so all the typical ones are noted:
- increased body temperature, sometimes up to 39 °C;
- general weakness, drowsiness, lack of appetite;
- painful nausea, episodes of repeated vomiting;
- diffuse abdominal pain or around the navel;
- spasmodic pain;
- diarrhea is watery, the volume of feces is significant, pathological impurities (blood, pus, mucus), as a rule, are absent;
- the development of symptoms of the disease is rapid and is associated with the consumption of poor quality food or violation of sanitary and hygienic rules.
Acute enteritis, with timely consultation with a doctor and adequate treatment, ends safely. Complications are most likely to develop in young children (first 3 years of life), patients with chronic heart disease and endocrine system. Sometimes a protracted course of the disease and the formation of intestinal dysbiosis are possible.
Signs of chronic enteritis
Chronic enteritis is characterized by periods of deterioration of the patient's condition (exacerbation) and improvement (remission). The clinical picture is dominated not by inflammatory, but dystrophic processes(atrophy of the intestinal mucosa), disturbances in the processes of absorption () and digestion (), deficiency of one or more enzymes. 
Local signs (intestinal manifestations)
Clinical signs of chronic enteritis are appropriately divided into local and general. Among the local ones they note:
- bowel disorders in the form of frequent watery diarrhea;
- feces liquid, yellow with areas of undigested muscle fibers or a grayish tint with areas of fat;
- increase in the number of bowel movements 4-20 per day;
- practically constant flatulence, which intensifies in the afternoon, decreases after the passage of gas and bowel movements;
- pain in the abdomen of moderate intensity associated with the accumulation of gases, damage to nerve endings;
- (sweet, dairy, flour), which is manifested by worsening clinical symptoms.
General signs (extraintestinal manifestations)
Change general condition patient with chronic enteritis due to severe disturbances in absorption and digestion nutrients. Clinical symptoms depend on the predominant damage to one or another type of metabolism.
| Type of metabolism | How does it manifest itself? |
| Protein metabolism disorder |
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| Lipid metabolism disorder |
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| Carbohydrate metabolism disorder |
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| Mineral metabolism disorder |
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All patients with moderate and severe chronic enteritis have several similar signs:
- increasing weakness and fatigue;
- decreased appetite;
- irritability, memory impairment;
- deterioration of the condition of the skin, hair, nails.
Causes and risk factors
The reasons for the development of acute or chronic enteritis are the presumed etiology of the disease, which is indicated in the classification (see above). It is advisable to dwell on possible predisposing factors that provoke the development of this disease. Among them the most significant:
In most cases, a combination of several provoking factors plays a role, especially when it comes to the formation of chronic enteritis.
Diagnostic methods
The doctor may suspect enteritis already during the examination and interview of the patient. At objective examination the patient is observed:
To confirm or refute the diagnosis of enteritis, special laboratory tests are required, less often instrumental studies. In the complex diagnosis of acute enteritis, the following are used:
In the diagnosis of chronic enteritis, it is more important to assess the severity of metabolic disorders, as well as the motor-evacuation function of the intestine. For this we use:
Differential diagnosis is a difficult process, even for a doctor, of finding common and distinctive points for enteritis of various etiologies And , .
Treatment
Therapy for acute and chronic enteritis is significantly different. In the acute form of the disease, it is necessary to replenish the loss of water and electrolyte balance and destroy the microbial agent. In chronic pathology, it is more important to compensate for the metabolic disturbances that occur.
Therapy of acute enteritis
Includes dietary food, appointments medicines. Treatment at home is allowed, preferably under the supervision of a doctor.
First aid
Consists of refusing to eat and bed rest. If a person repeatedly vomits and attempts to drink do not even large number fluids lead to vomiting, then help is needed in a hospital setting - intravenous fluid administration. If there is no vomiting, the patient should drink fluids ( mineral water still, boiled water) in small sips every 10-15 minutes.
Diet food
On the first day you are supposed to be hungry. As the patient's condition improves, crackers, low-fat kefir, vegetable soup without meat, porridge cooked in water. In the following days, a gradual expansion of the diet is allowed.
Medicines
All medication prescriptions must be made by a doctor. In complex therapy of acute enteritis the following are used:
The duration of therapy for acute enteritis usually does not exceed 5-7 days.
Therapy of chronic enteritis
It is possible to cure chronic enteritis completely only in rare cases. The main goal of therapy is to achieve long period remission. The treatment is prescribed by the doctor, and the patient follows all his recommendations at home. Therapy in a hospital is required only in case of severe general condition of the patient and severe metabolic disorders.
Diet food
Dietary restrictions for a patient with chronic enteritis are constantly indicated, that is, it is necessary to completely reconsider your diet, since some foods must be completely excluded.
| Not Recommended Products | Recommended Products |
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Medicines
Medication prescriptions are determined by the severity of metabolic disorders. Can be assigned:
The duration of use of a particular drug is determined by the doctor.
Possible consequences and prevention
Poor digestion is the cause of metabolic disorders and deterioration in the patient’s quality of life. Only poses a threat to life chronic disease without adequate therapy. Acute enteritis without treatment, especially the severe version of the disease, can lead to fatal outcome due to the development of a state of shock.
There are no universal remedies. Everything that is familiar to every person, such as a healthy lifestyle, can be considered as prevention of the development of acute and chronic enteritis.
Enteritis is an inflammatory disease of the small intestine, which results in impaired absorption and breakdown of nutrients.
Classification
According to the course of the pathology, enteritis is divided into:
- spicy;
- chronic.
According to the location of the disease:
- jejunitis - the inflammatory process affected only the jejunum;
- ileitis – disease of the ileum;
- total enteritis - inflammation has spread to the entire intestine.
By localization:
- isolated enteritis - the inflammatory process has affected 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 the occurrence:
The main cause of the development of acute enteritis are viral or bacterial diseases that affect the mucous membrane of the small intestine. These include:
- typhoid fever;
- salmonellosis;
- cholera;
- staphylococci;
- enteroviruses;
- rotoviruses.
In addition, acute enteritis can result from:
- poisoning with mushrooms, berries;
- eating fatty, hot and spicy foods;
- poisoning with toxic substances (sublimate, arsenic);
- abuse of alcoholic beverages;
- allergic reactions to foods or medications.
Chronic enteritis can develop against the background of:
- worms;
- hereditary factors;
- drinking alcohol in large quantities;
- drug use;
- exposure to chemicals, heavy metals;
- taking certain medications;
- operations performed on the intestines or stomach;
- autoimmune pathologies.
Also, acute and chronic enteritis can be a consequence of diseases of the gastrointestinal tract, vascular inflammation, renal failure, enzymopathies.
How does it manifest?
Acute enteritis manifests itself very quickly and is accompanied by:
- frequent (up to 10-15 times), watery, profuse diarrhea;
- painful sensations in the abdominal area;
- nausea, vomiting;
- increase in body temperature (up to 39⁰ and more);
- rumbling, bloating;
- white coating on the tongue;
- headache;
- weakness of the whole body;
- dry, pale skin.
In cases where diarrhea is protracted, enteritis becomes more severe and manifests itself:
- severe dehydration of the body;
- the appearance of seizures;
- blood clotting disorder (increased bleeding).
If the patient is not provided with timely assistance, the above symptoms will lead to shock to the body, and then to coma.
Chronic inflammation is characterized by a longer course of the disease (from 2 to 6 months). Symptoms of enteritis are as follows:
- bloating, especially after eating;
- pain at the navel;
- cramping pain in the upper abdomen;
- mushy or loose stool(up to 5 times a day);
- gurgling in the stomach;
- uncomfortable sensations during bowel movements;
- yellow, watery stool with undigested food particles;
- language white over a long period of time;
- signs of hypovitaminosis;
- significant reduction in body weight;
- dizziness;
- decreased 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 cecum, Obraztsov’s symptom appears - noise, splashing. Also with chronic enteritis there are frequent urge to defecation, with the release of a small amount of stool of a liquid green consistency.
Diagnostics
Primary diagnosis of the disease is based on the patient’s complaints and palpation of the abdomen. To confirm the diagnosis, many procedures are necessary.
Complete blood count - shows the presence of anemia, infection, increased ESR and leukocytes.
Blood biochemistry - identifying malabsorption - insufficient absorption of nutrients into the small intestine. Shows micronutrient deficiency, protein starvation.
X-ray of the intestine with contrast - allows you to detect the presence of ulcers, tumors, changes in structure, segmental lesions.
Endoscopy of the small intestine with biopsy of the mucous membrane. Atrophic and dystrophic phenomena of intestinal villi and epithelial cells are revealed.
Bacteriological examination of stool is performed to identify an intestinal infection or an imbalance of beneficial and harmful intestinal microorganisms.
Absorption tests help detect the presence of carbohydrates in the blood, saliva, and urine.
To exclude pathologies that are also accompanied severe diarrhea, carry out differential diagnosis performed using computer technology. Such diseases include:
- diabetes mellitus;
- nonspecific ulcerative colitis;
- thyrotoxicosis;
- Crohn's disease;
- chronic pancreatitis;
- tuberculous ileotiphlitis;
- 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 caused by any infection, the patient is hospitalized in the infectious diseases department in a separate isolated box. For toxic enteritis, treatment is carried out in the gastroenterology department.
In case of microbial intestinal infection, treatment of the disease requires taking antibacterial drugs and a corrective diet. In cases where intestinal infection was caused by a virus, treatment will be based on eliminating symptoms.
Diet. In case of 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, consolidation therapy is carried out. Sorbent agents are prescribed - activated carbon, smecta, rice decoction, enterosgel.
If enteritis is accompanied by dysbiosis, therapy is performed aimed at restoring intestinal flora. For this purpose, Hilak Forte, Linex, Bifidumbacterin, and other drugs containing beneficial bacteria are prescribed.
If the patient is dehydrated, procedures are performed to inject sodium chloride and glucose. If protein metabolism is disrupted, polypeptide solutions are injected into the patient's body.
In severe forms of pathology and with obvious signs of an inflammatory process (pus, mucus or blood in the stool), antibiotics are prescribed wide range actions (ofloxacin, norfloxacin).
Chronic enteritis
The main treatment for exacerbation of chronic enteritis is to prescribe dietary table No. 4. The patient should stop using:
- sour;
- acute;
- rough food that can damage the digestive tract;
- fats;
- carbohydrates;
- fiber;
- whole milk.
You need to eat small portions of food with high content minerals, vitamins and protein.
For enteritis, the following is allowed:
- cottage cheese;
- lean meat;
- fish;
- bananas;
- soy (contains easily digestible protein);
- cheeses;
- raisins, dried apricots;
- fermented milk products (kefir, yogurt).
Animal fats are subject to restrictions.
Enzyme-containing medications are also prescribed. These include:
- festal;
- pancitrate;
- pancreatin;
- mezim;
- Creon.
In case of excessive intestinal motility, accompanied by seething and bloating, Imodium is prescribed. Correction of dysbiosis is carried out by prescribing eubiotics and probiotics, which will help normalize the digestion and absorption of nutrients.
To stimulate better absorption into the intestines useful elements Preparations containing nitrates with positive effects are recommended. It could 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).
Surgery is performed when diagnosing formations in the small intestine - diverticula or polyps.
Chronic enteritis during exacerbations is treated in a hospital.
Prevention
Prevention of enteritis consists of:
- processing products before consumption;
- avoiding food poisoning (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 lungs and moderate severity It is quite possible to cure in 4-5 days, if prescribed necessary medications and dieting. A pathology that cannot be treated during this time can lead to...
Enteritis in children is most pronounced by digestive dysfunction, and symptoms manifest in the child with diarrhea.
Chronic enteritis can develop after gastrectomy, with chronic hepatitis, liver cirrhosis, renal failure, and various skin diseases (psoriasis, eczema).
Symptoms of enteritis
Symptoms of the disease can be called pain of varying intensity in the middle parts of the abdomen, deepening in the afternoon, sometimes cramping like “ intestinal colic”, subside with the appearance of a loud rumbling.
Symptoms of enteritis include bloating and a feeling of fullness.
During the period of exacerbation, diarrhea occurs 3-6 times per knock, feces are abundant, light yellow in color, without admixture of blood, mucus or pus; in severe cases, the frequency of stools can reach 15 times a day.
Dumping syndrome-type disorders are likely, hypoglycemic phenomena: voracious appetite, cold sweat 2-3 hours after eating.
In the long-term or severe course of chronic enteritis, symptoms of impaired absorption of substances necessary for the body are noted: weight loss, swelling, more often lower limbs, signs of hypovitaminosis, iron deficiency anemia, dystrophy of internal organs, including the liver, myocardium.
Diagnosis of enteritis
When examining blood, a decrease in the content of potassium, calcium, magnesium, iron, and protein is possible. Scatological examination of stool: undigested fats, fiber, a lot of mucus and leukocytosis. Dysbacteriosis is detected. At x-ray examination the acceleration or delay of the passage of barium from the stomach through the small intestine, changes in the relief of its mucosa, and spasms of areas are determined.
Treatment of enteritis
Depending on the severity of the disease, meals are taken 5-7 times a day with equal intervals between them, all food is warm and pureed. The amount of animal fat required. Vegetables and fruits are best pureed.
Not good fatty varieties beef, veal, chicken, fish, eggs and cottage cheese, slimy soups, pureed porridges. Avoid milk, brown bread, carbonated drinks, and for diarrhea - prunes, grapes, cabbage, nuts, freshly baked flour products. In a hospital setting, “fasting” days are carried out as prescribed by a doctor.
When dysbiosis is detected, the issue of prescribing appropriate medications is decided: sulfonamides, antibiotics or drugs (colibasterin, bificol, bifidum).
In case of protein metabolism disorders, administration of protein preparations. B vitamins, ascorbic acid in injections. Against frequent heavy diarrhea - astringents. For anemia, iron supplements, vitamin B, and folic acid are indicated.
Enteritis - treatment with traditional methods
Enteritis is often treated traditional methods, using herbs, infusions and decoctions in treatment.
A set of herbs, 10 grams each:
- St. John's wort leaves and flowers,
- bird cherry fruits,
- peppermint,
- chamomile,
- fennel seeds,
- cumin,
- gray alder cones
- licorice root
Brew 2 tablespoons of this mixture in a thermos in half a liter of boiling water, leave for 60 minutes. Drink one hundred grams half an hour before meals. Helps against chronic enteritis and dysbacteriosis.
- 40 grams of dill,
- 50 grams of yarrow flowers,
- 30 grams of cumin and oregano.
Pour 5 tablespoons of a mixture of herbs into a liter of boiling water and leave in a thermos for at least an hour. Take a warm infusion of 100 milliliters in small sips when you have bloating. Dose – four times a day, course of treatment for 30 days in a row. Do not stop treatment.
1 tbsp. A spoonful of alder cones should be brewed like tea with a glass of water. You should take 1 tablespoon of this remedy throughout the day.
The decoction helps very well oak bark. 20 gr. raw materials are poured into 150 ml of water as tea. You also need to drink it during the day.
- 1/2 tsp. common bird cherry,
- 1/3 tsp of caraway seeds and chamomile. peppermint, licorice, rhizomes of snakeweed and St. John's wort,
- 5 tbsp. linden honey,
- 1 lwater.
Crush the dried herbs, stir and pour boiling water. Place over low heat and bring to a boil. After removing from heat, place the infusion in a cool place for 1-2 hours. After this, strain and add honey. Mix well. Drink the infusion warm 3-4 times a day 30 minutes before meals.
St. John's wort tincture and enterocolitis
Pour dry crushed St. John's wort herb with 40% alcohol (vodka) in a ratio of 1:5, leave in a dark place for 10-12 days, strain and drink 40-50 drops per glass. a large number water 3 times a day for:- enteritis,
- colitis and other diseases of the gastrointestinal tract,
- for cholelithiasis,
- cystitis,
- rheumatism,
- hemorrhoids
Enteritis is an inflammatory or inflammatory-dystrophic lesion of the small intestine, which in its chronic course leads to atrophy of its mucous membrane. The synthesis of intestinal juice and its barrier function are disrupted. Therefore, patients should, whenever possible, avoid products for which mechanical and chemical processing methods are used.
Enteritis can appear in patients of any age, and in children it appears acute stage, and in the older generation - chronic, which is associated with other diseases. The chronic stage develops when there is no treatment for the acute form.
Studies have shown that in countries with hot climates, enteritis is diagnosed more often than in countries with temperate climates. Very often the occurrence of enteritis is associated with long-term use antibiotics and other antibacterial drugs, alcohol abuse. Enteritis in children is especially dangerous, since it is often quite difficult to identify the cause of the disease and begin correct treatment.
According to statistics, every person in his life has suffered from an acute form of enteritis, and a quarter of the world's population has a chronic form of the disease.
Causes of enteritis
Enteritis is caused by the following reasons:
- poor nutrition;
- food poisoning;
- food allergens;
- alcohol;
- smoking;
- fatty foods;
- side effects of medications;
- infectious agents;
- autoimmune diseases;
- heredity;
- poisoning by chemicals with lead salts, mercury;
- surgical interventions and intestinal injuries.
Symptoms of enteritis
Enteritis most often begins suddenly.
Against the background of general malaise and loss of appetite, fairly intense abdominal pain occurs. Rumbling in the abdomen and diarrhea characteristic of enteritis appear. Stool occurs from 3 to 10 times a day. The stool is usually copious, at first sometimes with a putrid odor and a large amount of gas, later foamy and sour.
The temperature often immediately rises to high numbers; in other cases it is subfebrile, less often normal. Nausea, vomiting and belching are observed mainly in the presence of gastric damage. In addition to food debris, vomit contains mucus and bile impurities.
There is usually no appetite. Patients are thirsty. The face is usually pale, the tongue is dry and coated. The abdomen is more often bloated, less often retracted. During an attack of cramping abdominal pain, peristalsis can be visible to the eye.
During palpation, abdominal pain and rumbling are noted. Protein, hyaline casts, urobilin and indican are found in the urine. At severe forms enteritis, collapse phenomena may be observed - thread-like pulse, decreased temperature, convulsions, etc.
Food intoxication occurs most violently and is accompanied by fever and falling cardiovascular activity. They are often accompanied by an enlarged spleen and their manifestations are similar to typhoid fever, paratyphoid fever or cholera. Frequent diarrhea and vomiting lead to severe dehydration, anuria and the appearance of convulsions. The stool looks like rice water.
In some cases, Salmonella toxic infection can lead to death.
Treatment of enteritis
Patients with severe enteritis, as well as enteritis of toxic origin (the further course of which is difficult to determine in the first hours of the disease) must be hospitalized. Patients with infectious enteritis are hospitalized in infectious diseases hospitals.
In all cases of acute enteritis, in order to remove toxins from the gastrointestinal tract, the stomach is washed (with a tube or tubeless method) with a weak solution of sodium bicarbonate, and a laxative (30 ml) is given orally castor oil or 25 g of magnesium sulfate in 100 ml of water).
Viral enteritis
An acute inflammatory process in the mucous membrane of the small intestine caused by a viral pathogen is called viral enteritis. Often, along with the small intestine, the large intestine and stomach are affected, and enterocolitis or gastroenteritis develops.
ICD-10 code
All viral infections, causing disturbance bowel function international classification diseases (ICD) 10th revision belong to the group of intestinal infections, which, in addition to viruses, are also caused by bacteria and protozoa. The ICD-10 code for viral enteritis is A08.
Separate subgroups include rotavirus enteritis (A08.0), acute gastroenteropathy caused by the pathogen Norwalk (norovirus) (A08.1), adenoviral enteritis (A08.2), other viral enteritis (A08.3) and unspecified intestinal infection of viral origin ( A08.4).
Pathogens of viral enteritis
For enteritis viral type infection occurs with enterotropic viruses, in which the mucous layer is isolated small intestine. Sometimes in pathological process nearby and distantly located organs and systems are involved. The causative agents are viral infections such as enteroviruses, rotaviruses, ECHO or Coxsackie virus.
How does infection occur with viral enteritis?
The viral agent is transmitted from a sick person or carrier to a healthy person with a reduced immune status, mainly through “dirty hands”, by shaking hands, by coughing and sneezing, by consuming contaminated food and water, by kissing and hugging, and other contacts.
Transmission to the fetus from the mother during pregnancy is possible. Toddlers and children are most susceptible to viral enteritis. preschool age. They, as a rule, tolerate the disease much easier than adult patients.
Symptoms and treatment of viral enteritis
Viral enteritis is confirmed by specific symptoms of intoxication, vomiting, and diarrhea. Therapeutic measures consist of symptomatic, detoxification actions. But, unfortunately, there are no preventive and targeted antiviral measures for people.
Consequences of viral enteritis
The consequences of viral enteritis can be serious for vulnerable groups of patients, as they drink plenty of fluids may not be enough to correct dehydration. Young children sometimes refuse to drink.
Therefore, in severe cases, hospitalization is indicated for such patients. Intravenous administration liquids perfectly correct dehydration and make it possible to quickly restore normal water and electrolyte balance in the body.
Chronic enteritis
Reasons
The causes of chronic enteritis are most often the consequences of poor nutrition, helminthiasis, giardiasis, geotrichosis, and poisoning with certain heavy metals.
Also, chronic enteritis can be a consequence of long-term use of antibiotics and various medications (usually saline laxatives).
Some congenital diseases, accompanied by impaired synthesis of certain enzymes in the intestine, can also be causes of chronic enteritis.
Symptoms
With chronic enteritis, symptoms such as rumbling in the abdomen, dull pain in the peri-umbilical region are observed, weakness and nausea are also present, and in some cases there is diarrhea (more often with enterocolitis). On palpation of the cecum, rumbling and splashing is observed.
During defecation, there is an increase in the amount of stool, which becomes more watery or mushy, and its color is yellow-green with inclusions of undigested food.
The person’s general condition worsens, weakness and increased fatigue are observed, appetite decreases, sleep is disturbed, and the person becomes irritable.
Degrees
There are three degrees of severity of chronic enteritis.
Treatment
Treatment of chronic enteritis should be comprehensive, including agents that affect etiological and pathogenetic factors, as well as local and general manifestations diseases.
According to research, positive result from complex treatment, including diet, enzyme and weak choleretic drugs, antibacterial, enveloping, astringent, adsorbent, neutralizing organic acids, along with drugs that normalize the passage of contents through the intestines and reduce inflammatory processes in it, when applied topically, were received by 84% of patients with chronic enteritis.
The patients stopped having diarrhea, abdominal pain, bloating, and rumbling, which in 52% of cases was combined with a decrease in the degree of colonization of the upper parts of the small intestine by microorganisms.
Diet
An indispensable component of complex therapy is a mechanically, chemically and thermally gentle diet. Therapeutic nutrition has a positive effect on the main links in the pathogenesis of diarrhea: it reduces not only increased osmotic pressure in the intestinal cavity, but also intestinal secretion, leading to normalization of the passage of contents through the intestines.
First, during an exacerbation, diets No. 4 and 4a are prescribed, which help eliminate inflammation, fermentation processes in the intestines, and normalize intestinal motility. After 3-5 days the patient is transferred to a complete diet No. 4b, rich in protein, containing a normal amount of fats and carbohydrates (100-115 and 400-500 g, respectively).
Diagnosis of enteritis
The diagnosis is made on the basis of the clinical picture, epidemiological history, and laboratory test results.
On palpation, pain and rumbling in the area of the small intestine are noted. Oliguria, proteinuria, microhematuria, often leukopenia, and erythrocytosis are observed. A large amount of mucus, undigested fiber, starch grains, muscle fibers.
The results of bacteriological and virological research stool, detection of pathogen antigens in urine, saliva, blood or an increase in the titer of antibodies to them.
Differential diagnosis
Differential diagnosis is carried out with acute appendicitis, less often with acute intestinal obstruction, perforated gastric or duodenal ulcer, acute pancreatitis. When excluding appendicitis, take into account that in adults it usually occurs without diarrhea.
Pain from appendicitis is usually localized in the right iliac region, in contrast to acute enteritis, signs of peritoneal irritation are revealed. For acute intestinal obstruction there is no stool, the abdomen is not bloated, gases do not pass, bowel sounds disappear, symptoms of peritoneal irritation appear, and fluid levels are determined during an X-ray examination of the intestines.
For perforated ulcer Characterized by “dagger” pain in the abdomen, severe tension in the anterior abdominal wall (board-shaped abdomen), absence of stool, leukocytosis, and the presence of free gas in the abdominal cavity during x-ray examination.
In acute pancreatitis, the pain is usually of a girdling nature, often due to intestinal paresis, stool retention is observed, and the level of a-amylase in the urine and blood increases.
Enteritis in children
The disease can occur in a child at any age.
Enteritis in children is dangerous due to the complexity of its course, which is especially important in the case of young children who mainly eat dairy products and cannot, for obvious reasons, talk about unpleasant sensations.
Reasons
The causes of the appearance and development of the disease are extremely varied. All kinds of digestive disorders, decreased efficiency of the small intestine, rapid passage of food through the intestines, poor nutrition - these are the factors that can cause enteritis in a child.
Symptoms
Symptoms of the disease depend on the severity and form of the disease. As a rule, enteritis in children is accompanied by diarrhea, changes in the color of stool (from light yellow to gray), diarrhea, gas formation, rumbling in the stomach and pain in the stomach area. Doctors make an accurate diagnosis after a preliminary examination of the child and carrying out the necessary tests.
Treatment
A complete diet is prescribed with a 10-15% increase in protein content, a physiological amount of fat and a restriction of carbohydrates. Avoid foods containing large amounts of fiber, as well as whole milk (diet No. 4).
The use of protein enpit and fermented milk lactobacterin enriched with lysozyme is effective. In severe cases use parenteral nutrition. Vitamins C, group B, and folic acid are administered.
The use of enzyme preparations (Pancreatin, Panzinorm, Polyzyme, Festal) is indicated. In severe cases of the process, antibacterial drugs are prescribed: derivatives of 8-hydroxyquinoline (enteroseptol), nitrofuran series (furadonin, furazolidone), nalidixic acid (nevigramon), as well as sulfasalazine and biseptol.
After the course antibacterial treatment shown biological drugs, normalizing intestinal microflora (colibacterin, bificol, lactobacterin, bifidumbacterin). Bacteriophages (staphylococcal, pseudomonas, coli-proteus, etc.) are also used.
Enveloping and adsorbing agents are effective (tanalbin, white clay, bismuth preparations), medicinal plants(chamomile, peppermint, St. John's wort, nettle, blueberries, etc.). Forecast at long-term treatment favorable.
Prognosis for enteritis
The prognosis for enteritis is favorable.
If the patient with acute form will be treated strictly according to the doctor’s recommendations, then recovery will begin in the near future. As for the chronic stage, things are somewhat different. Chronic form constantly progresses, due to the exhausted body in adults, death occurs.
Questions and answers on the topic "Enteritis"
Question:What is enterostasis?
Answer: Hello. Enterostasis - intestinal obstruction.
Question:Hello! My baby is 8 months old. The doctor diagnosed us with enteritis. We receive treatment: Stopdiar, Enterosgel and Creon. Supposedly we don't have enough enzymes. The symptoms are lactase deficiency. We can’t start complementary feeding - the doctor sends us for a consultation with a geneticist. Please tell me what information we can get from a geneticist? How long is this consultation necessary? What tests will need to be taken before this consultation?
Answer: Hello. A geneticist will help you understand how likely cystic fibrosis is - another digestive disorder, but already caused by a genetic predisposition. There is no need to take any tests before a geneticist; he will direct you wherever he sees fit.
Question:Hello! My child was diagnosed with enteritis at the age of 11 months (before that, she had been treated for dysbacteriosis for a month to no avail; food was very poorly digested). The diagnosis was made by an experienced gastroenterologist, who, unfortunately, is not from our city. Treatment was prescribed: enterol + bifiform + diet, we coped with this problem, but for a while, because with the slightest violations in nutrition or hygiene (dirty hands), she begins to have diarrhea and her tummy hurts. Now she is 5 years old, we took another course in January after an exacerbation. Over the past 3-4 weeks, my daughter has often begun to complain of a tugging pain in the abdomen in the navel area. The gastroenterologist at our clinic is so “experienced” (I wouldn’t like to discuss the doctor, but she was not able to give us the correct diagnosis, she didn’t know about such a disease) that the only thing left is to either go for a consultation in another city, or a virtual consultation. I understand that treatment in absentia is not prescribed, at least a consultation! And another question is: can the body get used to the drugs? In particular, to the biological product bifiform? Does it make sense to drink, for example, Linux?
It is a widespread disease, occurring in both children and adults.
Chronic enteritis varies in severity.
I degree has mild intestinal symptoms, minor violations general condition. At this level, functional tests are minimally modified.
II degree is characterized by joining intestinal disorders moderate metabolic disorders. All functional tests change significantly.
III degree is characterized by severe metabolic changes due to significant disorders intestinal digestion and suction. Characterized by a significant change in functional tests and indicators of almost all types of metabolism.
Also, chronic enteritis is conventionally divided according to the degree of activity at the stage of remission and exacerbation of the process.
Symptoms:
The clinic of chronic enteritis is characterized by various symptoms. All signs of the disease can be divided into local intestinal and general, which are expressed to varying degrees by metabolic disorders.
The clinical picture of chronic enteritis consists of three main syndromes. These are enteral syndrome, enteritis coprological syndrome and insufficient absorption syndrome (malabsorption syndrome), which results in general symptoms diseases - phenomena of polyhypovitaminosis, endocrine insufficiency, dystrophic changes in various internal organs.
Enteral dyspepsia syndrome is expressed in unpleasant sensations in the peri-umbilical region of the abdomen, pressure, distension and bloating. Characteristic of chronic enteritis is Obraztsov’s symptom, which consists of the appearance of strong rumbling and splashing during palpation of the cecum. This symptom occurs as a result of impaired digestion and absorption, in which rapid passage of chyme occurs through small intestine and the entry of undigested and unabsorbed liquid contents and intestinal gas into the cecum.
The pain occurs rarely, is dull or spastic in nature, localized in the umbilical region, intensifies in the afternoon, sometimes has a cramping type, subsides with the appearance of a loud rumbling. With palpation of the abdomen and strong pressure slightly to the left and above the navel, pain is often detected (Porges symptom), and pain can also be detected along the mesentery of the small intestine (Sternberg symptom). Sometimes after eating, phenomena reminiscent of... The appearance of these signs indicates the transition of the disease to a severe form.
Enteritic coprological syndrome is manifested by frequent (4-6 times a day) and copious stools ( total quantity feces per day can reach 1.5-2 kg). The consistency of the stool is mushy, the color is light yellow due to the presence of unreduced bilirubin and a large amount of fat, which also gives the stool a clayey, ointment-like appearance. Noteworthy is the presence of particles in the stool undigested food, but without visible mucus and admixtures of blood or pus. If putrefactive processes predominate in the small intestine, then the feces become foul odor and alkaline reaction. When fermentation processes predominate, feces have a foamy appearance with gas bubbles and an acidic reaction. In severe cases, the frequency of stools can reach 15 times a day.
Exacerbation of chronic enteritis occurs as a result of dietary violations. Typically, patients do not tolerate foods containing large amounts of fats and carbohydrates, milk, spicy and fatty foods. Also, the appearance of scatological syndrome is noted in response to overeating. Sometimes there is a violent urge to defecate soon after eating, and after defecation a sudden weakness occurs, accompanied by dizziness, nausea, cold sweat, hand tremors, and decreased blood pressure (jejunal). In mild cases and in the absence of concomitant diarrhea, diarrhea may be absent.
Malabsorption syndrome (insufficient absorption) is manifested by a pronounced decrease in body weight, sometimes even to the point of exhaustion, weakness, increased fatigue, irritability, headaches, dizziness, and decreased performance.
Due to impaired absorption of vitamins and minerals signs of polyhypovitaminosis appear: angular, increased, hair loss, thinning and polyneuritis, disorder twilight vision etc.
Due to disturbances in the absorption of nutrients and microelements, signs of damage develop internal glands. When the pancreas is damaged, hypoglycemic phenomena appear, which consist of the appearance of weakness, cold sweat, feeling of heat, palpitations, and pain in the heart area 2-3 hours after eating. These phenomena are associated with fluctuations in blood sugar levels.
If the absorption of microelements is impaired, the amount of a number of ions, especially calcium, decreases. Because of this, signs of parathyroid gland insufficiency (hypoparathyroidism) appear, which are characterized by pathological fragility of bones, positive symptoms Khvostek and Trousseau, with convulsions.
With insufficient pituitary function, signs of moderate severity appear, such as in combination with hypoisosthenuria. As it develops, the symptoms of Addisonism come to the fore: especially skin folds palms, oral mucosa, arterial and muscular hypotension. When the function of the gonads is impaired, impotence develops in men, and impotence in women.
With a long course of chronic enteritis, symptoms of iron and dystrophy of internal organs, including the liver, myocardium, kidneys and other organs, develop, manifested by corresponding symptoms.
Diagnosis of chronic enteritis includes general and biochemical tests blood, scatological and bacteriological examination of stool, ultrasound of the liver, biliary tract, pancreas, endoscopic methods intestinal examinations with targeted biopsy. IN general analysis blood reveals the presence of anemia, in the biochemical - a decrease in the amount of protein and cholesterol. A scatological examination reveals undigested fat (steatorrhea), muscle fibers (creatorrhoea), extracellular starch (amilorrhea), fiber, and an increased number of mucus and leukocytes. At bacteriological research dysbacteriosis is detected.
Causes:
Also, its frequent causes are various nutritional disorders, alcoholism, abuse of certain medications (such as antibiotics (neomycin), drugs of the salicylic group (aspirin), cytotoxic drugs, immunosuppressants). These factors lead to an imbalance of microflora in the intestine - dysbiosis, which plays a significant role in the pathogenesis of the disease.
Signs of chronic enteritis can be observed when food allergies. The disease can develop under the influence of industrial poisons (phosphorus, mercury, arsenic, lead, etc.) or ionizing radiation.
There are congenital forms of decreased intestinal function, which are expressed in enzyme deficiency lesions of the small intestine. As a result, the digestive processes in the small intestine, a picture of enteritis gradually develops.
Several main factors play a role in the mechanism of disease development. Inflammation in the intestine occurs in response to direct chronic damaging effects on the wall of the small intestine (toxic, irritant, etc.). As a result, dysbiosis develops. Typically, the small intestine has a sparse bacterial flora, which is detected mainly in its distal sections. With dysbacteriosis, the cavity of the small intestine is abundantly populated with atypical microflora, the number of opportunistic microbes increases, their cultural characteristics are transformed, and the aggressiveness of microorganisms towards the mucous membrane of the small intestine increases. For this reason, indigestion worsens, and some toxic substances, produced by opportunistic microflora and synthesized as a result of cleavage food products microbial enzymes that have a damaging effect on the wall of the small intestine.
In addition, immunological disorders play an important role in the development of the disease, which are expressed in the formation of hypersensitivity to hydrolysis products nutrients or collapse bacterial cells. In chronic enteritis, proteins are transformed due to toxic effects intestinal wall, which themselves subsequently play the role of an antigen, autoallergy develops.
The weakening of local factors protection, decreased production of secretory immunoglobulins. Under the influence of the inflammatory process, there is a disruption in the production of intestinal enzymes that are involved in cavity and parietal digestion, as well as carrier enzymes that carry out absorption in the small intestine. A very important factor in pathogenesis is also an increase motor function and increased tone of the small intestine. At the same time, there is an increase in the excitability of nerve endings in the small intestine, resulting in increased production of water and mucus.
All mechanisms of pathogenesis interact with each other according to the principle of a vicious circle.
As a result of the inflammatory process in the small intestine, pronounced changes occur in the histological structure of enterocytes. Their regeneration is disrupted, dystrophic and atrophic changes are noted, and the size of the villi is greatly reduced. Because of this, the absorption function of the small intestine is impaired, the production of intestinal enzymes decreases, and parietal digestion is disrupted. In chronic enteritis, a secondary dysfunction of many organs is detected: endocrine glands, nervous system, immunity, etc.
Treatment:
For treatment the following is prescribed:
Treatment includes a set of measures aimed at eliminating inflammatory processes and correction of absorption processes. It consists of diet therapy, drug therapy, and physiotherapeutic procedures.
Diet therapy plays an extremely important role in the treatment of chronic enteritis. In case of exacerbation, depending on the severity of the disease, diets No. 4, No. 4b, No. 4c are prescribed. In the acute stage, diet No. 4 is first used, then, as the inflammatory processes subside, diet No. 4b is used. During the recovery period, diet No. 4c is indicated (see “Diet for organ diseases digestive tract, occurring with diarrhea”). After diet No. 4c, it is recommended to prescribe diet No. 2 (see “Treatment of gastritis with secretory insufficiency”) for a smooth transition to the general table. The duration of compliance with these diets is very variable and, as a rule, depends on the severity of the disease and individual characteristics body.
Drug therapy includes the use of antibiotics, drugs containing normal intestinal microflora, enzymatic drugs (such as Creon, Panzinorm, Mezim, Festal), sorbents, antidiarrheal drugs, protein drugs, vitamins and microelements.
Prevention of chronic enteritis includes adherence to the principles of rational nutrition and adequate treatment of acute and food poisoning.
