Gastroenterology / / May 04, 2016
ENTEROCOLITIS - inflammation of the mucous membrane of the small and large intestines - one of the most common diseases of the digestive tract.Long flowing inflammatory-dystrophic their disease - a chronic enterocolitis - leads to mucosal atrophy and intestinal problems.
enterocolitis Enterocolitis is caused pathogens (dysentery bacteria, amoebas, balantidiums, Salmonella, Staphylococcus, Streptococcus, and others.), Intestinal worms.The cause of enterocolitis may be the presence of chronic foci of infection in the body, especially in the organs are anatomically associated with the gut (pancreas, gall bladder), as well as inflammation of the pelvic organs in women.
Nutritional enterocolitis develop as a result of diet disorders (irregular eating, eating mostly foods poor in vitamins and protein, indigestible, spicy foods, alcohol, big breaks between meals).
Toxic enterocolitis occur when exogenous poisoning kolotropnymi substances (heavy metal salts, alkalis) and endogenous intoxi
Medication enterocolitis are due to the damaging effect on the mucous membrane of the intestine of a number of medicines (digitalis, salicylates, etc..), As well as irrational therapy broad-spectrum antibiotics that inhibit the normal intestinal microflora, chronic administration of laxatives of plant origin.
Secondary enterocolitis developed in violation of the stomach, liver, gall bladder, in cases of habitual constipation with kolonospazme, dolichosigma, as well as in diseases of the cardiovascular system.In the development of the disease, usually more than one value is an etiological factor, and their complex.
symptoms of enterocolitis
primary lesion of the colon
In cases of lesions of the colon in the clinic is dominated by local symptoms: abdominal pain and disorders of the chair.The pains are dull, aching in nature.Paroxysmal pain characterized by spastic colitis.Diffuse nature of pain (around the belly) is a testament to pankolita and localization of pain in different parts of the colon indicates its segmental lesions.Characteristically pain relief after passing flatus, and feces.As a result, digestive disorders enhanced gassing, which causes bloating - flatulence.Patients feel the severity, abdominal distension, often palpitation, shortness of breath, discomfort in the heart of pushing up the diaphragm due to the swollen loop of intestines.Violation of the chair shown in alternating diarrhea and constipation symptoms of inadequate emptying bowels when there is a release of a small amount of liquid or mushy stools with mucus and the patient experiences a feeling of incomplete bowel evacuation after defecation.False urge to bottom (tenesmus), when only depart gases and mucus, characteristic of proctosigmoiditis.
persistent constipation caused by slow motility of the colon with symptoms of spasm (spastic constipation) or atony intestines.Spastic constipation is characterized by inflammation of the distal intestine.It is manifested by pain during bowel during a bowel movement.Cal is released in stages during the day and has a fragmented form ( "sheep feces").
primary lesion of the small intestine
enterocolitis For patients with a predominance of lesions of the small intestine characterized by complaints of pain around the navel, which appear after 3-4 hours after a meal and accompanied by flatulence and rumbling in the abdomen.Disorders of the chair more often manifested in the form of diarrhea is characterized by an increase in the amount of feces (polifekaliya), which contains the remains of undigested food.In severe stages of the disease to the fore the common symptoms caused by disorders of the digestive and absorptive functions of the small intestine, the development of malabsorption syndrome - insufficient intake.Last seen metabolic disorders of proteins, fats, carbohydrates, vitamins, as well as water and mineral metabolism.
Clinically, this results in a sharp decrease in the weight of different trophic disorders of the skin and mucous membranes.There have dry skin, brittle nails, phenomenon glossitis, stomatitis, bleeding gums, esophagitis, paresthesia in the legs and other manifestations of hypovitaminosis.Characterized by tachycardia, hypotension, decreased performance, hypochondria symptoms ( "disease care").
dyspeptic syndrome in its manifestations reminiscent of dumping syndrome: after a meal suddenly occur severe weakness, hot flashes, palpitations, which are replaced in the body trembling, sweating, dizziness.Such conditions caused a sharp fluctuation of blood sugar levels - short of his rise and steep decline.Typical milk intolerance.Long-term course of the disease leads to disruption of the pancreas and liver.
Persons elderly enterocolitis occurs with Just noticeable pain.Characterized atonic constipation, sometimes alternating with diarrhea, flatulence.Often a combination of enterocolitis with other diseases of the digestive system: chronic gastritis, pancreatitis, cholecystitis, which exacerbates the pathological process.Atonic and spastic constipation cause the development of hemorrhoids, anal fissures, which makes constipation more steadfast in turn.Diagnosis
In diagnostics enterocolitis matters coprological study, with which elements exhibit inflammation (mucus, leucocytes, erythrocytes) when enterocolitis, mainly affecting the colon or undigested food residues - when enterocolitis, mainly affecting the small bowel.A study of feces for protozoa and helminth eggs, feces on planting dysenteric bacteria group on a dysbacteriosis.The blood tests for severe enterocolitis revealed anemia, hypoproteinemia, Dysproteinemia, lowering lipid levels in blood serum, as well as sodium, potassium, calcium.
endoscopic methods of investigation (colonoscopy, sigmoidoscopy) give a picture of catarrh of the colon mucosa (hyperemia, mucosal edema, hemorrhage point, the presence of mucus).X-ray examination of the colon using a contrast enema (barium enema) gives a picture of changes in the mucous relief characterizes the motor activity of the intestine (atony, spasm).The small intestine is studied radiographically, conducted a special study to determine the absorptive function of the small intestine, aspiration biopsy.
conduct differential diagnostics of enterocolitis accounts with many diseases.colon Dyskinesia clinically in many ways similar to the enterocolitis.At the same time, psoriasis is not a distinct tenderness to abdominal palpation, chair disorder often manifested by constipation, which only occasionally alternating with diarrhea.Kal - without pathological impurities and remnants of undigested food.The final diagnosis is made by endoscopy with biopsy of the colon.Signs of inflammation in this case absent.
Ulcerative colitis - a disease of unknown etiology, characterized by the development of ulcers, erosions, hemorrhages in the intestinal wall.Manifested abdominal pain, diarrhea with tenesmus, intestinal bleeding.Often the only symptom at the beginning of the disease may be discharge of blood with mucus and pus during defecation ( "hemorrhoids like" principle).Perhaps rectal bleeding is due to defecation.This pathology is observed in individuals aged 20 to 40 years old.Abdominal pain localized mostly in the left groin, palpation determined spastic sigmoid colon.At the beginning of the disease pathological process captures only the rectum.For ulcerative colitis is characterized by the severity of the disease most common symptoms: sudden weight loss, weakness, anemia, leukocytosis with a left shift often, in severe cases - toxic granularity of leukocytes.When barium enema and endoscopy observed multiple ulcers, scar narrowing of the intestinal lumen.
necessary to differentiate enterocolitis and Crohn's disease.For this disease, the etiology of which is unclear, mainly characterized by inflammation of the final limited part of the ileum with granulomatous changes across the intestinal wall, mucosal ulceration and narrowing of the intestinal lumen up to complete obturation.The pathological process in Crohn's disease can affect any part of the digestive tract - from the esophagus to the rectum.Most of her persistent symptoms - diarrhea and prolonged, not intensive abdominal pain.With the defeat of the duodenum they are located in the upper right quadrant of the abdomen, with the defeat of the jejunum - in the umbilical region, iliac - in the lower right quadrant of the abdomen by stimulating chronic appendicitis.Chair normally without any admixture of pus and mucus, has a gray-clay color.From the general symptoms noted weight loss, weakness, persistent low-grade temperature, features polyhypovitaminosis.Often in the right iliac region can palpate painful infiltration, which can not detect when enterocolitis.Many diagnostic value has inspection of the anal region: Crohn's disease is marked swelling of the mucosa and perianal tissue, resulting in perineal skin becomes bluish-purple hue.Characteristically education maloboleznennyh wide cracks and ulcers anal area.These changes may be the first manifestations of the disease.To diagnose matters endoscopy with biopsy of the mucosa area.
tumors of the colon can occur enterocolitis on type.Hallmarks are the persistence of constipation, lack of regularity in the change constipation diarrhea, constipation appearance after a long copious fetid liquid stools.Often, the relative intestinal obstruction symptoms.About cancer should think, if the patient or the average elderly observed unmotivated weakness, weight loss, appetite worsens, symptoms of "intestinal discomfort".Patients underwent barium enema, sigmoidoscopy and colonofibroscopy with biopsy of the colon area.
- Crohn's Disease: Causes, symptoms, diagnosis, treatment
- complex physical therapy in colitis
- Colitis: causes, symptoms, treatment
- Irritable Bowel Syndrome or noise, rumbling in the stomach and intestines
treatment of enterocolitis enterocolitis
Treatment should be complex.The main method of pathogenetic therapy is a health food.Choosing the right diet helps normalize the motor-evacuation function of the intestine and digestive.Results frequent small feedings (4-6 times a day) mechanically sparing diet with enough protein, vitamins, digestible carbohydrates and fats.During an exacerbation prescribe diet №4 by Pevzner, in remission - a diet №2 and №4.The benchmark in clinical nutrition should be the nature of the chair at the time.
Antibacterial therapy is indicated for persistent phenomena of inflammatory bowel disease, disorders of the stool, which can not normalize diet dysbiosis phenomena.
When colitis caused by opportunistic flora, recommended antibiotics (chloramphenicol, polymyxin, etc..).The course should last no longer than 10 days due to a possible strengthening of dysbiosis and development of side effects.Because sulfa drugs used sustained release formulations (sulfadimetoksin, ftazin et al.).In dysentery and salmonella enterocolitis etiology nitrofuran derivatives used (furazolidone, furadonin).
When phenomena dysbacteriosis after antibiotic therapy given biological preparations containing the main microorganisms of the intestinal microflora (colibacterin bifidumbakterin and bifikol).These drugs, normalizing the microbial flora, eliminate bloating, stool disorders, reduce pain.In violation of the secretory function of the stomach and pancreas administered enzyme preparations (festal, mezim forte).
to normalize stool in diarrhea prescribed drugs with astringent, enveloping and adsorbent properties (white clay, bismuth preparations, Tanalbin et al.).With the same purpose used herbs - concoctions flax seeds, psyllium, oak bark, pomegranate peels, wild cherry and blueberry fruits, rhizomes of Potentilla.If flatulence provide common daisy, peppermint, dill, fennel fruit.Have anti-inflammatory effects of calendula flowers, eucalyptus leaf, herb St. John's wort, sage leaf, yarrow.
Constipation are indication for a variety of laxatives: senna leaf, buckthorn bark, rhubarb root, izafenina, castor oil, seaweed, magnesium sulfate, petroleum jelly, vegetable oils.Long, uncontrolled intake of laxatives enhances inflammation in the intestines.
Therapeutic enemas are effective in lesions of the distal colon (proctosigmoiditis, proctitis).They are administered with fish oil, sunflower oil, olive oil, wild rose oil, etc., pain and tenesmus, 10% propolis tincture, spastic phenomena -. Atropine sulfate.
important place in the treatment of enterocolitis takes physiotherapy.Acceptance of mineral water should be strictly individualized depending on the functional condition of the intestine.The remission is recommended spa treatment.