ischemic enteritis
Introduction
Introduction to ischemic enteritis Ischemic enteritis is a kind of colon disease caused by colonic ischemia, that is, a certain part of the colon tissue is insufficient for blood supply due to some reasons, resulting in damage or necrosis of the intestinal wall. Abdominal pain, bloody stools, and diarrhea are called the three main signs of ischemic enteritis. 70% to 100% of patients have abdominal pain symptoms, abdominal pain characterized by sudden, diffuse mid-abdominal cramps, 70% of the first symptoms of bloody stools or diarrhea, a small number of patients with first symptoms of vomiting, dizziness or urgency. Most of them are spontaneous, usually without obvious vascular occlusion, and it is clinically difficult to find a clear cause of colonic ischemia. Most of these patients are elderly, and vascular abnormalities revealed by mesenteric angiography may not be consistent with clinical symptoms after colonic ischemic changes. Spontaneous colonic ischemia can be induced for a variety of reasons, with hypotension being most common among various causes. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: arteriosclerosis, heart disease, shock, intestinal obstruction
Cause
Causes of ischemic enteritis
Spontaneity factor (30%):
Most of them are spontaneous, usually without obvious vascular occlusion, and it is clinically difficult to find a clear cause of colonic ischemia. Most of these patients are elderly, and vascular abnormalities revealed by mesenteric angiography may not be consistent with clinical symptoms after colonic ischemic changes. Spontaneous colonic ischemia can be induced for a variety of reasons, including hypotension, which is most common in various causes, such as septic shock, cardiogenic shock, anaphylactic shock, neurological shock, etc., accompanied by heart disease and hypertension. Diabetes and taking drugs that affect visceral blood flow (such as booster drugs) can significantly increase the chance of colonic ischemia. Mesenteric blood supply is reduced, causing colonic ischemia, and a wide range of acute mesenteric blood supply disorders can cause significant irreversible cardiac output reduction, resulting in a vicious circle of mesenteric ischemia.
Trauma (30%):
In vascular obstructive colonic ischemia, the most common causes are trauma of the mesenteric artery, mesenteric vascular thrombosis or embolism, and ligation of the inferior mesenteric artery during abdominal aortic reconstruction or colon surgery.
Other reasons (25%):
Insufficient tissue perfusion caused by various causes, such as shock, dehydration, acidosis, myocardial failure, etc. can also aggravate intestinal ischemia caused by colonic obstruction.
Prevention
Ischemic enteritis prevention
The age of onset of ischemic colitis is more than 50 years old, so the elderly should pay more attention to regular living, avoid tobacco and alcohol, eat more vitamin-rich foods such as vegetables and fruits, try to avoid eating fat, animal internal organs and other high Fat food. In addition, you should also participate in some indoor and outdoor sports within your ability.
Complication
Ischemic enteritis complications Complications, arteriosclerosis, heart attack, intestinal obstruction
More with hypertension, arteriosclerosis, heart disease, shock and long-term medication. In severe cases, intestinal wall necrosis, perforation or persistent intestinal ischemia may occur.
1. Intestinal obstruction: In the early stage of gangrenous ischemic colitis, patients with extensive lesions may have paralytic ileus due to severe acute ischemia of the colon, while those with chronic ischemic colitis are due to fiber during chronic inflammation. Tissue hyperplasia and scar formation, narrowing the intestinal lumen and incomplete intestinal obstruction.
2. Shock: In gangrenous ischemic colitis, due to the massive absorption of necrotic tissue and bacterial toxins, microcirculatory vessels are widely open, and the effective blood volume is insufficient, and patients may experience low volume and/or toxic shock.
Symptom
Ischemic enteritis symptoms common symptoms abdominal pain, blood, dizziness, nausea, vomiting, vomiting, intestinal tension reduction
Acute inflammatory changes in the gastrointestinal mucosa caused by eating foods containing pathogens and their toxins, or improper diets, such as excessive amounts of irritating, non-digestible foods. Its pathological manifestations include hyperemia, edema, and mucus secretion in the gastrointestinal mucosa, sometimes accompanied by bleeding and erosion. In China, the incidence rate is higher in summer and autumn, and there is no gender difference. The general incubation period is 12-36 hours.
Examine
Examination of ischemic enteritis
Most of the clinical lesions in the rectum and sigmoid colon are valuable for sigmoidoscopy. For patients with chronic or suspected whole colon, fiberoptic colonoscopy should be performed. Generally do not use clean enema, acute acute phase should be listed as taboo to prevent perforation. Endoscopy has the value of diagnosis. By repeating the macroscopic changes and histological changes of the colon under direct vision, it can not only understand the nature and dynamic changes of inflammation, but also detect precancerous lesions early, and accurately collect the diseased tissue under the microscope. And secretions to facilitate the exclusion of specific intestinal infectious diseases.
1, X-ray barium enema examination: the most significant signs in the acute phase refers to the pressure and mucosal roughness, irregularities, intestinal limitations, colonic bags disappear.
2, selective angiography: can determine the location, extent and extent of arterial stenosis.
3, fiber colonoscopy: hemorrhagic necrosis should not be implemented.
Diagnosis
Diagnosis and diagnosis of ischemic enteritis
1, pediatric fungus: more common in children aged 1-7 years, systemic symptoms, diarrhea as the first symptom, stool more than 10 times a day, for mucus, stool microscopic examination showed a large number of white blood cells, stool PH value greater than 7, stool culture Visible Shigella is visible.
2, viral enteritis: more common in 6 months - 2 years old children, systemic symptoms are light, with vomiting, cough as the first symptom, stool 3-10 times a day, a watery stool, stool PH value less than 7, can be separated Rotavirus.
