chronic enteritis
Introduction
Introduction to chronic enteritis Enteritis is intestinal inflammation and colitis caused by bacteria, viruses, fungi, and parasites. Clinical manifestations include abdominal pain, diarrhea, septic flushing or mucus pus and blood. Some patients may have fever and sensation after urgency, so it is also known as infectious diarrhea. Enteritis is divided into acute and chronic according to the length of the disease. The course of chronic enteritis is generally more than two months. Clinically common are chronic bacterial dysentery, chronic amoebic dysentery, schistosomiasis, non-specific ulcerative colitis and limited enteritis. The clinical manifestations are long-term chronic or recurrent abdominal pain, diarrhea and dyspepsia. In severe cases, there may be mucus or watery stools. The degree of diarrhea varies, and the lighter bowel movements are 3 to 4 times a day, or diarrhea constipation alternates. In severe cases, every 1 to 2 hours, even fecal incontinence. Some patients may have nocturnal diarrhea and/or postprandial diarrhea. When the rectum is seriously affected, there may be a sense of urgency. The faeces are mostly mushy, mixed with a large amount of mucus, often with pus and blood. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: colon cancer diarrhea
Cause
Causes of chronic enteritis
Autoimmune (15%):
With the development of society, the advancement of medicine, and the rapid growth of immunology, there are many unknown causes to be identified. At present, the incidence of immune diseases is high and treatment is difficult, which has attracted attention. Therefore, chronic colitis is difficult to cure under conventional treatment.
Infection factor (35%):
Infection is one of the main causes of colitis. Although no pathogens, viruses or fungi were detected in the feces. Whenever the disease occurs, the use of antibiotics has different degrees of control and treatment effects, which indicates that antibiotics have the ability to inhibit E. coli and other pathogenic bacteria, which can reduce clinical symptoms and are generally considered to be related to infection.
Allergic factors (20%):
Allergic lesions are affected by individual differences. Mainly intestinal allergies, but also involving the skin. Allergic reactions are stimulated by sensitizing substances, causing self-immunization to cause reactions, releasing self-defense substances and stimulating a large number of immune cells to aggregate, which are all accumulated on the mucosal surface of the digestive tract, thereby causing inflammation of the mucosal surface edema, congestion and exudation. Allergic reactions are individual changes in human life, eating habits, and are major factors in digestive allergy.
Most of the lesions are induced by acute enteritis or mistreatment. Gastrointestinal mucosa congestion, edema, exudation, and gradual increase, the surface of the yellow exudate is diffuse, and the mucosal folds are deepened or the amount of bleeding is large. Surface epithelial cell necrosis is more serious, due to mucosal vascular injury with hemorrhage, more obvious plasma extravasation, submucosal hemorrhage, edema or even perforation, or intestinal mucosal disorders, intestinal fistula, bowel shortening, gastrointestinal or intestine The curvature of the fistula and colon pockets between the songs is deepened or disappeared, filling defects, etc., sometimes accompanied by intestinal fat, or malignant rectal changes, colonic malignant lesions.
According to the amount of clinical diarrhea, the number of times increased, feces thin, and even watery stools, accompanied by bowel, but no urgency, nutritional disorders, combined with repeated episodes or the cause of chronic enteritis, the diagnosis is generally not difficult.
(1) Chronic intestinal bacterial infections: such as chronic bacterial dysentery, ulcerative intestinal tuberculosis, Salmonella infection, intestinal flora imbalance.
(2) Intestinal parasitic diseases: such as chronic amoebic dysentery, chronic schistosomiasis, intestinal flagellosis, colonic pouch ciliate, intestinal helminthiasis, etc.
(3) Non-bacterial inflammation: such as Crohn's disease, chronic non-specific ulcerative enteritis, colonic diverticulitis, colon polyps complicated by colitis.
(4) Intestinal tumors: such as colon cancer, rectal cancer, small intestinal malignant lymphoma.
(5) Gastric chronic diarrhea: such as chronic atrophic gastritis, advanced gastric cancer, gastric jejunostomy.
(6) Pancreatic chronic diarrhea: such as chronic pancreatitis, advanced pancreatic cancer.
(7) Chronic diarrhea caused by liver and biliary diseases.
(8) Endocrine and metabolic disorders: hyperthyroidism, chronic adrenal insufficiency, anterior pituitary hypofunction, diabetes.
(9) uremia, pellagra, radiation enteritis, scleroderma.
(10) spastic colon (allergic colitis), neuropsychiatric diarrhea.
Prevention
Chronic enteritis prevention
First, pay attention to household hygiene, loading screens, fighting flies, cockroaches, and environmental cleanliness.
Second, avoid bringing children to public places.
Third, avoid eating cold and unclean things.
Fourth, the children's food utensils pay attention to safety and cleanliness.
5. Isolate the patient and handle its excretion carefully.
6. Personal hygiene and hygiene education, especially those with children, should wash their hands frequently, wash their hands after changing diapers, and wash their hands after contact with children's secretions to prevent bacterial transmission to children.
Complication
Chronic enteritis complications Complications colon cancer diarrhea
1, intestinal perforation: intestinal perforation is a complication of toxic intestinal dilatation, can also occur severe, mostly in the left colon, the application of corticosteroids is considered a risk factor for intestinal perforation.
2, toxic bowel dilatation: toxic bowel dilatation clinical manifestations of rapid deterioration of the disease, symptoms of poisoning, accompanied by diarrhea, abdominal tenderness and rebound tenderness, bowel sounds weakened or disappeared, increased white blood cell count, easy to have intestinal perforation.
3, intestinal stenosis: intestinal stenosis occurs in a wide range of lesions, the duration of the disease lasts for more than 5-25 years, the site is more common in the left colon, sigmoid colon or rectum, clinically generally asymptomatic, can cause intestinal obstruction in severe cases, In the case of intestinal stenosis in this disease, be alert to the tumor and identify benign and malignant.
4, colon cancer: chronic colitis about 5% of cases of cancer, more common in the lesion involving the entire colon, early onset and medical history of more than 10 years.
Symptom
Chronic symptoms of enteritis Common symptoms Nausea and vomiting Abdominal pain Watery stools Defecation diarrhea Feces Abnormal Fecal pus
(1) Digestive tract symptoms: often present intermittent abdominal pain, abdominal distension, abdominal pain, diarrhea is the main manifestation of this disease. In case of cold, greasy things or emotional fluctuations, or especially after exertion. The number of stools increased, several times a day or dozens of times, the anus fell, the stool was unhappy. In the acute onset of chronic enteritis, high fever, abdominal cramps, nausea and vomiting, and urges such as water or sticky blood can be seen.
(2) systemic symptoms: chronic consumption symptoms, lack of vitality, lack of energy, lazy words, limb weakness, like temperature and cold. For example, in the acute inflammatory phase, in addition to fever, loss of water, acidosis or shock bleeding can be seen.
(3) physical signs: long-term abdominal discomfort or less abdominal pain, the body can be seen in the abdomen, umbilical or abdomen, with mild tenderness, bowel sounds hyperthyroidism, rectal prolapse.
Examine
Chronic enteritis examination
(1) Peripheral blood examination: white blood cells, red blood cells, and erythrocyte sedimentation rate are seen in blood routine.
(2) stool routine or culture: more common abnormalities, a small amount of white blood cells and red blood cells or a small number of pus cells can be seen. If the bacteria are infected, pathogenic bacteria can be found.
(3) Physical examination at the time of onset may have abdominal tenderness.
(4) X-ray barium examination and colonoscopy can exclude other specific intestinal inflammation.
Diagnosis
Diagnosis and diagnosis of chronic enteritis
Diagnostic criteria
(1) When the attack occurs, diarrhea, abdominal pain, etc. occur. Chronic malnutrition occurs when the disease is long. Physical examination can have abdominal tenderness.
(2) White blood cells, red blood cells and a small number of pus cells can be seen routinely in stool. Stool culture can find pathogenic bacteria.
(3) X-ray barium examination and colonoscopy can exclude other specific intestinal inflammation.
Differential diagnosis
(1) Intestinal tuberculosis: slow onset, mostly in the lower right abdomen, may have paroxysmal colic, increased bowel sounds, often have bowel habits change, dry and thin alternate. Light is only loose, and heavy is mucus and pus. Can have nausea, vomiting, bloating, loss of appetite. The physical examination only had tenderness in the right lower quadrant. Auxiliary examination: ESR increased, colonic test was positive, and acid-fast bacilli were found in stool culture. A fiber enteroscopy was given to confirm the disease.
(2) Primary intestinal malabsorption syndrome: The typical symptom of this disease is steatorrhea. The stool is light in color, and the amount is large. It is oily or foamy, and often has a foul smell on the surface of the water. More with abdominal distension, abdominal pain, fatigue, weight loss, bleeding and other malnutrition, long course of disease, light and heavy when the disease is a good diagnosis of X-ray barium meal examination.
(3) Crohn's disease: It is a chronic intestinal inflammatory disease of unknown cause. It has a slow onset and has symptoms such as weight loss, poor appetite and fatigue. Abdominal pain is located in the umbilicus or in the lower right abdomen Diarrhea is initially intermittent and gradually becomes persistent. 3 to 6 times a day, soft or semi-liquid. The lower right abdomen is tender and can reach the mass. Late manifestations of weight loss, anemia, intestinal malabsorption and electrolyte imbalance. Mesenteric angiography or endoscopy and biopsy can confirm the diagnosis.
(4) idiopathic ulcerative colitis: the cause of this disease is unknown, is a chronic disease associated with immunity, mostly ulcers, involving the conjunctival mucosa, more common in young adults. Abdominal pain is often marked in the left lower abdomen or full abdomen, with bowel sounds hyperthyroidism. There are symptoms such as loss of appetite, weight loss and malnutrition. Sigmoidoscopy and biopsy are available for diagnosis.
(5) Gastrointestinal neurosis: This disease is a gastrointestinal dysfunction caused by advanced neurological disorders. The onset is slower, and the clinical manifestations are mainly gastrointestinal symptoms, including neurological hernia, anorexia, vomiting, mental diarrhea, colonic irritation, and splenic syndrome.
