Necrotizing enteritis
Introduction
Introduction to necrotic enteritis Necrotic enteritis is an acute enteritis associated with infection of C-type Clostridium perfringens. The disease is mainly in the small intestine. The pathological changes are characterized by hemorrhagic necrosis of the intestinal wall and often acute onset. The main clinical manifestations are abdominal pain, blood in the stool, fever, vomiting and bloating. In severe cases, there may be complications such as shock, intestinal paralysis and other symptoms such as intestinal perforation. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of transmission: mouth communication Complications: intestinal obstruction, shock, disseminated intravascular coagulation
Cause
Cause of necrotic enteritis
Susceptibility factors include: intestinal ischemia, intestinal infection, impaired intestinal barrier function, respiratory distress syndrome, hemorrhage, asphyxia, congenital heart disease with heart failure, sepsis, shock, hypothermia, erythrocytosis and/or blood High viscosity, artificial feeding, etc. It is believed that the onset of this disease is related to the infection of the B-toxin-producing Welchii bacterium (C-type Clostridium perfringens), which can cause intestinal tissue necrosis and produce gangrenous enteritis.
Prevention
Necrotic enteritis prevention
1. In addition to avoiding cold and controlling emotions, diet is a very important aspect. Should pay attention to food hygiene, do not eat cold, hard and deteriorating food, alcohol and spicy spicy seasonings. Avoid overeating and overeating cold and greasy food. Timely treatment of intestinal parasitic diseases.
2, usually should strengthen exercise, such as playing Tai Chi, to strengthen the waist and strengthen the kidney.
3, pay attention to the abdomen to keep warm.
Complication
Necrotic enteritis complications Complications, intestinal obstruction, shock, disseminated intravascular coagulation
There may be local mesenteric lymphadenopathy, softening; liver steatosis, acute splenitis, interstitial pneumonia, pulmonary edema; other cases may be accompanied by adrenal focal necrosis. In severe cases, there may be complications such as shock, intestinal paralysis and other symptoms such as intestinal perforation.
1, intestinal obstruction: due to the role of bacteria, endotoxin, intestinal wall congestion, edema, loss of elasticity and peristalsis, intestinal retention, intestinal obstruction symptoms. Clinically misdiagnosed as mechanical intestinal obstruction.
2, shock and diffuse intravascular coagulation (DIC): bacteria, endotoxin absorption into the blood, causing systemic poisoning disorders and hemodynamic disorders, about one-fourth of patients may develop toxic shock, or with DIC .
Symptom
Necrotic enteritis symptoms Common symptoms Drainage-like bloody stool fever accompanied by abdominal pain, ... Bloody stools, wilting, bloating
1, abdominal pain, abdominal distension and abdominal pain are mostly sudden, persistent and can be aggravated. The abdominal pain is mostly in the umbilical or upper abdomen. Some patients may have total abdominal pain, which may have mild bloating in the early stage and then worsen.
2, vomiting: abdominal pain, accompanied by nausea, vomiting, spit with bile, coffee or bloody water.
3, diarrhea and blood in the stool: the degree is different, more than 10 times a day. According to the lesion site, bleeding rate, in the intestinal retention time and intestinal peristalsis, the feces can be blood, broth, jam or black stool, and often mixed with rotten tissue and special odor. If the lesion is limited in the small intestine, there is no urgency after the phenomenon.
4, the symptoms of body poisoning: due to bacterial, endotoxin translocation caused by inflammatory reaction in the body may have fever or body temperature is not rising, apathetic or irritability, if there is more convulsions or coma, the condition is serious, multiple organ dysfunction (MODS) and There may be cases of intestinal necrosis.
5, infant and young children symptoms: atypical, infants and more than 3 to 10 days after birth. Due to premature birth or low body weight, he was admitted to the intensive care unit. During artificial feeding or during the establishment of gastric tube nasal feeding due to incomplete establishment of swallowing reflexes in immature children, there was retention in the stomach, followed by bloating, vomiting, blood in the stool or fever. , heart rate is too fast or slow, abdominal muscle tension, abdominal flatulence, abdominal wall erythema and other signs. It is generally believed that the smaller the gestational age, the higher the incidence of AHNE. The incidence of low birth weight children was 12%.
Clinical classification:
1, gastroenteritis type: seen in the early stages of the disease have abdominal pain, watery stools, low fever, may be associated with nausea and vomiting.
2, toxic shock: high fever, chills, apathy, lethargy, slang, shock and other performance, often occur within 1 to 5 days of onset.
3, peritonitis type: obvious abdominal pain, nausea and vomiting, abdominal distension and acute peritonitis signs, affected intestinal wall necrosis or perforation, bloody exudate in the abdominal cavity.
4, intestinal obstruction type: abdominal distension, abdominal pain, frequent vomiting, defecation exhaust stop, bowel sounds disappear, there is a sac.
5, intestinal bleeding type: blood-like or dark red bloody stools, the amount can be as much as 1 ~ 2L, obvious anemia and dehydration.
Examine
Examination of necrotic enteritis
1, blood routine: the performance of white blood cell count increased, smear classification of nuclear left shift phenomenon; red blood cell reduction, hemoglobin reduction; progressive platelet count reduction.
2, blood biochemical examination: may have hypoproteinemia, electrolyte imbalance, metabolic acidosis, high or low blood sugar and other performance.
3, liver, kidney and coagulation function: In some cases, liver and kidney function damage and DIC manifestations may occur.
4, fecal occult blood test is positive.
5. Bacteriological culture of blood and feces This test helps to judge the infected flora.
6. Abdominal X-ray film: The performance of X-ray is related to the severity of AHNE. Most of the early stage can have different degrees of intestinal lumen inflation, and the intestinal gap is slightly widened. Due to the inflammatory exudation of the intestinal wall edema, the inner edge of the intestinal wall is blurred. As the disease progresses, the image of the intestinal wall can be found. It is generally believed that the gas in the intestinal cavity passes through the damaged mucosa and enters the submucosa or subserosal. As a result, the intestinal gap is widened due to increased exudation. In the late stage, there are fixed and dilated intestinal fistulas, portal vein gas, ascites, and pneumoperitoneum. Dynamic observation of X-ray changes in the abdominal intestines is often helpful in judging the vitality of the intestines. X-ray examination of barium enema should be classified as contraindication because it may aggravate bleeding or cause perforation in the acute phase.
7, fiber colonoscopy: early detection of intestinal inflammation and bleeding.
8, B-ultrasound: the continuous accumulation of gastrointestinal imaging experience, there is a trend to complement the X-ray examination will be more convenient and faster.
Diagnosis
Diagnosis and diagnosis of necrotic enteritis
1, a history of eating unclean, in the summer and autumn, sudden onset of severe abdominal pain, diarrhea and stagnation of blood in the stool, nausea and vomiting and obvious symptoms of poisoning, should consider the possibility of the disease.
2, according to the stage of the disease and the patient's performance, distinguish different clinical types: diarrhea and bloody stool type, with diarrhea and blood in the stool as the main performance; peritonitis type, mainly showing signs of mesenteric inflammation; poisoning type, with shock as prominent or with DIC; intestinal obstruction Type, with the characteristics of acute intestinal obstruction as the main performance.
Physical examination:
Abdominal distension, abdominal tenderness, due to inflammatory exudation can show different degrees of peritoneal irritation, intestinal type, abdominal mass, such as intestinal necrosis, perforation can show typical signs of total abdominal peritonitis. For those with toxic shock, there are many unstable respiratory and circulatory systems, shortness of breath, low blood pressure, increased heart rate, mental disorders, and skin spots.
