decreased intestinal tone
Introduction
Introduction Intestinal ischemia refers to the obstruction of blood vessels supplying intestinal blood for some reason, resulting in the reduction or loss of blood source of the intestinal tract. It is not required for the physiological activities of the intestinal tract, and the intestinal wall is congested, edematous or ulcerated. Necrosis, hemorrhage, perforation, and peritonitis can occur. Ischemic bowel disease (ischemic boweldisease) is a disease caused by intestinal wall ischemia, hypoxia, and eventually infarction. The disease is more common in elderly patients with arteriosclerosis and cardiac insufficiency. Most of the lesions occur in a segmental manner centering on the spleen of the colon. The direct causes of colonic ischemia are mostly mesenteric arteries and veins, especially vascular occlusion and stenosis caused by atherosclerosis or thrombosis in the superior mesenteric artery. Heart failure, shock caused by lower blood pressure, and insufficient local blood supply to the intestine may also be the cause of the disease.
Cause
Cause
Mainly caused by various causes of the body, it is one of the clinical symptoms of constipation.
Caused by involvement of atherosclerosis-related organs.
Examine
an examination
Related inspection
Gastrointestinal CT examination, enteroscopy, fiberoptic colonoscopy, gastrointestinal imaging
Diagnosis of constipation
Diagnosis is generally based on medical history and symptoms. Supplementary for routine, gastrointestinal X-ray, intestinal endoscopy, stool phosphate, etc., can be clearly functional constipation or organic constipation.
Diagnosis of atherosclerosis
Mainly determined by the degree of ischemia of vascular lesions and affected organs, aortic atherosclerosis is often asymptomatic, coronary atherosclerosis, if the diameter of the tube is more than 75%, angina, myocardial infarction, arrhythmia, and even sudden death. Cerebral arteriosclerosis can cause cerebral ischemia, brain atrophy, or cerebral vascular rupture, renal atherosclerosis often causes nocturia, refractory hypertension, severe cases may have renal insufficiency. Mesenteric atherosclerosis can be manifested as symptoms such as abdominal pain and blood in the stool after a meal. Lower extremity atherosclerosis caused severe stenosis of the vascular lumen may occur intermittent claudication, the dorsal artery pulsation disappeared, and even severe gangrene may occur.
an examination
1, patients often have elevated blood cholesterol, triglycerides, high-density lipoprotein decreased, lipoprotein electrophoresis pattern abnormalities, most patients with type III or type IV hyperlipoproteinemia.
2, X-ray examination shows aortic elongation, expansion and distortion, sometimes visible calcium deposition.
3, angiography can show the stenosis, lesions and extent of the quadriple artery, renal artery and coronary artery caused by atherosclerosis.
4, Doppler ultrasound examination helps to determine the blood flow of the arteries and renal arteries of the extremities.
Diagnosis
Differential diagnosis
Differential diagnosis of constipation
It is not difficult for the diagnosis of constipation. Because of the many causes of constipation, it is necessary to distinguish the cause of constipation. Common causes are habitual constipation, neurological diseases, colon tumors and so on. Acute constipation is mostly caused by acute infection or by intestinal obstruction.
(1) Habitual constipation
In the medical history, there is generally a partial eclipse that does not eat vegetables or a diet that is too fine or has not developed a habit of defecation on a regular basis. The toilet is inconvenient or the working environment is inconvenient for defecation. Emotional stress also affects habitual constipation. Physical examination X-ray or colonoscopy No organic lesions were found to be diagnosed as habitual constipation.
(2) Irritable bowel syndrome
There are three clinical manifestations of irritable bowel syndrome: 1 colonic spasm mainly causes chronic abdominal pain and constipation; 2 chronic intermittent painless watery diarrhea; 3 clinical features of irritable bowel syndrome with constipation and diarrhea alternating with constipation : 1 chronic abdominal pain with constipation or diarrhea constipation alternately; 2 patients in the sigmoid colon area often have intermittent abdominal cramps relieved after deflation or defecation; 3 physical examination can be mild tenderness in the left lower abdomen and sigmoid colon filled with feces and sputum Anal finger examination of the rectum and abdomen without feces; 4 patients often accompanied by heartburn, abdominal distension, back pain, weakness, weakness, dizziness, palpitations and other symptoms.
Diagnostic points: 1 has the above clinical features; 2X line sputum angiography or colonoscopy no positive findings or only sigmoid colon; except for other causes of constipation; 3 in the left lower abdomen and mass should be differentiated from colon cancer using enema or Other methods allow the patient to have a lumps of dry stool after the bowel movements have disappeared.
(three) laxative enteropathy
Laxative enteropathy refers to the patient's dependence on laxatives caused by constipation or rectal anal lesions in patients with difficulty in defecation. The long-term application of laxatives for defecation is called laxative enteropathy.
Diagnostic points: 1 patients with constipation or difficulty in defecation for a long time frequent application of laxatives; 2 except for endocrine rectal anus and other organic constipation can be considered as laxative enteropathy without a history of medication can not diagnose laxative bowel disease.
(four) colorectal cancer
Colorectal cancer including colon and rectal cancer has data indicating that colorectal cancer is more than 1/3 of the rectum 2/3 of the cancer in the rectum and sigmoid colon.
1 main clinical features 1 early symptoms of colorectal cancer are not obvious changes in bowel habits such as constipation or diarrhea or alternating between the two may be early manifestations of colorectal cancer; 2 blood in the stool, especially after defecation bleeding is a common symptom of colorectal cancer; 3 may have abdomen Persistent painful constipation and urgency often exist simultaneously; 4 invasive colorectal cancer is prone to intestinal obstruction; 5 abdominal examination and anal finger examination sometimes touch the mass.
2 diagnosis based on patients over the age of 140 have the above clinical manifestations; 2 occult blood continued to be positive and no evidence of stomach disease; 3 abdominal examination along the colon or rectal examination revealed that the mass 14 carcinoembryonic antigen can be elevated but not specific; Agent contrast and colonoscopy are important means of diagnosing colon cancer.
(5) Megacolon
Megacolon refers to a significant expansion of the colon with severe constipation or intractable constipation that can occur at any age. It can be a congenital or acquired acquired toxic megacolon that is a serious complication of fulminant ulcerative colitis. There are several common types:
1 congenital megacolon: is a congenital dysplasia of the intestine is due to the lack of ganglion, so it is also called ganglion deficiency, such as sex megacolon, see more than male infants than females
Familial
(1) Main clinical manifestations: 1 significant tympanic colon without colonic movement; 2 can cause chronic intestinal obstruction and cause malnutrition; 3 mild symptoms are not obvious until puberty is diagnosed 4 anal finger examination anal sphincter normal rectum ampullary Accumulate "feces".
(2) Diagnosis basis: 1 has the above clinical manifestations; 2 anal finger test rectal ampulla without a feces; 3x line abdominal plain film can be seen dilated colonic barium enema in the rectum sigmoid region with a narrow segment of the upper colon significantly expanded feces; 4 confirmed diagnosis depends on the colonic biopsy of the disease section for histochemical staining showing no ganglion cells.
2 chronic idiopathic megacolon: often in the elderly children or in the elderly over the age of 60, the cause of unknown patients often due to habitual constipation personality changes and incontinence (so-called contradictive diarrhea).
Diagnosis basis: 1 elderly children or elderly people over 60 years of age have "contradictory diarrhea"; 2 anal finger examination in the rectum ampulla can touch the feces; 3X line abdominal plain film elderly patients throughout the colon expansion right colon has gas and feces Mixed; children's sputum enema full colon expansion filled with fecal stenosis; 4 biopsy ganglion normal
3 physical or mental megacolon: this disease is often associated with abnormal neurosis or mental illness in the body and mind. Some patients imagine that they have constipation or have obsessive attitudes and behaviors, and they feel the inhibition. They must take laxatives or enema to feel the smoothness of bowel movements. . Otherwise, you feel uncomfortable with a general discomfort. Long-term use of anthracene colon stimulants, degeneration of the myenteric plexus and colonic dilatation. Patients with depression often have defecation and sensation of inhibition and autonomic imbalance. Commonly used eagle mites and diazepam can directly or indirectly inhibit constipation caused by colonic movement through the central nervous system.
Diagnostic basis: 1 clinical history of constipation and bloating; 2X line examination of colonic expansion; 3 can exclude intestinal diseases of the organic disease.
4 secondary megacolon: Central and South American (hagas disease) can destroy the colonic ganglia causing severe neurological diseases of the megacolon such as brain atrophic spinal cord injury or Parkinson's disease (Parkinson) can cause megacolon hypothyroidism and invasiveness Diseases such as amyloidosis sclerosis can reduce colonic movement and cause megacolon.
The diagnosis is mainly to find the primary disease.
5 toxic megacolon is a serious complication of fulminant ulcerative colitis easily combined with intestinal perforation.
(1) Clinical features: 1 rapid onset of hyperthermia and severe symptoms of poisoning; 2 bulging and abdominal tenderness; 3 increased white blood cell count may have hypoproteinemia and electrolyte imbalance.
(2) Diagnosis basis: 1 The above medical history and clinical manifestations; 2x line abdominal plain film showed colonic widening and flatulence.
6 Constipation caused by other causes: acute constipation is more common in her intestinal obstruction after abdominal surgery, toxic megacolon acute peritonitis intussusception. Constipation with severe abdominal pain is more common in intestinal obstruction, lead poisoning, bloody leaf disease and so on.
Differential diagnosis of atherosclerosis
Aortic atherosclerosis caused by aortic changes and aortic aneurysm, need to be differentiated from syphilitic aortitis and aortic aneurysm, chest radiograph found that aortic shadow widening should also be differentiated from mediastinal tumor. The ischemic or necrotic manifestations of other target organs need to be differentiated from those caused by other causes of arterial disease. Coronary atherosclerotic angina and myocardial infarction need to be differentiated from other causes of coronary artery disease such as coronary arteritis, coronary artery malformation, coronary embolism. Myocardial fibrosis needs to be differentiated from other heart diseases, especially primary dilated cardiomyopathy. Hypertension caused by renal atherosclerosis needs to be differentiated from other causes of hypertension. Renal artery thrombosis needs to be differentiated from kidney stones. Symptoms of atherosclerosis in the extremities need to be differentiated from other causes of arterial disease such as polyarteritis.
