Chronic enteritis

Description:

Chronic enteritis is an eurysynusic disease, occurs both at children, and at adults.
Chronic enteritis differs on severity.
The I degree has slight intestinal symptoms, insignificant disturbances of the general state. At this degree functional tests are changed minimum.

The II degree is characterized by accession to intestinal disorders of moderately expressed exchange disturbances. All functional tests considerably change.

The III degree is characterized by heavy metabolic shifts owing to considerable disturbances of intestinal digestion and absorption. Considerable change of functional tests and indicators practically of all types of exchange is characteristic.
Also chronic enteritis is conditionally subdivided on a degree of activity into stages of remission and an aggravation of process.

Symptoms of Chronic enteritis:

The clinic of chronic enteritis is characterized by various symptoms. All symptoms of a disease can be subdivided on local intestinal and the general which are expressed in a varying degree by metabolic frustration.

The clinical picture of chronic enteritis consists of three main syndromes. It is a syndrome of enteral dyspepsia, an enteritny koprologichesky syndrome and a syndrome of insufficient absorption (sprue) from which the general symptoms of a disease — the phenomenon of a polyhypovitaminosis, anemia, endocrine insufficiency, dystrophic changes in various internals result.

The syndrome of enteral dyspepsia is expressed in unpleasant feelings in paraumbilical area of a stomach, pressure, a raspiraniye and abdominal distention. For chronic enteritis the symptom of Obraztsov which consists in emergence of strong rumbling and splash at a caecum palpation is characteristic. This symptom arises owing to disturbance of digestion and absorption at which occur a bystry passage of a chyme on a small bowel and receipt of the undigested and not soaked up liquid contents and intestinal gas in a caecum.

Pains arise seldom, have stupid or spastic character, are localized in paraumbilical area, amplify in the second half of day, sometimes have skhvatkoobrazny character as intestinal colic, abate with the advent of loud rumbling. At a palpation of a stomach and strong pressure a little more to the left and above a navel morbidity (Porges's symptom) often is defined, and also it is possible to reveal morbidity on the course of a mesentery of a small bowel (Shternberg's symptom). After food there can sometimes be phenomena reminding a dumping syndrome. Emergence of these signs demonstrates transition of a disease to a severe form.

The Enteritny koprologichesky syndrome is shown frequent (4 — 6 times a day) and a plentiful chair (total quantity of fecal masses can reach per day 1,5 — 2 kg). A consistence of fecal masses kashitseobrazny, color light yellow because of availability of not recovered bilirubin and a large amount of fat which also gives to fecal masses a clay, mazeobrazny look. Existence in the fecal mass of parts of undigested food, but without visible slime and impurity of blood or pus attracts attention. If in a small intestine putrefactive processes prevail, then fecal masses gets a fetid smell and alkali reaction. At dominance of fermentative processes of excrements have a foamy appearance with vials of gas and acid reaction. In hard cases frequency rate of a chair can reach 15 times a day.

The exacerbation of chronic enteritis results from disturbances in a diet. Usually patients badly transfer the food containing a large amount of fats and carbohydrates, milk, hot and fat dishes. Also emergence of a koprologichesky syndrome is noted in response to an overeating. Sometimes there are rough desires to defecation soon after food, and after defecation there is a sharp weakness which is followed by the dizziness, nausea cold then, trembling of hands, a lowering of arterial pressure (eyunalny diarrhea). In not hard cases and in the absence of the accompanying colitis of a ponosa can be absent.

The sprue (insufficient absorption) is shown by the expressed decrease in body weight, sometimes up to exhaustion, weakness, increased fatigue, irritability, headaches, dizzinesses, decrease in working capacity.

Because of disturbance of absorption of vitamins and mineral substances symptoms of polyhypovitaminosis appear: a xeroderma, angular stomatitis, the increased fragility of nails, a hair loss, thinning and a peeling of skin, polyneurites, disturbance of twilight sight, etc.

Because of disturbances of processes of nutritive absorption and microelements signs of defeat of internal glands develop. At damage of a pancreas there are hypoglycemic phenomena which consist in emergence in 2 — 3 h after food of weakness, cold sweat, feeling of heat, heartbeat, pains in heart. These phenomena are connected with fluctuation of level of sugar in blood.

At disturbance of absorption of microelements the quantity of a number of ions, especially calcium decreases. Signs of insufficiency of epithelial bodies (hypoparathyroidism) which are characterized by pathological fragility of bones, Hvostek and Trusso's positive symptoms, spasms appear from behind it.

At insufficient function of a hypophysis there are signs of moderately expressed not diabetes mellitus, such as polydipsia, polyuria in combination with a hypoisosthenuria. At development of adrenal insufficiency to the forefront there are addisonizm symptoms: hyperpegmentation of skin, especially skin folds of palms, mucous membrane of a mouth, arterial and hypomyotonia. At dysfunction of gonads at men impotence develops, and women have an amenorrhea.

At the long course of chronic enteritis symptoms of iron-and B12-scarce anemia, the dystrophy of internals, including a liver, a myocardium, kidneys and other bodies which is shown the corresponding symptoms develop.

Diagnosis of chronic enteritis includes the general and biochemical blood tests, koprologichesky and bacteriological researches a calla, ultrasonography of a liver, bilious ways, a pancreas, endoscopic methods of a research of intestines with an aim biopsy. In the general blood test existence of anemia, in biochemical — decrease in amount of protein, cholesterol comes to light. At a koprologichesky research find undigested fat (steatorrhea), muscle fibers (creatorrhea), extracellular starch (amylorrhea), cellulose, the raised number of slime and leukocytes. At a bacteriological research dysbacteriosis comes to light.

Reasons of Chronic enteritis:

Chronic enteritis can be caused by a set of the reasons. This polyetiological disease. Sometimes it develops after the postponed acute enteritis of a small intestine, at various intestinal infections (such as dysenteric stick, staphylococcus, salmonellas, iyersiniya, campylobacters, rotaviruses), parasitic diseases (lyambliya, helminths, etc.). In this case chronic enteritis is considered as postinfectious process at which inflammatory changes in a small bowel continue, despite elimination of the causative agent of an acute infection.

Also various alimentary disturbances, alcoholism, abuse of some medicines are its frequent reasons (such as antibiotics (Neomycinum), drugs of salicylic group (aspirin), cytostatic drugs, immunodepressants). These factors lead to disturbance of balance of microflora in intestines — to dysbacteriosis which plays a significant role in a disease pathogeny.

Symptoms of chronic enteritis can be observed at food allergy. The disease can develop under the influence of industrial poisons (phosphorus, mercury, arsenic, lead, etc.) or ionizing radiation.

There are inborn forms of the lowered function of intestines which are expressed in enzimodefitsitny defeats of a small bowel. As a result of it digestive processes in a small bowel are broken, the enteritis picture gradually develops.

There is a big group of secondary chronic enterit which result from dysfunction of other bodies. This group of a disease meets at chronic atrophic gastritis secretory insufficiency, chronic pancreatitis, hepatitis, cirrhosis, a renal failure, various skin diseases (psoriasis, eczema), and also after a stomach resection.

In the mechanism of development of a disease several major factors play a role. The inflammation in intestines arises in response to the immediate chronic damaging effect on a wall of a small bowel (toxic, irritating, etc.). As a result of it dysbacteriosis develops. Usually small bowel has a scanty bacterial flora which comes to light generally in its distal departments. At dysbacteriosis the cavity of a small intestine plentifully becomes populated by microflora, atypical for it, the quantity of opportunistic microbes increases, their cultural features are transformed, aggression of microorganisms in relation to mucous a small bowel increases. For this reason digestion disturbance is aggravated, and some toxic substances produced by opportunistic microflora and which are synthesized as a result of splitting of foodstuff microbic enzymes povrezhdayushche affect a wall of a small intestine.

Besides, in development of a disease the large role is played by immunological disturbances which are expressed in formation of hypersensitivity to hydrolysates of feedstuffs or disintegration of bacterial cells. At chronic enteritis owing to toxic influences proteins of an intestinal wall which play further an antigen role are transformed, the autoallergy develops.

In development of a disease weakening of local factors of protection, decrease in production of secretory immunoglobulins have a certain value. As a result of inflammatory process there is a disturbance of production of intestinal enzymes which participate in band and pristenochny digestion, and also the enzymes carriers which are carrying out absorption in a small bowel. Very important factor of a pathogeny are also increase in motive function and increase in a tone of a small intestine. At the same time increase in excitability of nerve terminations in a small intestine therefore production of water and slime amplifies is noted.

All mechanisms of a pathogeny interact among themselves by the principle of a vicious circle.

Inflammatory process in a small bowel is resulted by the expressed changes in a histologic structure of enterocytes. Their regeneration is broken, dystrophic and atrophic changes are noted, the sizes of fibers strongly decrease. Because of it there is a disturbance of vsasyvatelny function of a small intestine, products of intestinal enzymes decrease, pristenochny digestion is broken. At chronic enteritis secondary dysfunction of many bodies comes to light: hemadens, nervous system, immunity, etc.

Treatment of Chronic enteritis:

Treatment includes a complex of the actions directed to elimination of inflammatory processes and correction of processes of absorption. It consists of a dietotherapy, medicamentous therapy, physiotherapeutic procedures.

The dietotherapy plays an extremely important role at treatment of chronic enterit. At an aggravation depending on disease severity diets No. 4, No. 4b, No. 4v are appointed. In an aggravation stage the diet No. 4, then in process of subsiding of inflammatory processes — a diet No. 4b is applied in the beginning. During recovery the diet No. 4v is shown (see. "A diet at diseases of the bodies of a digestive tract proceeding from ponosa"). After a diet No. 4v purpose of a diet No. 2 is recommended (see. "Treatment of gastritises with secretory insufficiency") for smooth transition to a table d'hote. The term of observance of these diets very variable and, as a rule, depends on disease severity and specific features of an organism.

Medicamentous therapy includes use of antibiotics, the drugs containing normal intestinal microflora, enzymatic drugs (such as креон, панзинорм, mezy, festal), sorbents, antidiarrheal drugs, proteinaceous drugs, vitamins and microelements.

Prevention of chronic enteritis includes respect for the principles of a balanced diet, adequate therapy of acute intestinal infections and food poisonings.