A. Symptoms and treatment of enteritis
1, anti-infective drugs: salicyl azo sulfadiazepine for the treatment of various ministries of colitis, to prevent complications have good efficacy. Some cause nausea, vomiting, headache, skin rash, granulocytopenia, anemia and poor liver function. If ineffective and with adverse reactions, metronidazole may be used instead. Neomycin and phthalothiazole are also effective.
2, hormone therapy: adrenal corticosteroids, hydrocortisone and prednisone can improve the general condition, so that the course of the disease remission, the number of fecal discharge decreased, relapse symptoms reduced and appetite increased. However, there are patients with poor results and can make the ulcer perforated, bleeding and slow healing. The application is now considered to be small, and for patients with acute fulminant or early severe attacks can lead to a significant reduction in symptoms and improvement; for long-term recurrent attacks the effect is not satisfactory; corticosteroid units dissolved in glucose solution, intravenous drip, and switch to intramuscular injection when symptoms improve. Hydrocortisone is given intravenously, and the dose is gradually reduced after the symptoms are relieved. Corticosteroids have better utility than cortisone for symptom relief, but less utility than cortisone for maintaining relief. This treatment should not be continued for more than 2 weeks if the symptoms do not improve.
3. Immunosuppressive drugs: Azathioprine, once daily, can change the course of the disease and suppress clinical manifestations, but cannot change the underlying disease; it is often used in the quiescent phase to reduce relapses and may be toxic, so care should be taken. 6 thiopurine (6-MP) in combination with hormones can reduce symptoms.
4, antidiarrheal drugs: can reduce the number of fecal excretion, reduce abdominal pain, commonly used compound phenylephrine, codeine and compound camphor tincture. Antidiarrheal drugs for acute episodes of ulcerative colitis may cause toxic megacolon, should be used with caution. Can also give sedative drugs and antispasmodic drugs.
5, retention enema: commonly used in rectal and sigmoid colitis, can reduce symptoms and promote ulcer healing.
6, Chinese medicine treatment: for chronic colitis long-term patients or patients willing to repeatedly, it is recommended that you can use Chinese medicine for treatment, and pay attention to the diet, such as the course of taking “Yongcang Huling anti-diarrhea capsule” effect is very good.
The diet of enteritis is contraindicated
1, avoid tobacco and spicy food: ethanol can dissolve the epithelial lipoprotein layer of the gastric mucosa, there is greater damage to the gastric mucosa, people in smoking, the smoke of harmful substances, dissolved and attached to the mouth, throat, with swallowing into the stomach, these harmful substances on the gastric mucosa is also very damaging. Therefore, patients with acute and chronic gastritis, must quit smoking and drinking to avoid aggravating the disease, and even cause malignant changes.
Especially the old and frail, gastrointestinal function is reduced, 4-5 meals a day is better, each time to sixty to seventy percent full is good. Pay attention to the ratio of sugar, fat and protein in food, pay attention to the content of vitamins and other essential nutrients.
3, avoid unclean diet: gastritis patients should pay special attention to dietary hygiene, especially in summer, raw fruits and vegetables to wash, do not eat spoiled food. The reason is that the contaminated and spoiled food contains a lot of bacteria and bacterial toxins, which have a direct damaging effect on the gastric mucosa. Food placed in the refrigerator, must be cooked thoroughly before eating, such as found spoiled, to firmly throw away, prohibit consumption.
4, avoid too cold, hot, hard food: too cold food and drink, after eating people can lead to stomach cramps, gastric mucosal vasoconstriction, not conducive to inflammation; too hot food and drink, after eating will directly burn or stimulate the mucosa in the stomach. The food for gastritis patients should be soft and hard, too hard and rough food, coarse fiber vegetables, fried or barbecued food with oil, after consumption can increase the mechanical digestive burden of the stomach, so that the gastric mucosa is damaged by abrasion, aggravating the inflammatory lesions of the mucosa.
In addition, chili pepper, mustard, pepper, strong tea, coffee, cocoa and other food or drink, the gastric mucosa has a stimulating effect, can make the mucosa congestion, aggravate the inflammation, should also be abstained.
Third, enteritis and dysentery dietary therapy
1, dysentery patients diet to less oil (oil food), less fiber-based. In the early stage of the disease can only eat light liquid food such as thick rice soup, light juice, noodle soup, hot tea, to quench thirst.
2, after the number of bowel movements is reduced, you can drink some broth (remove oil), milk, soy milk, egg white soup juice and other liquid diet. Later, you can gradually give a light, less oil, less residue semi-liquid diet, such as rice porridge, lotus root powder, noodles, etc.
3, diarrhea such as complete cessation, you can add egg custard, fish fillets, minced tender lean meat, vegetable puree and other soft foods. Even if you have a strong appetite, you can only use a small amount of multi-meal eating method, and the total amount of food per meal should not be too much, in order to facilitate digestion (digestive food).
4, such as intestinal fermentation is too strong, you can eat food containing protein (protein food) and a small amount of fat such as dairy, eggs, soy milk, tofu, etc.; eat less sugar, because sugar is easy to fermentation, gas production. If the intestinal corruption is strong, eat starchy foods such as potatoes, taro, rice, flour, etc.; eat less meat, eggs, fish and beans and other protein-rich foods that can easily cause intestinal corruption.
5, every day should be given a large number of drinks containing vitamin (vitamin food) C such as fresh orange juice, tomato juice. The condition of giving fortified vitamin C juice, is more ideal (i.e., in the juice with vitamin C tablets in the drink).
6, avoid alcohol, coffee, fat, cold tea, soft drinks, hard and multi-fiber vegetables (vegetable food), fruits (fruit food), etc.
The determination of pediatric viral enteritis
The symptoms of pediatric viral enteritis are mostly due to infection with coxsackie virus, echovirus, and poliovirus. These viruses have a strong affinity for myocardial cells, and when a child’s resistance decreases, the intestinal virus will “take advantage of the situation” and attack the myocardium through the digestive tract via the blood circulation, interfering with myocardial metabolism and affecting myocardial blood supply, causing inflammatory damage to the myocardium and triggering viral myocarditis.
Viral myocarditis accounts for the first of all types of myocarditis, and the incidence is increasing year by year. Children with the disease often have fever, fatigue, loss of appetite, vomiting, abdominal pain, and resolution of dilute watery stools 1-4 weeks before the disease. The clinical manifestations of myocarditis are pallor, dizziness, chest tightness, panic, discomfort or pain in the precordial area, and examination reveals findings such as arrhythmia and heart enlargement; in severe cases, facial swelling, inability to lie down, difficulty in breathing, etc., and even life-threatening due to cardiogenic shock and severe arrhythmia.
Therefore, children with recurrent fever and diarrhea should be alerted to viral myocarditis if the above symptoms appear. Once diagnosed, patients should rest in bed for 1-3 months during the acute phase.
V. Performance of patients with chronic enteritis
Chronic enteritis refers to a chronic inflammatory disease of the intestinal tract, the cause of which can be bacterial, mycobacterial, viral, protozoan and other microbial infections, but also allergies, allergic reactions and other causes. Clinical manifestations are long-term chronic or recurrent abdominal pain, diarrhea and dyspepsia, and in severe cases, mucus stools or watery stools.
The symptoms of chronic enteritis in Chinese medicine.
1, to identify the disease slowly and urgently: chronic diarrhea onset slowly, the course of the disease is long, prolonged for a long time, every improper diet, excessive fatigue and relapse, often dominated by spleen deficiency. Or the disease is prolonged and the kidneys, the appearance of the five shifts of diarrhea, waist and knees afraid of cold, is the fate of the fire failure, spleen and kidney disease, treatment is the spleen and kidney treatment.
2.Discern the severity of the disease: general diarrhea, if the spleen and stomach do not fail, eating as usual, most of the symptoms are mild, the prognosis is good. If the diarrhea can’t eat, the body is thin, the drainage is inordinate; or long diarrhea slippage can’t be stopped, resulting in fluid exhaustion, there is a death of yin, death of yang changes, most of them are serious. “The disease cavity catharsis not to eat, the pulse is urgent, then death.” It can be seen that can eat and can not eat, for weighing the severity of diarrhea has important significance.
3, identify cold deficiency: where the disease is long, abdominal pain is not very, abdominal pain like press, small convenience, not thirsty, mostly deficiency evidence. The fecal matter is clear and thin like water, abdominal pain like warm, fear of cold and swelling cold, stubborn, hands and feet are not warm, more cold disease.
4, chronic enteritis of traditional Chinese medicine identification points include identification and hostages: diarrhea and also vicious cold sweating, fever, headache, pulse floating, for hostage to the wind; diarrhea occurs in the hot summer season, the symptoms see body heat and thirst, head heavy sweating, pulse moistening number, for hostage to the summer; diarrhea and cavity and abdominal stuffiness, belching sour odor, for hostage to injury.
Seven, the symptoms of acute enteritis
Acute enteritis is caused by eating food containing pathogenic bacteria and their toxins, or improper diet, such as an excess of irritating indigestible food and acute inflammatory changes in the mucosa of the gastrointestinal tract. The pathological manifestations are congestion, edema, increased mucus secretion, sometimes accompanied by bleeding and erosion of the mucosa of the gastrointestinal tract. In China, the incidence is higher in summer and autumn, without gender differences, and the general incubation period is 12D36 hours.
The symptoms of enteritis are nausea, vomiting and diarrhea are the main symptoms of acute gastroenteritis. Why does acute gastroenteritis cause vomiting and diarrhea? It is produced by the action of nerve reflex. In acute gastroenteritis, due to bacteria, toxins or inflammation of the gastrointestinal mucosa, the receptors of the digestive tract are stimulated and impulses are transmitted to the vomiting center of the medulla oblongata, causing excitation of the vomiting center, which reaches the stomach, diaphragm, respiratory muscles, abdominal muscles and pharynx, palate and epiglottis respectively through the efferent nerves, causing a series of coordinated movements that make up the vomiting action. At the same time, due to the inflammatory stimulation of intestinal mucosa, the intestinal contents increase, which directly or reflexively causes increased intestinal peristalsis and decreased absorptive function, and diarrhea occurs.
Since vomiting and diarrhea have a certain protective effect on the human body under certain circumstances, different measures should be taken clinically according to different situations, such as food poisoning or accidental poisoning, not only should anti-diarrheal drugs not be given, but on the contrary, emetic and laxative drugs should be given to promote the excretion of the poison. If the vomiting and diarrhea caused by inflammation of the digestive tract, in order to reduce the adverse effects of water and salt metabolism and electrolyte imbalance on the body, antiemetic and antidiarrheal treatment should be given along with active treatment of the cause.
Eight: Tips for preventing enteritis in summer
Gastroenteritis caused by bacterial infection is easier to prevent. For example, feeding utensils or comfort pacifiers should be disinfected before they are used. Make sure that members of the family are very hygienic and that food is stored at the right temperature. To avoid salmonella infection, eggs and chicken should be cooked well. You must also pay special attention to your child’s personal hygiene, especially making sure that he washes his hands after using the toilet.
Prevention of acute gastroenteritis
Acute gastroenteritis is a common disease of the gastrointestinal tract, usually caused by inflammation of the mucous membrane of the gastrointestinal tract from eating food contaminated with bacteria or viruses. This disease can be prevented as long as the “disease from the mouth” off.
Ten, do not eat unclean fruits and melons
Melons and fruits during the growth of watering, fertilization, spraying pesticides, in the collection, handling and sale process, susceptible to bacterial infection, so many melons and fruits with bacteria, insect eggs and chemical pesticides on the skin, so melons and fruits must be repeatedly rinsed with water several times before eating. Where the melon can be peeled, should be peeled before eating, otherwise pesticide accumulation poisoning is likely to occur.
Eleven, pediatric viral enteritis and bacillary dysentery differentiation
Varies depending on the pathogen. Generally should be based on the epidemiological history and clinical manifestations of the initial judgment. Further confirmation of diagnosis depends on laboratory tests. Bacterial enteritis can be made vomit and stool culture to obtain the pathogenic bacteria to confirm the diagnosis. Some pathogens, such as Salmonella infection, can be blood cultures. Viral gastroenteritis can be examined for viral antigens and antibodies by electron microscopy, immunoelectron microscopy, immunofluorescence and serological tests such as complement binding test, enzyme-linked immunosorbent assay and radioimmunoassay. The virus can also be isolated by tissue culture. Parasitic enteritis can be examined directly by microscopy to look for pathogens and their eggs. Fungal enteritis can be direct smear from the stool, fungal examination under the microscope or stool fungal culture.
1, pediatric bacillary dysentery: most commonly seen in children aged 1-7 years, systemic symptoms, diarrhea as the first symptom, stool more than 10 times a day, mucus stool, stool microscopy can be seen in a large number of white blood cells, stool PH value greater than 7, stool culture can be seen Shigella positive.
2, viral enteritis: mostly seen in 6 months-2 years old children, light systemic symptoms, vomiting, cough as the first symptoms, stool 3-10 times a day, watery stool, stool PH value less than 7, the stool can be isolated rotavirus.
Twelve, the general classification of enteritis
The pathogenesis is complex, and the pathogenic bacteria adhere to the epithelial cells of the intestinal mucosa through bacterial hairs, allowing the bacteria to grow and multiply in the intestinal wall, which becomes a prerequisite for disease. The pathogenic bacteria of bacterial enteritis can be divided into two categories: enterotoxin-producing and invasive. The pathogenesis and clinical manifestations of enteritis caused by different pathogenic bacteria are different.
Enterotoxic bacterial enteritis. The pathogenesis, such as cholera, is that the pathogenic bacteria adhere to but do not invade the intestinal mucosa, and secrete enterotoxins during bacterial growth and reproduction, which bind to the epithelial cell membrane receptors of the small intestinal mucosa and activate adenylate cyclase on the cell membrane. When the level of intracellular cAMP increases, a series of enzymatic reactions cause the mucosa of the small intestine to secrete a large amount of water and electrolytes, which are retained in the intestinal lumen and cause watery diarrhea, called “secretory diarrhea. In these patients, except for the hypersecretion of small intestinal mucosal epithelial cells, the pathological changes in the intestine are often absent or very mild. The pathogen mainly infects the small intestine, so the basic clinical manifestations are more frequent diarrhea, a large number of watery stools, no pus and blood, generally no abdominal pain, no feeling of urgency, often accompanied by vomiting, prone to dehydration, electrolyte disorders and acidosis, and mild symptoms of systemic toxicity. The stool microscopy is often without red and white blood cells or very few.
Invasive bacterial enteritis. As in bacterial dysentery, the pathogenic bacteria adhere to and invade the intestinal mucosa and submucosa, causing significant inflammation. Different pathogenic bacteria invade different parts of the intestine, some invade mainly the small intestine, some invade mainly the colon, and some cause inflammation of the small intestine and colon. The basic clinical manifestations of this type of enteritis are: significant systemic toxemia, high fever, and infectious shock in severe cases. The stool may be mucopurulent and bloody, with low stool volume and high stool frequency. Abdominal pain is obvious, with paroxysmal colic. If the lesion invades the lower colon, especially the rectum, there may be a feeling of urgency and heaviness. On sigmoidoscopy, diffuse inflammation and ulceration can be seen. If only the small intestine or upper colon is invaded, the stool contains more water and is not accompanied by shortness of breath. The stool microscopy has a majority of white blood cells, especially in the case of lower colitis is more obvious.
Thirteen, bacterial enteritis disease pathology
Bacterial enteritis. The pathogenesis is more complex, the pathogenic bacteria adhere to the epithelial cells of the intestinal mucosa through bacterial hairs, so that bacteria can grow and multiply in the intestinal wall, which becomes a prerequisite for disease. The pathogenic bacteria of bacterial enteritis can be divided into two categories: enterotoxin-producing and invasive. The pathogenesis and clinical manifestations of enteritis caused by different pathogenic bacteria are different.
Enterotoxic bacterial enteritis. The pathogenesis, such as cholera, is that the pathogenic bacteria adhere to but do not invade the intestinal mucosa, and secrete enterotoxins during bacterial growth and reproduction, which bind to the epithelial cell membrane receptors of the small intestinal mucosa and activate adenylate cyclase on the cell membrane. When the level of intracellular cAMP increases, a series of enzymatic reactions cause the mucous membrane of the small intestine to secrete a large amount of water and electrolytes, which are retained in the intestinal lumen and cause watery diarrhea. In these patients, except for the hypersecretion of small intestinal mucosal epithelial cells, the pathological changes in the intestinal tract are often absent or very mild. The pathogen mainly infects the small intestine, so the basic clinical manifestations are more frequent diarrhea, a large number of watery stools, no pus and blood, generally no abdominal pain, no feeling of urgency, often accompanied by vomiting, prone to dehydration, electrolyte disorders and acidosis, and light systemic symptoms of toxicity. The stool microscopy is often without red and white blood cells or very few.
Invasive bacterial enteritis. As in bacterial dysentery, the pathogenic bacteria adhere to and invade the intestinal mucosa and submucosa, causing significant inflammation. Different pathogenic bacteria invade different parts of the intestine, some invade mainly the small intestine, some invade mainly the colon, and some cause inflammation of the small intestine and colon. The basic clinical manifestations of this type of enteritis are: significant systemic toxemia, high fever, and infectious shock in severe cases. The stool may be mucopurulent and bloody, with low stool volume and high stool frequency. Abdominal pain is obvious, with paroxysmal colic. If the lesion invades the lower colon, especially the rectum, there may be a feeling of urgency and heaviness. On sigmoidoscopy, diffuse inflammation and ulceration can be seen. If only the small intestine or upper colon is invaded, the stool contains more water and is not accompanied by shortness of breath. The stool microscopy has most white blood cells, especially in the case of lower colitis.
The causes of enteritis
Chronic enteritis is most commonly caused by bacteria and viruses. A small number of enteritis of unknown etiology. The causative agent of bacterial enteritis is Bacillus dysenteriae most commonly, followed by Campylobacter jejuni and Salmonella. Among viral gastroenteritis, rotavirus is the main cause of diarrhea in infants and children, while norovirus is the main cause of epidemic viral gastroenteritis in adults and older children. Parasite-induced enteritis is more commonly associated with ameba in lysate. Fungal enteritis is most frequently caused by Candida albicans. In addition, irregular rest and mental overstrain is also a cause of this disease.
Fifteen, enteritis has more causes, the main causes are as follows.
1, viral enteritis
Viral enteritis is seen in enteritis caused by canine distemper virus, canine microvirus, canine and feline coronavirus, feline panleukopenia virus, etc.
2, bacterial enteritis
Bacterial enteritis can be seen in enteritis caused by E. coli, Salmonella, Yersinia (causing small intestinal colitis), hair-like bacterium, Campylobacter jejuni, Clostridium (canine hemorrhagic gastroenteritis), etc.
3, fungal enteritis
Fungal enteritis see histoplasma, algae, Aspergillus, Candida albicans, etc. caused by enteritis.
4, parasitic enteritis
Parasitic enteritis can be seen in enteritis caused by flagellates, coccidia, toxoplasma, roundworms, hookworms, etc.
5.Enteritis caused by diet
The food is not only a good source of food, but also a good source of food.
6, drug-induced enteritis
The abuse of antibiotics, changing the microbiota present in the intestine, or the emergence of antibiotic-resistant strains of bacteria caused by enteritis.
Sixteen, the basic overview of enteritis
Enteritis is a bacterial, viral, fungal and parasitic cause of gastroenteritis, small bowel inflammation and colitis. Clinical manifestations are nausea, vomiting, abdominal pain, diarrhea, dilute watery stool or mucus-purulent blood stool. Some patients may have fever and a feeling of urgency, so it is also called infectious diarrhea. Enteritis is divided into two categories, acute and chronic, according to the length of the disease.
The duration of chronic enteritis is usually more than two months, and the common clinical conditions include chronic bacterial dysentery, chronic amebic dysentery, schistosomiasis, nonspecific ulcerative colitis, and restrictive enteritis. Enteritis is extremely common, with about 3-5 billion cases worldwide each year, and the incidence and mortality rates are especially high in developing countries, especially in children. According to the World Health Organization, infectious diarrhea is the most prevalent infectious disease among children in developing countries, with a mortality rate of about 20%, and it claims the lives of about 4.6 million infants and children each year in Asia, Africa and Latin America alone.