Chronic enteritis

Clinical symptomatology. The diagnosis. The clinical picture is observed in chronic enteritis due to functional disorders associated with structural changes (mainly atrophic process) in the mucosa of the small intestine. A significant decrease in the total surface of the small intestine (atrophy of the villi), violation of adsorption properties of its mucosa (dystrophy and change of ultrastructure kamchatyi cell surface epithelium) leads, on the one hand, in violation of processes hydrolysis in the small intestine (wall digestion), and with another - to reduce the intensity of absorption of nutrients. With the failure of hydrolysis ("maldigestion") is associated with a number of symptoms of a local nature United in local enteral syndrome. With the failure of suction ("malabsorbtion") you want to associate the common symptoms of enteric syndrome.
Incomplete hydrolysis leads to the fact that undigested substances change osmotic pressure in the cavity of the small intestine. Liquid contents absorbed insufficient, which leads to "osmotic diarrhea" (Fahrlander, 1965). It should be noted that a day in the digestive tract enters 8200 ml only the secrets of digestive glands (saliva, gastric, pancreatic and intestinal juices), most of which are newly reabsorbiruetsa (Wilkcn, 1969). Consequently, even the increased absorption of fluids in the large intestine often not able to compensate for the violation of absorption in the furnace intestine and bring the water content in Calais to normal (above 80%). Chair in chronic enteritis is rich, not very frequent (4-6 times a day), mainly in the second half of the day (the value of meals and allocation of digestive secretions). Fecal masses of light-yellow color, acid reaction; pus, blood, mucus in them does not happen. In Calais often admixture undigested fat (walls-torreilles).
The next symptom of local enteral syndrome is bloating (flatulence). Last chronic enteritis is accompanied by enhanced flatulence (excessive discharge of gases). Flatulence is more pronounced in the second half of the day. Often at considerable flatulence reflex come functional changes in other organs (heart, symptoms of angina, headaches). Subjectively, flatulence accompanied by a sense of gravity, and if it is expressed considerably, and pain.
The presence of large amounts of liquid content and gases in the subtle and the caecum with some increased peristalsis leads to the rumbling in the stomach, which is also one of the symptoms of local enteral syndrome.
Symptoms of local enteral syndrome include abdominal pain and nausea. These symptoms may accompany the flatulence, and then they are connected with the extension of the intestine wall (distantsionnye pain). Pain in chronic enteritis may also be due to the reduction (spasm) of the small intestine. In these cases they are very intense, more localized and are paroxysmal character.
As mentioned above, the local symptoms of enteric syndrome should be associated with the failure of hydrolysis of food substances (maldigestion). In this regard, in patients with chronic enterocolitis the whole complex of these symptoms (diarrhea, rumbling, bloating, nausea, pain) is the short-term in severe degree after receiving a sufficient amount of fresh milk. The milk intolerance is due to a lack of hydrolysis of milk sugar (lactose). It clearly reveals taking these sick inside purified milk sugar (1 g per 1 kg of body weight), that approximately corresponds to its content in 1 liter of milk. Intolerance to milk is one of the most frequent and initial signs pointing to the defeat of the small intestine.
The main symptom of total enteral syndrome is weight loss. Weight loss in patients with chronic enterocolitis may steadily progress to 25-30 kg and more. Depending on the severity of a pathological process and, consequently, the degree of malabsorption weight loss can occur faster and slower. Failure suction necessary substances leads to gipoproteinemii, which in severe degree (reduction of concentration of total protein in blood up to 4 grams per cent) can cause edema. Broken vitamin and mineral metabolism, may be a secondary hypochromic anemia, caused by insufficient intake of iron. Rarely observed B12-deficiency hyperchromic anemia.
Objective examination of patients with chronic enteritis the most important are the data inspection and palpation. Pallor of the skin, dry skin, more or less marked depletion, the manifestation of gipovitaminozy (brittle nails, bleeding gums, etc.). The abdomen is often swollen, palpation of his painful without clear localization. The greatest tenderness patients mark in the navel, more on the left. Palpation, especially the area of the caecum, often accompanied by rumbling.
When expressed signs of chronic enteritis with the involvement of the entire small intestine and colon (enterocolitis) data scatological studies indicate typical signs of digestion in the small intestine. Increase the daily amount of feces (politically), reaching 1 kg or more (at a rate of 0,2-0,3 kg), there is a large amount of fat (steatorrhea), altered muscle fibers (creatore) and extracellular starch (amenorea). These scatological symptoms may be absent if the abnormal limited by the upper parts of the small intestine. In these cases, the digestive process is carried out at the expense of the underlying departments intestine. On the other hand, impaired absorption of nutrients with relevant scatological symptoms can also occur with the normal state of the small intestine due to lack exocrine function of the pancreas or bile secretion, as well as a sharp strengthening of the motor activity of the bowel.
A certain value in the diagnosis of chronic enteritis is given to the study of intestinal juice, obtained with the help of the probe. It defines usually alkaline phosphatase and enterokinase. Study of the activity of these enzymes in the intestinal juice has shown that their number in the lungs and moderate cases of chronic enteritis increased, and in severe reduced (candidate of biology of Bahadirov, 1966; A. B. Frolkis et al., 1967). According to the authors, the increase in enterokinase in the intestinal juice in chronic enteritis due to increased exclusion of the epithelium in the cavity cancer.
The most accurate indicator of impairment hydrolysis of food substances in the small intestine is a feature wall digestion. It is broken in the very beginning of the development of chronic enteritis, and changes are in accordance with the degree of histopathological changes in the mucous membrane of the small intestine. Parietal digestion can be studied at the rate of adsorption properties of the surface of the small intestine (the Church, Masevich and E. A. Zabelin, 1967) or by using differentiated carbohydrate load (M. I. Demos, 1967; A. A. Levin, 1969).
Along with the violation of wall digestion, chronic enteritis may change and the vacuum function. A study last possible with quantitative determination in Calais entered per os labeled oleic acid (M. A. Vinogradova, 1965) or one of the other methods described above.
In the diagnosis of chronic enteritis, in addition to these functional studies, a significant role belongs lifetime morphological study of the mucous membrane method aspiration biopsy. It is important to stress once again that in the interpretation of data obtained by the method of aspiration biopsy, have meaning only pathological changes. Their absence does not exclude the pathological process in other parts of the small intestine. In this connection, an in vivo morphological studies using aspiration biopsy does not eliminate the need functional studies of the small intestine.
The peculiarity of chronic enteritis is a certain cyclic recurrence of the disease. The phase of deterioration together with a remission phase. The transition to the latter often occurs gradually and quite long, that gives the basis to speak about another phase of disease, incomplete remission. If her symptoms are expressed mild, and such patients differential diagnosis between chronic enteritis and other diseases of the digestive system is the most difficulties. In such cases, the role of aspiration biopsy in the diagnosis of the disease is becoming leading.