Pathogenesis, signs and therapy of intestinal ulcers. Diseases of the ileum: symptoms and signs of the disease, treatment

Diagnosis of diseases of the small intestine

N. B. Gubergrits, Dr. med. Sciences, Professor of the Department of Internal Medicine No. 1
Donetsk State Medical University

Diseases of the small intestine are one of the least studied areas of internal medicine. The difficulties in diagnosing diseases of the small intestine are largely explained by the peculiarities of the location of the organ, which is almost inaccessible for research, the similarity of clinical syndromes, and the presence of extraintestinal symptoms of the disease in patients - hemorrhagic, endocrine, osteoarthralgic, skin and other systemic signs of malabsorption. The clinical picture of diseases of the small intestine is determined mainly by the presence of malabsorption syndrome (MSS), while the symptoms of the underlying disease may not be sufficiently pronounced, which makes differential diagnosis difficult.

In cases of II and especially III severity of SNV, a targeted examination allows us to identify more rare but severe forms of pathology: celiac enteropathy, common variable immunodeficiency (CVID), Crohn's disease, Whipple's disease, diverticular disease of the small intestine, lymphoproliferative and other diseases.

Of decisive importance in the differential diagnosis of diseases of the small intestine is the analysis of the characteristics of the clinical picture, as well as histological, endoscopic, radiological and immunological methods. The role of each of them is not the same for different nosological forms.

During visual endoscopic examination, patients with malabsorption syndrome often exhibit varying degrees of atrophy of the small intestinal mucosa. In exudative enteropathy, lymphoproliferative diseases, lymphangiomatosis, primary and secondary lymphangiectasia, as well as in some patients with Whipple's disease, the mucous membrane has a greasy appearance, on its surface there may be whitish deposits resembling snow flakes, the folds are sharply thickened. As a result of edema, the intestinal lumen narrows, and its diameter is only slightly larger than the diameter of the endoscope tourniquet. These changes are caused by lymphostasis. Primary and secondary immunodeficiencies are characterized by multiple elements of nodular lymphoid hyperplasia in the submucosal layer, sometimes reaching large sizes.

The advantages of the intestinoscopy method include: 1) the possibility of obtaining biopsy material from various parts of the small intestine, 2) the diagnosis of focal lesions, 3) the possibility of performing endoscopic polypectomy. It should be noted that to recognize most diseases of the small intestine it is not necessary to have special equipment (intestinoscope and enterobiopsy machines). Pathological changes in the jejunum and postbulbar part of the duodenum (according to the Central Research Institute of Gastroenterology) are the same in most patients with SNV, so the diagnosis of the most clinically important diseases can be successfully carried out in almost any medical institution. However, the information content of biopsies largely depends on the processing of the material, defects of which can lead to artifacts and distort the morphological picture of the mucous membrane.

Biopsy of the small intestinal mucosa is the method of choice in the diagnosis of celiac enteropathy (GEP), Whipple's disease, primary lymphangiectasia and amyloidosis. In patients with GEP, atrophy of varying severity is observed. The villi of the small intestine are smoothed or completely absent, the crypts are elongated. The number of mitotic figures is sharply increased in them, and there is abundant lymphoplasmacytic infiltration in the stroma.

In Whipple's disease, using the morphological method, large PAS-positive macrophages can be detected infiltrating the own layer of the mucous membrane. In the acute stage of the disease, electron microscopy reveals carinobacteria.

In patients with primary intestinal lymphangiectasia, the villi and crypts are normal, but dilated lymphatic vessels are visible in the stroma.

Functional methods for studying the small intestine include the hydrogen test and the jejunoperfusion method. The phenomenon of an increase in the level of hydrogen in the exhaled air after a load with lactose is used to diagnose hypolactasia, and the hydrogen “peak” after a load of lactulose, which is not broken down in the small intestine, is used to determine the time of its passage through the large intestine. The hydrogen test is used to detect bacterial contamination of the small intestine; it directly depends on the concentration of hydrogen in the exhaled air on an empty stomach: in patients with dysbiosis of the small intestine it is several times higher than the norm.

The use of the method of jejunoperfusion of the small intestine with nutrient solutions makes it possible to solve diagnostic issues at the level of modern achievements in the physiology of digestion, to identify increased secretion of water and electrolytes into the intestinal lumen, and the influence on these processes of glucose and other substances that provide energy to the transport systems of enterocytes.

Immunological methods play a major role in the recognition of CVID with deficiency of all classes of immunoglobulins, heavy a-chain diseases. With OVID, the concentration of immunoglobulins G decreases, and in most patients, immunoglobulins A and M. In heavy a-chain disease (Mediterranean lymphoma), pathological immunoglobulin A is detected at an early stage, the molecules of which consist only of heavy a-chains.

In the differential diagnosis of Crohn's disease, tumors of the small intestine, tuberculous ileotiflitis, diverticulosis of the small intestine, ulcers of the small intestine, congenital anomalies of rotation, the leading role belongs to X-ray methods. The characteristic radiological signs of Crohn's disease are clear boundaries of the intestinal lesion, a cellular pattern of the mucosa due to leakage of barium suspension into deep slit-like ulcers (a symptom of "cobblestone pavement"). When scarring ulcers, shrinkage and shortening of the intestine, stenosis of its lumen occurs. Internal fistulas, an adhesive conglomerate of intestinal loops, may also form. The most reliable signs of Crohn's disease are endoscopic and histological changes. The latter are characterized by hyperplasia of lymphoid elements in the form of follicles in the submucosal layer, the formation of granulomas consisting of epithelioid cells and Langhans giant cells. Ulcers and intramural abscesses may be found. The morphological changes described above are fully revealed when studying the resected section of the intestine.

In tumors of the small intestine, radiographically observed filling defects, invaginations, circular narrowing of the intestinal lumen, deformation of the mucosal relief, rigidity of the shadow of the intestinal walls and the shadow of the tumor itself. In patients with lymphomas, the intestine has polycyclic contours due to external compression by enlarged lymph nodes.

With diverticular disease, multiple pouch-like protrusions of various sizes are identified on the outer surface of the small intestine.

Using X-ray methods, rotational anomalies of the intestine are also detected, which are characterized by displacement of the small or large intestine in the abdominal cavity and the presence of a common mesentery.

Chronic diarrhea can be observed not only in diseases of the small intestine, but also in many others: hyperthyroidism, Addison's disease, Symonds, duodenal ulcer, duodenitis, cholelithiasis and chronic cholecystitis, chronic hepatitis, pancreatitis, intestinal syphilis, nonspecific ulcerative colitis, diseases Crohn's colon, tumors of the stomach and colon, pancreas, etc.

To clarify the diagnosis, in some cases, it is necessary to involve not only gastroenterologists, but also endocrinologists, oncologists, neuropsychiatrists and other specialists.

Thus, differential diagnosis of diseases of the small intestine is possible only in the conditions of gastroenterological departments of multidisciplinary hospitals.

Literature

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Parfenov A. I., Krums L. M., Ekisenina N. I. Diagnosis of diseases of the small intestine // Clinical Medicine.- 1991.- No. 11.- P. 103–107.
Sivash E.S. Clinical and radiological picture of the small intestine in the syndrome of impaired absorption (SNS) // Ros. gastroent. journal - 1997. - No. 4. - P. 123.
Sivash E. S. X-ray examination of the small intestine in malabsorption syndrome // Proc. report Ros. Association of Radiologists “Radiation diagnostics and therapy of the bronchopulmonary system and gastrointestinal tract.” - M., 1998. - pp. 101–104.
Sivash E. S., Tsvetkov V. F. The importance of the X-ray method of examination in the diagnosis of celiac sprue // Bulletin of Radiology. and radiol.- 1991.- No. 4.- P. 20–26.
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The literature remains poor in reports of nonspecific ulcers of the small intestine. The first detailed work in Russian literature devoted to this issue belongs to S. M. Rubashev (1928). By 1961, we were able to find descriptions of 47 cases of nonspecific ulcers of the small intestine. P. 3. By 1965, Kletskin and B.A. Berlinskikh had collected 130 cases in the domestic literature and added their own 9 (139 in total). Subsequently, a description of 29 more observations appeared: D. V. Fedotkin, E. L. Kenng (1967) - 9, A. G. Kutepov (1968) - 19, P. A. Sazhenin, V. S. Kurko (1974) - 1. We must assume that this is not exhaustive, but close to the truth data - about 200 ulcers of the small intestine are described in the domestic literature. This disease is also rare in other countries. Watson, by 1963, found a description of only 170 cases of nonspecific ulcers of the small intestine in the world literature (Anderson, Drake, Beal, 1966).

Small intestinal ulcer has many synonyms: idiopathic, nonspecific, peptic, tryptic, simple, round - there are more names than the number of patients encountered by each surgeon. In our opinion, for simplicity and convenience, this disease should be called “ulcer of the small intestine” without explanatory words, by analogy with peptic ulcer of another localization (for example, stomach). This also makes sense because peptic ulcer of the small intestine has much in common with gastric ulcer (K. D. Toskin, 1955). Small intestinal ulcers are more common in men aged 30 to 60 years. The causes of small intestinal ulcers are not clear. In many patients, the disease can be associated with long-term poor diet, frequent consumption of strong alcoholic beverages and other negative effects on the functional state of the gastrointestinal tract and the body's defense reactions. Some authors (Dyck, 1963) associate the severe progressive course of penetrating ulcers of the small intestine with a sharp increase in the content of hydrochloric acid in gastric juice. Importance is given to heterotopia of the gastric mucosa. Sometimes acute ulcers of the small intestine occur after operations on the stomach (Alnor, Ehlers, 1962), after appendectomy (S. 3. Kletskin, B. A. Berdinskikh, 1968), with relapse of stomach cancer (V. I. Rusakov, 1961), after abdominal bruises. Apparently, powerful neuroreflex influences are important, since ulcers and necrosis of the intestine associated with brain damage have been described (N. N. Burdenko, V. N. Mogilnitsky, L. O. Korst, etc.) and with brain disorders, caused by impaired cardiovascular activity (P. 3. Kletskin, B. A. Berdinskikh; Anderson, Drake, Beal. 1966). P. 3. Kletskin and B.A. Berdinskikh described a case of perforation of two ulcers of the small intestine in a patient with a wound to the lung and heart. The data presented are similar to those for stress gastric ulcers.

Localization of small intestinal ulcers

Pathogenesis peptic ulcer of the small intestine is unique and differs significantly from the pathogenesis of gastric and duodenal ulcers. A feature of the pathogenesis of small intestinal ulcers is their tendency to rapidly destroy the organ wall, which causes very frequent perforation and complications with massive bleeding. Ulcers of the small intestine are not prone to penetration. Only isolated cases of penetration of ulcers into the upper parts of the intestine have been described. The rapid course of the process, frequent perforations, sometimes accompanied by hemorrhages in the mesentery and intestinal wall, force us to think about the participation of allergic factors in the etiology and pathogenesis of small intestinal ulcers. Chronic ulcers with scarring and development of peri-process can be the cause of obstructive or strangulating intestinal obstruction.

Let us present one of our observations relating to the period of work in Novosibirsk.

Patient P., 44 years old (case history 671) was taken to the surgical department of the 1st clinical hospital by ambulance on 05/08/52 at 13:00. 20 minutes. intoxicated with complaints of cramping abdominal pain and vomiting. The patient is of average height, somewhat undernourished, groans, and stands at times intensifying to the point of screaming, which coincides with motor restlessness, expressed in taking bizarre poses in search of a position that alleviates suffering. There is vomiting of cloudy liquid with a greenish tint. Answers questions vaguely. I only managed to find out that I drank a lot of vodka the night before. I woke up in the morning with stomach pains. I had never had abdominal pain before.

The general condition of the patient is moderate. The pulse is rhythmic, satisfactory filling, 78 beats per minute. The boundaries of the heart are within normal limits, the tones are somewhat muffled, but clear. Lungs unchanged.

The tongue is thickly coated with a grayish-brown coating and is dry. Many teeth are missing. The abdomen is flat, the upper half is slightly involved in the act of breathing. On palpation, sharp pain is noted in the lower half of the abdomen. The Shchetkin-Blumberg symptom is vague. Percussion revealed a shortening of the sound in the left iliac region. Hepatic dullness is preserved. It is impossible to palpate the abdominal organs due to the sharp tension of the muscles of the anterior abdominal wall. Auscultation - silence. The rectal ampulla is empty; a painful elastic formation resembling an intestine in shape is palpated on the left.

With a diagnosis of intestinal obstruction, peritonitis, the patient was taken to the operating table.

Operation. Under ether anesthesia, the abdominal cavity was opened layer by layer using a lower midline incision, from which a large amount of cloudy hemorrhagic fluid with a fetid odor was released. The adjacent loops of the intestine are sharply hyperemic with fibrinous-purulent plaque. A round hole with a diameter of up to 2.5 cm was found on one of the loops of the ileum. The edges of the perforation hole are uneven, bordered by protruding mucosa, the serous membrane is thickened and compacted. Loose blood clots are visible in the intestinal lumen. In the pelvis there is a large amount of purulent mucous fluid mixed with intestinal contents and the remains of undigested food (pieces of tomatoes, eggshells). There are many small hemorrhages throughout the intestine and mesentery. At the root of the ileal mesentery, near the perforation, there is a large hemorrhage, protruding in the form of a sausage-shaped formation up to 10 cm long. After toileting the abdominal cavity, a resection of the intestine was performed for 8 cm, followed by the application of a suspended enterostomy to a slightly changed area of the ileum. 400,000 units of penicillin were injected into the abdominal cavity. Two rubber strips are placed to the lateral abdominal folds and one to the pelvis. Suturing the wound. The postoperative period proceeded without complications. 06/23/52 patient was discharged from the clinic in good condition.

Microscopic examination of the preparation - at the edges of the ulcer there is tissue necrosis and impregnation with leukocytes. No specific changes found.

Ulcers are most often localized in the ileum, but are also found in other parts of it (Fig. 59). According to K. D. Toskin (1955), in half of the patients the ulcers are localized in the terminal part of the ileum and in 1/3 - in the initial part of the jejunum. As a rule, the ulcers are solitary. A. G. Kutepov (1968) of 19 patients found a single ulcer in 15, two ulcers in 2, and three (all perforated) in 3. The size of the ulcers is from 0.5 to 1.5-2.5 cm.

The clinical picture of uncomplicated ulcers of the small intestine is inexpressive: periodic abdominal pain, sometimes worsening after eating, sometimes diarrhea, bloating, “sensation of peristalsis” and other symptoms that can occur with many other diseases,

The main manifestation of a small intestinal ulcer is perforation into the abdominal cavity. Provoking factors can include rich food, alcoholic drinks, and physical activity. In about half of patients, the disease begins suddenly in the midst of full health.

All authors write about the impossibility of preoperative diagnosis of a perforated ulcer of the small intestine, which is most likely explained by the exceptional rarity of the disease and the limited familiarity of doctors with this disease. Of course, it is impossible to differentiate between perforation of a nonspecific ulcer and, for example, perforation of a benign tumor of the small intestine. But in some cases the localization of the perforation can be determined.

The disease begins with sudden abdominal pain, which patients compare to being stabbed by a knife. Pain most often occurs in the lower half of the abdomen, but often in the epigastrium. Patients take a forced position, groaning from pain, which, unlike a perforated stomach ulcer, is accompanied by repeated painful vomiting. The abdomen becomes board-shaped, the tongue quickly dries out, the initially slow pulse increases sharply, intoxication increases - diffuse peritonitis develops, with which the patient is taken to the hospital.

In patients with perforated ulcers of the small intestine, intoxication increases very quickly. In a short period of time, large changes in the white blood formula develop. With a slight increase or normal number of leukocytes, a sharp shift to the left occurs, eosinophils disappear, and the number of lymphocytes and monocytes decreases significantly, which indicates inhibition of the body's defense reactions. Consequently, the characteristic symptoms for a perforated ulcer of the small intestine are sudden dagger pains (this also happens when the stomach wall is perforated) and vomiting (which happens very rarely with a perforated gastric ulcer).

In a minority of patients, the first manifestation of a small intestinal ulcer is massive bleeding. The clinical picture depends on the intensity of bleeding and the characteristics of the patient's reactions. Feszler (1964) believes that in 4.5% of patients, massive gastrointestinal bleeding is associated with ulcers of the jejunum. The clinical picture in some patients consists of two complications: perforation and massive bleeding.

Cicatricial narrowing of the intestinal lumen and deformities cause symptoms of a gradually increasing clinic of intestinal obstruction. Ulcers, accompanied by penetration and periprocess, can give a picture of acute intestinal obstruction, especially severe when the ulcer is localized in the upper small intestine.

Diagnosis of chronic ulcers of the small intestine is almost impossible. Ulcers complicated by perforation, bleeding or intestinal obstruction are also poorly recognized. Patients, as a rule, are operated on with a diagnosis of “perforated gastric ulcer”, “acute appendicitis”, “intestinal obstruction”, and in case of massive bleeding they most often think about a duodenal ulcer or a disintegrating tumor.

The starting point in the diagnosis of perforated ulcers of the small intestine can be dagger pain in the lower abdomen, repeated vomiting, symptoms of peritonitis and gas in the abdominal cavity. Air in the abdominal cavity is detected in approximately 40% of patients (D.V. Fedotkin, E.A. Koenig, 1967).

The diagnosis should use the entire range of studies of a patient with acute abdominal pathology. The most important condition must be to follow the basic rule of emergency surgery: if there are symptoms of peritonitis, immediate surgery. The diagnosis in such cases is clarified on the operating table. A diagnostic error by a surgeon who does not recognize the cause of peritonitis will not cause any harm to the patient. Tactical mistakes and delays in operations are dangerous. In patients with perforated ulcers of the small intestine, delay in surgery is especially dangerous, since peritonitis develops quickly, violently and has a very high mortality rate even after operations in the first hours after perforation.

A special group consists of patients with perforated ulcers of the small intestine that have developed after operations on the stomach or other abdominal organs (stress ulcers). Alnor, Ehlers (1962) operated on 40 patients with such ulcers and noticed in a number of patients a tendency to recurrence of the ulcer process.

Treatment depends on the shape of the ulcer. Chronic ulcers are not recognized, and therefore targeted treatment cannot be provided. Perforated ulcers are subject to immediate surgical treatment. Once again, we pay attention to the severity and speed of development of peritonitis in patients with perforated ulcers of the small intestine. This is an insufficiently deciphered aspect of pathogenesis.

The operation consists of suturing the perforation hole. The ulcer should be excised before suturing, as re-perforation is possible. Bowel resection should not be performed; this significantly complicates the operation and worsens the outcome. Indications for resection are large changes in the intestinal wall, kinks, cicatricial narrowings, infiltrates, suspicion of a cancerous or specific process. After excision of the ulcer, the intestinal wound is sutured in the transverse direction with a two-story suture. It is necessary to perform a thorough toilet of the abdominal cavity, in case of severe peritonitis, rinse it with antibiotic solutions with a 0.8% solution of methyluracil, drain it with rubber strips and synthetic tubes, and in case of diffuse peritonitis with purulent exudate and fibrinous deposits, ensure constant or periodic washing of the abdominal cavity. It is advisable to prescribe proteinase inhibitors and desensitizing agents.

The operation can present great difficulties when the ulcer penetrates into neighboring organs, the presence of infiltrates and interintestinal fistulas. In this regard, the observation of Dyck (1963) is of great interest. A 40-year-old patient underwent bowel resection with side-to-side anastomosis due to a perforated jejunal ulcer 16 cm from the ligament of Treitz. Due to the dense edges, it was impossible to suture the ulcer. After 7 months, a repeat operation was performed for a callous ulcer penetrating into the transverse colon and its mesentery - resection of the transverse and small intestines. After 7 and a half months, the patient died from progressive anemia and exhaustion. The section revealed a bleeding ulcer of the anastomosis of the small intestine and a connection (fistula) with the large intestine.

Bleeding ulcers require partial or circular resection of the intestine. Narrowed sections of the intestine are subject to resection with end-to-end anastomosis.

The results of treatment of perforated ulcers of the small intestine are unsatisfactory. Mortality reaches 50% (K. D. Toskin; D. V. Fedotkin, E. A. Koenig, 1967; C, 3. Kletskin, B. A. Berdinskikh, 1968). Apparently, this is explained by the serious condition of the patients and the advanced state of peritonitis. In D.V. Fedotkin and E.A. Koenig, out of 9 operated patients, two died, admitted by the end of the day after perforation. In A.G. Kutepov, out of 19 patients, 4 died. The mortality rate is very high and not entirely clear. A.V. Gabay explains this by late surgical intervention due to the unclear clinical picture, but it is difficult to agree with this, since acute peritonitis of any etiology is an indication for immediate laparotomy.

The ileum (from the Latin word “ileum”) is the lower section. This element of the gastrointestinal tract has its own functions and structure. You can find out a little about them below.

Ileum: where is it located?

The ileum is located in the right iliac fossa (or lower part of the abdominal cavity) and is separated from the cecum by the bauhinian valve, or the so-called ileocecal valve. A small part of this organ occupies the epigastrium, the umbilical region, and the pelvic cavity.

Structure

The ileum and jejunum are quite similar in structure. The entire inner layer of such an organ is a mucous membrane, which is abundantly covered with villi (raise by about 1 millimeter). In turn, the surface of these elements consists of columnar epithelium. In the center there is a lymphatic sinus, as well as capillaries (blood vessels).

It should be especially noted that there are much fewer villi in the ileum than in the jejunum. However, they all participate in the process of obtaining useful and nutritious substances. Fats are absorbed through the veins, and amino acids and monosaccharides are absorbed through the veins. The entire ileal mucosa has a rather uneven surface. This is due to the presence of crypts, villi and circular folds. These formations significantly increase the total surface of the intestinal lining, which undoubtedly affects the process of absorption of digested food.

Features of the structure of the ileum

The jejunum and ileum have identical villi, the shape of which resembles leaves or fingers. It should be noted that they are found only in the lumen of these organs. The number of villi in the ileum can vary from 18 to 35 pieces per 1 square meter. mm. Moreover, they are slightly thinner than those located in the duodenum.

Intestinal crypts, or the so-called Lieberkün glands, are depressions in the shell, shaped like small tubes. The mucosa and submucosa of the ileum form circular folds. The epithelium on them is prismatic, single-layered, bordered. By the way, the mucous membrane of this organ also has its own submucosa, followed by muscle tissue. The latter are represented by 2 smooth layers of fibers: outer (or longitudinal) and inner (or circular). Between them is loose connective tissue, which has blood vessels and nerve musculo-intestinal plexuses. The thickness of this layer decreases towards the terminal part of the small intestine. It is worth noting that the muscular membrane of this organ performs the function of mixing the chyme and pushing it.

The outer lining of the ileum is serous. It is covered with it on all sides.

Main functions of the ileum

The represented body performs several functions. These include the following:

enzyme release;
absorption of nutrients, minerals and salts;
digestion of incoming food.

Features of the ileum

The intestinal juice of this organ begins to be released under the influence of chemical and mechanical irritation of the walls by chyme. In 24 hours its production can reach 2.4 liters. In this case, the reaction of the juice is alkaline, and its dense part consists of lumps-epithelial cells that produce and accumulate enzymes. At the right moment, the cells begin to be rejected into the intestinal lumen and then destroyed, thereby ensuring cavity digestion.

It should be noted that on the surface of each epithelial cell there is a microvilli. They are peculiar outgrowths on which enzymes are fixed. Thanks to them, another level of digestion occurs, called membrane (parietal). At this stage, food is hydrolyzed and absorbed in the ileum.

As you know, intestinal juice contains exactly 22 enzymes. The main one is called enterokinase. This enzyme is designed to activate pancreatic trypsinogen. In addition, the ileum secretes juice, which contains substances such as lipase, amylase, sucrase, peptidase and

The promotion of chyme to other parts of the intestinal tract is carried out due to the contraction of the fibers of the muscle layer. Their main types of movement can be called peristaltic and pendulum. The second group of contractions mixes the chyme. As for the worm-like (peristaltic) waves, they move food to the distal sections.

By the way, both presented types of digestion exist in direct connection. With cavitary hydrolysis of more complex substances to the so-called intermediate occurs. The processed foods are then broken down by membrane digestion. Next, the process of absorption of nutrients and nutrients begins. This is due to an increase in intra-intestinal pressure, as well as the motility of muscle tissues and the movement of the villi.

Disorders in diseases of the ileum

The ileum (where this organ is located is described a little higher) is quite often subject to inflammatory processes. All diseases of this part of the small intestine have similar manifestations. As a rule, they are based on a violation of the digestive, excretory, suction and motor functions. In medical practice, these deviations are usually combined under one common name - malabsorption syndrome.

General symptoms of diseases

The ileum, diseases of which can arise for various reasons, almost always makes itself felt by general signs of malaise. These include the following:

pain syndromes;
stool disorder;
rumbling in the intestines;
increased gas formation.

Quite often, patients complain to their doctors that they have diarrhea for a long time with trips to the toilet up to 4-7 times a day. In this case, undigested food remains may be found in the stool. In the first half of the day, the patient often feels it, which usually subsides only in the evening.

The affected ileum sometimes causes pain. They can have different localization (in the umbilical region, to the right of the midline of the abdomen and under the “spoon”) and character (bursting, pulling and aching). As a rule, the intensity of such pain decreases noticeably after the gases that have formed are released.

External symptoms of ileal diseases

Diseases of this part of the small intestine may also be accompanied by extraintestinal manifestations. They are caused by impaired absorption and breakdown of nutrients, vitamins and minerals. At the same time, patients lose weight quite quickly and cannot gain weight. Deficiency of B vitamins and iron often leads to the development of anemia, the formation of cracks in the corners of the lips and inflammation of the oral cavity. If the body begins to lack vitamin A, this can manifest itself in dry conjunctiva and night blindness. If there are hemorrhages on the patient’s body, this indicates a vitamin K deficiency.

Crohn's disease

The most severe and common disease of this section of the small intestine is Crohn's disease (or the so-called. Usually with this diagnosis, inflammation is localized in the last 15-20 centimeters of the ileum. Rarely, the process involves the blind, thick and duodenal sections of the gastrointestinal tract.

Inflammation of the ileum, the symptoms of which we will consider below, should be treated in time. Otherwise, after 3-4 years the patient may develop complications such as intestinal obstruction, fistulas, abscesses, peritonitis, amyloidosis, bleeding and others.

Symptoms of Crohn's disease

The signs of this disease vary.

Intense pain in the right region (often reminiscent of acute appendicitis). In this case, the patient has a fever and is bothered by constant nausea and vomiting. Typically, pain occurs 3-5 hours after eating.
Development of anemia and exhaustion.
Scar changes in the ileum, which cause intestinal obstruction.
Constant constipation or diarrhea, as well as rumbling in the intestines.
Heavy bleeding or slight blood in the stool

Other diseases

Lymphoid hyperplasia of the ileum occurs against the background of an immunodeficiency state and proliferative changes in the intestinal walls. Typically, such changes are transient and often disappear without a trace on their own. The reason for the development of such a deviation may be an inadequate reaction of the intestinal lymphoid tissue, which occurs to external stimuli.

Signs of lymphoid hyperplasia

Symptoms include:

diarrhea;
abdominal pain;
blood and mucus in the stool;
increased gas formation and bloating;
weight loss;
reduced body resistance to various infections.

With severe hyperplasia, they can form. Among other things, diseases of this part of the intestine include enteritis and cancer.

Diagnosis of diseases and causes

Inflammation of the ileum is diagnosed by the external signs and condition of the patient after taking blood, urine and stool tests, as well as using such a modern examination method as fiber endoscopy. In this case, patients often show changes in the submucosal layer of the intestine. Such nonspecific abnormalities can develop against the background of diffuse polyposis, chronic tonsillitis and functional disorders in the colon.

Treatment of diseases

Usually affects only the terminal ileum. This disease is a concomitant condition, and therefore it does not require treatment. As for Crohn's disease, cancer and other inflammatory processes, if they are treated late, they can affect the entire gastrointestinal tract, which subsequently leads to death. In this case, therapy consists in the use of medications, including antibacterial ones, which are prescribed only by an experienced gastroenterologist. By the way, often such diseases in the later stages of development are treated with the help of surgical intervention.

It is also worth noting that along with medications for the treatment of diseases of the ileum of the small intestine, a strict diet is also prescribed. As a rule, it includes only light, quickly digested and vitamin-rich foods. In addition, the patient is strictly forbidden to consume alcoholic beverages, highly salty, spicy, fatty, fried and heavy meat, fish, mushroom dishes. The patient's diet should include warm cereals cooked with semi-milk, white wheat bread of yesterday's production, sometimes butter, egg scrambled eggs, tea, compotes, fruit drinks, decoctions of wild rose, blueberries, bird cherry. If you follow a diet and take all the medicines prescribed by your doctor, the outcome of the treatment of an inflamed ileum will be necessarily favorable.

The human body is a reasonable and fairly balanced mechanism.

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Small intestinal ulcer symptoms

Small intestinal ulcer is a common gastrointestinal disease in gastroenterology. In total, several types of small intestine ulcers are distinguished in medicine: these are nonspecific, idiopathic, peptic, trophic, round, etc.

The statistics of cases and the frequency of the disease depends on the type of ulcer of the small intestine, as well as on the type of gastrointestinal tumor (carcinoid or others). For example, a primary ulcer of the small intestine is a fairly rare disease. The main characteristics of small bowel ulcers are somewhat similar to gastric and duodenal ulcers. But the main difference between ulcers of the small intestine is that in most cases this disease occurs in men. In fact, an ulcer of the small intestine is an inflammation of the mucous membrane of this part of the gastrointestinal tract with the presence of numerous manifestations on its wall. An ulcer of the small intestine may occur due to non-treatment of a number of diseases of the gastrointestinal tract, including Helicobacter pylori, as well as due to the lack of treatment of gastrointestinal candidiasis.

Rarely, patients suffering from small intestinal ulcers complain of pain in the epigastrium or right iliac region. As a rule, these pains occur within a couple of hours after eating. If the patient is examined by a gastroenterologist, he will note tension in the muscles of the abdominal wall.

When testing for the presence of a small intestinal ulcer, it indicates the presence of hidden bleeding in the stool. If the patient is prescribed a targeted X-ray examination, then specialists at the diagnostic center identify a small intestinal ulcer based on this method only in rare cases.

Intestinal ulcer signs and methods of diagnosis

The duodenum is the most common site for peptic ulcers to appear. Our stomach normally produces hydrochloric acid to help digest food and kill pathogens and bacteria. This acid is quite caustic, so the superficial accessory cells create a natural mucus barrier that protects the lining of the stomach and duodenum. There is a balance between the amount of acid the body produces and the amount of mucus. If this balance is disturbed, an intestinal ulcer develops.

Risk factors for intestinal ulcers

Use of aspirin and non-steroidal anti-inflammatory drugs
Infection caused by the bacterium Helicobacter pylori
Chronic gastritis
Smoking
old age
Certain blood clotting problems

Symptoms of duodenal ulcer

Pain in the upper abdomen, just below the sternum. As a rule, it appears and then disappears. May occur before meals or when you have not eaten for a long time. The pain is relieved by eating or taking antacid tablets. Sometimes discomfort can occur at night.
Bloating, vomiting and feeling unwell. Sometimes the pain gets worse after eating.

In some cases, intestinal ulcers can cause complications. These include:

Bleeding. Can range from a trickle of blood to life-threatening bleeding
Perforation. This is the name for a situation in which an ulcer passes directly through the wall of the duodenum. Food and acid from the duodenum will then enter the abdominal cavity. Typically, perforation causes unbearable pain and requires immediate medical attention.

Methods for diagnosing intestinal ulcers

If you suspect you have an ulcer, then it is useless to search the Internet for “intestinal ulcer signs photo.” The first step is to do an endoscopy. This test can confirm or deny the presence of the disease. The doctor will be able to “look” inside the stomach and duodenum using a thin, flexible tube that will go down the esophagus. This way it will be possible to detect any inflammation or ulcer. Also, if you suspect a duodenal ulcer, doctors usually recommend doing a test to identify the bacterium Helicobacter pylori. If it is found, then most likely it is the cause of the disease.

Sources: zheludok.ru, ilive.com.ua, yazvainfo.ru

gem-prokto.ru

Symptoms and features of treatment of small intestinal ulcers

In the jejunum, mucosal ulcerations are much less common than the same duodenal defects. Most often, men of young and middle age (35-50 years) are exposed to their appearance. An ulcer of the small intestine is a nonspecific disease that can occur in both acute and chronic forms.

The manifestations of the disease become apparent in the fall or spring, during the period of exacerbation of the pathology, and when the stage of remission occurs, they are almost imperceptible. Their number can also fluctuate from single to numerous, often constituting more than a dozen, defective ulcerations.

Experts comment on this trend by saying that representatives of the stronger sex are more susceptible than women to harmful habits - alcohol abuse and smoking.

Causes of pathology

The etiology and mechanism of development of this type of peptic ulcer is not fully understood these days. Most often, assumptions are made about the primary role of mechanical damage to the mucosa, since in the pathomorphological picture of the disease the predominant place is occupied by the phenomena of acute necrosis, and not by the changes characteristic of a chronic ulcer.

There are also suggestions that the disease can be triggered by local vascular disorders (thrombosis, spasms, constrictions), increased acidity of gastric juice or damage to the mucous membrane by bacterial poisons. There are also external risks that provoke the development of pathology:

Main signs and diagnosis of the disease

With a small intestinal ulcer, the symptoms are usually nonspecific and do not allow the pathology to be identified based on the clinical picture alone. But this disease can also be completely asymptomatic for a long time until the process of perforation of the ulcer begins, which is characterized by signs of an acute abdomen.

The pathology can also be complicated by internal bleeding, but this happens in rare cases. The main alarming manifestations that may indicate that the ulcer that has developed on the walls of the small intestine has worsened are the following:

significant loss of appetite;
vomiting, interspersed with blood;
abdominal cramps;
colic in the abdominal cavity both before and after meals;
acute and painful abdomen;
constant diarrhea;
temperature rise to high levels.

A person with a small intestinal ulcer that is in the acute stage feels constantly tired and may experience sudden weight loss. If such symptoms appear, it is necessary to urgently seek advice from a specialist, since all these manifestations, especially starvation and exhaustion, can quickly lead to dysfunction of other systems and organs.

Clinical diagnosis of the disease is quite difficult. Only occasionally, when there are ulcer-like pains or signs of repeated intestinal bleeding, can a doctor, by excluding diseases with such symptoms, make a conclusion about the development of a pathology of this type. X-ray examination is also not able to give a complete picture of the disease.

This is due to the location of the small intestine and the specific structure of its mucosa. An ulcer in this part of the digestive system can only be partially detected when resection or laparotomy of the gastrointestinal tract is performed due to massive bleeding resulting from perforation.

Basic therapeutic measures

Comprehensive drug treatment for ulcerations that have developed in the small intestine in uncomplicated cases has been poorly developed to date. Due to the fact that the specialist is not sure that this defect represents tumor ulceration, surgical intervention is always preferable.

If the pathology does not have complications, its treatment is carried out according to the protocol for the treatment of duodenal ulcer. All treatment recommendations for this disease are given depending on the form of the ulcerated defect on the jejunal mucosa.

Since ulcers that develop chronically are not recognized, it is impossible to select targeted drug therapy for them. For such defective ulcerations, urgent surgical treatment is provided. This is due to the fact that their perforation, due to the anatomical structure of the small intestine, occurs very quickly and leads to peritonitis of the abdominal cavity, which can be fatal within a few hours, or at best days.

Surgical intervention consists of suturing the hole at the site of the perforated ulcer, but before this it is excised, since in the absence of this preoperative procedure, secondary perforation of the ulcerated defect is possible.

Intestinal resection is usually not performed for this disease, since such surgical treatment not only complicates the operation, but also worsens further prognosis for the person. This type of surgical intervention is performed only for special indications, which include:

major changes that have occurred on the wall of this organ of the digestive system;
developed cicatricial constrictions, provoking the rapid occurrence of fecal obstruction;
significant bends, also leading to obstruction;
suspicion of malignancy of pathological defects of the mucous membrane;
formation of infiltrates.

Only in these cases is treatment carried out by resection. But after this, the patient faces a long recovery period, and possibly lifelong disability. Also, the operation to remove an ulcer that has penetrated (sprouted) into neighboring organs presents great difficulties. This is due to the fact that during this pathological process, interintestinal fistulas and infiltrates are formed.

A poorly understood disease of the small intestine, associated with partial or complete ulceration of its walls, is so dangerous and difficult to diagnose that people at risk for its development should pay more attention to their health.

Maintaining a healthy lifestyle, giving up bad habits and regularly visiting a gastroenterologist for diagnostic tests will help to avoid the risk of developing pathology or identify it at the very early stage, when the use of drug therapy is still possible and radical surgical intervention is not required.

gastrolekar.ru

Ulcer of the large and small intestine: symptoms, treatment with folk remedies, diet, medications

Peptic ulcer is one of the most common diseases of the digestive system, affecting more than 10% of the population.

It occurs due to damage to the intestinal mucosa under the influence of digestive acid and pepsin. The disease is characterized by periods of exacerbation, which most often appear in the fall or spring.

In contrast to superficial damage to the mucous membrane (erosion), intestinal ulcers have a deeper wound surface and therefore heal, as a rule, with the formation of a scar.

There are many factors contributing to the occurrence of the disease:

In 1st place is the factor of heredity. It means that the body is prone to increased production of gastric enzymes and juice.
In 2nd place is the bacterium Helicobacter pylori, which, entering the body through household items, dishes, and dirty hands, destroys mucous cells.
In 3rd place - violation of diet, consumption of fatty, fried, smoked, spicy foods.
In 4th place are smoking and alcohol abuse.
In 5th place is stress.

Experts also advise not to forget about the effect of medications on the mucous membrane. When taking aspirin, antibiotics, contraceptives, iron supplements, and feeling discomfort in the abdomen, you must remember that timely contact with a gastroenterologist will help prevent the development of peptic ulcers.

Signs of a small intestinal ulcer are in many ways similar to gastric ulcers. May occur:

periodic pain in the epigastric region;
heartburn;
belching;
hungry night pain;
the appearance of vomiting, which brings relief;
sour taste in the mouth.

In some cases, damage to the small intestine is asymptomatic; acute clinical manifestations occur when the ulcer perforates.

With ulcerative lesions of the large intestine, the following symptoms may occur:

pain during defecation;
bleeding or bloody inclusions in the stool;
With chronic peptic ulcer disease, prolonged constipation may occur.

Quite often, the symptoms of a colon ulcer can be similar to the signs of other diseases, and do not have specific signs, so differential diagnosis is important here.

Complications

This intestinal disease is dangerous, first of all, due to perforation or perforation of the ulcer, which can result in internal bleeding and the development of acute pancreatitis.

The consequence may also be:

Diagnostics

Examination methods to detect intestinal ulcers:

How to treat pathology?

Treatment of intestinal ulcer is complex, including drug therapy and diet.

Exacerbations of ulcers are usually treated in a hospital with the appointment of measures aimed at speedy scarring of the damage. In difficult cases, or in case of an ulcer caused by damage to the mucous membrane by a foreign body, surgical treatment is performed.

The following groups of drugs are used to treat ulcers:

Antibacterial agents for the infectious nature of the disease.
Antisecretory drugs to reduce the secretion of gastric juice, which has an aggressive effect on the mucous membrane.
Prokinetics to improve intestinal motility and eliminate dyspepsia.
Antacids that help relieve pain and heartburn.
Gastroprotectors that have an enveloping property, which prevents hydrochloric acid from having a destructive effect on the mucous membrane.
Analgesics and antispasmodics to reduce pain.

Diet

The diet for intestinal ulcers involves split meals several times a day. Prohibited:

starvation;
smoking;
taking any alcohol;
eating fried, spicy, smoked, canned food;
carbonated drinks.

Preference should be given to:

dairy products;
boiled or stewed vegetables;
non-acidic fruits;
fresh lean meat, fish and poultry;
porridge.

Healing an intestinal ulcer is a long process that requires compliance with all doctor’s recommendations in terms of diet and lifestyle. Only with an integrated approach to treatment can positive results be achieved and relapses of the disease avoided.

Treatment with folk remedies

For the speedy healing of ulcers, people widely use decoctions of medicinal herbs that have a wound-healing effect:

plantain;
St. John's wort;
chamomile;
calamus;
sage;
aloe.

Recipes using propolis and honey have a good effect in reducing the acidity of gastric juice and healing ulcers. The latter can be consumed several times a day with tea or milk.

Following these basic rules helps a lot to protect yourself from intestinal ulcers:

rejection of bad habits;
proper healthy nutrition that does not irritate the mucous membrane, which is especially important in the presence of gastritis or other gastrointestinal diseases;
compliance with personal hygiene standards;
control over your emotions to avoid stress.

And most importantly, at the slightest discomfort or suspicion of a disease, immediately contact a gastroenterologist. This is the only way to avoid the development of the disease and prevent its complications.

gidmed.com

Nonspecific ulcers of the small intestine: causes, symptoms, diagnosis, treatment

Nonspecific ulcers of the small intestine are extremely rare. Only isolated descriptions of this disease can be found in the literature. These are nonspecific ulcers, in contrast to ulcerations of an established nature, which can be tuberculous, syphilitic and cancerous. It is believed that this disease is approximately 3 times more common in men than in women, and is found mainly in middle-aged and elderly people.

The causes and pathogenesis of the disease are unknown. Since the pathomorphological picture is more often dominated by the phenomena of acute necrosis than by changes characteristic of a chronic (peptic) gastroduodenal ulcer, it can be assumed that local vascular factors (embolism, thrombosis), local mechanical damage to the mucous membrane or a focal inflammatory process may be the cause of these diseases.

Symptoms, course and complications. Small intestinal ulcers can be acute or chronic, asymptomatic or with atypical pain in the paraumbilical area. However, most often for the first time they manifest themselves suddenly with symptoms of intestinal perforation and clinical symptoms of an acute abdomen. Thus, after analyzing 130 reports described in the literature about primary nonspecific ulcers of the small intestine, it was found that in 81 cases it was perforation of the ulcer.

In more rare cases, ulcers of the small intestine are complicated by intestinal bleeding.

Clinical diagnosis is difficult. Only in rare cases, in the presence of ulcer-like pain and signs of repeated intestinal bleeding, by excluding peptic ulcers and other diseases of the gastroduodenal zone, as well as lesions of the colon, can the doctor come to the conclusion about a possible disease of the small intestine and direct the radiologist to a targeted examination of this part of the intestine. However, due to known difficulties due to the structural features of the mucous membrane of the small intestine, as well as the location of the intestine, it is difficult to detect an ulcer of the small intestine using radiographs. If the ulcer has perforated or massive intestinal bleeding has occurred, small intestinal ulcers can often be detected during laparotomy and resection of the gastrointestinal tract.

Signs of perforation of a small intestinal ulcer do not differ from those of perforation of a peptic gastroduodenal ulcer.

In chronic ulcers, a rare complication is stenosis of the intestinal lumen.

Treatment of small intestinal ulcers is therapeutic and poorly developed in uncomplicated cases. Since it is never certain that an ulcer represents ulceration of a tumor, surgical treatment is more appropriate. In complicated and diagnostically questionable cases, treatment is surgical.

V.A.Golbraikh, S.S.Maskin, A.V.Bobyrin, A.M.Karsanov, T.V.Derbentseva, D.S. Lopasteisky, A.R. Tadzhieva
Acute ulcers of the small intestine in patients with widespread purulent peritonitis

Acute perforated ulcers of the small intestine in patients with total purulent peritonitis

V.A.GOLBRAYKH, S.S.MASKIN, A.V.BOBYRIN, A.M.KARSANOV, T.V.DERBENZEVA, D.S.LOPASTEYSKY, A.R.TADGYEVA

Volgograd State Medical University

The paper presents modern views on the etiology and pathogenesis of acute small intestinal ulcers (AUS) complicated by perforation. One of the causes of acute stress ulcers is widespread purulent peritonitis (SPP). Of 493 patients operated on for RGP, perforation of acute small intestinal ulcers was diagnosed in 16 patients (3.2%). Risk factors for the occurrence of postoperative ulcers of the small intestine have been identified: high Mannheim peritonitis index (above 15), prolonged nasointestinal, prolonged mechanical ventilation and intestinal paresis after. Prevention of SNF should include the elimination of circulatory hypoxia, intestinal paresis, and endotoxicosis.

Key words: stress ulcers of the small intestine, purulent peritonitis, programmed relaparotomy

Modern views on etiology, pathogenesis of acute ulcers of the small intestine (AUSI) complicated by perforation were presented. Purulent total peritonitis (PTP) is one of the reasons of acute stress-ulcers beginning. Perforation of AUSI in this group was diagnosed in 16 (3.2%) patients. By the example of patients with PTP, the risk-factors of AUSI formation were determined: high level of the Mannheim peritonitis index (more than 15), long-term nose-intestinal intubation, prolonged artificial lung ventilation and enteroparesis in the postoperative period. For prophylaxis of AUSI elimination of circulatory hypoxia, enteroparesis, endotoxicosis are in demand.

Key words: acute ulcers of the small intestine, purulent peritonitis, programmed relaparotomy

The upper gastrointestinal tract (GIT) is one of the targets in acute surgical diseases of the abdominal cavity in terms of the development of acute ulcers (AUT). Prevention and treatment of stress ulcers of the gastrointestinal tract were discussed at the 31st Congress of the Critical Medicine Society (San Diego, 2002), the All-Russian Congress of Anesthesiologists-Resuscitators (Omsk, 2002), the Congress of Anesthesiologists-Resuscitators of the Central Federal District of the Russian Federation (2005) and other medical quorums, which indicates the relevance of the problem and the unresolved nature of many of its issues.

Back in the 30s of the twentieth century, G. Selye established the main clinical conditions associated with the formation of OT - surgical interventions and sepsis, thermal and mechanical injuries, neurological disorders. Reactions to stress, which have an adaptive character at the beginning of the disease, later lead to a violation of homeostasis, various stress damage to the gastrointestinal tract.

There are four types of acute lesions of the gastrointestinal mucosa: 1) true OCs, developing after massive operations or in severe combined trauma, hepatic-renal failure; 2) Curling ulcers - in patients with widespread burns; 3) Cushing's ulcers - with brain damage; 4) drug-induced ovarian cancer.

Most publications concern acute gastroduodenal ulcers complicated by bleeding or perforation. Few works are devoted to stress ulcers of the small intestine. In 1805, Baillie first described lesions of the small intestine with ulcers that superficially resemble those of peptic ulcers of the stomach and duodenum.

Purpose of the work: to identify the frequency of acute perforated ulcers of the small intestine in patients with RGP, to analyze the possible causes of small intestinal ulcers, to improve the results of treatment of this group of patients.

Material and methods

The article was prepared and edited by: surgeon