Duodenitis. Duodenal stasis
Duodenal stasis is understood as a violation of motor and evacuation activity duodenum of various etiologies, leading to delay (stasis) of its contents. With dyskinesia, the coordination and sequence of movements of the duodenum are disrupted, but retention (stasis) of its contents is not necessary.
Etiology and pathogenesis. Acute violation of the patency of the duodenum is associated with the entry of large gallstones into it, compression of the duodenum of the upper mesenteric artery, abdominal aortic aneurysm.
Mechanical causes in the development of chronic duodenostasis, which is observed much more often than acute, are of less importance. They can be congenital (developmental anomalies) or acquired. Among the mechanical causes in the development of chronic duodenostasis, certain importance is attached to compression of the duodenum by the superior mesenteric artery, which can occur at any time (Mansberger et al., 1968) if the function of the organ is impaired.
Most common etiological factor in chronic duodenostasis is functional impairment motor activity of the duodenum. The latter, as is known, is associated both with the activity of the autonomic nervous system and with the intramural nervous apparatus of the intestine itself. Chronic obstruction of the duodenum occurs as independent disease quite rare. More often given pathological condition accompanies other diseases of the digestive system (peptic ulcer, diseases of the biliary tract, pancreatitis or previous gastric surgery). The mechanism of development of duodenostasis in such cases is associated with dystrophic changes in the intramural nervous apparatus of the duodenum. It is possible that the latter are due to long-term reflex influences negative character from pathologically altered digestive organs. According to A.P. Mirzaev (1970), chronic duodenostasis caused by non-mechanical reasons occurs six times more often than in the presence of a mechanical obstruction in the duodenum.
Consequently, duodenostasis is a polyetiological disease. Mechanical obstruction of the duodenum, which is essential for the development acute disorder intestinal patency, plays a lesser role in the etiology of chronic duodenostasis. The latter can be either the main (less often) or concomitant (more often) disease. It is most likely that the formation of chronic duodenostasis is associated with the disorder autonomic innervation or with dystrophic changes in the intramural nervous apparatus of the duodenum. Negative reflex effects from pathologically altered digestive organs: stomach, biliary tract, pancreas.
Clinical symptoms. Diagnosis. The development of acute duodenal obstruction occurs very quickly (hours!) and is accompanied by a violent clinical picture (sharp pain in upper half abdomen and umbilical region, frequent vomiting, bloating, collapsed state).
The clinical picture of chronic duodenostasis is varied. Features of symptoms depend on the duration of the disease, the presence of pathological processes in adjacent organs, pathohistological changes in the mucous membrane of the duodenum (chronic duodenitis). Finally, the course of chronic obstruction of the duodenum, like other chronic diseases, is characterized by phases of exacerbation and remission, which differ from each other in the severity and manifestation of individual symptoms.
The exacerbation phase of chronic duodenostasis is characterized by the following triad: pain, nausea and vomiting. Pain in most cases is not associated with eating. They do not have (unlike pain in peptic ulcers) a clear localization, and are most intense in the right hypochondrium and in the epigastric region. Often the pain has the character of attacks with increasing intensity. One must think that the occurrence of pain is due to two reasons: stretching of the duodenum by its contents and its strong peristalsis. The reflex spasm of the pylorus is also of certain importance (A. D. Efremov and K. D. Eristavi, 1969). Similar paroxysmal pain can occur in the absence of duodenostasis with intestinal dyskinesias. Nausea with duodenostasis is often constant, prolonged and therefore especially painful. Vomiting occurs several times a day, often immediately after eating or independently of it. Vomit, as a rule, contains an admixture of bile. In this regard, immediately after vomiting or during it, patients experience a bitter taste in the mouth. After vomiting, short-term relief is observed.
In addition to these main symptoms, with exacerbation of chronic duodenostasis, poor appetite, constipation, weight loss, sometimes a collapsed state occurs at the height of intense pain. Some patients have pronounced general symptoms intoxication: headache, fever, general weakness, sleep disturbance, irritability, pain in calf muscles(loss of chlorides due to frequent vomiting).
At objective research moderate or significant weight loss is noted. The abdomen may be distended in the upper half. Its palpation is painful mainly in the right upper quadrant; sometimes in this area it is possible to detect a “splashing noise” (by palpation).
X-ray examination is essential. The main radiological signs of duodenostasis are: retention of barium suspension in the duodenum for more than 40 seconds, expansion of the intestine at the site of contrast retention, a combination of spasm in one segment and expansion in another, and throwing of contents into the proximal sections (N. A. Gryaznova and M. M. Salman , 1969). The last two radiological signs are also characteristic of duodenal dyskinesia in the absence of retention of its contents.
Clinical and radiological signs of duodenostasis are often combined with manifestations of other diseases of the digestive system, with which chronic disorder patency of the duodenum may be genetically related (peptic ulcer, chronic duodenitis, cholecystitis, pancreatitis). In such cases, the diagnosis of duodenostasis can sometimes be very difficult, just as the layering of symptoms of duodenostasis on the clinical picture of another disease complicates the diagnosis and course of the latter. X-ray signs of duodenostasis then become even more important.
Duodenal stasis, even of a congenital nature, can be asymptomatic for many years and appear only in mature age. Purchased forms are also long time occur hidden or with minimal symptoms, which patients usually do not pay attention to. However, over time, symptoms develop to varying degrees. Most authors draw attention to the absence of any signs pathognomonic for this suffering. There are two groups of signs that occur with duodenostasis more often: 1) gastric ( painful attacks V epigastric region or to the right of the navel, a feeling of bloating, rumbling, belching of air, and sometimes vomiting of bile, unstable stool); 2) intoxication, associated with stagnation of contents in the duodenum (fatigue, headaches, apathy, neurasthenia).
There are stages of duodenostasis: compensation, subcompensation and decompensation, as well as periods of progression: quiescence and exacerbation.
When the cause of impaired patency of the duodenum is compression of its lumen by the superior mesenteric artery, the course of the disease can be acute, corresponding to the manifestation of high small intestinal obstruction.
Among the 78 patients we studied, an independent form of duodenal stasis was more common in patients aged 20-50 years. Among them there were 49 women, 29 men. Only 3 patients had no history of gastric complaints in the past, and they were hospitalized during the first attack of the disease. The majority of patients had complaints of pain and dyspeptic disorders lasting from several months to 35 years.
In 8 patients, during one of the exacerbations of the disease, scleral icterus was observed; 13 patients had already been operated on in the past: 3 had an appendectomy with assumptions that appendicitis was the cause of gastric ailments, 2 had a cholecystectomy, and 8 had a diagnostic transection.
According to complaints and the clinical picture of the disease at the time of hospitalization, our patients could be divided into 5 groups: a) with symptoms of acute abdomen (6 people); b) with manifestations of hepatic colic or cholecystopancreatitis (28); c) duodenal ulcers (29); d) tumor lesion (11); e) gastritis (4 people).
The leading complaints in 4 out of 6 patients admitted with the picture acute abdomen, there were cramping pains in the upper half of the abdomen, which were accompanied by vomiting with an admixture of bile and failure of gases, i.e. there were signs characteristic of high small intestinal obstruction, about which they urgently and were operated on. During surgery in 3 patients, it was determined that the cause of obstruction was compression of the intestine by the superior mesenteric artery, for which an appropriate operation was performed. In one patient, even during surgery, the cause of obstruction was not identified. Two of these 6 patients were admitted to the clinic and were operated on due to suspected acute appendicitis. Although during the operation there were inflammatory changes on the part of vermiform appendix was not identified, audit abdominal cavity was not carried out and therefore the tactics were wrong.
Among 28 patients who had complaints and clinical picture were similar to hepatic colic, or cholecystopancreatitis, in the anamnesis there were indications of repeated attacks of pain in the upper half of the abdomen, more on the right, which were accompanied by vomiting mixed with bile. Many of them were already being treated for cholecystitis or cholecystopancreatitis.
Due to repeated attacks of pain and a long history, 18 of these 28 patients were operated on with suspected cholecystopancreatitis. However, during the operation it turned out that the main cause of their disease was duodenal stasis, and the changes in the biliary tract and pancreas were secondary and were either functional or secondary anatomical disorders. In 10 out of 28 patients in this group, with dynamic observation and the corresponding study in the hospital, a diagnosis of chronic recurrent duodenal stasis was made as the main suffering, for which appropriate treatment was carried out.
In 29 patients, symptoms and objective examination data were very similar to peptic ulcer disease. Along with dyspeptic complaints, they were bothered by attacks of pain in the upper abdomen. This was more common for men low nutrition. Many of them were repeatedly hospitalized with the specified diagnosis, but without special effect. 16 of these patients were even operated on due to the assumption of an ulcer. Only during transection and revision of the abdominal organs was it established that the main cause of suffering was a violation of the motor-evacuatory function of the duodenum with its ectasia and atony (anatomical confirmation of duodenal stasis).
Among 29 patients in this group, in 11, based on complaints, clinical picture and dynamic observation, confirmed by X-ray examination and even surgery, it was established that primary disease they had duodenal stasis, and later an ulcer developed.
In 11 patients, the symptoms of the disease were similar to tumor lesions. Along with dyspeptic disorders, in the form of belching and vomiting mixed with bile, these patients had complaints of general malaise, loss of appetite, emaciation, and unstable stool. At the same time, the deterioration of the condition occurred in recent months before hospitalization. The nutrition of patients in this group was noticeably reduced, and pain was noted in the upper abdomen. Although most of them have X-ray examination data for organic lesion was not found, but duodenostasis with ectasia of the duodenum with prolonged stagnation of its contents was detected, yet 8 patients were subjected to surgery with suspected tumor damage! Only during transection and examination during the operation was the diagnosis of a tumor rejected, and signs of impaired patency of the duodenum were established of different nature in the form of ectasia of the latter, which determined the clinical picture of the disease.
In 3 out of 11 patients in this group, taking into account clinical and radiological data, the correct diagnosis was made.
Finally, in last group In patients (4 people), the leading complaints were episodic minor pain in the epigastric region, not associated with food intake, occasional rumbling to the right of the navel or dyspeptic disorders (belching with air and sometimes bitterness, unstable stool). These patients were treated as suffering from gastritis. The reason for their hospitalization was a slight deterioration in their condition and increased pain in the epigastric region. X-ray examination showed that the cause of the suffering of these patients was a violation of the patency of the duodenum. After a course of conservative treatment, their condition improved markedly, and they were discharged for outpatient treatment.
Analysis clinical manifestations duodenal stasis indicates that the symptoms of this suffering largely depended on: 1) the stage of development of the disease (compensation, subcompensation or decompensation); 2) period of flow (calm or exacerbation); 3) complications associated with impaired motor-evacuation activity of the duodenum.
In the initial stage of duodenostasis and in the period of calm against the background of a generally satisfactory condition, complaints may be absent or minimal (in the form of moderate dyspeptic disorders). During X-ray examination at this stage, usually no disturbances in the motility of the duodenum are observed. Such patients are usually treated as suffering from gastritis.
At the same time, during the period of exacerbation of the disease, even in the initial stage, the usual complaints are attacks of pain in the epigastrium or to the right of the navel, and pain is also noted there. Sometimes attacks are accompanied by belching or vomiting mixed with bile. The stomach is soft to the touch. Usually, with dynamic observation, the pain subsides. If the patient is not examined, he is discharged with a diagnosis of “intestinal colic” or “biliary dyskinesia”. X-ray examination during this period can reveal phenomena of duodenal stasis. If the study is carried out after the attack has subsided, the functional activity of the intestine may not be changed.
With prolonged suffering and the development of anatomical changes in the duodenum in the form of ectasia and atony (stage of sub- or decompensation), even during a period of calm, patients complain of decreased appetite, belching, and sometimes vomiting mixed with bile, rumbling in the epigastric area or to the right of the navel, unstable stool. These patients most often have low nutrition and asthenic build. Common complaints they also have are headaches and decreased performance. Palpation of the abdomen causes pain to the right of the navel, and a splashing sound is sometimes detected there. In some patients, the clinical picture resembles chronic gastritis or a tumor lesion of the stomach. At X-ray examination it is possible to determine impaired motility of the duodenum in the form of a delay contrast agent in the lumen with ectasia and atony of the intestine. However, in other cases, the true cause of suffering may not be revealed with a single x-ray examination, especially if special attention is not paid to the force of contraction of the stomach and the horseshoe of the duodenum.
During the period of exacerbation and the stage of sub- or decompensation, the symptoms will be significantly expressed, and clinical course duodenal stasis can manifest itself in the form of acute pain in the upper abdomen, which is accompanied by vomiting of bile. These patients are usually hospitalized with a diagnosis of hepatic colic", "cholecystopancreatitis" or "exacerbation of peptic ulcer". However, it should be noted that among incoming patients diagnosed with hepatic colic or cholecystopancreatitis, painful attacks often occurred for no reason, without connection with an error in diet, which is usually observed with cholecystitis or pancreatitis. Many of these patients were malnourished and had a labile nervous system. They noted that they were periodically bothered by bitter belching or vomiting with bile. On objective examination, although there was tenderness in the right hypochondrium or above the navel, in no case was the gallbladder enlarged and no symptoms of peritonitis were observed. Soon after admission to the clinic, in many patients the attack of pain subsided without special treatment.
Among patients admitted with suspected peptic ulcer disease, it could also be noted that painful attacks were not associated with errors in diet and no seasonality of the disease was observed. These patients noted that the treatment they had received in the past was ineffective.
As our studies have shown, the above symptoms of suffering, simulating other diseases, were largely due to dysfunction of the biliary tract and pancreas, as well as the mucous membrane of the duodenum and stomach due to duodenal stasis. In a number of patients, the symptoms were explained not only by impaired motility and the duodenum, but also by complications of the biliary tract, pancreas, as well as the mucous membrane of the stomach and duodenum.
The most severe group consisted of patients whose clinical picture corresponded to high small intestinal obstruction as a result of complete violation patency of the duodenum. However, in retrospect, it can be noted that in cases where patients were admitted with suspected acute appendicitis, the clinical picture was much more severe. It was noted that there was bloating of the abdomen, there was no reaction of the peritoneum in the right iliac region and there was repeated vomiting mixed with bile. And most importantly, having not found a modified appendix during the operation, the surgeon did not perform a full examination of the abdominal organs, but completed the operation with an unnecessary appendectomy.
One of the features of duodenal stasis is the progression of the disease and the gradual involvement of organs intimately associated with the duodenum. In the initial stage of the disease, dyspeptic disorders and pain, characterizing duodenal dyskinesia, dominate. However, over time, periods of exacerbation become more frequent, pain begins to be more constant, and symptoms of dysfunction of the stomach, biliary tract and pancreas appear. At first it is functional in nature, and then the symptoms are caused by anatomical changes. In such cases, signs of damage to organs associated with the duodenum already come to the fore. “These patients are usually treated as suffering from peptic ulcer, cholecystitis or pancreatitis and are treated, and sometimes incorrectly. surgical intervention with the assumption of these diseases. Only with a targeted study did it become clear that the primary suffering was duodenal stasis, and changes in adjacent organs were secondary, as a result of long-term impaired motility of the duodenum. We could be convinced of this during dynamic observation, repeated research, and sometimes reoperation in 59 patients suffering from duodenal stasis as an independent disease. Most patients were examined several times. During the initial hospitalization and examination, these patients showed duodenal stasis at the initial stage of its development. Subsequent observation of these patients, repeated studies, and sometimes surgery (and periods from 2 to 10 years after the initial study) showed that in 35 of the observed patients the condition had changed little. They were only occasionally bothered by aching pain in the epigastrium, which sometimes had a paroxysmal character, and dyspeptic disorders. Clinical and radiological examination did not reveal any significant changes compared to previous years. However, in 24 patients there was a clear deterioration in condition. Along with the progressive deterioration of duodenal motility, symptoms of involvement of organs intimately associated with the intestine in the disease process appeared, which was not the case in previous studies. Thus, in the 24 patients examined, duodenal stasis moved from the stage of compensation to the stage of sub- or decompensation. The following observation is revealing.
Patient Zh., 41 years old, has been experiencing attacks of pain in the right hypochondrium for 20 years, which are accompanied by vomiting mixed with bile. The chair is unstable. Reduced nutrition. The abdomen is painful in the right hypochondrium and epigastric region. Hb -80/14%, l. 5000, ROE 4 mm per hour. Urine diastasis -32 units. Gastric juice: total acidity 8-16-20, free HC1-0-20-10. Cholecystography: 15 and 16 hours after taking the contrast suspension, an enlarged gallbladder is determined with satisfactory concentration, but reduced contractility.
Radiologist's conclusion: there is no evidence of organic damage to the stomach and duodenum.
Preoperative diagnosis: cholecystitis. During the operation it was revealed that the gallbladder was distended and there were no stones in it. The duodenum is wide, flabby, elongated. It has been stated that the main cause of suffering is duodenal stasis of a non-mechanical nature. A duodenojejunostomy was performed. Postoperative course without complications. Re-examined after 8 years. After the operation, she noted only temporary improvement. Subsequently, the attacks of pain recurred and became more persistent. During one of the attacks, she was hospitalized and operated on for developing cholecystitis. A cholecystectomy was performed. After the operation, the condition did not improve. The pain began to be constant, radiating to the back. X-ray examination reveals prolonged duodenostasis in the lower horizontal part of the duodenum within an hour of observation. Only occasionally is evacuation through duodenojejunostomy observed. A year later, during one of the attacks, she was hospitalized. X-ray examination reveals persistent hypotonic duodenostasis; There is no evacuation from the duodenum within 2 hours of observation, the intestine is atonic and dilated. The patient was operated on again. During the audit, it was revealed that the duodenum was sharply distended - up to 12 cm in width. We are going through duodenojejunostomy. The pancreas is compacted. The common bile duct is slightly dilated.
A resection of the stomach was performed with a Y-shaped anastomosis according to Roux. Postoperative course without complications.
Monitoring the patient’s condition 2 years after the operation: you feel well, attacks of pain do not recur. The patient resumed her previous job.
As we have already noted, in 11 patients, against the background of existing duodenal stasis, an ulcer developed over time.
In cases where duodenal stasis occurred as concomitant disease, the symptoms of duodenal motility disorders were not always the same.
At the initial stage of development of the duodenal region and the absence of anatomical changes in the wall of the duodenum, no clinical manifestations of impaired intestinal motility were observed. Duodenal stasis was only an X-ray finding as an indirect sign of another disease.
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Duodenitis– inflammation of the mucous membrane of the duodenum (duodenum). The disease manifests itself acutely or nagging pain in the upper abdomen, nausea, vomiting, upset stool.
Duodenitis is the most common disease of the duodenum; 5-10% of the population have experienced its symptoms at least once in their lives. It equally affects representatives of different age groups. In men, it is diagnosed 2 times more often due to addiction to alcohol and an unhealthy lifestyle.
According to the stages of the disease and the duration of the course, acute and chronic duodenitis are distinguished.
Acute duodenitis develops rapidly due to poisoning or ingestion spicy food. It causes superficial inflammation of the mucous membrane, the appearance of ulcers and erosions, and rarely phlegmon (cavities filled with pus). The disease manifests itself with acute pain and digestive disorders. At proper treatment and following a diet, acute duodenitis disappears in a few days. With repeated inflammation, the risk of developing chronic duodenitis is 90%.
Chronic duodenitis often occurs against the background of other chronic diseases gastrointestinal tract(gastritis, peptic ulcer, pancreatitis), as well as poor nutrition. The disease can cause deep erosions and atrophy (thinning) of the upper layer of the duodenum. Periodically, chronic duodenitis worsens - severe pain and indigestion occur. This form of the disease requires long-term drug treatment and dieting.
Anatomy of the duodenum
Duodenum (duodenum)– initial department small intestine. It starts from the pylorus of the stomach, goes around the head of the pancreas and passes into the jejunum. The length of the duodenum in adults is 25-30 cm, capacity is 150-250 ml. The duodenum is fixed to the walls of the abdominal cavity with the help of fibers connective tissue.The main pancreatic duct and the common bile duct open into the lumen of the duodenum. At the point of their exit, a major papilla duodenum (papilla of Vater). It is a cone-shaped formation equipped with a sphincter. With its help, the flow of bile and pancreatic secretions into the intestines is dosed. At the exit site of the accessory pancreatic duct there is a minor papilla.
Functions
- Neutralization gastric juice. In the duodenum, food gruel mixed with acidic gastric juice acquires alkaline reaction. Such contents do not irritate the intestinal mucosa.
- Regulating the production of digestive enzymes, bile, pancreatic juice. The duodenum “analyzes” the composition of food and sends the appropriate command to the digestive glands.
- Feedback with the stomach. The duodenum ensures the reflex opening and closing of the pylorus of the stomach and the passage of food into the small intestine
Parts
- The upper part - the ampulla or bulb - is a continuation of the pylorus of the stomach and, unlike the other parts, has longitudinal folds.
- Descending part
- Horizontal part
- Rising part
Blood supply The duodenum is supplied by 4 pancreatic-duodenal arteries and veins of the same name. The intestine also has its own lymphatic vessels and 15-25 lymph nodes.
Innervation. The nerve branches of the superior mesenteric, celiac, hepatic and renal plexuses approach the wall of the duodenum.
Histological structure. The mucous membrane of the duodenum has a special structure, as it must withstand the effects of hydrochloric acid, pepsin, bile and pancreatic enzymes. Its cells have fairly dense membranes and are quickly restored.
In the submucosal layer are located the Brunner's glands, which secrete a thick mucous secretion that neutralizes the aggressive effects of gastric juice and protects the mucous membrane of the duodenum. Causes of inflammation of the duodenum
Causes of acute duodenitis
- Consumption of foods that irritate the digestive mucosa
- roast
- bold
- smoked
- acute
- Foodborne illnesses caused by:
- Helicobacter pylori, which causes peptic ulcers
- enterococci
- clostridia
- Diseases of the digestive organs
- pancreatitis
- peptic ulcer
- Reverse reflux of small intestinal contents into the duodenum (reflux). It may be associated with spasm lower sections intestines or obstruction. Thus, bacteria are introduced from the lower intestines that cause inflammation.
- Swallowing toxic substances , which cause burns to the gastrointestinal mucosa. These can be acids, alkalis, chlorine compounds or other household chemicals.
- Swallowing foreign bodies or indigestible parts of food products leads to mechanical damage duodenum.
Causes of chronic duodenitis
- Intestinal dysfunction
- chronic constipation
- poor peristalsis
- adhesions
- innervation disorder
- Chronic diseases stomach. Chronic gastritis with high acidity leads to the fact that hydrochloric acid gradually damages the intestinal cells, leading to thinning of the mucous membrane.
- Chronic diseases of the pancreas, liver, gall bladder lead to disruption of the flow of enzymes into the duodenum. As a result, the stability of the intestines is disrupted and its protective properties are reduced.
- unhealthy or irregular diet
- chronic constipation
- disruption of hormone production
- taking a lot of medications
- bad habits
Symptoms of duodenitis
Symptoms of duodenitis depend on the cause of the disease and concomitant pathologies of the digestive organs. The disease is often “masked” as a stomach ulcer, gastritis, or hepatic (biliary) colic, which makes diagnosis difficult. Symptoms of duodenitis
- Pain in the epigastric region. Pain increases with palpation (palpation) abdominal wall.
- At chronic duodenitis the pain is constant, dull in nature, which is associated with inflammation and swelling of the wall of the duodenum. The pain intensifies 1-2 hours after eating and on an empty stomach.
- If duodenitis is associated with impaired patency of the duodenum, then the pain appears when the intestines are full and is of a paroxysmal nature: acute bursting or twisting.
- Local inflammation in the area of the papilla of Vater disrupts the flow of bile from the gallbladder, which is accompanied by symptoms “ renal colic" There is acute pain in the right or left hypochondrium, girdle pain.
- Ulcerative duodenitis, caused by the bacteria Helicobacter pylori. Severe pain appears on an empty stomach or at night.
- If duodenitis is caused gastritis with high acidity, then the pain occurs after eating 10-20 minutes. It is associated with the entry into the intestines of a portion of food mixed with acidic gastric juice.
- General weakness and rapid fatigue are signs of intoxication of the body caused by inflammatory products. In acute duodenitis, body temperature may rise to 38 degrees.
- Indigestion. Violation of the synthesis of digestive enzymes leads to fermentation of food in the intestines and its rotting. This is accompanied by:
- decreased appetite
- nausea
- rumbling in the stomach
- increased gas formation
- diarrhea
- Bitter belching, vomiting with bile associated with duodenal overflow. Its contents do not pass into the intestines, but are thrown into the stomach - duodenogastric reflux.
- Jaundice of the skin and sclera with duodenitis it is explained by stagnation of bile and increased levels of bilirubin in the blood. This occurs when the papilla of Vater becomes inflamed and the bile duct narrows. Bile does not exit into the intestines, but overflows the gallbladder and enters the blood.
- Disorders of the nervous system. Prolonged duodenitis causes atrophy of the mucous membrane and glands that produce digestive enzymes. This negatively affects the absorption of food. The body is experiencing a deficiency nutrients. To improve digestion, blood flow to the stomach and intestines is increased, while the brain and lower limbs are “robbed”. Dumping syndrome develops, the symptoms of which appear after eating:
- fullness in the stomach
- feeling of heat in the upper half of the body
- dizziness, weakness, drowsiness
- trembling hands, ringing in the ears.
- hormonal deficiency develops, which negatively affects the functioning of the autonomic nervous system.
Diagnosis of duodenitis
Signs of duodenitis:- areas of narrowing of the duodenum - indicating a tumor, the formation of adhesions, developmental abnormalities
- enlarged areas - consequences of mucosal atrophy, impaired motility, blockage of the underlying intestinal sections, decreased tone intestinal wall in case of innervation disturbance
- a “niche” in the wall of the duodenum may be a sign of erosion, ulcer, diverticulum
- gas accumulations are a sign of mechanical intestinal obstruction
- with swelling, immobility and inflammation, the folds can be smoothed out
- reflux of food mass from the duodenum into the stomach
Radiography is better tolerated by patients, it is accessible and painless. However, x-rays are not able to detect changes in the mucous membrane, but only indicate gross disturbances in the functioning of the organ.
Laboratory tests for duodenitis:
- a blood test reveals anemia and increased ESR;
- in stool analysis - hidden blood in bleeding erosions and ulcers.
Treatment of duodenitis
Treatment of duodenitis includes several areas:- elimination of acute inflammation
- preventing the disease from progressing to chronic stage
- restoration of duodenal function
- normalization of digestion
Indications for hospitalization for duodenitis:
- exacerbation of duodenitis
- suspected tumor of the small intestine
- heavy general condition patient, advanced cases of illness
- inflammation of the serous covering of the duodenum (periduodenitis) and nearby organs
- presence or threat of bleeding (erosive or ulcerative form duodenitis)
Treatment of duodenitis with medications
| Group of drugs | Mechanism therapeutic effect | Representatives | Directions for use |
| Inhibitors proton pump | Suppresses the secretion of gastric juice. The drugs block the functioning of the glands that secrete hydrochloric acid and reduce irritant effect on the mucous membrane of the duodenum. | Omeprazole 20 mg Lansoprazole 30 mg Pantoprazole 40 mg Esomeprazole 20 mg | Apply 2 times a day in the morning and evening 20 minutes before meals. Duration of treatment is 7-10 days. |
| Antibiotics | Prescribed in the presence of an infection caused by a bacterium Helicobacter pylori. | Tetracycline 500 mg | 4 times a day, for 7-10 days. |
| Clarithromycin 500 mg Amoxicillin 1000 mg Metronidazole 500 mg | 2 times a day for 7-14 days. Take regardless of food intake. | ||
| H2-histamine blockers | Prescribed for the treatment of ulcer-like duodenitis. They inhibit the secretion of hydrochloric acid and reduce it irritant effect on DPK. | Ranitidine | 0.15 g 2 times a day. Course 45 days. |
| Famotidine | 0.02 g 2 times a day in the morning and evening before bed. |
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| Antacids | They have an enveloping and local anesthetic effect. Neutralize hydrochloric acid. | Almagel Maalox | Use as needed: for diet disorders, pain. 1 dose of the drug is taken an hour after meals 1-3 times a day. |
| Prokinetics | Prescribed for gastritis-like form of duodenitis. Regulate contractions of the gastrointestinal tract, promote gastric emptying and the movement of food masses through the intestines. They have antiemetic and local antiedematous effects. | Itomed Ganaton | 1 tablet (150 mg) 3 times a day before meals. |
| Multienzyme preparations | Contains pancreatic enzymes. Normalize digestion, promote the absorption of nutrients and the disappearance of symptoms of the disease. | Creon 10000 | One capsule is taken before meals, the other during or after meals. The capsule is not chewed. The drug is taken with every meal. |
| Antispasmodics | They relax the smooth muscles of the intestinal wall, relieve spasms and eliminate pain. | No-shpa (Drotaverine) Papaverine | 2 tablets 3 times a day, regardless of meals. |
Individual therapy is selected for each patient depending on the manifestations of the disease and the form of duodenitis. Self-medication can be dangerous to health.
Nutrition for duodenitis
Proper nutrition plays a key role in the treatment of duodenitis. At acute inflammation or exacerbation of chronic duodenitis, the first 3-5 days must be followed strict diet 1a. Its basis is slimy decoctions of cereals (rice, rolled oats), pureed soups, liquid milk porridges (semolina, buckwheat flour) and products baby food. Chicken or lean fish (pike perch) in the form of puree or steam soufflé are allowed once a day. Meals are fractional: 6 times a day, in small portions.- ulcerative-like duodenitis - diet No. 1
- gastritis-like duodenitis (with reduced gastric secretion) - diet No. 2
- cholecysto- and pancreatitis-like duodenitis diet – No. 5
General recommendations- Eat small meals 4-6 times a day. The feeling of hunger should not arise, otherwise “hunger pains” may appear.
- Food is served warm at 40-50°C.
- Dishes should be prepared in such a way as not to irritate the gastrointestinal mucosa. Preference is given to pureed soups with the addition of sour cream or cream and semi-liquid porridges (oatmeal, rice, semolina).
- Boiled lean meat with a minimum amount of connective tissue, removed from skin and tendons. Before use, it is advisable to mince it or grind it in a blender.
- Dairy products: milk, cream, steamed curd soufflé, yogurt, kefir, yogurt.
- Boiled vegetables, fruits without peels and seeds, baked or in the form of jelly. You can use canned baby food.
- Soft-boiled eggs or as a steam omelet. 2-3 per day.
- Fats: highly refined butter, olive and sunflower oil.
- Juices are a source of vitamins and improve digestion.
- Dried bread and crackers. They are better tolerated than fresh baked goods.
- Sweets - honey, jam, mousse, jelly, hard cookies, caramel in limited quantities.
- canned food
- smoked meats
- concentrated broths from meat, fish, mushrooms
- fatty meats and fish (pork, duck, mackerel)
- pepper, mustard, garlic, horseradish, pepper, onion
- ice cream
- carbonated drinks
- alcohol
- raw vegetables and fruits
Consequences of duodenitis
- Intestinal obstruction– a condition in which the movement of food through the intestines is partially or completely stopped. It is accompanied sharp pain in the upper abdomen, 15 minutes after eating, repeated vomiting mixed with bile. This phenomenon can be caused by the proliferation of connective tissue and the formation of adhesions at the site of the inflammatory process.
- Peptic ulcer of the duodenum. A deep defect forms on the wall of the duodenum - an ulcer. Its appearance is associated with the effect of hydrochloric acid and pepsin on the weakened mucous membrane. Manifested by pain in the upper abdomen against the background long breaks between meals, when drinking alcohol and physical activity. Digestion is also disturbed: bloating, alternating diarrhea and constipation.
- Maldigestion/malabsorption syndrome– impaired absorption of nutrients through the intestinal mucosa due to enzyme deficiency. The development of a complex of symptoms is associated with disruption of the glands digestive tract. This condition manifests itself in the early stages as diarrhea. Subsequently, exhaustion appears, changes in the composition of the blood - anemia, immunodeficiency - a decrease in the body's resistance to infections. Children have noticeable delays in physical development.
- Intestinal bleeding may be a consequence of erosive duodenitis. It is manifested by weakness, dizziness, drop in blood pressure, blood in the stool (discharge turns black).
Duodenitis is a fairly common disease, but highly treatable. If symptoms appear, consult a doctor and strictly follow his instructions! You should not self-medicate to prevent the disease from becoming chronic.
Inflammation of the duodenum, or duodenitis, is rare in isolation - in most cases, this disease is combined with other diseases of the gastrointestinal tract (gastritis, ...). This pathology is diagnosed in people of different age groups, and affects both men and women equally.
Classification
According to generally accepted classification duodenitis happens:
- by etiology - acute and chronic; acute, in turn, is divided into catarrhal, ulcerative and phlegmonous, and chronic is divided into primary (an independent disease) and secondary (a disease accompanying another pathology of the digestive tract);
- by localization of foci - local, diffuse, bulbar, postbulbar;
- by level structural changes– superficial (affects only surface layer mucous membrane), interstitial ( inflammatory process spreads to the deeper layers of the intestine) and atrophic (thinning of mucosal areas, absence of glands in the affected areas);
- according to the endoscopy picture - erythematous, erosive, hemorrhagic, atrophic, hypertrophic, nodular;
- special forms of duodenitis - fungal, immunodeficiency, tuberculosis, Crohn's disease...
Etiology of duodenitis
Alcohol abuse quite often leads to duodenitis.Most common reasons acute duodenitis are:
- food poisoning;
- excessive consumption of spicy foods and alcoholic beverages;
- mechanical damage to the intestinal mucosa by a foreign body.
Chronic duodenitis is often the result of irrational and irregular nutrition.
Factors provoking the onset of the disease are the presence of the Helicobacter pylori bacterium in the stomach cavity and duodenostasis (impaired movement of food through the duodenum). In addition to the above factors, the development of duodenitis is facilitated by:
- ascariasis;
- giardiasis;
- outbreaks chronic infection in the oral cavity, in the genital area.
Pathogenesis
Acute and primary duodenitis occur as a result of damage to the mucous membrane of the duodenum by gastric contents increased acidity. If the number of protective factors in the duodenum is reduced, hyperacid juices have an irritating effect on the intestinal mucosa, causing inflammation in it.
Secondary duodenitis is a consequence of duodenostasis: the contents of the stomach, falling into the duodenum, are retained in it for more long term, than necessary, which means it irritates the mucous membrane for a longer time, which leads to inflammation.
Symptoms of inflammation of the duodenum
Acute duodenitis is characterized by patient complaints of:
- severe pain in the epigastric region 1.5–2 hours after eating, night pain;
- nausea and vomiting;
- general weakness.
The symptoms of chronic duodenitis are more smoothed out and vary greatly in different forms of the disease. Patients are usually concerned about:
- constant aching, dull ache in the epigastric region;
- feeling of fullness, heaviness in the upper abdomen after eating;
- and belching;
- nausea, in some cases – vomiting;
- decreased appetite;
- general weakness, irritability, headaches and other so-called general symptoms.
With duodenostasis, pain in the epigastrium or in the right hypochondrium is pronounced, twisting, bursting, and paroxysmal in nature; Patients also complain of rumbling in the stomach, a feeling of bloating, bitterness in the mouth and vomiting bile.
If duodenitis is combined with duodenal ulcer, the symptoms of the above disease come to the fore, namely intense pain in the epigastric region on an empty stomach.
In cases where duodenitis is combined with another intestinal disease, it is manifested primarily by intestinal symptoms (pain along the intestines, bloating, frequent loose stools).
If the disease lasts for a long time, the mucous membrane of the duodenum atrophies and the synthesis of enzymes that promote normal digestion. As a result, profound disorders arise not only in the gastrointestinal tract, but also in many other systems of our body, including the central and autonomic nervous systems.
Diagnosis of duodenitis
The patient's complaints, medical history and objective examination will help the doctor suspect duodenitis. On palpation, you will notice varying degrees of pain in the epigastric area. To clarify the diagnosis of duodenitis and differentiate it from other gastrointestinal pathologies, the patient may be prescribed:
- EGDS (esophagogastroduodenoscopy) – examination of the upper part of the digestive organs through a probe; may be performed with or without biopsy;
- Ultrasound of the abdominal organs;
- study of gastric juice (determination of its acidity and composition);
- X-ray of the stomach and duodenum;
- coprogram;
- biochemical blood test (liver tests, amylase and other indicators).
Duodenitis: treatment
The food of a patient with duodenitis should be mechanically and thermally gentle, and it is recommended to prepare it by steaming, boiling or baking. The main point in the treatment of duodenitis is diet.
- Food should be as thermally, chemically and mechanically gentle as possible; therefore, sour, spicy, fried, cold and hot foods, as well as alcohol, canned food and smoked foods are completely excluded for 10–12 days.
- Grinded food prepared by boiling or steaming should form the basis of the diet, and it should be taken in small portions 5-6 times during the day.
- Recommended for consumption: yesterday's wheat bread, porridges cooked in water or milk (rice, buckwheat, semolina, rolled oats), small pasta, cereal puddings or casseroles, low-fat varieties meat and fish, soft-boiled eggs or in the form of a steam omelet no more than 2 per day, fermented milk products, whole milk, dry biscuit, vegetables (potatoes, beets, broccoli, cauliflower, zucchini, carrots).
- Excluded from the diet: legumes, millet, barley, large pasta, fresh bread, muffins, pancakes, fried or hard-boiled eggs, fatty dairy products, salty or sharp cheeses, overcooked butter, fatty meat and fish, sweets, carbonated and strong drinks .
Diets must be followed throughout life, but acute period of the disease, it should be as strict as possible, and as the signs of exacerbation fade, the patient should gradually expand the diet (of course, within the limits of what is permitted).
The phlegmonous form of acute duodenitis is an indication for surgical treatment followed by antibiotic therapy.
Prevention
The main preventive measures for duodenitis are:
Which doctor should I contact?
If symptoms of duodenitis appear, you should contact a gastroenterologist who will prescribe EGD. Additionally, consultation with a parasitologist or infectious disease specialist may be required. In addition, for full treatment You need to consult a nutritionist who will help you create the right menu.
The disease duodenostasis is a pathological condition in which there is obstruction of the duodenum of a physical or mechanical nature. If the pathology is detected in time, it responds favorably conservative treatment. In the advanced stage, surgical intervention is indispensable. Duodenostasis most often affects women 20-40 years old.
General information
Duodenostasis is a violation of the movement of chyme (half-processed food) through the duodenum. This occurs due to the fact that peristalsis (wavy contractions of the walls that push the bolus of food, starting from the stomach and up to the jejunum itself) is discoordinated, and subsequently begins to increase and draw nearby organs into the pathogenic process.
Often the diagnosis of the disease is incorrect, which is why inappropriate tactics of surgical treatment are carried out.
Reasons
The causes of duodenal dyskinesia are divided into 3 groups:
- Functional disorders:
- pathologies of the nervous system;
- autonomic disorders due to gastrointestinal diseases;
- failure of the endocrine system.
- Internal pathologies:
- gastritis, stomach ulcer, duodenal ulcer;
- inflammatory process in gallbladder, pancreas;
- , pancreatitis;
- other gastrointestinal pathologies.
- Mechanical problems:
- kinks, adhesions and other inherited or acquired defects in the structure of the duodenum;
- the presence of stones and worms in the organ;
- the small intestine is compressed by the mesenteric vessels;
- various diseases during the development of duodenum;
- neoplasms in the area of the small intestine, as well as nearby organs;
- consequences of the operation.
Very rarely, duodenal obstruction does not have certain origin, which significantly complicates further medical actions.
Classification
Duodenostasis is divided into 2 forms:
- Primary - during diagnosis, no other diseases were found that could be the cause of development.
- Secondary – problems have been identified in the body that have led to pathology. For example, chronic disorders of the digestive tract, pancreas, liver, diseases of the duodenum.
There are 3 stages of development of duodenostasis:
- Compensation – contractile functions of the intestine are constantly changing. There is uncoordinated spasm and relaxation of some areas, as a result of which peristalsis is disrupted, and the contents return into the duodenal bulb.
- Subcompensation - changes in the movement of the food bolus through the small intestine become permanent. IN pathological process retracts lower area stomach, valve system. The pylorus is not able to protect the stomach from duodenogastric reflux, which adversely affects the organ.
- Decompensation is a permanent disorder, and negative impact on nearby organs lead to a chronic disorder of their functions. A cycle of disorders has occurred: a disorder of the duodenum picks up the improper functioning of neighboring organs, and vice versa.
Therefore, it is important to notice pathology at the initial stage of development.
Symptoms
As with many diseases of the intestinal tract, at the first stage of duodenostasis the symptoms may not be noticeable. The course of the pathology up to the stage of decompensation can last from a couple of weeks to several years.
The main manifestations of symptoms can be divided into 2 categories: dyspeptic, intoxicating. The first includes:
- stool disorder;
- sour belching;
- nausea, possibly vomiting, which does not provide relief;
- feeling of discomfort in the upper region of the peritoneum;
- sometimes abdominal pain.
Usually painful sensations appear after eating. Some people experience such nausea that they develop an aversion to food. Because of this, there is a decrease in body weight and vomiting with bile. At the stage of decompensation, pain is constant, frequent vomiting, nausea.
Intoxication signs of duodenitis:
- malaise, fatigue;
- indifference;
- causeless irritability;
- There is absolutely no appetite.
If intoxication dyskinesia of the duodenum is not treated, damage to the heart, kidneys, and, even worse, death can occur.
Complications of duodenostasis can include gastrointestinal dysfunction, adhesive obstruction, CDN, and duodenal ulcer.
Diagnostics
The patient's complaints do not accurately determine the diagnosis. Many gastrointestinal pathologies have similar symptoms. To establish the disease, you will need to consult an endoscopist, surgeon, or gastroenterologist.
For diagnosis, instrumental laboratory tests are carried out:
- duodenal intubation - analyzes the contents of the duodenum, whether there is intoxication or stagnation in it;
- endoscopy – necessary to determine the condition of the intestinal walls, whether pathological disorders predominate in them;
- Ultrasound of the stomach identifies existing mechanical disorders that cause duodenostasis;
- antroduodenal manometry - establishes the tone of the small intestine, whether a food coma is being supplied or not;
- esophagogastroduodenoscopy - allows you to see the enlargement and relaxation of the duodenum, the condition of the pylorus, and whether there is reflux.
In addition, it is carried out general analysis blood, urine.
Treatment
Regardless of the stage of development of the disease, conservative methods of therapy are used. Produced complex treatment duodenostasis with mandatory diet and intake medicines. During the decompensation stage you will need surgery, which will help improve the condition of the intestines and eliminate substances that lead to intoxication.
Drug treatment
In gastroenterology, the following drugs are used for duodenostasis:
- Antispasmodics (No-Shpa, Drotaverine) - to relieve pain in chronic obstruction.
- Prokinetics (Domidon, Itomed) - intended for intestinal motility.
- Ranitidine, Maalox - help reduce acidity and the release of hydrochloric acid.
- Vitamins.
For any diseases of the abdominal cavity, treatment of duodenostasis with medication should be carried out as prescribed by a specialist, since wrong actions can lead to negative consequences.
Physiotherapy
At the initial 2 stages of the disease, physiotherapeutic measures are carried out:
- Therapeutic gymnastics - exercises help strengthen muscles and have a beneficial effect on the condition of the intestines.
- Washing – eliminates intoxication of the body, normalizes contractile function. Using a probe, 300-500 ml of mineral water is poured into the duodenum, then removed.
- Self-massage of the abdomen - increases the contraction of the walls of the organ, increases the movement of chyme.
If unsuccessful conservative therapy perform surgery. Resection of the digestive organ is performed according to Billroth 2. But, unfortunately, the operation in many cases does not have the desired result, so it is performed in extreme cases.
Diet
A mandatory method of treating duodenostasis is diet. It is important to exclude fermented products from the diet: juices, grapes, baked goods.
| Prohibited | Allowed |
|---|---|
| Fatty, salty, fried foods. | Dried yesterday's bread. |
| Preservation, marinades. | Dried fruit compotes. |
| Dairy fatty products. | Not strong brewed tea, cocoa. |
| Alcohol, soda, tea, coffee. | Low-fat milk. |
| Cream confectionery products. | Vegetable soups. |
| Fatty fish, meat. | Porridge on the water. |
| White wheat bread. | Dietary meat, fish. |
It is necessary to follow a diet. Eat food in small portions 5-6 times a day. Dishes should not be cold or hot, liquid or puree food should be taken.
In more severe cases or with obstruction of duodenostasis, compliance dietary nutrition will be for life.
In addition, the disease can be treated using traditional methods. Anti-inflammatory, restorative, choleretic plants are used: plantain, chamomile, currant, rose hips, dandelion.
Prevention
To prevent the development of the disease, you need to:
- eat right;
- timely treatment of any gastrointestinal ailments;
- strengthen immunity;
- eliminate bad habits;
- physical activity should be moderate.
