Special Pathology. Most common diseases of the intestine are dyskinesia, inflammatory af­fections (enteritis, colitis, enterocolitis) and tumours (mostly cancer of the large

Most common diseases of the intestine are dyskinesia, inflammatory af­fections (enteritis, colitis, enterocolitis) and tumours (mostly cancer of the large intestine).

According to their clinical course, inflammation of the small intestine (enteritis) and of the large intestine (colitis) may be acute or chronic.

Chapter 7. Digestive System

Acute Enterocolitis

Acute inflammation of the small and large intestine usually combines with affection of the gastric mucosa and arises after ingestion of spoiled food infected with microorganisms or after ingestion of a large amount of hardly digestable or incompatible foods (gastroenterocolitis).

Clinical picture. The clinic of acute enterocolitis varies from mild illness to fatal outcomes. The onset of the disease is sudden (3—4 hours following ingestion of inadequate food). Its first symptom is dyspepsia (diarrhoea). The body temperature is subfebrile or higher. The tongue is dry and the abdomen distended, tenderness is diffuse. Acute symptoms subside in 8—12 hours and the patient's condition improves in few days. Collapse may occur in severe cases due to poisoning.

Treatment. The stomach should be lavaged and purgative salts given. Sulpha drugs are given with a special diet; subcutaneous injections of sodium chloride are useful in marked dehydration.

Prophylaxis. This consists in adequate hygiene of nutrition, thorough inspection of cook­ing and foods storage conditions, especially during hot seasons.

Chronic Enteritis

Aetiology and pathogenesis. Chronic enteritis arises due to various causes. These are (1) infection: typhoid fever, dysentery, salmonellosis, etc.; (2) acute enteritis (a forerunner); (3) dysbacteriosis: upset microbial equilibrium in the intestine; (4) alimentary factor: irregular meals, inges­tion of cold food, chronic overeating of poorly digestable foods; (5) radioactive exposure; (6) alcohol abuse; (7) allergic factors; (8) congenital enzymopathy; deficient quantity of enzymes responsible for absorption of foods (gluten and lactase deficiency); (9) endocrine factors (diarrhoea in thyrotoxicosis); (10) diseases of other alimentary organs (stomach, hepatobiliary system, pancreas). For example, in the presence of achlorhydria, insufficiently digested food enters the small intestine to ir­ritate its mucosa and to provoke inflammation.

Pathological anatomy. Mucosa of the small intestine is oedematous and hyperaemic. Haemorrhage and ulceration are possible. In grave cases, inflammation may involve all layers of the intestinal wall to cause its perforation.

Clinical picture. The patient usually complains of pain in the umbilical region and distension of the abdomen. Stools are not formed; constipa­tions are alternated with diarrhoea. Nutrition is impaired, the skin is pallid. Signs of polyhypovitaminosis are present: dry skin, brittle and laminated nails. Splashing and rumbling sounds are heard in the right iliac region. Stools contain mucus; microscopy of faeces reveals the presence of drops of neutral fat and muscle fibres. Specific X-ray signs are hypotonia, the

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Chapter 7. Digestive System

presence of gas and liquid in the small intestine, and level relief or feather-like pattern of its mucosa.

Course. Chronic enteritis can be complicated by involvement of the pancreas, the liver, the large intestine, by development of hypochromic anaemia, and polyhypovitaminosis.

Treatment. Complex therapy is required. It is necessary to take into ac­count the degree of the peptic disorder, complications if any, and the general condition of the patient. In exacerbations of the disease, sulpha preparations, eubiotics, and enzyme preparations (abomin, pancreatin, pansinorm, festal, and others) are indicated.

Prophylaxis. This consists in eradication of possible causes of the disease and timely and thorough treatment of acute enterocolitis, chronic gastritis, diseases of the liver and the pancreas.

Chronic Colitis

Aetiology and pathogenesis. Causes of inflammatory affections of the large intestine are quite varied. Most frequent causes of chronic colitis are infections (dysentery, salmonellosis, tuberculosis, syphilis, etc.), parasites (helminths, protozoa, etc.), and toxic effects (poisoning with arsenic, phosphorus, mercury, etc.). Irregular nutrition, overeating, and chronic constipations can account for development of colitis as well.

In the presence of motor hyperfunction of the small intestine, the in­gested food is not processed sufficiently before it enters the large intestine, and it thus irritates its mucosa. Long-standing kinetic disorders cause col­itis. Persistent constipations can provoke chronic colitis. Mucosa of the large intestine has the excretory function. It releases microbes and their toxins, i.e. toxic products that circulate in the body in cases with upset metabolism. These factors can become the cause of chronic colitis, e.g. renal dysfunction causes development of colitis. And finally, auto-infection (e.g. coli bacilli which become pathogenic under certain condi­tions) can stimulate the onset of colitis.

Classification of colites. The following colites are distinguished: I, in­fectious colites: (1) specific, and (2) non-specific; II, parasitary colites: (1) protozoal (amoebic, trichomonal, lambliogenic), (2) helminthic; III, toxic colites: (1) exogenous and (2) endogenous; IV, alimentary colites; V, symp­tomatic or secondary colites; and VI, colites of mixed aetiology.

Pathological anatomy. The entire large intestine or its separate sections may be affected by inflammation. Catarrhal, follicular, infiltrative, purulent, ulcerative, and gangrenous colites are differentiated from the standpoints of pathological anatomy.

Clinical picture. The patient with chronic colitis complains of local and general disorders. Local complaints include pain in the lower abdomen or the iliac region, distension of the abdomen, tenesmus, constipation and diarrhoea. General complaints are irritability, deranged sleep, headache, and low moods. Appetite is decreased, nausea and sometimes vomiting oc­cur. Objective examination shows that nutrition is adequate. The study of the abdominal cavity reveals pain by the course of the large intestine and rumbling. Protozoa or helminths can be found in faeces. Stools may also contain traces of blood and mucus; dysbacteriosis is also possible. X-ray examination may reveal spasms, atonia of separate portions of the large in­testine, and changes in the relief of the intestinal mucosa. Rec-tosigmoidoscopy and colonoscopy are valuable diagnostic techniques.

According to the clinical course of the disease, mild, medium gravity and grave chronic colites are distinguished. Mild forms of colitis have no pronounced symptoms; only occasional diarrhoea or constipations are observed; the general condition of the patient is not affected substantially.

Signs of the disease are pronounced in chronic colitis of medium gravi­ty. Grave forms of the disease are marked by fever, headache, asthenia, disability, involvement of other organs, and complications (haemorrhage, perforation).

Treatment. A correct treatment is only possible if the cause of chronic colitis has been discovered. Changes in other organs of the digestive system and the presence of complications should also be taken into account. The appropriate diet should be prescribed along with symptomatic therapy (spasmolytics, analgesics, etc.).

Prophylaxis. Prophylactic measures are quite varied; this agrees with the variety of causes that provoke development of chronic colitis. Labour hygiene, sanitary conditions at home, and adequate nutrition are of primary importance. Patients with acute intestinal disorders should be thoroughly examined and treated. Regular out-patient observation of population is also important (control of intestinal parasitosis, treatment of constipation and other diseases of the digestive system that may cause pathologies in the large intestine, e.g. peptic ulcer, chronic gastritis, etc.).

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