Primary ulcers of the small intestine. Diagnosis of diseases of the small intestine

In the jejunum, mucosal ulcerations are much less common than similar duodenal defects. Most often they occur in young and middle-aged men (35-50 years old). Ulcer small intestine is nonspecific disease, which can occur in both acute and chronic forms.

Manifestations of the disease become obvious in the fall or spring, during the period of exacerbation of the pathology, and when the stage of remission occurs, they are practically imperceptible. Their number can also vary from single to numerous, often amounting to 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

Etiology and mechanism of development of this variety peptic ulcer these days it is not completely clear. 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 gastric juice or damage to the mucous membrane by bacterial poisons. There are also external risks, provoking the development of pathology:

• errors in diet;
• frequent stress and chronic fatigue;
• depression;
• bad habits, alcoholism, even beer drinking, and smoking.

It is necessary to take into account genetic predisposition. Some people inherit a pathology in which the production of gastric juice significantly exceeds the norm. Any person who has such a negative hereditary factor, you should minimize bad habits, reduce coffee consumption, constantly follow a diet and carefully monitor your diet.

There are 2 mechanisms for the development of ulcers in the small intestine - this is an aggressive effect on the mucous membrane of hydrochloric acid, due to which wounds and inflamed surfaces form on it, as well as the penetration of Helicobacter pliori into the digestive tract, pathogenic microorganism, causing the appearance of ulcerations.

Main signs and diagnosis of the disease

For ulcers small intestine symptoms are usually non-specific and do not allow one to identify the pathology clinical picture. But also this disease Maybe long time be completely asymptomatic before the onset of the process, which is characterized by signs acute abdomen.

The pathology may also become more complicated internal bleeding, but this happens in in rare cases. Main alarming manifestations, which 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, which is in the acute stage, feels constant fatigue 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 short time 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. Partially detect an ulcer in this section digestive system is possible only when resection or laparotomy of the gastrointestinal tract is performed due to massive bleeding resulting from perforation of the defect.

Basic therapeutic measures

Complex drug treatment ulcerations that have developed in the small intestine in uncomplicated cases have 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 peptic ulcer disease duodenum. All treatment recommendations for this disease are given depending on the form of the ulcerated defect on the mucous membrane jejunum.

Since ulcers developing over chronic type, not recognized, targeted drug therapy it is impossible to choose for them. For such defective ulcerations, urgent surgical treatment. This is due to the fact that their perforation due to anatomical structure small intestine occurs very quickly and leads to peritonitis of the abdominal cavity, which can occur within a few hours, and in best case scenario days will end in death.

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 this surgery not only complicates the operation, but also worsens further prognosis for the person. This type surgical intervention executed only by 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 pathological defects mucous membrane;
• formation of infiltrates.

Only in these cases is treatment carried out by resection. But after her patient there is a long wait recovery period, and perhaps permanent disability. Also, the operation to remove an ulcer that has penetrated (sprouted) into the neighboring organs. This is due to the fact that at the same time 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 the right image life, abandonment bad habits and regular visits to a gastroenterologist for diagnostic study will help avoid the risk of developing pathology or identify it in the first place initial stage, when the use of drug therapy is still possible and radical surgical intervention is not required.

Diseases are among the most common pathologies digestive tract. The appearance of disturbances in the functioning of an organ can be due to many reasons. Often the disease is caused by inflammatory processes; autoimmune and allergic factors play a certain role in the development of pathology. Despite the diversity clinical symptoms, diseases of the small intestine have similar symptoms, which are caused by specific reaction organ for damage.

All clinical manifestations characteristic of small intestinal disorders can be divided into two main groups - local and general.

Local symptoms

Local symptoms are directly related to organ damage. This group includes:

General symptoms

Many have severe course, at which pathological changes extend not only to the digestive system, but also to other organs. Therefore, diseases of the small intestine are characterized by a number of common symptoms which can often be found in patients. These include:

• General weakness. Fast fatiguability patient, decrease physical activity- This is one of the manifestations of intoxication syndrome. It occurs with severe inflammation, which accompanies most diseases of the small intestine.
• Increased irritability. Emotional reactions (nervousness, tearfulness, irritability of the patient) may be the first symptoms of dysfunction nervous system, which are also caused by severe intoxication of the body.
• Manifestations from the outside of cardio-vascular system. General decompensation of the patient's condition can lead to disruption of the heart and associated vascular reactions. These include arrhythmias (disturbances in the rhythmic contractions of the heart muscle), high or low blood pressure.

The severity of general symptoms directly depends on the course of the underlying disease - intestinal pathology. In mild forms, they are manifested by mild weakness of the patient and decreased mood. More severe forms pathologies are accompanied by clear somatic manifestations, including those of the cardiovascular system.

Possible causes of pathologies

Experts identify many factors that can cause the appearance of pathologies of the small intestine. These include:

A common cause of diseases of the small intestine can be perverted immune reactions. This group includes allergic and autoimmune responses of the body, which lead to damage to the body's own intestinal cells.

Diagnostics

A gastroenterologist diagnoses diseases of the small intestine. At the first appointment, the specialist clarifies the patient’s complaints in detail and carries out general examination. This allows one to suspect the presence of pathologies of the small intestine and prescribe a number of specialized studies.

IN diagnostic complex includes both laboratory and instrumental methods for examining the patient. TO instrumental studies relate:

The most common pathologies of the small intestine

Inflammatory diseases

Enteritis is a pathology that is characterized by the development of an inflammatory process in the wall of the small intestine. The disease can be combined - accompanied by damage to the stomach (gastroenteritis) or large intestine (enterocolitis).

Enteritis is characterized by the appearance of symptoms of intestinal damage. The most common symptoms of this disease are diarrhea, changes in stool characteristics (color, consistency), cramping abdominal pain and flatulence. Often local symptoms are accompanied by communication - elevated temperature, general weakness, lethargy.

Crohn's disease

is a disease of autoimmune origin that occurs due to damage to the mucous membrane of the small intestine by one’s own immune complexes body.

The disease has a severe course, characterized by the following symptoms:

• constant nausea, vomiting;
• severe pain in the lower abdomen on the right;
• flatulence and bloating;
• diarrhea.

When analyzing stool, the appearance of blood in the stool is noted.

Irritable bowel syndrome

- This functional impairment, which occurs due to increased motility of the small intestine. Main clinical manifestation disease is diarrhea, which occurs in daytime. Other symptoms of the pathology are strong pain during an attack and flatulence.

Lactose intolerance

- This hereditary disorder, appearing due to a lack of enzymes in the patient’s body. As a result, the patient cannot break down milk sugar normally, which leads to the appearance of characteristic symptoms: diarrhea, flatulence, nagging pain in a stomach.

Allergic reactions

Allergic enteropathies are hypersensitivity reactions to an allergen that enters the patient’s body through the digestive system. For of this disease characterized by diarrhea, cramping pain, and nausea. On the background food allergies intoxication may develop, which manifests itself general weakness and fever.

Other diseases

Prevention and therapy of diseases of the small intestine

Treatment of diseases of the small intestine depends on the cause that caused the development of the pathology. However, it is possible to highlight a number common factors, characteristic of most intestinal pathologies.

Of great importance in the treatment of the disease is therapeutic diet. For all patients, it is forbidden to eat salty, fatty and fried foods, drink alcoholic drinks. Other features depend on specific disease(for example, if you are lactose intolerant, you should not consume dairy products).

To compensate for insufficient digestion, the patient may be prescribed replacement therapy. It involves the introduction digestive enzymes while eating. These substances ensure normal absorption nutrients in the intestines.

In case of severe damage to the digestive system, the patient is prescribed substances that have a beneficial effect on the mucous membrane. These may be the following medications:

1. Omperazole or Omez;
2. Ranitidine;
3. Maalox;
4. Gaviscon.

Precise selection of therapy is carried out based on the characteristics of the disease in a particular patient.

Prevention of intestinal diseases includes a number of recommendations. Nutrition should be correct and varied, contain sufficient amounts of nutrients and vitamins. It is important to take care of your intestinal microflora. To do this, the diet includes dairy products or a course is being held prophylactic intake probiotics

To avoid the development of drug-induced intestinal damage, it is necessary to control the intake of drugs from the risk group (antibiotics, cytostatics, salicylates). Medicines should be used only as prescribed by a doctor. Uncontrolled use of these funds can lead to serious complications, therefore it is necessary to strictly follow the instructions for use.

In 1805 Baillie first described damage to the small intestine by ulcers, which outwardly resemble those of stomach ulcer And duodenum. Unlike secondary ulcers, resulting from any diseases of the small intestine, these ulcers appear as if on their own. They are described in the literature under various names: simple, primary, nonspecific, idiopathic, peptic, tryptic, trophic round.

The disease is quite rare. IN foreign literature About 200 cases have been described. According to our calculations, domestic authors provide about 100 observations. It is possible that the disease is much more common, but due to the characteristics of the clinic and lack of awareness among doctors, it is rarely diagnosed. Men are more often affected, and people aged 30 to 60 years are predominantly affected.

Speculation has been made about the role mechanical injury mucous membrane, increased acidity and digestive ability of gastric juice, valve insufficiency, local vascular disorders, increased proteolytic activity of pancreatic juice, damage to the mucous membrane by bacterial poisons, dystrophies of the gastric mucosa and pancreatic tissue.

Importance is attached to neurotrophic changes and endocrine imbalance. In particular, cases of ulceration of the small intestine during treatment with prednisolone have been described. There are reports of the occurrence of ulcers of the small intestine as a result of taking potassium salts and thiazide derivatives.

Primary ulcers most often found in the ileum; predominantly its terminal sections and proximal sections of the jejunum are affected. These ulcers are often single, but can also be multiple, have a round or oval shape, a diameter of 0.5 to 2 cm. They are located mainly along the free edge of the intestine; sometimes the edges of the ulcers are undermined, the bottom is often covered with reddish granulation tissue. Microscopy reveals in some cases inflammatory cell infiltration with vascular thrombosis, and in long-term cases fibrosis.

At uncomplicated ulcers are noted periodic pain in the stomach, which intensify 3-4 hours after eating mostly rough or spicy food. They sometimes decrease after a relatively short period of time after eating or taking alkalis, can radiate to the back and are localized when the jejunum is affected in the epigastric region or in the left half of the abdomen, and when affected ileum- in the navel area or in the right lower quadrant of the abdomen.

On palpation in the corresponding areas of the abdomen, slight resistance and increased pain are sometimes noted. If the terminal segment of the small intestine is affected, it is spasmodic and white on palpation.

Many patients experience diarrhea and, less commonly, constipation. Laboratory research. Sometimes anemia is detected in the blood, and often in stool occult blood. It comes down to identifying a niche on the topography of the mucous membrane of the small intestine and its deformation around the niche.

Complications, judging by the literature, in most patients they are the first sign of the disease. The most common is perforation, which usually occurs in a free abdominal cavity with the development of spilled. Bleeding and obstruction occur less frequently.

More often it develops gradually and is associated mainly with stenosis of the intestinal lumen due to scarring of ulcers or adhesions due to the peri-process, to which primary ulcers of the small intestine are very prone.

In uncomplicated and complicated primary ulcers, it is diagnosed extremely rarely; other diseases are more often diagnosed. When ulcers perforate, most patients are operated on, assuming a perforated ulcer of the stomach, duodenum, or appendicitis.

Course and prognosis. Primary ulcers of the small intestine are often asymptomatic, rarely recur, and tend to heal. Therefore, the prognosis for uncomplicated ulcers is usually favorable. If complications develop, it worsens sharply. A. M. Karyakin points out that, according to various authors, mortality in perforation of primary ulcers of the small intestine in postoperative period ranges from 50 to 70%.

The ability of patients to work, especially in jobs related to physical activity, during exacerbations of the disease is limited up to total loss with the development of complications. If there are no complications, treatment is basically the same as for duodenal ulcer. In case of complications, surgical intervention is required.

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

Case statistics and frequency of the disease depend on the type of small intestinal ulcer, as well as on the type of gastrointestinal tumor (carcinoid or other). So, for example, a primary ulcer of the small intestine is enough rare disease. The basic characteristics of small intestinal ulcers are somewhat similar to gastric and duodenal ulcers. But the main difference between small intestinal ulcers is that in most cases this disease occurs in men. In fact, a small intestinal ulcer is an inflammation of the mucous membrane of this part of the gastrointestinal tract with the presence of numerous lesions on its wall. An ulcer of the small intestine can occur due to the lack of treatment for a number of gastrointestinal diseases, including Helicobacter, as well as due to the lack of treatment for 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 feces. If the patient is prescribed targeted X-ray examination, then specialists diagnostic center Small intestinal ulcers are detected using this method only in rare cases.

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 mucous membrane or 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 a clinical picture of an acute abdomen. Thus, after analyzing 130 reports described in the literature about primary nonspecific ulcers 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 even radiologically. If the ulcer perforated or a massive intestinal bleeding, during laparotomy and resection gastrointestinal tract ulcers of the small intestine can often be detected.

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

At chronic course ulcers 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.

Intestinal ulcer signs and methods of diagnosis

The duodenum is the most common site for peptic ulcers to appear. Our stomach usually 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 ( Helicobacter pylori)
• Chronic gastritis
• Smoking
• Old age
• Specific problems with blood clotting

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 may occur at night.
• Bloating, vomiting and bad feeling. 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 a duodenal ulcer is suspected, 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

If you experience frequent weakness during illness, get plenty of rest. It is useful to take tinctures of mint, sage, chamomile and calendula herbs. Drinks will help relieve spasms, soothe mucous membranes and cope with nausea, and help boost immunity.

The patient must implement the described methods and means daily to combat the disease. It is important to remember that for complete cure This is not enough, you need to consult a doctor.

Outpatient examination and treatment of illness

A gastroenterologist will tell you how to use medications and procedures. When examining a patient, the doctor pays attention to the symptoms and signs of the disease and sends for tests:

• mucous membrane for the presence of infections;
• blood for antibodies;
• urine for the presence of bacteria in the body;
• stool for antigens (bacteria that cause ulcers).

Basic diagnostic information is obtained by full examination on special equipment: X-ray and endoscopic examination, which will 100% confirm or refute the diagnosis. Motor and towing activity will be visible internal organs.

Gastroscopy is performed on an empty stomach. A tube with an optical device is inserted through the mouth into the stomach cavity. The gastroenterologist examines the esophagus, stomach and intestines. If necessary, a biopsy has to be done to examine the mucous membrane in the laboratory. This is an unpleasant but informative procedure. X-rays are rarely performed if a duodenal ulcer is suspected. Ultrasonography internal organs of the abdomen are prescribed to clarify the diagnosis if the picture from previous procedures is unclear.

After determining the type of ulcer and location, drug treatment is prescribed: a number of drugs and procedures necessary to eliminate the pathology. Antibacterial, pain relieving, antacids and absorbents are the main components of an ulcer medicine kit. Physiotherapy is prescribed.

An individual diet must be selected and prescribed, depending on the type of ulcer. It is necessary to follow the recommendations regularly to maintain human health.

You will have to go through a surgical cure if the ulcer has worsened and caused peritonitis, perforation or penetration, or transformation into cancer. A different course of recovery and struggle is already being used here.

After treatment, you will have to take tests again to make sure that the pathology has disappeared. Monitor your body’s behavior and don’t neglect going to the doctor. Self-medication is dangerous; you should always consult a doctor before taking medications. This will prevent an unpleasant illness or save a life.