Enteritis

　　The most common cause of colitis is bacterial and viral infection, with a few cases of unknown etiology. The most common pathogen of bacterial colitis is Shigella, followed by Campylobacter jejuni and Salmonella. In viral gastroenteritis, rotavirus is the main cause of infantile diarrhea, while Norwalk virus is the main cause of epidemic viral gastroenteritis in adults and older children. Intestinal amebiasis caused by parasites is more common. Fungal colitis is most often caused by Candida albicans. In addition, irregular rest and excessive mental tension are also a cause of this disease.

　　The complications of colitis include:

　　1, Intestinal polyps, colon cancer:If proctitis lasts for more than five years, the ulcerated surface of the intestinal tract is prone to abnormal hyperplasia under the long-term stimulation of inflammation, causing intestinal polyps. Larger intestinal polyps can also lead to cancer.

　　2, Intestinal stenosis:It often occurs in cases with extensive lesions and a long course, and the location is mostly in the rectum. Clinically, it is generally asymptomatic, and in severe cases, it can cause intestinal obstruction. When intestinal stenosis occurs in this disease, one should be vigilant for tumors and differentiate between benign and malignant diseases.

　　3, Anal sinusitis:If proctitis is not treated in time, it can lead to complications such as anal sinusitis and other anorectal diseases, and there is a risk of secondary perianal abscess. 4, Anal canalitis: This is a complication of the disease, often referred to as anal canalitis along with proctitis. If anal canalitis is not treated for a long time, there is also a risk of cancer. 5, Hematochezia: Hematochezia is one of the main clinical manifestations of the disease, and the amount of hematochezia is also an indicator of the severity of the condition. Chronic chronic bleeding can lead to iron deficiency anemia.

　　Patients with acute colitis have an acute onset, with main symptoms including nausea, vomiting, and diarrhea. During acute gastroenteritis, due to the stimulation of the digestive tract receptors by bacteria, toxins, or inflammation of the gastrointestinal mucosa, impulses are transmitted to the vomiting center in the medulla oblongata, causing excitation of the vomiting center. Through efferent nerves, they reach the stomach, diaphragm, respiratory muscles, abdominal muscles, and pharynx, soft palate, epiglottis, and other places, causing a series of coordinated movements that make up the vomiting action. At the same time, due to the inflammation of the intestinal mucosa, the content of the intestines increases, which directly or reflexively causes an increase in intestinal peristalsis and a decrease in absorption function, leading to diarrhea.

　　The etiology of chronic colitis can be caused by bacterial, mold, virus, protozoa, and other microorganisms, as well as allergies and变态反应for other reasons. The clinical manifestations include long-term chronic, or recurrent abdominal pain, diarrhea, and dyspepsia, and in severe cases, there may be mucous stools or watery stools.

　　Enteritis varies with the pathogen. Generally, it should be initially judged based on the history of epidemic and clinical manifestations. The diagnosis of enteritis depends on laboratory examination, commonly including:

　　1. Laboratory examination

　　Including bacterial culture, platelet count, white blood cell count, stool culture, blood culture, bacterial typing, anaerobic bacterial culture, red blood cell count, etc.

　　2. Endoscopic examination

　　Most of the lesions in clinical practice are located in the rectum and sigmoid colon. Sigmoidoscopy is used. Sigmoidoscopy is very valuable. For patients with chronic colitis or suspected to have total colitis, it is advisable to undergo fiberoptic colonoscopy. Generally, clean enema is not performed. In the acute stage, severe cases should be prohibited to prevent perforation. Endoscopic examination has diagnostic value. By observing the gross changes and histological changes of the colon under direct vision, it can not only understand the nature and dynamic changes of inflammation but also early detect precancerous lesions. It can accurately collect lesion tissue and secretions under the microscope to facilitate the exclusion of specific intestinal infectious diseases.

　　3. Digital gastroenterology imaging instrument

　　Digital gastrointestinal imaging examination has a high diagnostic rate of up to 99.5% for various common gastrointestinal diseases such as chronic gastritis, gastric ulcer, antrum gastritis, gastrointestinal polyps, gastric cancer, etc., providing objective diagnostic evidence for clinical treatment and effectively preventing misdiagnosis and missed diagnosis.

　　4. Radiological barium examination

　　During the clinical stationary phase, barium enema examination can be performed to judge the proximal colonic lesions. Those who need to exclude Crohn's disease should undergo a complete gastrointestinal barium meal examination. The double-contrast method of air and barium is more likely to discover superficial mucosal lesions. Routine barium enema X-ray examination shows: ① In patients with mild ulcerative colitis, X-ray examination is negative, while moderate and severe patients have typical manifestations. ② The barium shadow of the colon wall margin is like a small sawtooth projection, and the barium shadow of the rail-like creases. ③ There is a filling defect, the formation of pseudo-polyps, and in a few cases, due to fibrosis of the colonic wall and polyp hyperplasia, the lumen of the intestine can become narrow. ④ The colon pouches disappear or become shallow, the colon shortens and becomes rigid, and even like a water pipe. ⑤ Snowflake sign: due to the adhesion of barium to small ulcers and erosions, barium spots, and the air-barium double-contrast imaging shows like snowflakes. ⑥ Abnormal barium excretion. ⑦ The posterior rectal space increases to more than 2cm, indicating severe inflammation between the rectum and the posterior rectal tissue. ⑧ Attention should be paid to the presence or absence of colon cancer.

　　For patients with acute enteritis, in addition to paying attention to rest and actively treating the cause of the disease, dietary principles should be adopted, such as easy digestion, low irritation, moderate warmth, rich nutrition, eating small meals frequently, and timely water supplementation.

　　The early stage of enteritis is characterized by acute congestion, edema, inflammation, and exudation of the intestines. At this time, intestinal peristalsis is active or in a spastic state, and its digestive and absorptive functions are relatively weak. Patients in the early stage of onset can eat liquid foods such as rice porridge, lotus root starch, egg paste, thin noodles, and thin noodle slices. If diarrhea is severe or sweating is excessive, it is also appropriate to give the patient more soup and water, such as rice gruel, vegetable soup, fruit juice, and light salted water, to supplement the deficiency of water, vitamins, and electrolytes in the body.

　　During the improvement period of enteritis, patients can be given easily digestible and nutrient-rich liquid or semi-liquid foods, such as rice porridge, thin noodles, steamed egg custard, salted biscuits, etc. It is advisable to adopt the method of eating less and more meals, eating 4-5 times a day. It should be noted that milk and a large amount of sugar should not be consumed at this time, as these foods can easily ferment in the intestines, produce a large amount of gas, causing abdominal distension and pain, and increasing the patient's suffering. In addition, milk contains a lot of fat, which has the effect of lubricating the intestines and enhancing intestinal motility, which can increase the burden on the intestines and is not beneficial to the condition.

　　During the recovery period of enteritis, due to the pathological and physiological changes of the gastrointestinal tract, especially the intestines, the intestines are very sensitive to food at this time. Therefore, it is necessary to pay special attention to dietary restriction, and eat light, soft, and warm foods, avoiding eating fatty, fried, cold, hard, and fibrous foods such as celery, chives, and garlic sprouts prematurely. About 2-3 days after the recovery period, you can eat meals as usual.

　　Dietary taboos for enteritis patients:

　　1. Chronic enteritis patients should pay attention to dietary hygiene, not eat cold, hard, or spoiled foods, not drink alcohol, and not eat spicy and strong flavoring spices.

　　2. Foods with too much fat are not easy to digest, and their lubricating effect on the intestines often worsens diarrhea symptoms, so patients should not eat fried, fried, cold, and high-fiber foods.

　　3. For most chronic enteritis patients, fruits should also be avoided. This is because most fruits are cold and cool in nature, which can damage the spleen Yang and easily cause dampness, obstructing the transformation function of the spleen and stomach, and affecting the efficacy.

　　4. When there is excessive flatulence and borborygmi, it is advisable to eat less sucrose and easily fermentable foods, such as potatoes, sweet potatoes, white radish, pumpkin, milk, soybeans, etc.

　　5. Milk can stimulate the gastrointestinal tract, and most chronic enteritis patients should not drink it.

　　Conventional methods of Western medicine for treating enteritis include:

　　(1) Antimicrobial drugs: Generally, antimicrobial drugs are not recommended for enteritis caused by enterotoxigenic bacteria. For invasive bacterial enteritis, it is best to select antimicrobial drugs based on the results of bacterial drug sensitivity tests. For bacterial dysentery, compounds such as sulfamethoxazole (sulfamethizole), pipemidic acid, gentamicin, and amikacin can be used. Enteritis caused by Campylobacter jejuni can be treated with erythromycin, gentamicin, and chloramphenicol. Enteritis caused by Yersinia enterocolitica is generally treated with gentamicin, kanamycin, sulfamethoxazole, tetracycline, and chloramphenicol. For mild cases of salmonellosis enteritis, antimicrobial drugs may not be necessary, while for severe cases, chloramphenicol or sulfamethoxazole can be used. Enteritis caused by amebiasis, Giardia lamblia, and trichomonas can be treated with metronidazole (灭滴灵). Schistosomiasis can be treated with praziquantel. Oral nystatin is effective for candidal enteritis.

　　(2) Hormonal therapy: Adrenal cortical hormones, hydrocortisone, and prednisone can improve the overall condition, alleviate the course of the disease, reduce the frequency of defecation, alleviate recurrence symptoms, and increase appetite. For patients with acute fulminant or early onset of severe symptoms, hormonal therapy can significantly alleviate symptoms and improve the condition; however, the effect of long-term recurrence is not satisfactory.

　　(3) Immunosuppressants: Azathioprine can change the course of the disease, suppress clinical manifestations, but cannot change the underlying disease, and is commonly used to reduce recurrence during the quiescent phase.

　　(4) Antidiarrheal drugs: They can reduce the frequency of defecation, alleviate abdominal pain, and are commonly used in combination with benzylpiperazine, codeine, and camphorated tincture. Antidiarrheal drugs may cause toxic megacolon in patients with acute exacerbation of ulcerative colitis and should be used with caution. Sedative drugs and antispasmodic drugs can also be administered.

　　(5) Retention enema: Often used for proctitis and sigmoid colitis, it can alleviate symptoms and promote ulcer healing.

　　(6) Supplementation of fluids and correction of electrolyte and acidosis: For those with mild dehydration and not severe vomiting, oral rehydration can be taken. For those with severe dehydration or vomiting, intravenous administration of normal saline, isotonic sodium bicarbonate and potassium chloride solutions, as well as glucose, can be used.

　　(7) Reduce intestinal motility and secretory drugs. Scopolamine, atropine, and propantheline can be used in small amounts to reduce intestinal motility, relieve pain and diarrhea. Chlorpromazine can also be used, which has a sedative effect and can inhibit excessive secretion of the intestinal mucosa caused by enterotoxins, reducing the frequency and amount of bowel movements.