Acute enteritis

　　Acute enteritis is the most common disease in the digestive system. It is often associated with intestinal infections including enteroviruses (such as Coxsackie virus, Echovirus), bacteria (such as bacilli, Salmonella, Staphylococcus aureus, cholera, Candida albicans), intestinal amebas, parasites, and so on; it is also related to improper diet, overconsumption of unrefrigerated food causing food poisoning, chemical and drug poisoning, and food allergies. Clinical manifestations include diarrhea, abdominal pain, bloating, accompanied by varying degrees of nausea and vomiting, and in severe cases, it can lead to dehydration and even shock.

　　This disease can occur at any age, more frequently in summer and autumn, and is more common in areas with poor public health. With clear etiology and timely diagnosis and treatment, it is generally curable.

　　Acute enteritis has the following complications:

　　1. Sepsis: It often starts abruptly, with chills or shivering followed by high fever, with an unpredictable fever pattern, such as remittent or persistent fever. There may be malaise or restlessness, and in severe cases, pale or bluish-gray complexion or confusion. The extremities become cold, breathing becomes rapid, heart rate increases, and blood pressure decreases.

　　2. Intestinal stricture: It often occurs in cases with extensive lesions and a long course of 5 to 25 years or more, mainly in the rectum. Clinically, there are generally no symptoms, and in severe cases, it can cause intestinal obstruction. When intestinal stricture occurs in this disease, one should be vigilant for swelling and differentiate between benign and malignant conditions.

　　3. Anal canalitis: This is a complication of the disease, often referred to as anal canalitis along with proctitis. Many patients suffer from persistent pain due to long-term fecal stimulation, which makes the patient unable to move comfortably, restless in sitting or lying down; anal itching, moisture; a feeling of descent in the anal area, abnormal defecation. Anal canalitis that is left untreated for a long time also has a risk of malignant transformation.

　　4. Anal sinusitis: If acute enteritis is not treated in time, it may lead to anal sinusitis, characterized by a sense of urgency, a feeling of descent in the anal area, a desire to defecate, but difficulty or only a small amount of stool in the toilet; discomfort and hidden pain in the anal area, exacerbated during defecation; a small amount of mucus and blood may be present in the stool; when the anal papillae are hypertrophic, they may prolapse from the anus; there is also a risk of secondary perianal abscess.

　　5. Intestinal perforation: Abdominal pain often occurs suddenly, presenting as persistent cutting pain, which intensifies during deep breathing and coughing. The extent of pain is related to the degree of spread of peritonitis; abdominal breathing is weakened or absent, and there is marked tenderness and rebound pain throughout the abdomen. Muscles are tense and rigid, and the liver dullness sound may disappear. There may be mobile dullness, and bowel sounds may be weakened or absent.

　　Acute enteritis can cause symptoms in various parts of the body. Generally speaking, one can observe it from the following three aspects: systemic symptoms, gastrointestinal symptoms, and signs and symptoms of physical examination.

　　Physical symptoms: Generally, the symptoms are mild throughout the body, while severe patients may have symptoms such as fever, dehydration, acidosis, shock, and occasionally acute upper gastrointestinal bleeding. Symptoms include bloating, weight loss, fatigue, bowel sounds, insomnia, nightmares, and aversion to cold. Severe cases may have fever, accelerated heart rate, and weakness, anemia, dehydration, imbalance of electrolyte levels, and nutritional disorders.

　　Gastrointestinal symptoms: Nausea, vomiting, abdominal pain, and diarrhea are the main symptoms of acute enteritis. Vomiting occurs abruptly, often preceded by nausea, followed by vomiting, and the vomit is usually gastric contents. Severe cases may vomit bile or blood-stained matter. Mild patients may have no abdominal pain or only discomfort. Generally, there is mild to moderate abdominal pain, which is cramping pain in the lower left abdomen and can involve the entire abdomen in the pattern of pain--desire to defecate--relief after defecation. Severe cases may present with colicky pain. Diarrhea is characterized by watery stools, occurring several to dozens of times a day, accompanied by a foul odor, mostly deep yellow or greenish stools, rarely with pus or blood, and without a sense of urgency. Sometimes diarrhea and constipation alternate.

　　In terms of signs and symptoms: in the early stage or mild cases of inflammation, there may be no signs or symptoms. During physical examination, there may be slight tenderness in the upper abdomen or around the umbilicus, and the bowel sounds are often significantly increased. Generally, patients with acute enteritis have a short course of illness and can recover spontaneously within a few days.

　　The summer and autumn seasons are peak periods for acute enteritis. How should one scientifically prevent it?

　　1. Reasonably arrange the diet, pay attention to a balanced diet of nutrition. In summer and autumn, food should be light in taste, especially for children who like to eat meat, parents should pay more attention to adjusting the dietary structure, encouraging children to eat more vegetables and fruits. Do not overindulge in cold drinks, do not eat too much at each meal, and avoid causing damage to the gastrointestinal function.

　　1. Reasonably arrange the diet and pay attention to a balanced diet of nutrition. In summer and autumn, food should be light in taste, especially for children who like to eat meat, parents should pay more attention to adjusting the dietary structure, encouraging children to eat more vegetables and fruits. Do not overindulge in cold drinks, do not eat too much at each meal, and avoid causing damage to the gastrointestinal function.

　　2. Pay attention to dietary and personal hygiene, and educate children to develop the good habit of washing hands before and after meals from a young age. It should be taught that children should not eat at street vendors or restaurants with poor hygiene conditions, and should not walk and eat while holding food. For families with pets, it is necessary to maintain the hygiene of pets and warn children not to feed pets while eating.

　　3. For infants and young children, encourage breastfeeding, especially in the first summer and autumn after birth, which is very important and should avoid weaning in the summer and autumn. When artificial feeding, attention should be paid to dietary hygiene and water source cleanliness. Whether breastfeeding or artificial feeding, complementary foods should be added in a timely manner, and the process should be gradual, without adding several complementary foods at the same time.

　　1. Blood routine: a slight increase in the total white blood cell count and the percentage of neutrophils.

　　2. Faecal routine: yellow watery stool, which may contain a small amount of mucus, and occasionally white blood cells and pus cells. Cultivation can detect pathogenic bacteria.

　　Acute enteritis is divided into the early stage, improvement stage, and recovery stage, each with its own dietary principles.

　　The early stage of acute enteritis is a stage of acute congestion, edema, inflammation, and exudation of the intestines. At this time, intestinal motility is active or in a spastic state. Both digestion and absorption functions are relatively weak. Therefore, within 8 to 12 hours after the onset, patients can eat liquid foods such as rice porridge, lotus root powder, egg paste, thin noodles, and stewed thin noodles. If diarrhea is severe or there is excessive sweating, some more soup and water should be given to the patient appropriately, such as rice juice, vegetable soup, fruit juice, and dilute 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 nutritious liquid or semi-liquid foods, such as rice porridge, thin noodles, steamed egg custard, and salted biscuits. It is recommended to adopt the method of eating small meals more frequently, with 4 to 5 meals per day. It should be noted that milk and a large amount of sugar should not be consumed at this time, as these foods are prone to fermentation in the intestines, producing a large amount of gas, causing abdominal distension and pain, and increasing the patient's suffering. In addition, milk contains a large amount of fat, which has the effect of lubricating the intestines and enhancing intestinal motility, which can increase the burden on the intestines and is unfavorable for 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 moderation, and it is advisable to eat light, soft, and warm foods, avoiding eating fatty meats, fried foods, cold and hard foods, and high-fiber foods such as celery, chives, and garlic sprouts as soon as possible. After about 2 to 3 days after the recovery period, one can eat meals as usual.

　　The treatment of acute enteritis with Western medicine is divided into the following points:

　　1. General treatment: Rest and fasting, during the period of abdominal pain, hematochezia, and fever, complete bed rest and fasting should be maintained. Early intake of food may lead to recurrence of the disease, but delayed recovery of eating may affect nutritional status and delay recovery. Only when vomiting stops, hematochezia decreases, and abdominal pain subsides can liquid food be introduced, and the amount can be gradually increased thereafter. During the fasting period, high-nutrition fluids should be administered intravenously, such as 10% glucose, compound amino acids, and hydrolysable protein, etc. Severe abdominal distension and vomiting can be treated with gastrointestinal decompression. Antispasmodics can be given for abdominal pain.

　　2. Correction of water and electrolyte imbalance: This disease is more common with dehydration, sodium loss, and potassium loss. The total fluid volume and composition can be determined according to the condition. Children's daily fluid intake is about 80-100ml/kg, adults 2000-3000ml/d, of which 5%-10% glucose solution accounts for about 2/3-3/4, normal saline accounts for about 1/3-1/4, and appropriate potassium chloride is added.

　　3. Antishock: Rapidly replenish effective circulating blood volume. In addition to crystalloid solutions, appropriate amounts of plasma, fresh whole blood, or human serum albumin and other colloidal fluids should be infused. For those with unrisen blood pressure, vasopressor drugs can be used in conjunction with antishock therapy, such as α-receptor blockers, β-receptor stimulants, or Scopolamine, etc., which can be selected according to the situation.

　　4. Antibiotics: Controlling intestinal infections can alleviate clinical symptoms, and commonly used antibiotics include: Ampicillin (4-8g/d), Chloramphenicol (2g/d), Gentamicin (160,000-240,000u/d), Kanamycin (1g/d), Sulfamethoxazole (6.0g/d), Fortum 4g/d, or Polymyxin and Cephalosporins, etc., generally selected in combination with two types.

　　5. Adrenal cortical hormones: They can alleviate toxic symptoms, suppress allergic reactions, and help correct shock, but there is a risk of aggravating intestinal bleeding and causing intestinal perforation. Generally, the application should not exceed 3-5 days; children use hydrocortisone 4-8mg/kg per day or dexamethasone 1-2.5mg/d; adults use hydrocortisone acetate 200-300mg/d or dexamethasone 5-20mg/d, all administered intravenously.

　　6. Symptomatic therapy: Severe abdominal pain can be treated with Durotropine; for those with high fever and irritability, oxygen therapy, antipyretics, sedatives, or physical cooling can be provided.