Intestinal Necrosis

　　The etiology of this disease has not been fully elucidated. It is currently believed that the onset of the disease is related to the infection of bacteria producing B toxin (type C clostridium perfringens), which can cause necrosis of intestinal tissue and produce gangrenous enteritis.

　　In the highland region of Papua New Guinea, where the incidence of the disease is high, research has found that the local residents have low concentrations of proteases in the intestinal lumen, which is related to low-protein diet and the heat-resistant trypsin inhibitors contained in the sweet potatoes, which are the staple food in the region. In animal experiments, when the liquid containing bacilli is infused through the gastric tube, the animals do not become pathogenic; however, if the liquid containing trypsin inhibitors from raw sweet potato powder or raw soybean powder is infused at the same time, the animals can become pathogenic and produce histopathological changes similar to acute hemorrhagic necrotizing enteritis. Animal experiments also prove that the trypsin-containing extract from dog pancreas can prevent and alleviate the occurrence and development of the disease.

　　The above facts suggest that the occurrence of the disease is not only related to the intake of contaminated meat containing pathogenic bacteria but also to other dietary factors, such as a sudden change in dietary habits, which is conducive to the proliferation of bacilli; or if the diet is mainly sweet potatoes, the large amount of trypsin inhibitors present in the intestines reduces the destruction of B toxin.

　　Most cases occur within 1-2 days after birth. Initially, there are often systemic manifestations such as unstable body temperature, apnea, bradycardia, drowsiness, and so on. At the same time or subsequently, varying degrees of gastric retention, abdominal distension, vomiting, diarrhea, and hematochezia may occur. Physical examination may show intestinal shape, reddened abdominal wall, abdominal tenderness, a mass in the lower right abdomen, weakened or absent bowel sounds, and in severe cases, complications such as sepsis, intestinal perforation, or peritonitis are common.

　　Premature infants have less gastric acid secretion, poor gastrointestinal motility, low protease activity, high permeability of the intestinal mucosa, and low digestive absorption and local immune response. Therefore, under the action of pathogenic factors such as infection, intestinal wall ischemia and hypoxia, and inappropriate intestinal feeding, intestinal injury leading to NEC is likely to occur.

　　Infection

　　During sepsis or intestinal infection, bacteria and their toxins can directly damage the mucosa or indirectly increase the release of inflammatory mediators such as platelet-activating factor (PAF), interleukin (IL), tumor necrosis factor (TNF), etc., causing intestinal mucosal damage. In addition, the overgrowth of bacteria in the intestines can also aggravate intestinal injury, with common bacteria including Escherichia coli, Clostridium botulinum, Pseudomonas aeruginosa, Salmonella, Klebsiella, Clostridium perfringens, etc. Viruses and fungi can also cause this disease.

      Intestinal necrosis is a severe disease, often complicated with intestinal paralysis, abdominal cavity infection, and sepsis. In severe cases, it can even cause intestinal perforation. In addition, postoperative complications may include malabsorption of nutrients, leading to secondary anemia.

　　Symptoms of intestinal necrosis: one, abdominal pain

　　The disease onset is acute, with sudden abdominal pain, which is also often the first symptom, mostly around the umbilicus. In the early stage, it often manifests as gradually intensifying umbilical or epigastric paroxysmal colic, which then gradually becomes persistent pain with periodic exacerbation.

　　Symptoms of intestinal necrosis: two, nausea and vomiting

　　It often occurs simultaneously with abdominal pain and diarrhea. The vomit may be watery yellow, coffee-like, or bloodwater-like, or it may vomit bile.

　　Symptoms of intestinal necrosis: three, diarrhea and hematochezia

　　Diarrhea and hematochezia may occur after abdominal pain. The stool is initially paste-like with fecal matter, then gradually becomes watery yellow, followed by clear water-like or red bean soup and jam-like, and even bright red blood or dark red blood clots. The stool is less and has a foul smell. There is no urgent need to defecate.

　　The amount of bleeding is not fixed. The mild case may only have diarrhea, or may only be positive for occult blood in feces without hematochezia; in severe cases, the daily bleeding volume may reach several hundred milliliters. The duration of diarrhea and hematochezia is short, only 1～2 days, and the long one can last for more than a month, and it may present intermittently or repeatedly. Severe diarrhea can lead to dehydration and metabolic acidosis.

　　Symptoms of intestinal necrosis: four, abdominal signs

　　Relatively less common. Sometimes there may be abdominal fullness, seeing intestinal patterns. There may be significant tenderness around the umbilicus and upper abdomen. Early bowel sounds may be hyperactive, and then may weaken or disappear.

　　Symptoms of intestinal necrosis: five, systemic symptoms

　　Systemic symptoms such as discomfort, weakness, and fever may appear as soon as the disease onset. Fever is generally between 38～39℃, a few cases may reach 41～42℃, but fever usually subsides within 4～7 days, and it is rare to last for more than 2 weeks.

　　The common occurrence sites of neonatal intestinal necrosis are the distal ileum and the proximal ascending colon. In severe cases, it can involve the entire gastrointestinal tract, with the duodenum less affected. The main changes are intestinal cavity inflation, mucosal patchy or large-scale necrosis, varying degrees of intestinal wall gas accumulation, hemorrhage, and necrosis, and in severe cases, the entire thickness of the intestinal wall necrosis and perforation.

　　Prevention mainly lies in preventing meat contamination, increasing nutrition, and strengthening dietary hygiene. Strengthening the management of animal husbandry and environmental hygiene, avoiding dense feeding and bedding accumulation, reasonably storing feed, reducing bacterial contamination, and strictly controlling the impact of various internal and external factors on the body can effectively prevent and reduce the occurrence of the disease.

　　In the early stage of acute hemorrhagic necrotizing enteritis, the abdomen is slightly distended and soft, with mild tenderness, but without a fixed tender point, and the intestinal rumbling is intense. In the late stage of intestinal paralysis, abdominal distension increases, intestinal rumbling decreases or disappears. When the necrotic intestinal wall involves the serosa or intestinal perforation occurs, peritoneal irritation signs appear: generalized abdominal tenderness and rebound pain, abdominal muscle tension, and in shock, the reaction is dull. Peritoneal irritation signs may not be obvious. When intestinal perforation occurs, the liver dullness border disappears.

　　1. Acute hemorrhagic necrotizing enteritis has an acute onset, severe condition, and some may appear peritonitis, intestinal perforation, or toxic shock within 48-72 hours.

　　Since acute hemorrhagic necrotizing enteritis often occurs in rural areas, mostly in summer and autumn, it is easy to misdiagnose and mistreat, with a high mortality rate. Therefore, disease prevention and control education and measures should be strengthened in high-risk areas, early diagnosis and treatment should be implemented, and those with abdominal pain, diarrhea, vomiting, hematochezia, and fever should seek medical treatment as soon as possible to improve the rate of early diagnosis and cure.

　　Guidance for acute hemorrhagic necrotizing enteritis patients to pay attention to dietary hygiene, eat at regular intervals, avoid eating foods that are difficult to digest, and eat less or avoid cold,刺激性, fried, and deep-fried foods.

　　1. Stool examination: The appearance is dark red or bright red, or strong positive occult blood test, under the microscope, a large number of red blood cells are seen, and occasionally, the fallen mesentery can be seen. There may be a small or moderate amount of pus cells.

　　1. X-ray examination: Abdominal flat films can show intestinal paralysis or mild to moderate intestinal dilation. Barium enema examination can show thickening of the intestinal wall, significant edema, and disappearance of the colon pouches. In some cases, gas between the intestinal wall can be seen, which is a sign of partial intestinal wall necrosis caused by bacterial invasion of the colon; or ulcers or polypoid lesions and rigidity may be seen. Some cases may also show intestinal spasm, stricture, and intestinal wall cystic gas accumulation.

　　Eating standards, fasting time: once diagnosed, fasting should be initiated immediately, for mild cases 5-10 days, for severe cases 10-15 days or longer. Gastrointestinal decompression should be provided when abdominal distension is obvious.

　　Standard for resuming eating: the disappearance of abdominal distension, negative occult blood in stool, normal abdominal X-ray film, and significant improvement in general condition. If the child experiences abdominal distension and vomiting after eating, the child should be fasting again.

　　Attention should be paid to the following aspects for intestinal necrosis:

　　Low-fat and low-fiber. Foods with too much fat are not easy to digest and often worsen diarrhea symptoms due to their lubricating bowel action. Therefore, patients should not eat fried, baked, cold, and high-fiber foods, and can choose easily digestible thin noodles, fried noodles, wontons, tender leaves, fish, shrimp, eggs, and soy products to allow the intestines to rest.

　　If chronic colitis patients have symptoms of dehydration, they can drink some diluted salt water, vegetable soup, congee, fruit juice, and rice porridge to supplement water, salt, and vitamins.

　　When flatulence and intestinal rumbling are excessive, it is advisable to eat less sucrose and easily gas-producing fermented foods, such as potatoes, sweet potatoes, white radishes, pumpkins, milk, soybeans, etc.

　　Chronic colitis patients are generally weak and have poor resistance, so they should pay more attention to dietary hygiene, avoid eating raw and cold foods, hard and deteriorated foods, do not drink alcohol, and avoid spicy and strong stimulant seasonings.

　　5. Pay attention to the combination of work and rest, do not overwork; patients with fulminant type, acute onset, and severe chronic type should rest in bed.

　　6. Pay attention to clothing, keep warm and cold appropriate; do appropriate physical exercise to enhance physical fitness.

　　7. Generally, soft, easy-to-digest, nutritious, and sufficient heat foods should be eaten. It is advisable to eat small and frequent meals, and supplement various vitamins. Do not eat raw, cold, greasy, and high-fiber foods.

　　8. Pay attention to food hygiene, avoid intestinal infections that may trigger or worsen the disease. Avoid smoking, drinking, spicy foods, milk, and dairy products.

　　9. Keep a pleasant mood in daily life, avoid mental stimulation, and relieve various mental stresses.

　　In terms of treatment, the acute stage focuses on clearing heat and detoxifying, and activating blood and removing blood stasis. In the convalescent stage, it focuses on replenishing qi and strengthening the spleen, with the assistance of activating blood and removing blood stasis.

　　The treatment of this disease can be differentiated according to the zangfu and blood and qi. In the acute stage, it focuses on removing pathogenic factors and restoring health. In the convalescent stage, it focuses on tonifying deficiency. Since blood stasis is the main pathogenic factor, the method of activating blood and removing blood stasis should run through the whole process.

　　Ready-made medicine:

　　1. Babao wudan medicine ink: It has the effects of cooling blood and stopping bleeding, clearing heat and detoxifying, and calming wind and calming惊. It is suitable for patients with heat-toxin accumulation. Take 0.25g, twice a day.

　　2. Huangming glue: It has the effect of nourishing yin and stopping bleeding. It is suitable for patients with yin deficiency. Take 2g, twice a day.

　　3. Hemostatic gel: It has the effect of nourishing yin and stopping bleeding. It is suitable for patients with qi and yin deficiency. Take 2ml, three times a day.

　　Special formula:

　　1. Detoxifying and activating blood soup: 16g of purple flower anemone, 16g of凤尾草, 16g of liujinuzu, 16g of hongteng, 16g of diyu, 31g of xianhecao. Take one dose a day, take frequently.

　　2. Clean intestine and detoxify soup: 6g of kushen, 6g of danggui, 6g of baijiecaogen, 6g of baishao, 2g of xuanmingfen, 5g of peach kernel, 5g of danpi, 5g of hongteng, 5g of diyu, 10g of zhishizhi. Decoct, add kushen later, and take xuanmingfen by冲服. Take one dose a day, divided into three times.

　　3. Horse-tail herb mixture: 200g of horse-tail herb, 10g of raw rhubarb, 30g of dandelion, 30g of sophora flower, 5g of peach kernel, 10g of red peony root, 10g of white peony root, 10g of raw dioscorea, 10g of areca nut. The juice of horse-tail herb is mixed with the decoction, raw rhubarb is added later, and the whole medicine is decocted. Take two doses a day, take frequently.