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Gabriella Rose
5 years ago
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6 Enteropathies (EP)

7 1. 2.

9 Enzymopathies (2): -

12 Genetic factors Parasitic invasion Radiation Toxic substances incl. medicines Primary diseases of other organs and/or systems Diet and nutritional quality disturbance alimentary factors CE PATHOLOGY - dysbacteriosis; - immune reaction changes (local) + allergy; - undertreated chronic infections and parasitic invasion; - dysfunction of gastrointestinal endocrine system; - enzymopathies

13 - inflammatory; - dystrophic; - dysgenerative; - atrophic Intestinal function disorders: - digestive; - absorbent; - motor; - secretory Extraintestinal disturbances (mild to severe)

14 CE classification (1): 1.1. Primary chronic enteritis: a) infectious (postinfectious), parasitic; b) toxic; c) drug-induced; d) allergic; e) radiative Secondary chronic enteritis: a) in other digestive organs diseases; b) in congenital enzymopathies and intestinal anomalies; c) in immunodeficiency; d) After surgery; e) in other systems diseases.

15 CE classification (2):

16 CE classification (3): 4. By clinical features: 4.1. Severity: a) mild (I stage); b) moderate (II stage); c) severe (III degree) 4.2. Phase: a) exacerbation; b) remission. 5. Clinical-laboratory syndromes (if any): a) maldigestion syndrome; b) malabsorption syndrome; c) dysbacteriosis syndrome (I, II, III degree); g) secondary exudative enteropathy syndrome; e) dyskinetic syndrome.

17 CE classification (4): 6. By complications (if any): 6.1. Solar plexitis Nonspecific mesenteric lymphadenitis Extraintestinal signs (evident disturbances of protein, fat, carbohydrate, mineral, vitamin metabolism, endocrine glands functions).

18 CE clinical presentation I. Local enteral syndrome (local signs): - dyskinetic; - pain; - dyspeptic. II. General (systemic) enteral syndrome): - asthenoneurotic; - jejunal-like; - anemic; - general-dystrophic.

19 Diarrhea «small intestine» «large intestine» With blood or mucus Without blood or mucus Tenesmus Without tenesmus Polyfecalia Stool is frequent but with small portions

20 Symptom Malabsorbed Nutrient Anemia (hypochromic, microcytic) Iron Anemia (macrocytic) Vitamin B12, folate Bleeding, bruising, petechiae Vitamins K and C Carpopedal spasm Ca, Mg Edema Protein Glossitis Vitamins B2 and B12, folate,niacin, iron Night blindness Vitamin A Pain in limbs, bones, pathologic K, Mg, Ca, vitamin D fractures Peripheral neuropathy Vitamins B1, B6, B12

22 The main diagnostic criteria of CE: - pathological stool changes (characteristic coprogram changes, increased enzymes fecal excretion, dysbacteriosis); - extraintestinal (general) and laboratory signs of malabsorption syndrome; - characteristic clinical enteral symptoms

23 Diagnostic criteria of chronic enteritis: 1. Clinical features and medical history 2. Instrumental methods of study (have only additional meaning): - gastrointestinal tract X-ray (gut passage) - detects motility and tone changes, meteorism in duodenum and other parts; sometimesdetects changes in mucous membrane relief - biopsy of small intestine with thin tube (by endoscope) - is held rarely

24 3. Laboratory methods (coproscopic, biochemical, bacteriological, radio-immune, etc.): a) help to detect specific clinical and laboratory syndromes, which are observed at CE: ~ malabsorption syndrome; ~ maldigestion syndrome; ~ intestinal dysbacteriosis syndrome; ~ exudative enteropathy syndrome b) detect other dystrophic and metabolic disorders (as a result of malabsorption syndrome): ~ blood- anemia, increased ESR; ~ hypoproteinemia, ~ hypoalbuminemia, ~ hypocholesterinaemia, ~ hypofermentemia, ~ hypovitaminosis

25 Differential diagnostics of chronic enteritis and chronic colitis: Chronic enteritis Of bursting character, around the navel, 3-4 hours after eating, sometimes worsens after stool

Principles of chronic enteritis treatment: 1.Way of life and diet correction: 1.1. regime; 1.2. dietotherapy: diet 4 and others 2. Drug therapy: 2.1. intestinal eubiosis regeneration; 2.

correction of metabolic and electrolyte disorders: - correction of protein metabolism, - correction of lipid metabolism, - correction of electrolyte disorder, trace elements

29 Principles of chronic enteritis treatment: 1.Way of life and diet correction: 1.1. regime; 1.2. dietotherapy: diet 4 and others 2. Drug therapy: 2.1. intestinal eubiosis regeneration; 2.2. diarrhea struggle (stool disorder correction) and normalization of intestinal motor function; 2.3. improvement of digestion and absorption; 2.4. correction of metabolic and electrolyte disorders: - correction of protein metabolism, - correction of lipid metabolism, - correction of electrolyte disorder, trace elements deficiency, - correction of vitamins deficiency, - correction of anemia - correction of endocrine disorders 2.5. Correction of immune disorders 3. Phytotherapy 4. Physiotherapy 5. Sanatorium-and-spa treatment

35 normal pathology hyperregenerative atrophy of small intestine mucous membrane

36 и

45 Thank You for attention!

Chronic diarrhea. Dr.Nasser E.Daryani Professor of Tehran Medical University

Chronic diarrhea. Dr.Nasser E.Daryani Professor of Tehran Medical University 1 Chronic diarrhea Dr.Nasser E.Daryani Professor of Tehran Medical University Timing Acute diarrhea: 4 weeks Definitions Derived from Greek