Acute hemorrhagic necrotizing enteritis

Introduction to acute hemorrhagic necrotizing enteritis Acute hemorrhagic necrotic enteritis is an acute enteritis associated with infection with C-type Bacillus capsulatum. The disease is mainly in the small intestine, and the pathological changes are characterized by hemorrhagic necrosis of the intestinal wall. The main clinical manifestations are abdominal pain, blood in the stool, fever, vomiting and bloating. In severe cases, there may be complications such as shock and intestinal paralysis and intestinal perforation. basic knowledge The proportion of the disease: the probability of the population is 0.013% Susceptible people: no special people Mode of infection: non-infectious Complications: shock

Causes of acute hemorrhagic necrotic enteritis

Pathogenic bacteria (40%):

The etiology of this disease has not yet been fully elucidated. It is believed that the pathogenesis of this disease is related to the infection of the B-toxin-producing Welchii bacterium (C-type Clostridium perfringens), which can cause intestinal tissue necrosis and produce gangrenous enteritis. In the Papua New Guinea plateau where the incidence of this disease is high, the study found that the local residents have low levels of protease in the intestine, which is associated with a low-protein diet and a heat-resistant trypsin inhibitor (heatstable) contained in the local sweet potato. Trypsin inhibitors) related. In animal experiments, the animal is not pathogenic by perfusion of Welchii bacilli through the gastric tube; however, if the raw sweet potato powder or raw soybean powder containing trypsin inhibitor is simultaneously infused, it can cause disease and produce the same as acute hemorrhagic necrotic enteritis. Histopathological changes. Animal experiments have also demonstrated that trypsin-containing dog pancreatic extract can prevent and alleviate the occurrence and development of this disease.

Dietary factors (20%):

In addition to eating meaty foods contaminated with pathogenic bacteria, there are other dietary factors, such as sudden changes in eating habits, which are beneficial to the reproduction of Welchii bacilli; or diets such as sweet potato, intestinal trypsin inhibitor A large amount exists to reduce the destruction of B toxin.

Acute hemorrhagic necrotizing enteritis prevention

Avoid eating meaty foods that are contaminated with pathogens. In addition, you should pay attention to your eating habits. Try not to use sweet potatoes as your main food.

Complications of acute hemorrhagic necrotic enteritis Complications

In severe cases, there may be complications such as shock, intestinal paralysis and other symptoms of poisoning and intestinal perforation.

Acute hemorrhagic necrotic small intestine symptoms common symptoms small finger unexplained pain, drowsiness, abdominal distension, bowel sounds, shock, watery, metabolic acidosis, high fever, low fever, diarrhea

1. History: The onset is urgent, there is a history of unclean diet before the onset, cold, tired, intestinal ascaria infection and malnutrition as predisposing factors.

2. Abdominal pain: sudden onset of illness, sudden onset of abdominal pain, often the first symptom, mostly in the umbilical cord, often manifested as gradually increasing umbilical or mid-upper paroxysmal cramps, and then gradually changed to Perinatal persistent pain and paroxysmal aggravation.

3. Diarrhea and blood in the stool: After the abdominal pain occurs, there may be diarrhea. The feces are mushy and faecal at first, and then gradually become yellow water, followed by white water or red bean soup and jam, even blood. Shaped or dark red blood clots, less feces and stench, no urgency and heavy, the amount of bleeding is uncertain, light can only have diarrhea, or only fecal occult blood positive and no blood in the stool; severe cases of up to hundreds of milliliters a day, diarrhea and blood in the stool The short time is only 1 to 2 days, the elderly can reach more than one month, and may have intermittent episodes, or repeated episodes. Dehydration and metabolic acidosis may occur in severe cases of diarrhea.

4. nausea and vomiting: often with abdominal pain, diarrhea at the same time, vomit can be yellow water, coffee or bloody water, can also vomit bile.

5. Systemic symptoms: Systemic symptoms such as general malaise, weakness and fever can occur after onset, fever is generally 38 to 39 ° C, a few can reach 41 to 42 ° C, but fever is more than 4 to 7 days, and continues Less than 2 weeks are rare.

6. Abdominal signs: relatively few, sometimes abdominal fullness, see intestinal type, umbilical and upper abdomen can have obvious tenderness, early bowel sounds can be hyperthyroidism, and then can be weakened or disappeared.

Clinical typing

1. Gastroenteritis type: In the early stage of the disease, there is abdominal pain, watery stool, low fever, and may be accompanied by nausea and vomiting.

2. Toxic shock: High fever, chills, apathy, lethargy, slang, shock, etc., often occur within 1 to 5 days of onset.

3. Peritonitis type: obvious abdominal pain, nausea and vomiting, abdominal distension and acute peritonitis signs, affected intestinal wall necrosis or perforation, bloody exudate in the abdominal cavity.

4. Intestinal obstruction type: There is abdominal distension, abdominal pain, frequent vomiting, defecation and exhaustion stop, bowel sounds disappear, and there is a sac.

5. Intestinal hemorrhage type: Mainly bloody or dark red blood, the amount can be as much as 1 ~ 2L, obviously anemia and dehydration.

Examination of acute hemorrhagic necrotizing enteritis

1. Blood: The peripheral blood leukocytes increase, even up to 4,000/mm3 or more, mainly neutrophils, often with nuclear left shift, red blood cells and hemoglobin are often reduced.

2. Fecal examination: the appearance is dark red or bright red, or the occult blood test is strong positive, a large number of red blood cells are seen under the microscope, and occasionally the mesenteric membrane is shed, and there may be a small amount or a medium amount of pus cells.

3. X-ray examination: Abdominal plain film can show intestinal paralysis or mild, moderate intestinal dilatation, barium enema examination can be seen thickening of the intestinal wall, significant edema, colonic bag disappears, in some cases, there is gas between the intestinal wall, This sign is caused by partial intestinal wall necrosis and colonic bacterial invasion; or ulcer or polypoid lesions and stiffness can be seen. In some cases, intestinal fistula, stenosis and cystic gas accumulation in the intestinal wall may occur.

Diagnosis and diagnosis of acute hemorrhagic necrotizing enteritis

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

The disease needs to be differentiated from toxic bacillary dysentery, allergic purpura, acute Crohn's disease, strangulated intestinal obstruction, intussusception, amoebic bowel disease and intestinal polyposis.

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