Primary small bowel ulcer

Introduction to primary intestinal ulcer Primary ulcers (primaryulcerofsmallintestine) are also known as non-specific small intestine ulcers, simple small intestine ulcers. The disease is a rare disease, the main feature is that the small intestine has one or more small ulcers. basic knowledge The proportion of illness: 0.04% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction, gastrointestinal bleeding, blood in the stool, anemia, abdominal pain

Cause of primary intestinal ulcer

(1) Causes of the disease

Bailli first reported the disease in 1795, the cause is unknown, central nervous system diseases, infection, trauma, malnutrition and hormone secretion disorders have been considered as the cause of the disease, but it is still inconclusive.

According to a retrospective survey in the 1960s, more than half of the patients had a history of taking thiazide diuretics and potassium chloride. In animal experiments, local stimulation of the small intestine can cause disease, and the monkeys are given potassium chloride daily. Tablets 500 ~ 1000mg, can cause typical small intestine ulcer, but it has not been confirmed in the dog's experiment, because the small intestinal ulcer caused by potassium chloride is confirmed, it is generally believed that the potassium chloride enteric-coated tablets are taken orally in the small intestine. It is rapidly dissolved and absorbed at a high concentration, causing vasospasm of the intestine and mesenteric vasculature, insufficient blood supply to the intestinal wall, causing celiac ischemia, necrosis and ulceration, indicating that the small intestine ulcer is vascular-derived, and it is speculated that any cause of intestinal wall is missing. There is a possibility of ulceration in the blood.

People also noticed that the disease occurred more than 50 years old, suffering from arteriosclerosis, hypertensive heart disease, and small intestinal ulcers in the elderly may be related to hardening of the arteries, insufficient blood supply to the intestines, and small blood vessel thrombosis in the intestine. Clinical observations revealed that Most of the ulcer is located on the opposite side of the mesentery, which also suggests a lack of blood supply.

Since the 1980s, with the widespread use of enteric-coated aspirin, the incidence of this disease has increased. Therefore, some scholars believe that enteric non-steroidal steroid drugs are related to the occurrence of this disease. The mechanism is that such drugs can Inhibition of prostaglandin synthesis, resulting in decreased intestinal mucosal integrity, increased permeability, to patients with this disease to take substances that are not easily absorbed under normal conditions, can be detected from the urine, support this theory, due to mucosal permeability The increase in certain pathogenic factors such as pathogenic microorganisms (which can be bacteria, viruses or others), toxins and bile acids can enter the intestinal mucosa, leading to ulcer formation.

(two) pathogenesis

Most of the ulcers are single or multiple. It is reported that the lesion is located in the ileum twice as much as the jejunum, and the distal ileum is more than the proximal ileum. However, some authors report that it is more common in the jejunum, and the ulcer is mostly small oval. Round or ring-shaped, the edges are neat, chisel-like, with clear boundaries. The base is covered with inflammatory granulation tissue, surrounded by mild edema. The lesion mainly invades the mucosa and submucosa, showing mucosal necrosis, ulceration, and inflammatory cell infiltration. And connective tissue hyperplasia; mucosal metaplasia around the ulcer is pyloric gland type, thrombus organicized in small blood vessels, except for perforation, generally does not invade the muscular layer, multiple ulcers, normal mucosa between ulcers, ulcer diameter is 0.5 ~ 4.0cm Most of them are 1.0-2.0cm. The ulcer is mostly located in the mucosa on the opposite side of the mesenteric margin. Occasionally, the ulcerated intestine occurs. In a small number of patients, the fibromuscular diaphragm surrounding the intestine is formed, which is also the pathological basis for intestinal obstruction. Acute ulcer Lack of inflammation, prone to perforation.

Primary intestinal ulcer prevention

People noticed that the disease is related to oral potassium chloride enteric-coated tablets, enteric-soluble aspirin, etc. Therefore, stopping or reducing the amount of medication can prevent the disease.

Primary intestinal ulcer complications Complications, intestinal obstruction, gastrointestinal bleeding, blood anemia, abdominal pain

Common complications include intestinal perforation, intestinal obstruction and gastrointestinal bleeding. There may be blood in the stool and anemia. The jejunal ulcer is more likely to be perforated than the ileal ulcer. Intermittent abdominal cramps often occur before perforation, followed by severe abdominal pain. Some patients Complications can be the first symptom.

Symptoms of primary intestinal ulcer Common symptoms Index finger half moon a pink abdominal pain umbilical hernia paroxysmal angina bloating nausea ulcer pain bowel fistula peptic ulcer intestinal perforation

A considerable number of patients have a history of taking non-steroidal steroid drugs or enteric potassium chloride tablets. The time of taking them is more than 3 to 4 months. Common symptoms are bloating, belching, nausea, vomiting, bowel, and umbilical hernia. Sexual colic, jejunal ulcer and ileal ulcer have different clinical symptoms. The jejunal ulcer has a similar pattern of duodenal ampullary ulcer pain, pain in the fasting umbilical cord, eating and alkaline drugs can be relieved; ileal ulcer abdominal pain Mostly in the lower abdomen or umbilical cord, and has nothing to do with diet, such as no complications, no special performance.

Examination of primary intestinal ulcer

1. X-ray examination X-ray barium angiography can find intestinal stenosis and other lesions, but it is not easy to show ulcers, X-ray film can be seen in the small intestine dilatation and fluid level, X-ray small intestinal gas angiography can show ulcers, improve diagnostic positive Rate, lesions of the distal ileum can also be examined by enema.

2. Small colonoscopy can directly observe the lesion and can take biopsy.

Diagnosis and diagnosis of primary small intestinal ulcer

diagnosis

Because the symptoms of this disease are not specific, and there is no simple and reliable diagnosis method for small bowel diseases, it is difficult to diagnose. Clinically, the following manifestations should be suspected as primary intestinal ulcers:

1. There were recurrent symptoms of peptic ulcer and no gastroduodenal ulcer was found by gastroscopy and X-ray barium meal examination.

2. Gastrointestinal hemorrhage or long-term fecal occult blood positive, but no lesions were found in esophagus, stomach, colon endoscopy and X-ray barium.

3. Unexplained small bowel obstruction or intestinal perforation.

4. Taking potassium chloride and diuretics in the near or near, abdominal pain, nausea, vomiting, bloating, high-infant small intestine ulcers.

5. For patients with surgical indications, feasible open exploration, small intestine ulcers were found during surgery, and other specific small intestinal ulcers were excluded after surgery.

Differential diagnosis

1. Bacterial dysentery is caused by Shigella, diarrhea is more common with pus or mucus, and the amount is small, and often there is urgency and heavy, and there are many cold and hot. Fecal microscopic examination can find a large number of pus cells, red blood cells and phagocytic cells, infants. Infant poisoning bacillary or atypical bacilli should be identified by pathogenic diagnosis.

2. After cholera cholerae infection, severe diarrhea occurs first and then vomiting, rarely nausea, vomit and diarrhea stools are rice sputum watery, the amount is more, no urgency and heavy, a small number of patients have a small amount of bloody stools, dehydration often causes muscles Painful phlegm, skin wrinkles, body surface temperature is lower than normal, microscopic examination can find extremely active Vibrio, should be further identified by bacterial culture.

3. Vibrio parahaemolyticus food poisoning caused by Vibrio parahaemolyticus, mainly due to eating food contaminated by the bacteria (more related to seafood), rapid onset, first with chills, paroxysmal abdominal pain (upper abdomen) Colic) began, vomiting diarrhea, mostly watery stools or bloody watery stools, mostly for the same meal, the disease should be identified.

4. Salmonella food poisoning eating caused by Salmonella typhimurium contaminated food, acute onset, often accompanied by cold, abdominal pain, bloating, nausea, vomiting, diarrhea, watery stool and stench, early bacteremia, Most people have a collective disease with the same meal, relying on pathogens, serological diagnosis and identification.

5. Viral diarrhea Diarrhea caused by enterovirus infection, characterized by highly contagious, rotavirus, small round virus and other infections have vomiting in the early stage, successive diarrhea, more watery stools and mucus, mostly in autumn In winter, other viral diarrhea is more common in summer and autumn, with nausea and vomiting. In addition to gastrointestinal symptoms, there are often respiratory symptoms, pharyngitis, and convulsions, often involving the neck muscles, back muscles, and children with green water are more common in the elderly. Or egg-like water, antibiotic treatment is generally ineffective, the course of disease is more than 5 to 7 days of self-healing, further identified by serology and virus isolation.

6. Campylobacter jejunum enteritis caused by Campylobacter jejuni is similar to viral enteritis, severely similar to ulcerative colitis or Crohn's disease, with fever, diarrhea watery or mucus-like stool, stench, bile color, Severe pus and bloody stools, phlegm and other phlegm recovery in 1 week, children often have abdominal cramps, convulsions can occur when high fever, the incidence is more related to contact with poultry, livestock or drinking unsterilized milk, raw water, dark field microscopic examination It was found that the archery-like active power of Campylobacter was further diagnosed by bacterial culture.

7. Yersinia enteritis is more common in children, related to food, water pollution, abdominal pain, diarrhea, hypothermia, watery stool, may have sepsis, can be complicated by nodular erythema, pseudo appendicitis, arthritis, bacterial culture Can be further identified.

8. Others should pay attention to the identification of diarrhea caused by Giardia, Amoebic dysentery, and amoeba or Giardia can be found in stool microscopy.

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