Dysentery

Introduction to dysentery Dysentery, the ancient name of the intestines, stagnation. It is one of the acute intestinal infectious diseases. Clinically, fever, abdominal pain, urgency, and stool pus and blood are the main symptoms. If the epidemic is infected, the incidence is sharp, accompanied by sudden high fever, dizziness, convulsions, and plague. At the beginning of dysentery, I saw abdominal pain first, followed by squatting, ranging from several times to dozens of times. It occurs mostly in the summer and autumn seasons. It is caused by the evil of dampness and heat, internal injury to the spleen and stomach, spleen and loss of health, and loss of stomach and stagnation. basic knowledge Sickness ratio: 2% Susceptible people: more common in children 3 to 7 years old Mode of infection: fecal-mouth transmission Complications: viral myocarditis dehydration

Disease

Causes:

Shigella is a genus of Shigella and is negative for Gram staining. It is a species of other Enterobacteriaceae. Do not exercise. It has two types of metabolism, respiratory and fermentative. Contact enzyme positive (except for one species only). Oxidase is negative. Organic can be nutritious. Fermented sugars do not produce gas (except for a few species of gas produced). Citrate or malonate is not used as the sole source of carbon. No growth in KCN, no production of H2S. It is an intestinal pathogen of humans and primates, causing bacterial dysentery. It is a facultative anaerobic bacterium that grows on ordinary medium to form a medium-sized, translucent smooth colony. A colorless colony is formed on the enterobacterial selective medium. According to different bacterial antigens, they are divided into four groups: Shigella, Fusarium, Bauer, and S. This genus has strong viability in the external environment, among which S. serrata is the strongest and Shigella is the weakest. It can be killed in half an hour under daylight, 10 minutes at 60 ° C, and immediately at 100 ° C. General disinfectants such as lysine, bleaching powder, neostigmine, peroxyacetic acid, etc. can be inactivated.

Epidemiology

Dysentery can occur all year round, but the incidence is high in summer and autumn. People with diseases and carriers are the source of infection, and people with mild, chronic diarrhea and healthy carriers are easily overlooked. The transmission route is mainly fecal and oral infection, and children with poor health habits are prone to the disease. Chronic bacillary dysentery in children is more subtle, atypical and protracted, and is not easy to be found, so it is easy to be popular among pediatric groups. After the person is infected, the immunity is not durable and can be re-issued. Cold, fatigue, improper diet, lack of nutrition, intestinal flora imbalance and other factors can reduce the resistance to the disease.

Diarrhea prevention

In order to prevent diarrhea, the following points should be done: do a good job in environmental sanitation, strengthen toilet and manure management, eliminate the breeding grounds of flies, and mobilize the masses to eliminate flies. Strengthen food hygiene and water management, especially for individuals and food vendors to conduct health supervision and inspection. For the cookers and caregivers of collective units and child care institutions, regular stools should be inspected for bacterial culture. Strengthen health education, everyone wash their hands before and after meals, do not drink raw water, do not eat spoiled and rotten food, do not eat food contaminated by flies. Do not overeating, so as not to reduce the resistance of the gastrointestinal tract.

Dysentery complications Complications, viral myocarditis, dehydration

Acute viral myocarditis is medically known as viral myocarditis and is one of the most dangerous complications of dysentery. Some dysentery can be caused by viruses. The virus that causes myocarditis most often is an enteric virus called Coxsackie virus. It can directly enter the cardiomyocytes to cause damage, and can also cause some harmful substances in the body to damage the cardiomyocytes. It causes myocardial degeneration, and it also affects the pericardium and endocardium. If it invades the cardiac pacing system, it will be life-threatening.

Cardiovascular and cerebrovascular accidents are complications that can cause death in acute dysentery in the elderly. During diarrhea, a large amount of water and sodium, potassium, calcium, magnesium and other cations are discharged from the stool. The loss of water causes the human body to be dehydrated, the blood volume is reduced, the blood viscosity is increased, the blood flow is slow, and thrombus is easily formed and the blood vessels are blocked. Coronary artery occlusion causes angina and myocardial infarction, and cerebral vascular occlusion causes ischemic stroke. Sodium, potassium, calcium and magnesium are important cations in the body. In addition to maintaining blood acid-base balance, it plays an important role in maintaining nerve conduction function and heartbeat rhythm. When it is lacking, it can cause severe heart rhythm disorder and sudden death.

Dehydration and acidosis are the main causes of acute dysentery. The carbon dioxide produced by metabolism in the body is usually excreted through the breath. The rest of the waste needs to be transported through the kidneys and excreted from the urine. When dehydration, the amount of urine is reduced due to the loss of water in the body. In severe cases, there is no urine. This will reduce the discharge of waste from metabolism in the body and accumulate in the body, causing symptoms of poisoning in the body. In addition to respiratory changes, the clinical manifestations can be There is fatigue and nervousness and nervous system symptoms.

After the stomach recurrence and dysentery, the digestive function of the human body gradually declines, and the intestinal disease resistance is also weakened, which makes the burden of gastrointestinal function worse, often leading to the recurrence of stomach diseases.

Symptoms of dysentery Common symptoms abdominal pain diarrhea diarrhea diarrhea abdominal pain with blood in stool feces black with blood convulsions abnormal stool

The clinical manifestations of dysentery are abdominal pain, diarrhea, urgency and urgency, drainage of pus and blood, and symptoms such as systemic poisoning. Infants do not respond strongly to infection, and the onset is slow. The stool is often indigestion-like and loose, and the course of disease is prone to prolongation. Children over the age of 3 have an acute onset, with fever, diarrhea, and abdominal pain as the main symptoms, and convulsions and vomiting can occur. Shihe or Fusarium infection is more serious, prone to poisoning dysentery, more common in children 3 to 7 years old. Artificial feeding children are weak and prone to complications.

Dysentery check

Laboratory inspection

1. Fecal examination: Fecal traits are mushy, loose or watery, with a large amount or stench. When the stool does not contain mucus, pus or blood, it is often suggested to be intestinal diarrhea or liver, gallbladder or pancreas. Low-grade diarrhea; if the amount of feces is small, it is more suggestive of colonic diarrhea when it contains mucus or pus, and protozoa, parasitic diarrhea can be suggested when protozoa, parasites or eggs are found in the feces, and other causes can be excluded. Fecal culture can separate a variety of pathogenic bacteria, which is of great value to the diagnosis, but it should be emphasized that the manure should be fresh, and the inspection should be timely, otherwise it will affect the diagnosis. In addition, if the culture is negative once, the infectious diarrhea cannot be easily denied, and the feces should be cultured several times, sometimes with positive results.

2. Pancreatic exocrine function test: If diarrhea is suspected to be caused by pancreatic disease, pancreatic exocrine function test should be performed, such as test meal test (Lundh test), benzoyl-tyrosine-p-aminobenzoic acid test (PABA test). And the secretin test.

3. Intestinal absorption function test

(1) Determination of fat globules, nitrogen content, muscle fiber and chymotrypsin content in feces: When the fat globules are up to 100 or more in the microscope high-power field (Sultan III staining method), fat malabsorption may be considered; when the nitrogen content in the feces increases Considering the absorption of carbohydrates; the increase of muscle fibers in feces and the decrease of chymotrypsin content suggest that the small intestine is malabsorbed.

(2) D-xylose test: D-xylose excretion in urine is often reduced in patients with poor intestinal absorption.

(3) Radionuclide labeled vitamin B12 absorption test (Schilling test): In the small intestine absorption dysfunction, the urinary radionuclide content is significantly lower than normal.

4. The breath test is mostly 14C-triacylglycerol breath test. In patients with fat malabsorption, 14C-labeled triacylglycerol was orally administered, and 14C-labeled CO2 exhaled from the lungs was reduced, while 14C-labeled CO2 excretion in feces was increased. In recent years, more 13C breath test has been carried out to observe the absorption of sugar, and it has important diagnostic value for lactose malabsorption. In addition, there are 14C glycine breath test and other methods.

Film degree exam

1. X-ray examination: barium meal or barium enema examination can understand the functional status of the gastrointestinal tract, peristalsis, etc., for small intestinal malabsorption, intestinal tuberculosis, Crohn's disease, ulcerative colitis, lymphoma, colon cancer, etc. Important diagnostic value.

2. B-ultrasound, CT or MRI examination: It can observe the liver, biliary tract and pancreas and other organs related to diarrhea, and can also provide evidence for intestinal tumor lesions. Therefore, B-ultrasound, CT and MRI examinations have diagnostic value for digestive malabsorption diarrhea and neoplastic diarrhea.

3. Colonoscopy: colonoscopy for ileal end lesions, such as intestinal tuberculosis, Crohn's disease, other ulcerative lesions and large intestinal lesions, such as ulcerative colitis, colon, rectal polyps and cancer, chronic schistosomiasis, etc. Both have important diagnostic value.

4. Retrograde cholangiopancreatography: has important diagnostic value for biliary and pancreatic lesions.

5. Small colonoscopy: Although enteroscopy has not been widely carried out (new enteroscopy is about to come out), it has important diagnostic significance for small intestinal malabsorption and Whipple disease. Small intestinal mucosa can be observed under direct vision of small enteroscopy, and biopsy can determine the changes of microvilli and glands.

Diagnosis of dysentery

diagnosis

Diagnosis can be performed based on clinical performance and laboratory tests.

Differential diagnosis

In the epidemic season, there is a history of dysentery contact or a history of unclean diet, fever, sticky pus and bloody stools, and urgency and other symptoms should be considered. In the summer and autumn of diarrhea, there are sudden high fever, convulsions, pale complexion, cold extremities, and pulse counts should consider poisonous bacteria. The disease has symptoms of vomiting and abdominal pain, but if the patient has severe vomiting and persistent severe abdominal pain, other intestinal and external diseases should be excluded first to prevent misdiagnosis. Attention should be paid to the identification of the following diseases:

1 Pathogenic E. coli enteritis occurs mostly in children under 2 years of age, with a high incidence rate of 5-8 months. There may be mucus in the feces, which has a stench smell. It is thin and thin, and it has a lot of stools. It is easy to cause dehydration and acidosis. Microscopic examination can have white blood cells and pus cells, which can be diagnosed by bacterial culture of feces.

2 Salmonella enteritis often occurs in families or groups, vomiting is more common, stool mucus is more than pus, often green jelly. The weight of the urgency is relatively rare, and the culture of fecal bacteria can be diagnosed.

3 viral diarrhea is more common in children under 2 years of age. Acute onset, accompanied by symptoms of upper respiratory tract infection, stool is watery or egg-flower soup, can have a small amount of mucus, no odor. Fecal bacterial culture is negative, and immunoelectron microscopy, enzyme-linked immunosorbent assay, and polyacrylamide gel electrophoresis detection, as well as virus isolation, are helpful in diagnosing this disease.

4 Amoeba dysentery is more common in the South, mostly in older children. The onset is slower, the frequency of bowel movements is more, but there is no urgency and heavy, the stool has blood and mucus, and it is purple-red jam-like. The fresh stool mucus microscopy can find the amoeba trophozoite.

6 hemorrhagic enteritis is an acute onset, with abdominal pain, bloating, vomiting and other symptoms. The stool is bloody, and shock often occurs in the late stage. Fecal culture is negative, and X-ray examination is helpful in diagnosing the disease.

6 Epidemic encephalitis is the same season as poisoning dysentery. When the poisoned dysentery lacks intestinal symptoms, the two are similar. Cerebrospinal fluid examination is helpful for the diagnosis of epidemic encephalitis; while warm saline enema, microscopic examination or culture, can confirm the diagnosis of poisoning dysentery.

7 Cholera and cholera in the epidemic season come from the epidemic area. There is a history of edible aquatic products, acute vomiting and diarrhea, and a large amount of water. It is a water-like sample. The bacterial culture of feces can help diagnose.

8 intestinal tuberculosis can appear pus and bloody stools, similar to dysentery, but its incidence is slow, there is a history of tuberculosis, there may be afternoon fever and night sweats, tuberculin test positive; fecal culture is helpful for diagnosis.

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