Terminology and Epidemiology
To make a correct diagnosis, it is necessary to clearly differentiate intestinal pathologies. Enteritis refers to inflammatory diseases localized in the small intestine. In contrast, enteropathies are disorders of the small intestine occurring without a prominent inflammatory component. They are characterized by dystrophic changes in the mucous membrane that lead to impaired digestive and absorptive functions. If the inflammatory process involves the large intestine, such a condition is classified as colitis.
The epidemiology of intestinal infections has a distinct geographical dependence. In countries with temperate climates, intestinal diseases are recorded less frequently, with non-infectious etiology and chronic course predominating. Tropical latitudes, however, are characterized by a high incidence of acute infectious and parasitic gastrointestinal disorders.
Etiological factors
Acute infectious enteritis is among the most common pathologies of the digestive system. The causative agents of the inflammatory process are traditionally divided into three main groups:
- Bacteria: pathogenic strains of Escherichia coli (Escherichia coli), causative agents of dysentery (Shigella), salmonellae (Salmonella), yersinia (Yersinia), and Vibrio cholerae (Vibrio cholerae).
- Viruses: inflammation can be caused by rotaviruses, enteroviruses, coronaviruses, astroviruses, and cytomegalovirus (CMV).
- Protozoa: the most typical representative of this group affecting the small intestine is Giardia (Giardia).
Clinical Presentation and Physical Status
The clinical symptoms of enteritis consist of a number of specific syndromes. The primary and earliest subjective manifestation is diarrheal syndrome. It is accompanied by pain syndrome, the localization and intensity of which directly depend on the specific pathogen. Dyspepsia in the form of vomiting is also frequently noted at the onset of the disease.
Intoxication syndrome manifests as general weakness, malaise, headache, as well as muscle and joint pain (myalgia and arthralgia). As fluid loss progresses, the patient develops persistent thirst, indicating increasing dehydration.
On physical examination, the severity of the condition correlates with the degree of dehydration, intoxication, and malabsorption (impaired nutrient absorption). Signs of progressive disease severity include:
- Decreased diuresis;
- Weight loss due to fluid loss;
- Hemodynamic disturbances: arterial hypotension and tachycardia.
Important: body weight loss of more than 10% is a criterion for a critical condition, as it leads to the development of hypovolemic shock and coma. Regular monitoring of the patient's weight is necessary to track the dynamics of the process.
Diagnostics and Therapeutic Tactics
The basis of primary diagnosis is a thorough analysis of the clinical picture combined with laboratory stool testing. The goal of this stage is to form a preliminary judgment regarding the etiology (cause) of the diarrheal syndrome.
The priority measure in treatment is continuous rehydration — replenishment of fluid losses using electrolyte solutions. This therapy is carried out uninterruptedly until diarrhea completely ceases.
Indications for intravenous rehydration include significant fluid loss accompanied by vomiting and the threat of hypovolemic shock. The standard composition of the infusion solution per 1100 ml of water includes:
- Glucose: 20 g;
- Sodium chloride: 3.5 g;
- Sodium bicarbonate: 2.5 g;
- Potassium chloride: 1.5 g.
Subsequently, patient management tactics involve switching to oral solution intake. The fluid should be administered fractionally, in small portions. Additionally, it is recommended to introduce tea and fruit juices into the diet. Antibiotic therapy is used strictly according to indications when an infection is confirmed. Diet therapy includes the early initiation of normal nutrition, but with mandatory restriction of lactose-containing products.
Briefly: answers to topical questions
What are the degrees of dehydration in intestinal infections depending on the percentage of body weight loss?
The degrees of dehydration in intestinal infections are classified according to the percentage of body weight loss as follows:
- Grade I — body weight loss up to 3%.
- Grade II — body weight loss of 4–6%.
- Grade III — body weight loss of 7–9%.
- Grade IV — body weight loss of 10% or more.
What laboratory tests and instrumental examinations are included in the standard diagnostic workup for acute enteritis?
The basis of primary diagnosis for acute infectious enteritis is the analysis of the clinical picture combined with stool examination; the goal is a preliminary assessment of the etiology of diarrhea. The sources indicate the following stool laboratory tests: stool bacteriological culture for the identification/verification of intestinal infection pathogens; stool biochemical examination with determination of volume, electrolytes, and osmolarity for the differential diagnosis of secretory and osmotic diarrhea. For primary laboratory screening, the sources also indicate PCR stool screening for DNA/RNA of intestinal infection pathogens and fecal microscopy for protozoa and helminth eggs. Instrumental examinations for the standard diagnosis of acute enteritis are not listed in the cited sources.
Which groups of antibacterial drugs are used to treat bacterial enteritis?
Antibiotic therapy for acute infectious enteritis is performed according to indications when an infection is detected. For shigellosis, all patients, after establishing a clinical (clinical and epidemiological) diagnosis, are recommended empirical etiotropic treatment with systemic antibacterial drugs; the choice of regimen is made taking into account regional shigella antibiotic sensitivity, clinical variant, and severity of the course. The sources explicitly indicate nosologically specific options: chloramphenicol — only for the treatment of yersiniosis and typhoid fever; erythromycin — for campylobacteriosis and cholera. For the treatment of acute and chronic Salmonella Typhi carriers, macrolides and fluoroquinolones are named as drugs of choice.
The composition of the rehydration solution can be memorized by the decreasing mass of components (per 1100 ml of water): 20 g glucose — 3.5 g NaCl — 2.5 g bicarbonate — 1.5 g KCl.
Class and exam questions
What is the fundamental difference between enteritis and enteropathy?
Enteritis is an inflammatory disease of the small intestine, whereas enteropathy occurs without marked inflammation and is characterized primarily by mucosal dystrophy with impaired digestive and absorptive functions.
Which parameter is critically important when monitoring the condition of a patient with enteritis?
The most important indicator is body weight. Regular weighing is necessary to assess fluid loss; a loss of more than 10% of body weight indicates the threat of hypovolemic shock.
When is it necessary to switch to intravenous fluid administration?
Intravenous rehydration is indicated when there is a threat of shock development, as well as in cases of severe fluid loss accompanied by vomiting, which makes oral intake impossible.
What else to study on this topic
- Mechanisms of malabsorption syndrome development in viral enteritis.
- Differential diagnosis of pain syndrome depending on the pathogen type.
- Features of laboratory stool examination in infectious diarrhea.
- Criteria for prescribing antibiotic therapy in intestinal infections.
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