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Chronic duodenitis

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Chronic duodenitis
Diagnosis, treatment

Chronic duodenitis — the disease which is followed by an inflammation and restructuring of a mucous membrane of a duodenum. The chronic duodenitis can be widespread and limited (local). Carry a papillitis and a diverticulitis to a local duodenitis.

Epidemiology
Chronic duodenitis — the most frequent disease of a duodenum. However the isolated duodenitis is observed seldom, as a rule, it is combined with chronic gastritis, a peptic ulcer, enteritis and other diseases. By data to various data, the chronic duodenitis occurs in 2 — 3 1/2raza more often at men, than at women.

Etiology and pathogeny
The duodenum has close anatomo-physiological interrelations with digestive organs therefore at diseases of a stomach, a small bowel, pankreatobiliarny system it can be involved in process, and a chronic duodenitis in turn to promote development of pathological changes in these bodies.

The factors leading to increase of aggression of a gastric juice and acidulation of a duodenum are the cornerstone of development of an atsidopeptichesky duodenitis, mainly a bulbit who is often combined with antral gastritis and a peptic ulcer. Diffusion atrophic process can extend to a duodenum at chronic fundal gastritis or enteritis.

Promotes emergence and progressing of inflammatory and dystrophic changes in a duodenum duodenostaz which arises owing to chronic duodenal impassability functional or organic more often (an arteriomesenteric compression, commissural process, etc.) genesis.

The reason of a local duodenitis is also various. In most cases the duodenal papillitis is a consequence of distribution of a duodenitis on a big nipple of a duodenum. On the other hand, the papillitis can be part of inflammatory process bilious and pancreatic channels. Duodenum diverticulums more than in 90% of cases are located in an okolososochkovy zone and in 33 98% of cases are complicated by a diverticulitis. An important pathogenetic link in development of a diverticulitis — stagnation of contents in a cavity.

Classification
The standard classification of a chronic duodenitis is absent.
Taking into account features of development and preferential localization of process it is reasonable to allocate 4 options:
1) the chronic duodenitis, mainly bulbit, atsidopeptichesky genesis;
2) the chronic duodenitis which is combined with atrophic gastritis or enteritis;
3) the chronic duodenitis which developed against a duodenostaz;
4) local duodenitis (papillitis, okolososochkovy diverticulitis).

Besides, on an endoscopic picture distinguish a superficial, hypertrophic and atrophic duodenitis; on a histologic picture of a chronic duodenitis without atrophy and with a mucosal atrophy.

According to the WHO classification of the IX review the duodenitis, as well as gastritis, is included in a heading 535, in subsection 535.6.

Approximate formulation of the diagnosis:
1. Chronic antral gastritis (gastritis of type B) with the increased secretory function of a stomach; the chronic superficial atsidopeptichesky duodenitis, mainly bulbit, an aggravation phase.
2. Chronic arteriomesenteric duodenal impassability, chronic atrophic duodenitis, reflux gastritis.
3. A chronic hypertrophic papillitis with disturbance of outflow of a secret of a pancreas; chronic pancreatitis, painful form.

 

Clinical picture, preliminary diagnosis
Diagnosis of a chronic duodenitis represents a difficult task in connection with difficult relationship it with the next bodies.
The clinical picture of a chronic duodenitis depends on its option.

The yazvennopodobny syndrome is characteristic of an atsidopeptichesky duodenitis (pain in an anticardium on an empty stomach, through 1 1/2 — 2 h after food and at night). The chronic duodenitis can be combined with enteritis and be shown by symptoms of this disease (a food intolerantnost, disturbance of digestion and absorption). At the duodenitis which developed against chronic duodenal impassability signs of a duodenal staz of whom constant or pristupoobrazny pain in epigastriums or to the right of a navel, the feeling of swelling and rumbling, nausea, an eructation bitterness, a cholemesis are characteristic usually prevail.

At a chronic duodenitis, especially its atrophic option, production of the gastrointestinal peptides (secretin, cholecystokinin-pancreozymin, somatostatin, motilin, enkephalins, etc.) possessing a broad spectrum of activity that leads to deep disturbances not only regulation of function of digestive organs is quite often broken but also makes the general impact on an organism. Therefore at patients a chronic duodenitis vegetative and psychoemotional frustration of disbolism are often observed.

Local duodenitis leads to disturbance of evacuation of pancreatic juice and bile that is shown by symptoms of dyskinesia of zhelchevyvodyashchy ways, chronic cholecystitis and pancreatitis. Pain at the same time usually irradiates in the right and left hypochondrium, sometimes has the surrounding character, the subikterichnost of scleras and easy yellowness of skin are observed. Similar symptoms can act as the main symptoms of a disease, creating serious difficulties in differential diagnosis.
From laboratory researches studying of gastric secretion which indicators at an atsidopeptichesky duodenitis usually happen raised matters, and at a duodenitis combination to atrophic gastritis and enteritis — lowered. At a duodenal papillitis and a parafateralny diverticulitis evacuation of bile and pancreatic juice can be broken, in this regard it is necessary to study a wide range of the biochemical functional trials characterizing a condition of a liver and a pancreas.

X-ray inspection of a duodenum does not play a crucial role in diagnosis a chronic duodenitis, but allows to reveal various motor evakuatornye the disturbances accompanying a disease or being its reason.

Special value has X-ray inspection for recognition of the chronic duodenal impassability leading to development of a duodenitis. For this purpose use a relaxation tubeless duodenografiya or a duodenografiya using a probe. The main signs of chronic duodenal impassability — a delay of a contrast suspension in a duodenum more than 45 with, expansion of a gleam of a gut are higher than a compression zone more than 4 cm, existence duodeno-
tour reflux. Administration of air in a duodenum at a probe duodenografiya allows to distinguish a mechanical prelum from its spasm. It is considered to be that it is not possible to eliminate a mechanical compression at increase of pressure in a gut gleam to 300 cm w.g.

The radiological method plays an important role in diagnosis of diverticulums and in detection of signs of a diverticulitis. Refer existence of a trekhsloynost of a shadow of a diverticulum (a baric suspension, liquid, gas) and a long delay of contrast weight to the last in it. At contrast research the expressed papillitis sometimes gives a picture of semi-spherical defect of filling on an internal contour of the descending department of a duodenum.

Endoscopic research takes the leading place in diagnosis a chronic duodenitis. Irrespective of the reasons which caused it. allocate a superficial, hypertrophic and atrophic duodenitis.

At a superficial duodenitis the mucous membrane is unevenly edematous, in zones of the expressed hypostasis the sharp hyperemia in the form of separate spots is usually visible, punctulate hemorrhages and a whitish plaque of fibrin can meet, in a gleam of a gut transparent light yellow opalescent liquid appears.

At a hypertrophic duodenitis of a fold of a mucous membrane become rough, high and wide, closely adjoin to each other, in the most changed sites multiple whitish grains with a diameter of 0,5 — 0,8 mm (a follicular form) can come to light. The gut hardly finishes air, in its gleam big accumulation of liquid contents decides on considerable impurity of bile and slime.

At an atrophic duodenitis the mucous membrane has pale, ashy color, becomes thinner, appear through vessels of a submucosal layer it. Atrophic process in a duodenum is observed considerably less than in a stomach, and usually has focal character.

According to endoscopic researches, inflammatory changes of a big duodenal nipple meet considerably more often than it was supposed. According to expressiveness of an inflammation the papillitis is subdivided on moderated and expressed. The expressed papillitis is characterized by a sharp hyperemia, hypostasis of a mucous membrane, a thickening of fibers, the top gets them whitish color that causes dim, opaque coloring of a big duodenal nipple, the sizes of the last increase to 1,5 cm. At a moderate papillitis the hyperemia and hypostasis are less clear, only insignificant increase in fibers is observed.

The endoscopic picture of a diverticulitis depends on expressiveness of inflammatory process and existence of erosive cankers of the mucous membrane covering a diverticulum. In a cavity of a diverticulum slime, muddy contents from the food remains can be found. Sometimes the entrance to a diverticulum does not manage to be revealed in connection with the expressiveness of folds increased by a peristaltics and especially existence of an inflammatory infiltration of the mucous membrane surrounding it.


 
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