Sinusitis

Reflux ileitis treatment. Inflammation of the ileum: causes, symptoms and treatment

Ileitis is a pathological process in the distal small intestine. It is rarely localized and is often combined with duodenitis and jeunitis. The disease can occur when exposed to infection, toxins, or hereditary pathology.

Diet plays a major role in treatment. To eliminate symptoms, sorbents, prokinetics, antibiotics, enzymes and probiotics are used.

Reasons

The disease can develop under the influence of such triggers:

The disease can occur at any age and regardless of gender. It has been revealed that ileitis occurs more often in people with the following predisposing factors:

Middle age (20-40 years).
Male gender.
Accommodation in large populated areas.
Food allergies.
Smoking.
Drinking alcohol.
Poor nutrition.
Insufficient physical activity during the day.
Concomitant diseases of the digestive system (pancreatitis, cholelithiasis).
Genetic predisposition.

Classification

There are acute and chronic ileitis. The first type is more often observed in childhood. Adults are characterized by a chronic relapsing course.

The disease may be localized and involve only the ileum. But the majority of cases are diffuse inflammatory processes that affect nearby sections or the entire intestine.

There are primary ileitis, when the primary focus is in the same section, and secondary, when the infection comes from other organs. Depending on the functionality, the disease is divided into atrophic and non-atrophic forms. With mucosal atrophy, the glands are affected and the production of intestinal juice is disrupted.

Degrees

Based on the severity of symptoms and laboratory parameters, the disease can be divided into the following degrees of severity:

light;
moderate;
heavy.

According to the activity of the process, the chronic form can occur as remission, partial remission or exacerbation.

Symptoms

In acute ileitis, the symptoms are well expressed and can go away on their own after some time. The main signs of the disease include:

indigestion - rumbling, bloating, nausea, vomiting;
subfebrile body temperature (in the acute form it rises to 39 degrees C);
diarrhea (up to 20 times a day). Loose stools occur immediately after eating. Residues of undigested foods are found in the stool;
stomach pain. May be localized in the right iliac region or spread to the entire lower abdominal cavity;
general weakness;
headache;
weight loss;
signs of hypovitaminosis and micronutrient deficiency;
fatigue.

In a chronic course, all of the above symptoms are mild, and a latent course is possible.

Complications

The consequences of the disease do not always occur. Their presence indicates that the disease has progressed to a severe stage and the need for additional treatment methods. The following complications of ileitis are distinguished:

Dehydration.
Hypovolemic shock.
Bleeding.
Cramps.
DIC syndrome.

Diagnostics

It is difficult to make a diagnosis of ileitis, since this part of the intestine is difficult to visualize, and the symptoms of the disease are not specific. Patients with suspected ileitis are prescribed the following examinations:

general clinical examinations of blood and urine. A blood test reveals inflammatory changes - a shift of the formula to the left, leukocytosis, increased ESR;
coprogram. Stool analysis reveals undigested dietary fiber and fats;
bacteriological, virological examination of stool;
Ultrasound of the abdominal organs. It is carried out to identify concomitant pathologies - diseases of the pancreas, liver, gall bladder;
stool examination for occult blood. With ileitis, the bleeding is not intense and is not detected when examining the stool. The reaction of feces to occult blood makes it possible to detect even minor blood loss;
X-ray of the intestine with contrast. The method is prescribed to assess motor function and intestinal patency. X-rays can confirm the presence of fistulas or strictures;
biochemical blood test. Allows you to identify a decrease in total protein, albumin, and ion deficiency;
CT, MSCT, MRI. They are carried out in complex diagnostic cases when there is a need to evaluate surrounding tissues and organs and exclude effusion in the abdominal cavity.

Treatment

Ileitis requires complex treatment, which includes diet and medication. It is allowed to eat foods that are easily digestible, prepared without spices using a gentle method (steamed, boiled). All acute infectious processes are treated in the infectious diseases department.

To eliminate symptoms and inflammatory processes, the following groups of drugs are used:

Enterosorbents (promote the removal of toxins and eliminate increased gas formation).
Astringents.
Enzymes.
Prokinetics.
Multivitamins.
Probiotics.
Solutions for infusion (glucose, saline).

In the presence of bacterial inflammation, antibacterial drugs are used. Hereditary fermentopathy requires lifelong adherence to a diet.

In conclusion, it must be said that ileitis is difficult to diagnose and treat. The blurred clinical picture leads to late diagnosis and delayed treatment.

Ileitis is a pathology that is characterized by the development of an inflammatory process in the distal intestine or the so-called ileum. This disease is most often diagnosed in young men aged 20–40 years. It should also be noted that the disease is diagnosed with greater frequency in residents of large cities. Instrumental diagnosis is difficult, since the ileum is inaccessible for endoscopic examination. Treatment, in most cases, is conservative.

Etiology

The following etiological factors can lead to the development of an inflammatory process in the ileum:

intoxication of the body with toxic substances, medications, poisons;
consequences of intestinal surgery;
exposure to rotavirus and enterovirus infections;
damage to the intestine by opportunistic or pathogenic microflora.

Predisposing factors for the development of intestinal ileitis include:

unhealthy diet - the diet is dominated by fatty, fried, spicy foods;
excessive consumption of alcoholic beverages and surrogates;
smoking;
the presence of gastroenterological pathologies of a chronic nature;
long-term use of certain medications.

In addition, ileitis may not be a separate disease, but a symptom of ulcerative colitis, typhoid fever and tuberculosis.

Classification

Due to the formation of the disease, the following forms of this pathological process are distinguished:

According to the criterion of localization of the lesion, the following forms of this disease are distinguished:

isolated;
with damage to the colon and stomach;
with damage to the entire intestine.

Ileitis is also distinguished between primary and secondary (arising against the background of existing gastroenterological pathologies) type.

Based on enzymatic activity, this intestinal disease can be atrophic or non-atrophic.

According to the nature of the intensity of the lesion, the disease can occur in the following forms:

light;
medium-heavy;
heavy;
with complications.

If chronic ileitis is diagnosed, then a distinction is made between the stages of exacerbation, complete and incomplete remission.

Symptoms

At the initial stage of development, the disease may be asymptomatic. The patient may occasionally be bothered by minor disturbances in the gastrointestinal tract, which are usually attributed to poor nutrition.

The acute form of this disease manifests itself in the form of the following symptoms:

bloating, rumbling;
diarrhea – frequency of bowel movements up to 10 times a day;
nausea, which is often accompanied by vomiting;
increased body temperature;
weakness;
headaches for no apparent reason.

It should be noted that a similar clinical picture can be observed with other intestinal diseases, so you cannot take treatment on your own. Unauthorized treatment measures without an accurate diagnosis can lead to the development of serious complications.

The chronic form of this gastroenterological disease has a less pronounced clinical picture and manifests itself as follows:

attacks of moderate pain in the iliac region, often localized around the navel;
watery stools that often contain particles of undigested food. Unlike the acute form of the disease, it does not appear so often;
weight loss, which is caused by metabolic disorders, impaired absorption of vitamins and minerals;
symptoms of hypovitaminosis.

A similar clinical picture in adults can also be a manifestation of ulcerative colitis or Crohn's disease, so you should urgently seek medical help and not self-medicate or ignore these symptoms. Prolonged bouts of diarrhea can lead to complete dehydration of the body, which is also fraught with the development of serious complications.

Diagnostics

If you have the above-described clinical picture, you should contact a gastroenterologist. After clarification of complaints, medical history and physical examination, a diagnosis is carried out, which includes the following laboratory methods:

general and biochemical blood test;
fecal occult blood test;
virological and bacteriological examination of stool.

To make an accurate diagnosis, the most informative instrumental method will be contrast radiography with barium, which can determine impaired intestinal motility, as well as intestinal obstruction.

To exclude other gastrointestinal ailments, the following are carried out:

Ultrasound of the abdominal organs;
FEGDS;
MSCT;
endoscopy.

Based on the examination results, a final diagnosis is made and the most appropriate treatment tactics are selected.

Treatment

Treatment of this gastroenterological pathology is only complex - drug therapy is combined with diet. In the acute form of the disease, hospitalization of the patient is implied.

Drug therapy may include taking the following medications:

means for normalizing intestinal motility;
astringents;
probiotics;
antibiotics.

If the patient experiences severe vomiting and diarrhea, infusion therapy is prescribed to prevent dehydration.

As for nutrition, in most cases, patients are prescribed dietary table No. 4 according to Pevzner. The following are excluded from the diet:

chicken eggs in any form;
fatty fish and meats;
smoked meats;
dairy products;
grape;
white cabbage;
hot and fatty sauces;
carbonated drinks.

The patient’s diet does not prohibit the consumption of the following foods:

yesterday's bread;
pasta;
broths from lean meats;
porridge with water;
low-fat varieties of fish and meat;
vegetable soups;
weak tea, dried fruit compotes without sugar.

This type of nutrition for the patient can relieve acute symptoms and reduce the load on the intestines. In the chronic form of the disease, the diet must be followed constantly. During periods of stable remission, it is possible to expand the menu, but in agreement with the attending physician.

Prevention

To prevent the development of this inflammatory process, the following recommendations should be followed:

healthy eating;
avoiding smoking and excessive drinking;
timely and correct treatment of all infectious and viral diseases.

You should also systematically undergo a preventive medical examination and consult a doctor if you feel unwell.

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Ileitis– inflammation of the ileum of various origins. The human small intestine consists of three sections: duodenum, jejunum and ileum. The health of the whole organism will depend on the coordinated work of all parts, since the absorption of the main share of nutrients (vitamins, microelements, amino acids, fatty acids) occurs in the small intestine.

By level of damage

Localized (only the ileum, most often the terminal area, is affected).
Widespread (with the transition of the inflammatory reaction to other parts of the small or large intestine).
Ileitis, combined with gastritis, pancreatitis and other pathologies of the gastrointestinal tract.

Due to the occurrence

Downstream

Easy degree.
Average.
Heavy current.

Also, ileitis can be acute and chronic (the process lasts more than 6 months), which depends on the cause, age, characteristics of the immune system’s response, and therapeutic measures.

According to the nature of intestinal tissue damage

Catarrhal inflammation (affects only the mucous membrane).
Erosive (formation of deep erosions up to the muscular or serous layer, sometimes with perforation of the intestinal wall). The most unfavorable variant of the course of terminal ileitis.

Reasons

There are quite a lot of factors leading to inflammation of the ileum. Sometimes it is not possible to discover the true cause of ileitis. The following predisposing moments occur:

Symptoms

Acute ileitis

It is characterized by a sudden onset and is manifested by the following symptoms:

Acute ileitis lasts several days (up to 2 weeks) and ends with complete recovery (sometimes spontaneous). In severe cases, complications develop: intestinal bleeding, dehydration (dangerous for children), malabsorption, intestinal obstruction, peritonitis, sepsis, formation of fistula tracts, infiltrates of the abdominal cavity.

Chronic ileitis

It is characterized by a gradual onset and nonspecific symptoms, so it can be difficult to distinguish it from other diseases of the gastrointestinal tract:

Vitamin deficiencies, heart rhythm disturbances, and blood protein levels decrease.

Diagnostics

Inflammation of the ileum manifests itself with nonspecific signs, therefore, in most cases, it is not possible to establish the correct diagnosis immediately. In addition, the terminal part of the small intestine is not accessible to endoscopic methods due to topographical features.

The following examinations can help in diagnosis:

The final diagnosis is based on visual examination of the intestinal mucosa () or biopsy results.

Treatment

All cases of acute ileitis in children or acute complicated ileitis in adults are treated in a hospital setting. For mild cases, outpatient therapy is possible with periodic monitoring by a gastroenterologist and infectious disease specialist, if necessary. Treatment of acute ileitis can last up to two weeks, chronic - up to 6 months.

The key to a speedy recovery is medication, diet and lifestyle changes.

Diet

The principles of diet therapy are based on the exclusion of spicy, fatty, smoked and canned foods; too hot or cold foods are also not recommended. Meals are divided into fractions, up to 5-6 times a day.

Drug therapy

The drug regimen and duration of treatment will depend on the suspected cause of ileitis:

Surgical therapy

Surgical treatment is required if complications occur, such as:

bleeding;
adhesions with obstructed patency;
fistulas;

Prognosis and prevention

The prognosis is favorable for acute ileitis. With chronic inflammation, the prognosis will depend on the degree of intestinal damage, the clinical picture and laboratory parameters. The more severe the disease, the more complications, the less favorable the prognosis is considered.

To prevent relapses, it is necessary to follow a strict diet rich in minerals and vitamins, give up bad habits, sanitize foci of chronic infection, visit your doctor and undergo appropriate preventive examinations. The quality of life of patients with chronic ileitis is improved by taking enzyme preparations and anti-relapse treatment with hormones and cytostatics.

Intestinal ileitis is an inflammation of the ileum, which can occur in acute or chronic form. There are several types of disease depending on the severity and etiology of the inflammatory process. Ileitis is most common among the male population in the age group of 20-40 years. There are many predisposing factors that cause the disease. The pathology is difficult to diagnose, this is due to the difficulty of inserting an endoscope into the ileum due to its location.

Reasons

The cause of the inflammatory process at the junction of the lower stomach and small intestine can be the following factors:

poisoning by toxins, poisons, drug overdose;
postoperative inflammatory processes in the intestines;
infection with rotavirus and enterococci;
exposure to conditionally pathogenic or pathogenic microflora.

Opportunistic microorganisms are always present in the human body, but only in some are they activated, multiply and turn into pathogens.

Predisposing factors that can trigger inflammation of the ileum are:

violation of the diet - the predominance of fatty, fried and spicy foods;
abuse of alcoholic beverages, especially surrogate production;
addictions such as smoking or chewing tobacco;
chronic diseases of the digestive system;
food allergies;
hereditary fermentation disorder, leading to disruption of the digestive process;
long-term treatment with medications, especially antibiotics.

In some cases, ileitis is a symptom of pathologies such as tuberculosis, intestinal colitis or typhoid fever.

The acute form most often develops in children, and the chronic form most often develops in adults; periods of remission often alternate with periods of exacerbation. Basically, ileitis is of bacterial origin and the causative agent is a representative of the group of enterobacteria - Yersinia. This bacterium is particularly resilient; it does not die at temperatures that are usually maintained in a household refrigerator and is not afraid of heating.

Chronic ileitis most often develops in people who constantly violate their diet; they automatically fall into the risk group for the disease.

Symptoms

In the initial stage, ileitis can occur latently for some time, occasionally disturbing the patient with symptoms of a harmless intestinal disorder. Most often, people do not pay attention to such signs, but believe that this is normal overeating or a diet disorder.

Nevertheless, acute ileitis has quite clear symptoms:

increased gas formation, accompanied by rumbling in the stomach;
severe diarrhea, which can occur more than 10 times a day, is dangerous because it can cause dehydration;
nausea and vomiting that does not bring relief;
abdominal pain resembling appendicitis;
increase in body temperature, often slight;
increased fatigue;
a sign of intoxication is headaches that do not stop after taking analgesics.

All of these symptoms are similar to many diseases of the digestive tract, so it is not possible to independently diagnose. If you have such signs, you should consult a doctor.

If the first symptoms are ignored, the disease becomes chronic, and the clinical picture is blurred:

pain in the ileum becomes moderate, localized mainly in the navel area;
diarrhea occurs rarely, but has a characteristic appearance - watery, with pieces of food that have not been digested;
the patient loses weight for no apparent reason, this is due to impaired absorption of nutrients;
Vitamin deficiency develops.

Symptoms can easily be confused with other pathologies of the digestive tract, and dehydration as a result of diarrhea can cause serious complications, so you need to contact a specialist for diagnosis and treatment.

Complications

If ileitis is not treated promptly, the patient’s condition will gradually worsen. The body will constantly lack the vitamins and minerals necessary for normal functioning.

As a result, the disease will cause a number of complications:

gradual loss of body weight, which has a progressive nature;
a significant decrease in performance, a person cannot engage in physical and intellectual labor;
Insomnia develops, the patient cannot fall asleep for a long time, sleep becomes restless and sensitive;
apathy appears, the person loses interest in life, the mental state is depressed;
due to developing hypovitaminosis, the patient’s vision deteriorates, hair becomes dry and brittle, nails can peel, the skin also suffers from excessive dryness and constant bruises that can occur at the slightest injury;
at a late advanced stage of ileitis, osteoporosis may develop, the bones change their structure and become brittle;
persistent diarrhea can cause dehydration and, as a result, hypovolemic shock, decreased blood clotting and convulsions;
the inflammatory process can provoke internal intestinal bleeding.

Inadequate treatment or its absence can result in death for the patient. Dehydration can only be treated with intravenous infusion of solutions, otherwise vomiting and diarrhea will only complicate the patient’s condition.

Diagnosis and treatment

It is difficult to diagnose ileitis based on symptoms; a physical examination is necessary, which in itself carries little information, but is mandatory:

it is necessary to pay attention to the condition of the patient’s tongue - a dry organ with a white coating is a sign of inflammation of the digestive organs;
upon palpation, the patient feels pain in the iliac region on the right;
if you tap a swollen belly, the sound will be ringing;
You can hear the stomach rumbling, especially in the navel area.

The structure of the stool will be liquid, light yellow in color, with pieces of food. Instrumental research has difficulties due to the location of the organ, and therefore is not informative, but is used to differentiate the disease from other pathologies.

A laboratory blood test confirms the presence of an inflammatory process in the body, and a stool test can identify the causative agent of ileitis; if the stool contains hidden blood, this indicates internal bleeding.

Treatment of acute ileitis is carried out only in a hospital setting. First aid is aimed at eliminating dehydration and relieving symptoms.

Treatment of inflammation of the ileum is carried out comprehensively and contains a number of therapeutic measures:

infusion therapy to replenish fluid in the body;
mandatory adherence to a dietary diet;
course of treatment with antibiotics depending on the type of pathogen;
Enzyme preparations are prescribed to improve digestion;
if diarrhea has a long course, sorbents and medications that have an astringent effect are used;
if the attacks of pain are severe, use antispasmodics to relax smooth muscles;
prebiotics and probiotics are used to suppress pathogenic microflora in the intestines and normalize bacterial balance;
A mandatory part of treatment should be vitamins that are necessary for a weakened body.

The diet for ileitis should contain easily digestible and vitamin-rich foods. It is recommended to eat small meals, food should be soft, chopped, cooked by stewing or baking, some foods can be boiled. The main thing is that the dish should not be eaten hot - only warm food.

Dietary requirements for ileitis:

it is necessary to avoid fatty, spicy, salty or excessively sour foods;
you should not eat rough food, fried foods and hot dishes;
the diet must contain sour dairy products;
protein foods, vitamins and microelements are also needed;
carbohydrate consumption should be kept to a minimum, as they contribute to flatulence;
the breaks between meals should not be long, this will reduce the impact of acidic gastric secretions on the mucous membrane of the organs.

Ileitis requires long-term treatment; throughout the course, which can last for several months, you should adhere to a diet. And people suffering from fermentopathy at the genetic level must follow such a diet throughout their lives.

DIAGNOSIS:

Diagnosis of the referring institution: Acute appendicitis.

Diagnosis on admission: Acute appendicitis.

Clinical diagnosis:

OPERATION:

Operation: Appendectomy, microirrigator. 12/17/98 0 30 — 2 00 .Local anesthesia.

Blood type II, Rh factor positive.

STATUS PRAESENS SUBJECTIVUS

The patient complains of constant aching pain in the area after the surgical wound in the right iliac region, not radiating; lack of stool; nausea; slight dizziness.

She considers herself sick since December 16, 1998, when, for no apparent reason, at about 4 p.m., dull, cramping pain appeared in the epigastric region, she took a No-Spa tablet, and the pain decreased. At night the pain intensified and shifted to the right iliac region. In the morning I went to school, but in the evening the pain became more intense, constant in nature, the temperature rose to 38 0 C. By ambulance she was taken to the emergency department of City Clinical Hospital No. 2 at 21 20 . B 0 30 The patient underwent surgery: Appendectomy, microirrigator. After the operation, analgesics and antibacterial drugs were prescribed through a microirrigator and intramuscularly. The postoperative period proceeds without complications. The patient continues treatment in the hospital; at the time of supervision, her condition is satisfactory.

Born in 1982 in the city of Vladivostok, she was the first child in a family of employees. She developed normally physically and intellectually and did not lag behind her peers. I went to school at the age of 7. I studied well. Meals are irregular, housing and material conditions are satisfactory.

HEREDITY

Close relatives are healthy. They do not have chronic diseases of the gastrointestinal tract.

EPIDEMIOLOGICAL HISTORY

Denies infectious hepatitis, sexually transmitted diseases, malaria, typhus and tuberculosis. Over the past six months, she has not had any blood transfusions, has not been treated by a dentist, has not had any injections, has not traveled outside the city and has had no contact with infectious patients.

GYNECOLOGICAL HISTORY

The first menstruation began at the age of 13; installed immediately. Denies diseases of the genital area. 0 pregnancies, 0 births, 0 abortions.

PAST DISEASES

She suffered all childhood infections.

BAD HABITS

Doesn't smoke, doesn't drink alcohol or take drugs.

HAEMOTRANSFUSION HISTORY

Blood type: II; Rh factor is positive. Blood transfusions had not been performed before.

ALLERGIC HISTORY

There are no allergic reactions to medications or food products.

STATUS PRAESENS OBJECTIVUS

GENERAL INSPECTION

The condition is satisfactory. Consciousness is clear. Position active. The facial expression is calm. Normosthenic body type, satisfactory nutrition. Subcutaneous fat tissue is moderately expressed (the thickness of the skin-fat fold is 2 cm). Appearance appropriate for age. The skin is flesh-colored, normal moisture, clean. The skin is elastic, tissue turgor is preserved. Dermagrophysm white is unstable. The hairline is uniform, symmetrical, and corresponds to the gender. Nails are oval shaped, pink, clean.

The mucous membrane of the eyes is pink, moist, clean. The sclera is not changed. The mucous membrane of the cheeks, soft and hard palate, posterior wall of the pharynx and palatine arches is pink, moist, clean. The tonsils do not extend beyond the palatine arches. The gums are not changed. The teeth are unchanged. The tongue is of normal size, moist, covered with a white coating, the papillae are pronounced.

The submandibular and posterior cervical lymph nodes are palpated, oval in shape, measuring 1 by 0.5 cm, elastic in consistency, not fused to the underlying tissues, painless.

Posture is correct, gait is normal. The joints are of a normal configuration, symmetrical, movements in them are full, painless. The muscles are developed satisfactorily, symmetrically, muscle tone is reduced. Height 170 cm, weight 62 kg.

The thyroid gland is of normal size, elastic consistency, painless. Symptoms of Graefe, Mobius, Derlympl, Stellvag are negative.

The mammary glands are located at the same level, of normal size, their contour is smooth, soft, elastic in consistency, painless. The nipples and areolar areas are unchanged.

RESPIRATORY SYSTEM

Breathing through the nose, free, rhythmic, shallow. Breathing type: chest. The respiratory rate is 20 per minute. The shape of the chest is correct, symmetrical, both halves of the chest are equally involved in the act of breathing. The collarbones and shoulder blades are symmetrical. The shoulder blades fit tightly to the back wall of the chest. The course of the ribs is oblique. The supraclavicular and subclavian fossae are well defined. The intercostal spaces are traced.

Palpation

The chest is rigid, painless. Voice tremors are symmetrical and not altered.

Percussion

Topographic percussion.

The lower borders of the right lung:
by l. Parasternalis - upper edge of the 6th rib
by l. Medioclavicularis - lower edge of the 6th rib
by l. axillaris anterior - 7th rib
by l. axillaris media - 8th rib
by l. axillaris posterior - 9th rib
by l. Scapuiaris – 10 rib
by l. Paravertebralis - at the level of the spinous process of the 11th thoracic vertebra

The lower borders of the left lung:
by l. parasternalis- ——-
by l. medioclavicularis- ——-
by l. axillaris anterior - 7th rib
by l. axillaris media - 8th rib
by l. axillaris posterior - 9th rib
by l. scapuiaris - 10 rib
by l. paravertebralis - at the level of the spinous process of the 11th thoracic vertebra

Upper borders of the lungs:
In front 3 cm above the collarbone.
Posteriorly at the level of the spinous process of the 7th cervical vertebra.

Active mobility of the lower pulmonary border of the right lung along the mid-axillary line:
on inspiration 3 cm
on exhalation 3 cm

Active mobility of the lower pulmonary border of the left lung along the middle axillary line:
on inspiration 3 cm
on exhalation 3 cm

Comparative percussion:

A clear pulmonary sound is detected over symmetrical areas of lung tissue.

Auscultation

Vesicular breathing is heard over all auscultation points. No wheezing. With bronchophonia, voice conduction is not changed.

CARDIOVASCULAR SYSTEM

The apex beat is not visually detected.

Palpation

The pulse is symmetrical, with a frequency of 78 beats per minute, rhythmic, with satisfactory filling and tension. The pulsation of the temporal, carotid, subclavian, axillary, brachial, ulnar, radial, femoral, and popliteal arteries is determined; their wall is elastic.

The apical impulse is palpated 1.5 cm medially from the left midclavicular line, with an area of 1.5 by 2 cm, moderate strength, resistant.

Percussion

Limits of relative cardiac dullness:
Right - in the 4th intercostal space 1 cm outward from the right edge of the sternum
Upper - at the level of the 3rd rib between l. sternalis et l. parasternalis sinistrae
Left - in the 5th intercostal space 1.5 cm medially from the midclavicular line

Limits of absolute cardiac dullness:
Right - along the left edge of the sternum
Upper - at the level of the 4th rib
Left - 1 cm medially from the border of relative cardiac dullness

The vascular bundle does not extend beyond the sternum in the 1st and 2nd intercostal spaces.

Auscultation

Heart sounds are rhythmic, clear, no murmurs. Blood pressure 120/80 mm Hg. Art.

DIGESTIVE SYSTEM

The tonsils do not extend beyond the palatine arches. The gums are not changed. The teeth are unchanged. The tongue is of normal size, moist, covered with a white coating, the papillae are pronounced.

The abdomen is correctly shaped, symmetrical, participates in the act of breathing, the navel is retracted. In the right iliac region there is a postoperative sutured wound, linear in shape 10 X 0.3 cm, the sutures are intact, the edges are not swollen, not hyperemic, there is no discharge. There is a micro-irrigator in the wound. The dressing is dry and clean.

Palpation

Surface: The abdomen is soft, moderately painful and tense in the right iliac region (in the area of the postoperative wound). Shchetkin-Blumberg's symptom is negative.

Deep: The sigmoid colon is palpated in the left iliac region in the form of an elastic cylinder, with a smooth surface 1.5 cm wide, mobile, not rumbling, painless. The transverse colon is not palpable. The stomach is not palpable. Rectum: the skin around the anus is of normal color, without damage; examination to a depth of 5 cm, no pain when passing the finger; sphincter tone is preserved; There is no pain or overhang of the intestinal walls.

The lower edge of the liver is sharp, smooth, elastic, painless, does not protrude from under the edge of the costal arch, the surface of the liver is smooth. The gallbladder is not palpable. Murphy's, Ortner's, frenicus, and Grekov's symptoms are negative. The pancreas is not palpable. The spleen is not palpable.

Percussion

Dimensions of the liver according to Kurlov: along the right midclavicular line 9 cm, along the anterior midline 8 cm, along the left costal arch 7 cm. The upper border of the spleen is along the left midaxillary line on the 9th rib, the lower on the 11th rib. Length – 8 cm, diameter – 6 cm.

URINARY SYSTEM

No visible changes were found in the lumbar region. The kidneys are not palpable. The symptom of tapping in the lumbar region is negative on both sides. Palpation along the ureters is painless.

NERVO-MENTAL STATUS

Consciousness is clear, speech is not changed. Sensitivity is not impaired. The patient is oriented in time, space, place. Gait without any peculiarities. Pharyngeal, abdominal and tendon-periosteal reflexes are preserved. Shell symptoms are negative. The eyeball, pupils and pupillary reflexes are normal. Sleep and memory are preserved.

PRELIMINARY DIAGNOSIS

Terminal ileitis. Secondary simple appendicitis.

EXAMINATION PLAN FOR THE PATIENT

Laboratory research:

Clinical blood test. We prescribe it to identify signs of acute inflammation (leukocytosis), as there is inflammation of the appendix. We are also interested in whether there are blood diseases - this can also worsen the prognosis of treatment.
Biochemical blood test. In it we are interested in indicators of the amount of total protein, protein fractions, indicators of protein sediment samples, aminotransferase activity, amount of sugar, electrolytes, to identify concomitant diseases and prevent complications during general anesthesia and in the postoperative period.
General urine analysis. We prescribe it to identify concomitant diseases of the urinary system and symptoms of inflammation.
Blood type, Rh factor. We prescribe, so intraoperative blood transfusion is possible.
EMF of blood.
SASS. It will help to navigate the possibility of bleeding or thromboembolic disorders.
Feces for worms and enterobiasis.

Instrumental studies:

Plain radiography of the abdominal cavity for the differential diagnosis of acute appendicitis, gastric perforation and acute intestinal obstruction.
ECG. To assess the risk of using anesthesia.
Diagnostic laparoscopy.

RESULTS OF LABORATORY AND INSTRUMENTAL STUDIES

Laboratory results:

Clinical blood test.
Leukocytes - 8x10 9 /l

eosinophils - 1%

rod-nuclear - 5%

segmented - 61%

Lymphocytes - 30%

Monocytes - 2%
Urinalysis.
Color light yellow Protein 0 g/l

Transparent Sugar 0

Acid reaction Urobilin (-)

Ud. weight 1.025 Bile. pigments (-)

Leukocytes 4 -5 in the field of view

Red blood cells 10 – 12 per field of view

Flat epithelium 6 - 7 in the field of view
EMF is negative.
HBsAg negative.

DIFFERENTIAL DIAGNOSIS

Crohn's disease (terminal ileitis) most often has to be differentiated from Meckel's diverticulum, intestinal yersiniosis, and acute gastroenteritis.

Meckel's diverticulum is present in 2% of the population; its clinical manifestations are nonspecific and develop with the appearance of complications - inflammation, perforation, bleeding. With diverticulitis, abdominal pain, fever, chills, and symptoms of peritoneal irritation appear, that is, the clinical manifestations are similar to those of acute appendicitis. Ulceration of a diverticulum may be accompanied by bleeding; with perforation, a clinic of diffuse peritonitis develops; chronic diverticulitis leads to adhesive obstruction. As you can see, it is quite difficult to clinically differentiate the manifestations of Meckel’s diverticulum from terminal ileitis. The main method for diagnosing a diverticulum is an x-ray examination with barium contrast of the intestine, which will give a symptom of a rounded shadow on the x-ray.

The abdominal form of intestinal yersiniosis is quite difficult to differentiate from Crohn's disease. In this form of yersiniosis, damage to the terminal portion of the small intestine predominates, which is manifested by abdominal pain, nausea, vomiting, intestinal dysfunction, and symptoms of peritoneal irritation may be observed (that is, symptoms of acute appendicitis). To make a diagnosis, the epidemiological history is taken into account: consumption of cabbage, etc. The main role in the diagnosis is played by serological reactions: RNGA by the 15th day (1:776), ELISA, bacterial lysis reaction.

Gastroenteritis occurs acutely, with symptoms of intoxication, abdominal pain, diarrhea, repeated vomiting, symptoms of dehydration, and there is an indication of the consumption of substandard products. The diagnosis is confirmed by bacterial culture of stool.

FINAL CLINICAL DIAGNOSIS

Terminal ileitis. Secondary simple appendicitis.

RATIONALE FOR THE DIAGNOSIS

Data obtained during surgery: the ileum 30 cm from the ileocecal angle is swollen, infiltrated, hyperemic, the lumen is narrowed by 2 times compared to other parts of the colon - allow us to leave a diagnosis of terminal ileitis (Crohn's disease).

Crohn's disease was the root cause of simple appendicitis. The clinical picture of the disease indicates appendicitis: pain syndrome (Kocher-Volkovich symptom), fever up to 38 0 C, positive appendicular symptoms - Rovsing, Voskresensky, Sitkovsky, Obraztsov, Cope.

Data obtained during the operation: appendix 12.0 x 0.5, vessels injected, confirm the diagnosis of simple appendicitis.

TREATMENT PLAN FOR A SUPERVISED PATIENT

Urgent appendectomy is indicated to prevent a life-threatening condition.

Premedication: Sol. Promedoli 2% – 1 ml

OPERATION:

Appendectomy. Micro-irrigator.

Under local anesthesia Sol. Novocaini 0.25% - 400.0 + neuroleptoanalgesia. The abdominal cavity was opened layer by layer using a Volkovich-Dyakonov incision in the right iliac region. There is no effusion. The cecum is not brought out into the wound, the vermiform appendix is not identified. The ileum, 30 cm from the ileocecal angle, is swollen, hyperemic, and twice as large in diameter as other sections. The wound is extended upward with muscle excision.

The vermiform appendix is hyperimilated, located retrocecally upward, and folded in half. Retrograde appendectomy was performed with great technical difficulties.

The stump of the process is immersed in purse-string and Z-shaped sutures. The mesentery of the process is cut off in portions using clamps, stitched and bandaged.

The abdominal cavity was treated with chlorhexidine solution, Sol. Novocaini 0.25% - 150.0; Sol.Canamicini 2.0 into the mesentery of the ileum.

Checking hemostasis, a microirrigator is removed through the wound. Layer-by-layer suture of the surgical wound. Aseptic dressing.

Specimen: Vermiform appendix 12.0 x 0.5 cm, vessels injected.

Postoperative etiopathogenetic therapy:

· Ward mode for the first day, then general.

· Famine diet in the first two days, then table No. 15.

· Antibacterial therapy for the prevention of purulent postoperative complications: Sol. Gentamicini sulfatis 4% - 2ml IM 2 times a day, Canamicini monosulfatis 1 - 2 g through a microirrigator.

· Analgesics Sol.Baralgini 5.0ml – i.m.

DIARIES

Complains of moderate dull constant pain in the area of the postoperative wound. Temperature in the evening 37.2; in the morning 36.7. Breathing is vesicular, no wheezing. Respiratory rate 18 per minute. Heart sounds are clear and rhythmic. Heart rate 78 per minute. Blood pressure 120/70 mm Hg. On superficial palpation, pain is noted in the area of the postoperative wound. On deep palpation, the sigmoid colon is painless, smooth, and tightly elastic. The chair is decorated. Urination is free, painless, diuresis is adequate to the fluid drunk.

Dressing: the wound is clean, there is no discharge, postoperative sutures are intact. Micro-irrigator removed. Alcohol, iodine. Aseptic dressing.

Complains of moderate dull constant pain in the area of the postoperative wound. Temperature in the evening 36.8; in the morning 36.5. Breathing is vesicular, no wheezing. Respiratory rate 18 per minute. Heart sounds are clear and rhythmic. Heart rate 78 per minute. Blood pressure 120/70 mm Hg. On superficial palpation, pain is noted in the area of the postoperative wound. On deep palpation, the sigmoid colon is painless, smooth, and tightly elastic. There are no peritoneal symptoms. The chair is decorated. Urination is free, painless, diuresis is adequate to the fluid drunk.

He makes no complaints. Temperature in the evening 36.6; in the morning 36.4. The condition is satisfactory. Breathing is vesicular, no wheezing. Respiratory rate 18 per minute. Heart sounds are clear and rhythmic. Heart rate 78 per minute. Pulse 78 satisfactory qualities. Blood pressure 120/70 mm Hg. On superficial palpation, pain is noted in the area of the postoperative wound. On deep palpation, the sigmoid colon is painless, smooth, and tightly elastic. The chair is decorated. Urination is free, painless, diuresis is adequate to the fluid drunk.

Dressing: the wound is clean, the stitches are removed. Alcohol, iodine. Aseptic dressing.

DISCHARGE EPIRIS

Patient x, 16 years old, was admitted to the clinic on December 16, 1998 with complaints of intense constant pain in the right iliac region, temperature 38 0 C. The clinic conducted an examination: clinical blood test (12/16/98) L 8.0 G/l, p- 5,s-64,e-1, lymphocytes-30, monocytes-2; General urine test (normal). A diagnosis was made: acute appendicitis. 12/17/98 0 30 – 2 00 surgery performed: Appendectomy, microirrigator. Based on the data obtained during the operation, the final clinical diagnosis was made: Terminal ileitis, secondary simple appendicitis. In the postoperative period she received analgesics and antibacterial therapy. The postoperative period proceeded without complications.

The prognosis for life is favorable. It is necessary to avoid heavy physical labor for an average of 3-4 months. The stay on sick leave will be 4-6 weeks. After this, working capacity is restored.

LITERATURE

1. B.V. Kirkin “New in the study of Crohn’s disease,” Russian Medical Journal.

2. M.A. Trunin. Acute appendicitis. (Guidelines)

3. M. Kh. Levitan “Crohn’s disease” M.; 1985