(1) Etiology of acute enteritis: (1) Overeating, eating too much high-fat and high-protein food, drinking too much, drinking too much cold drinks, or catching cold. (2) Eating rotten and polluted food, such as overnight food without heating and disinfection, rotten fish and shrimp, stale crabs and seafood, meat food stored in the refrigerator for a long time, fermented and deteriorated milk and dairy products, etc. (3) Individual patients have allergic reactions to food. Acute enteritis occurs frequently in summer, which is related to hot weather and perishable food. If the "disease from mouth to mouth" is well controlled, acute enteritis will be greatly reduced.
(2) Clinical manifestations of acute enteritis: (1) Abdominal pain and diarrhea are the main features. Most of them are pain around the navel, manifested as paroxysmal colic, which causes a feeling of defecation, and abdominal pain is slightly relieved after defecation. Diarrhea is mostly watery and contains indigestible food residues. Generally, you can defecate 7-8 times a day, up to a dozen times. After treatment, the patient returned to normal within 1 ~ 2 days, at most 2 ~ 3 days, and his condition was relatively good. (2) The bowel sounds are too high. You can clearly hear the "cooing" sound of the abdomen near the patient. (3) A few severe patients were accompanied by low fever, nausea, vomiting and dehydration. (4) Acute enteritis should be distinguished from diarrhea caused by other diseases. Generally speaking, the mild diarrhea is generally acute enteritis. Other diseases need to go to the hospital for further examination before they can be diagnosed.
(3) Rescue measures: (1) First, stay in bed, keep warm, and fast for 12 hours, and then gradually eat a small amount of liquid food, such as rice soup, lotus root starch, porridge, noodle soup, etc. , slowly return to normal diet. (2) Appropriate relief of pain and diarrhea. Oral belladonna tablets. If diarrhea is serious, you can eat some burnt steamed bread slices or rice porridge to stop diarrhea. (3) Encourage drinking more water. See "Emergency Measures for Acute Gastritis". (4) Patients with mild illness may not need "anti-inflammatory drugs". Generally, lactase, berberine, norfloxacin and other drugs can be selected. (5) Patients with severe diarrhea and dehydration should be sent to the hospital for intravenous infusion treatment in time.
What is acute enteritis?
Acute enteritis is a common and frequently-occurring disease in summer and autumn. Mostly caused by microbial infections such as bacteria and viruses, mainly manifested as abdominal pain, diarrhea, nausea, vomiting, fever and so on. In severe cases, dehydration, electrolyte disorder and shock can be caused.
The diagnosis of acute enteritis is not difficult, and patients often have sudden onset in summer and autumn. Most of them have a history of improper diet or eating by mistake; It is characterized by explosive epidemic; Most patients first show nausea and vomiting, followed by diarrhea, ranging from 3 to 5 days a day, or even dozens of times. The stool is watery, dark yellow or green, smelly, and may be accompanied by abdominal cramps, fever, body aches and other symptoms. Routine stool examination and stool culture, red blood cell and white blood cell counts can be normal or abnormal. The patient has nausea, vomiting, abdominal pain and diarrhea at the same time, so it is also called acute gastroenteritis.
What factors are associated with the onset of acute enteritis?
(1) bacterial and toxin infection
Salmonella and halophilic bacteria (Vibrio parahaemolyticus) are the most common infections, Staphylococcus aureus is the most common toxin, and viruses can also be seen. There are often cases of collective illness or multiple families. Such as eating contaminated poultry, livestock meat and fish; Or eat seafood such as crabs and snails bred by halophilic bacteria, and eat leftovers contaminated by Staphylococcus aureus.
(2) Physical and chemical factors
Eat cold food or some drugs such as salicylate, sulfonamides, some antibiotics, etc. ; Or taking strong acid, strong alkali and pesticide by mistake can cause this disease.
What are the pathological changes of acute enteritis?
The gastrointestinal mucosa is hyperemia, edema and exudation, and the surface is covered with flaky yellow exudate or mucus, and the lesion may be localized or diffuse. There are erosions and bleeding spots on the wall of mucosal folds. If superficial epithelial cells are necrotic and fall off, the intimal blood vessels are damaged, which will cause bleeding and plasma extravasation, often accompanied by neutrophils, lymphocytes, plasma cells and a small amount of eosinophils infiltration, and in severe cases, submucosa also has congestion and edema.
Small intestine is the main lesion of salmonella gastroenteritis, but it also involves colon, causing symptoms similar to dysentery. Salmonella is invasive, causing mucosal inflammatory reaction, accompanied by neutrophil infiltration in submucosa, and sometimes reaching the lamina propria. Inflammatory cells produce and release prostaglandin, which increases the activity of adenylate cyclase. Salmonella secretes enterotoxin, which directly stimulates adenylate cyclase system, so that the secretion ability of intestinal fluid is greatly increased, exceeding the reabsorption ability of intestine, causing diarrhea.
What are the clinical manifestations of acute enteritis?
(1) Gastrointestinal symptoms: Nausea, vomiting, abdominal pain and diarrhea are the main symptoms of this disease. Vomiting starts suddenly, often with nausea first, then vomiting, and most of the vomit is stomach contents. In severe cases, bile or bloody substances may be vomited. Abdominal pain is more common in the middle and upper abdomen, and severe cases can be paroxysmal colic. Diarrhea is characterized by watery stools, ranging from several times to dozens of times a day, accompanied by foul smell. The stools are mostly dark yellow or light green, with little pus and blood, and no urgency and heaviness.
(2) Systemic symptoms: Generally, systemic symptoms are mild. Severe patients have symptoms such as fever, dehydration, acidosis, shock, and occasionally acute upper gastrointestinal bleeding.
(3) Signs: Early or mild cases may have no signs. During physical examination, there may be mild tenderness in the upper abdomen or navel, and the bowel sounds are often obviously hyperactive. Generally, patients have a short course of disease and can heal themselves within a few days.
What are the laboratory tests of acute enteritis?
(1) Blood routine: The white blood cells in blood routine can be slightly increased, and the erythrocyte sedimentation rate is slightly increased.
(2) Routine stool or culture: most of them are normal, and a few white blood cells and red blood cells can also be seen. In the case of bacterial infection, pathogenic bacteria can be found.
What is the diagnostic basis of acute enteritis?
The diagnosis of this disease is mainly based on acute onset, recent history of eating disorders or taking drugs that have bad stimulation to the stomach, as well as clinical manifestations such as nausea, vomiting, abdominal pain and diarrhea. Routine stool includes mucus, red blood cells and white blood cells. Bacterial culture can find pathogenic bacteria. The number of white blood cells increased slightly.
What disease is acute enteritis differentiated from?
Upper gastrointestinal bleeding should be differentiated from peptic ulcer and esophageal variceal bleeding. A few cases have severe abdominal pain, which should be differentiated from peptic ulcer perforation, acute cholecystitis, acute peritonitis, acute appendicitis and atypical acute myocardial infarction.
What is the treatment principle of acute enteritis?
(1) Remove the inducement, stay in bed and eat light and digestible food.
(2) If pathogenic bacteria are found, they should be taken orally according to the drug sensitivity test, or berberine 0. 1 ~ 0.2g or PPA 0.5~ 1.0g, 3 ~ 4 times a day.
(3) Symptomatic treatment, abdominal pain can be treated with atropine. Dehydrated patients should be hydrated and pay attention to correct electrolyte disorder and acidosis. Shock is shock.
What are the commonly used therapeutic drugs for acute enteritis?
(1) spasmolytic and analgesic: Abdominal pain can be treated with spasmolytic agents, such as taking atropine 0.3 ~ 0.6 mg or propafenone/kloc-0.5 mg ~ 30 mg, intramuscular injection of anisodamine 5 ~/kloc-0.0 mg, or relieving abdominal pain 1.
(2) Antibacterial and anti-inflammatory: In case of bacterial infection, antibiotics should be selected, such as berberine 0.3g, three times a day, and compound sulfamethoxazole 1 ~ 2 tablets each time, three to four times a day. Norfloxacin 0. 1 ~ 0.2, three times a day. Gentamicin 1.6 million units, taken orally, 3 ~ 4 times a day. If you vomit violently or lose water obviously, give glucose saline intravenous drip. In the case of acidosis, 5% sodium bicarbonate solution should be properly kept still. Upper gastrointestinal bleeding should be rehydrated or transfused, gastric lavage with ice water and oral antacid.
How to identify acute enteritis by TCM?
Chinese medicine does not have the name acute enteritis. According to the main clinical manifestations of this disease, it belongs to the categories of vomiting, abdominal pain, diarrhea, cholera, strangulation and loss of syndrome in traditional Chinese medicine. The causes are pathogenic emotion, food injury, emotional disorder and viscera weakness, but the main key lies in spleen and stomach dysfunction and gastrointestinal dysfunction.
(1) Feel the evil of time
At the turn of summer and autumn, it is hot and humid. If the adjustment is not appropriate, feel the dampness of the summer heat; Or diseases caused by cold sleep, cold and wet soaking, cold and pathogenic factors, stagnation of middle energizer, damage of spleen and stomach, and imbalance of ascending and descending.
(2) Damage caused by diet
Gluttony and stagnation; Or eating fat and sweet, damp and hot; Or eating cold and unclean things by mistake, damaging the spleen and stomach, resulting in dereliction of duty in transportation, failing to absorb Shui Gu's essence, stopping instead of dampness stagnation, failing to raise clear qi, failing to lower turbid qi, vomiting and diarrhea, resulting in this disease.
(3) Emotional disorder
Deficiency of spleen-qi, or stagnation of original food, or stagnation of original dampness, which is not pathogenic, causes emotional imbalance, depression and anger, and mental stress, leading to stagnation of liver-qi, invasion of spleen, restriction of spleen and stomach, and abnormal transport. Just as the article "Jing Yue Quan Shu Xie" said: "Anyone who is angry and diarrhea will eat first and hurt the spleen and stomach. Therefore, if something is committed, it will happen with the touch. This disease of the liver and spleen is also covered by liver wood and hurt by temper. "
(4) Spleen and stomach weakness
Long-term eating disorders, fatigue and internal injuries, or long-term illness will lead to spleen and stomach weakness. Because the spleen governs transport and digestion, and the stomach governs reception, the weakness of the spleen and stomach can't tolerate Shui Gu and subtle transport and digestion, so that hydration turns into dampness, cereal turns into stagnation, and dampness stops, leading to the failure of the disease.
How does TCM recognize the pathogenesis of acute enteritis?
Spleen is the foundation of the day after tomorrow and the source of qi and blood biochemistry. Located in Zhongjiao, it belongs to dirty soil. It likes dryness and hates dampness, and it mainly promotes the clearing of qi, transports Shui Gu, and regulates body fluids. Stomach and spleen are in exterior-interior relationship, and the subject and recipient are Shui Gu, whose qi declines, and he likes moistening and hates dryness. Two dirty * * * are dry and wet, and one is collected and one is transported. * * * plays the role of solid collection and transportation. In summer and autumn, when the patient is hot and humid, he is greedy for cold or eats corrosive things by mistake, which leads to spleen and stomach injury, imbalance of turbidity and turbidity, gastrointestinal disorder, vomiting and diarrhea.
How to treat gastrointestinal damp-heat acute enteritis?
Syndrome manifestations: sudden onset, often nausea, vomiting, acid swallowing, abdominal pain, acute diarrhea, unpleasant stool, yellow and brown feces, yellow and greasy tongue coating and slippery pulse.
Syndrome analysis: Gastrointestinal damp-heat, common in summer, summer heat with dampness, spleen and stomach damage, stomach fu-organs disorder, turbid qi rushing up, nausea and vomiting; There is heat in the intestine, and the damp heat accumulates in the gastrointestinal tract, causing acute diarrhea; Dampness obstructs middle energizer, and abdominal pain occurs when qi is unfavorable; Yellow and greasy fur and slippery pulse are all damp-heat syndrome.
Treatment: clearing damp heat and regulating stomach.
Prescription: Gegen Qinlian Decoction: Radix Puerariae, Scutellariae Radix, Rhizoma Coptidis, Flos Lonicerae, Lotus Leaf, White Lablab, Glycyrrhrizae Radix and Plantaginis Semen.
Pueraria lobata and honeysuckle in the medicine can relax tendons and clear heat, clear heat and stop diarrhea; Scutellaria baicalensis Georgi and Coptidis Rhizoma taste bitter and cold, clearing heat and drying dampness; Poria cocos and plantain seeds strengthen the spleen and promote diuresis; Lentils and lotus leaves clear away heat and dampness; Licorice relieves pain and coordinates various drugs.
For patients with severe abdominal pain, add Radix Paeoniae Alba and Radix Aucklandiae to regulate qi and relieve middle warmer; Vomiting drama, you can take Yushu Dan to stop vomiting first; Food stagnation should be supplemented with medicated leaven, malt, hawthorn and other digestion products.
How to treat cold-dampness blocking acute enteritis?
Symptoms and signs: vomiting with clear water, nausea, diarrhea like water, abdominal pain and bowel sounds, aversion to cold and fever, body pain, thin white or greasy fur, and thready pulse.
Syndrome analysis: At the turn of summer and autumn, people are greedy for cold and sleep outdoors, cold and dampness invade the body, cold pathogens are committed, and the spleen and stomach are injured, so vomiting, diarrhea and watery stools will occur; Abdominal pain and bowel sounds will occur if the cold and dampness are abundant and the spleen and stomach qi are not smooth. If pathogenic factors bind the muscle surface, and camp is not harmonious with health, fever and aversion to cold will lead to headache and body pain. White and greasy fur, moist or floating pulse, is the image of cold and dampness.
Treatment: Eliminating pathogenic factors and turbidity, dispelling cold and removing dampness.
Prescription: Huoxiang Zhengqi Powder: Huoxiang, Pericarpium Arecae, Radix Angelicae Dahuricae, Perillae, Poria, Pinellia ternata, Atractylodis Rhizoma, Pericarpium Citri Tangerinae and Magnolia Officinalis.
In the prescription, Pogostemon cablin, Perilla frutescens and Magnolia Officinalis can eliminate pathogenic factors and remove turbidity, while Pinellia ternata, Pericarpium Citri Tangerinae, Poria, Pericarpium Arecae and Stomach can reduce adverse reactions. Angelica dahurica and perilla frutescens are pungent and warm to relieve exterior syndrome.
Addition and subtraction: Schizonepeta tenuifolia and Saposhnikovia divaricata can be added for those with aversion to cold and fever; Headache, plus Notopterygium Rhizoma and Radix Angelicae Pubescentis; If you have abdominal distension, remove Atractylodis Macrocephala, and add fried Massa Medicata Fermentata and Endothelium Corneum Gigeriae Galli to help digestion and guide stagnation.
Diagnosis and treatment of acute enteritis caused by food stagnation in gastrointestinal tract?
Syndrome manifestations: nausea, anorexia, poor diet, accelerated vomiting, abdominal pain, diarrhea with a foul smell, urgency and discomfort, pain relief after diarrhea, thick and greasy fur and slippery pulse.
Syndrome analysis: improper diet, especially eating corrosion, or overeating leads to cold, overeating, food retention, gastrointestinal obstruction, qi disorder, turbid qi rushing up, sour and smelly; If you bet on food, you will stink like a loser; If diarrhea erodes, abdominal pain will be relieved; Thick and greasy tongue coating and slippery pulse are signs of food stagnation.
Treatment: regulating stomach, reducing adverse reactions, resolving food stagnation.
Prescription: Baohe Pills: burnt hawthorn, fried Massa Medicata Fermentata, Poria, Pinellia ternata, dried tangerine peel, forsythia suspensa and radish seeds.
In the prescription, hawthorn, medicated leaven, radish seed and poria cocos can help digestion and strengthen stomach; Pericarpium Citri Reticulatae and Rhizoma Pinelliae regulate qi and reduce adverse reactions; Forsythia suspensa digestion, stagnation and heat.
Addition and subtraction: if food stagnation turns into heat and the stool is uncomfortable, you can take Zhi Zhi Daozhi Pill; If the stomach is hot and vomits, ginger, vermilion and ochre can be added.
How to treat acute enteritis with spleen and stomach weakness?
Syndrome manifestations: deficiency of congenital endowment, spleen deficiency and careless diet, that is, easy to vomit and diarrhea, thin stool, spitting clean water, occasional rest, accompanied by pale face, weakness of limbs, pale tongue and thready pulse.
Syndrome analysis: spleen and stomach weakness, dereliction of duty in transportation, easy vomiting and diarrhea, and long duration of diarrhea; The source of qi and blood is insufficient, so the face is dull and the limbs are weak; Pale tongue and wet pulse are all manifestations of weakness of the spleen and stomach.
Treatment: invigorating spleen and qi, regulating stomach and eliminating dampness.
Prescription: Shenlingbaizhu Powder: Ginseng, Atractylodis Rhizoma, Rhizoma Dioscoreae, Poria, Lentils, Amomum villosum, Coicis Semen and Radix Glycyrrhizae Preparata.
Ginseng, Atractylodis Rhizoma, Poria and Radix Glycyrrhizae Preparata are used for invigorating qi and strengthening spleen. Lentils, Coix seed and Chinese yam are lightly permeable to dampness; Amomum villosum regulates Qi-flowing, which can stop vomiting and diarrhea.
Addition and subtraction: for food stagnation, chicken gizzard-membrane, hawthorn and medicated leaven are added; For patients with abdominal pain and even like warm pressure, dried ginger and white peony root can be used; People with long-term diarrhea and proctoptosis can take Buzhong Yiqi Pill.
What traditional Chinese medicines and simple prescriptions are there for acute enteritis?
(1) Xiang Lian Huazhi Pill 1 pill, twice a day. It is used for damp-heat stagnation, abdominal pain and diarrhea, or red and white dysentery, which is urgent and then heavy. Or add flavored Xianglian pills to clear away heat and dampness, relieve depression and stop diarrhea. Xiangsha Yangwei Pill is used for preventing diarrhea due to cold and dampness, 6 grams each time, twice a day. For patients with gastrointestinal stagnation, Vaccinium hupehensis Baohe Pill, 6g each time, twice a day. Patients with spleen and stomach weakness use Xiangsha Liujunzi Pill, 6g each time, twice a day. Warming and invigorating qi, invigorating spleen and nourishing stomach.
(2) Poria cocos 15g, Coptidis Rhizoma 6g, Alismatis Rhizoma 5g, Coicis Semen 15g, Plantaginis Semen 15g, Radix Puerariae 15g, Talcum 15g, and Glycyrrhrizae Radix 3g for damp-heat diarrhea.
(3) Jiao Sanxian10g, Areca catechu10g, Amomum villosum10g, Radish10g, Salvia miltiorrhiza10g, Mint 6g, Pericarpium Arecae10g, Yuan Yuan.
How to master the principles and methods of TCM syndrome differentiation treatment for acute enteritis?
Acute enteritis is highly pathogenic, violent and sudden. The cause is often spleen injury and dampness accumulation. Spleen governs transport and transformation, preferring dryness and aversion to dampness. The stomach governs appetite, and it likes to moisten dryness and hates dryness. Spleen ascending and stomach descending, combining exterior and interior, dryness and dampness, * * * completes the function of digestion and absorption. Once the balance of dryness and dampness is out of balance, it is easy to have "diarrhea due to dampness". The pathogenesis of this disease lies in neglect of spleen and stomach transport, and the spleen will slide down and diarrhea if it does not rise. Acute enteritis is dominated by pathogenic factors, so eliminating pathogenic factors is the key, and eliminating pathogenic factors is health. Regardless of exogenous factors, food accumulation and internal injuries, dampness can be stopped from the inside, and the main pathogen can be eliminated, thus eliminating dampness. The method of eliminating dampness is nothing more than aromatherapy, light osmosis and diuresis, bitter cold and dampness, dispelling wind and overcoming dampness, pungent ventilation and dampness, invigorating spleen and dampness, warming yang and dampness. Drugs should be selected according to the syndrome differentiation of cold, heat, exterior, interior, yin, yang, deficiency and excess, and then the products of strengthening spleen and benefiting stomach should be used.
Although acute enteritis is caused by excessive pathogenic factors, it also varies from person to person. Men and women, old and young, have different constitutions and are treated separately. Those who are prone to diarrhea due to spleen deficiency or who have weak diarrhea and hurt qi and yin should pay special attention to strengthening the body resistance, rather than restraining the injury caused by excess evil, that is, simply recognizing the elimination of evil as the method, but should master the overall concept of traditional Chinese medicine and the characteristics of syndrome differentiation and treatment, and treat them according to symptoms. The key to its treatment lies in tonifying deficiency, warming and cooling, promoting digestion and resolving stagnation, clearing away damp-heat, ascending when sinking, and being steady and astringent when slipping. The commonly used methods of this disease are: eliminating stagnation, eliminating stagnation, clearing heat and promoting diuresis, promoting qi circulation and relieving bloating. For patients with chronic diarrhea due to physical weakness, the methods of warming the middle energizer and strengthening the spleen, astringing the intestine to stop diarrhea, nourishing yin and clearing away heat, and supporting yang to dissipate stagnation can be used. Common clinical symptoms of cold and heat, excess and deficiency often do not simply exist, so treatment and treatment can not be completely separated, and must be changed according to the condition and guided by the situation. Attention should be paid to the following points in medication: ① The products that clear away heat and bitter cold should be used for a long time, otherwise it will easily hurt the spleen and stomach. (2) It is not advisable to use lightly the agent for promoting diuresis. Excessive osmosis will dry up body fluid and suppress yin. ③ The astringent should not be used too early, and it will converge too early, leading to stagnation and accumulation of pathogenic factors. (4) Don't use too much medicine under attack. Too many attacks will hurt your vitality, especially for the weak.
After diarrhea stops, the stomach qi should be protected, and Shen Zhu Cao Ling can be given spleen and qi. If the deficiency of both qi and yin is manifested as dry mouth and too lazy to speak, you can throw away the pulse to replenish qi and nourish yin.
What is the prognosis of acute enteritis and how to carry out prevention and health care?
(1) Prognosis: The prognosis of this disease is generally good. Due to acute enteritis caused by Salmonella infection, intestinal pathogenic bacteria with severe gastrointestinal reaction are quickly excreted, so the symptoms of toxemia are generally mild, and patients recover better in a short time. Some patients have poor body resistance, or suffer from some chronic diseases or receive treatment such as adrenocortical hormone and immunosuppressant, which leads to the decline of body resistance, so bacteria can invade the blood from the intestinal wall, causing bacteremia and causing a greater infection process. Patients with sudden diarrhea should replenish water in time and pay attention to correct the electrolyte acid-base balance, otherwise it will have adverse consequences, especially for the elderly and infants.
(2) Prevention: Actively carry out health education and do not eat the meat and internal organs of dead livestock. Meat, poultry, eggs, etc. It should be cooked before eating. Strengthen food hygiene management, and do not allow the sale of spoiled and salmonella-contaminated food. Do a good job in canteen hygiene, establish a hygiene management system, pay serious attention to food production hygiene, and prevent food from being polluted. Do a good job in water source protection, drinking water management and disinfection.
(3) Health care: strengthen exercise, enhance physical fitness, and make spleen flourishing less susceptible to evil. Feel comfortable and keep the balance of gastrointestinal function. Diet is beneficial to the absorption function of the spleen and stomach. Be cautious in life, shelter from the wind and cold is yin, and the spirit is governance.
What is the cure standard of acute enteritis?
(1) Symptoms and signs disappeared.
(2) due to severe vomiting or dehydration, acidosis, corrected after symptomatic treatment. Routine stool and blood tests are normal.