Diseases of the duodenum

The duodenum has many functions in its function. It is the initial section of the small intestine, but it is anatomically connected with the stomach, liver and pancreas through the ducts entering the sphincter of Oddi. Therefore, duodenal diseases have their "roots" in the disruption of the functioning of various parts of the digestive tract.

What causes the need to isolate duodenal pathology?

The statistics indicate "rejuvenation" of patients with duodenal diseases, an increase in prevalence among schoolchildren. The urgency of studying the structure and pathophysiology of the organ is associated with the need to determine the method of intestinal damage and the choice of methods for optimal treatment.

Favorable results of therapy at the level of the duodenum can prevent dysfunction and problems of interested organs. There is no separate classification of the pathology of this particular gut. In the ICD, duodenal ulcers come in one class with diseases of the esophagus and stomach.

Clinicians on etiological principle divide them:

• on dyskinesia( functional disorders);
• inflammation( duodenitis);
• peptic ulcer;
• malignant tumors;
• structure anomalies.

To developmental anomalies are: congenital stenosis, diverticulum( protrusion) of the wall. Occur rarely, accompany other malformations of the digestive system.

Summary of Anatomy and Function

The history of medicine tells us that the name of the duodenum came from its length, which is equal to the width of 12 fingers. Just note that the fingers should have been very thick, because it has a length of 30 cm from the stomach is delimited by the sphincter of the gatekeeper. According to the location, taking into account the bends, there are 4 divisions.

The sphincter of Oddi forms the inner papilla in the descending zone. The ducts of the gallbladder and pancreas come together here. The inner mucosa is covered with villi, between the epithelial cells are located goblets, which produce mucus. The muscle layer provides motor and tone.

The main tasks of the body:

• neutralization of gastric juice by the incoming contents of the pancreas and chemical treatment of the food lump;
• further fragmentation of food particles, creating conditions for more complete access of intestinal bacteria in the lower intestine;
• regulation by feedback from the brain centers the amount of necessary production and intake of pancreatic enzymes;
• coordination with the stomach of the "order" for the synthesis of juice.

Causes of defeat

The causes of duodenal diseases practically do not differ from the general damaging factors of the digestive system:

• Disruption of diet and quality of consumed products: too long breaks, overeating, hungry diets, craze for fatty, fried and spicy dishes.
• Alcohol abuse, excessive stimulation of the mucosal function of the decay products of nicotine during smoking.
• Use of low-quality food with expired shelf life, which causes poisoning and damage to the mucous membrane.
• Ingestion of infection from nasopharyngeal discharge, carious teeth.
• Parasitic and helminthic invasion from the lower parts of the intestine( lamblia, ascarids, pinworms).
• The atony of the gatekeeper.
• The results of metabolic diseases( gout, renal-liver failure in cirrhosis), diabetes mellitus.
• Injury of the inner layer with stabbing and stiff objects, fish bones.
• Disruption of the regulatory function, which causes stressful situations, endocrine diseases.
• Long-term treatment with medications with irritating properties( Analgin, Aspirin, headache preparations, corticosteroids, anti-influenza mixtures, ascorbic acid).
• Congenital structural defects.
• Hereditary predisposition.

A person with 2 or more causes is likely to be affected by duodenal ulcers. The main signs of pathology we consider on the examples of individual diseases.

The main diseases of

The main pathological conditions of the duodenum, symptoms and peculiarities of the course are considered.

Dyskinesia

Disorders in the nervous activity lead to the disease, stressful overload. Damage to innervation is possible during operations on the stomach. In another way, it is called "duodenosis."

The essence of the violations: the contents in the gut are delayed, it does not enter other parts. The patient appears: blunt burgeoning pains in epigastrium, in the hypochondrium to the right, nausea and loss of appetite, prolonged constipation.

Duodenitis

Inflammation of the duodenum( duodenitis) occurs in acute or chronic form. Acute - occurs within three days, if a person takes some strong medicines, herbal tinctures, accompanies infectious gastroenteritis. Chronic - almost never isolated. Accompanies stomach diseases, cholecystitis, pancreatitis.

It is manifested: abdominal pain without an exact localization of the aching nature, without irradiation. Patients feel worse on an empty stomach, early in the morning. After eating, after 40 minutes, there is an improvement. Characteristic constipation. A prolonged process is accompanied by congestion and spasm of the sphincter of Oddi, cramping pains, vomiting. With duodenitis, pain in the epigastrium, around the navel is possible.

Bulbit

The disease is a kind of duodenitis. Inflammation is localized in the uppermost part of the duodenum - the bulb, so more often "continues" gastritis. In the form of: catarrhal and erosive, downstream - acute and chronic. In the catarrhal form - aching pain, rarely cramping. Appear on an empty stomach or at night. Accompanied by heartburn, belching sour, smell from the mouth, a sense of bitterness, nausea.

Erosive - is characterized by prolonged exhausting dull pain in the epigastrium, which appeared several hours after eating. There is vomiting with bile, belching bitterness.

Patients complain of general weakness, insomnia, drooling, headaches.

Morphological studies show the presence of cracks and maceration on the background of hyperemic inflamed mucosa. It is important that they are only in the surface layer, do not penetrate into the muscular wall. For chronic course typical periods of exacerbations in spring and autumn, during the rest of the time lull( remission).

Ulcer

Duodenal ulcer is seen as a complication and the next stage of duodenitis, erosive bulbit. Prevalence is higher among women than men.

In severe cases, it can cause bleeding, perforation of the wall, penetration into the adjacent organ. It is localized most often in a bulb. Perhaps the formation of two ulcers lying on opposite walls( "kissing" in the terminology of roentgenologists).

Symptoms are expressed by the following symptoms:

• intense epigastric pains with irradiation in the back, hypochondrium occur 1.5-2 hours after eating, early in the morning( "hungry");
• patients describe the feeling of "sucking on a substrate";
• heartburn disturbs 1/3 of the patients, is associated with reflux acid reflux into the esophagus;
• vomiting facilitates the condition;
• nausea;
• in vomit masses are possible admixtures of blood, less often in feces;
• in patients does not suffer from appetite, there is less aversion to food, weight loss is not observed.

Parasitic infections

The following parasites are found in the small intestine for living and breeding: ascarids, pinworms, lamblia, fluke, tapeworm, trichinella. Infection occurs through dirty hands, unwashed vegetables, ponds during bathing. The presence of helminths can be judged:

• on the itch of the skin, the appearance of acne;
• constipation or diarrhea;
• dryness and skin pigmentation;
• bloating and rumbling of the abdomen;
• joint and muscle pain;
• susceptibility to allergic reactions;
• weight loss;
• restless sleep with frequent awakenings;
• increased catarrhal diseases due to decreased immunity.

Neoplasms

Malignant and benign neoplasms in the duodenum are a rare finding. Of benign growth is adenoma, fibroaden, papillomas, lime, hemangiomas, neurofibre. There are tumors of the duodenal papilla. In appearance, resemble polyps on the leg. Identify single or multiple.

Flow asymptomatically, detected by accident. If they reach a large size, they cause symptoms of mechanical obstruction of the intestine, obstructive jaundice( compression of the biliary tract).

Cancer of the duodenum is only 0.25-0.3% of all localizations of malignant tumors in the digestive system. Most cases occur in the descending section above the duodenal papilla and around it, least of all - the bulb.

Older men are more likely to fall ill. The possibility of transformation from an ulcer and a benign tumor is proved. Cancerous tumor refers to a late metastatic species. The nearest lymph nodes, the pancreas, and the liver germinate. Other metastases are rare.

Clinical signs:

• excruciating pain;
• decreased appetite and exhaustion;
• signs of mechanical obstruction( severe vomiting, dehydration);
• disintegration causes severe bleeding;Icterus and sclera.

Intestinal obstruction

Symptoms of duodenal disease may manifest obstruction in this portion of the small intestine. It is caused by:

• congenital malformations;
• atypical rotation;
• is an inverted form;
• increased mobility;
• blockage by swelling of the duodenum or squeezing of the pancreas neoplasm;
• migration of stone.

Herniation

Hernias are called characteristic bulging of the intestinal wall. It is more often found in people after 50 years of age, leading a sedentary lifestyle. It is formed as a result of loss of tonus of the muscular layer. It is possible to suspect the disease if the patient has gastroesophageal reflux disease. Patients complain of heartburn, especially at night, belching, flatulence.

The main types of diagnosis

In the diagnosis of duodenal diseases are used: a blood test - allows you to judge the intensity of inflammation, identify anemia, the reaction of feces to the latent blood, the study of feces for eggs of worms, methods for detecting Helicobacter.

In the presence of jaundice, the blood is necessarily examined for viral hepatitis, liver tests, enzymes. Fibrogastroduodenoscopy is also necessary - the main method of visual examination of the mucosa, the detection of the form of inflammation, erosions, ulcers, and tumors.

Morphological examination of the site of tissue taken with biopsy, helps to distinguish the growth of malignant and benign neoplasm, as well as ultrasound.

The X-ray method continues to be applied in the clinic. An examination with a series of pictures is performed after the patient has taken the barium salt inside. On the recommendation of specialists for an improved review of the upper intestine is used a relaxation duodenography with a probe.

Directions for treatment of duodenal diseases

To treat diseases of the upper parts of the small intestine occurs in conjunction with other digestive organs. Strict adherence to the patient's diet is considered mandatory.

Recommendations for diet and regimen

In the acute phase of bulbitis, ulcers appoint fasting for 1-2 days. The maximum shading of the organ is provided in the future with the exception of feeding fried, salty, smoked, hot and fatty foods;alcohol and carbonated drinks;strong coffee and tea.

The daily ration necessarily includes: boiled meat and fish, soups without spices, liquid porridge, low-fat cottage cheese, jelly. It is necessary to eat 6 times a day, in small portions. After 2 weeks, gradually expand the diet, but the general limitations for chronic diseases last the rest of your life.

Bed rest is necessary for patients with duodenitis, peptic ulcer, tumors. If the patient's condition is satisfactory, then one should only get rid of physical exertion, learn to cope with stressful situations.

Some duodenal diseases do not need treatment. These include: a hernia, diverticula, anomalies of the structure, benign formations in the absence of clinical manifestations. Doctors conduct annual fibrogastroduodenoscopy to monitor the dynamics of pathology.

Treatment with medicines

Medications are prescribed by the etiological principle, taking into account the revealed functional disorders. Infection with worms will require a course of therapy with anthelminthic drugs with control studies of feces. Dyskinesia is treated with regimen, diet, soothing drugs, physioprocedures.

Confirmation of the presence of Helicobacteria - an indication for carrying out the course of eradication with drugs Amoxycycline, De-nol, Sumamed. For the purpose of anesthesia, the introduction of antispasmodics is indicated. To protect the intestine, drugs should be given in injections. At high acidity, antacids are prescribed: Maalox, Almagel, Gastal.

Omeprazole, ranitidine, and metoclopramide are used to restore the tone of the pyloric sphincter and motor function, to remove nausea. Symptomatic drugs( vitamins, cholagogue) will be needed for patients with long-term chronic course of the disease.

Chemotherapy for malignant neoplasms is performed with cytostatic drugs, which allow to stop the reproduction and growth of cancer cells. The combination with radiotherapy helps to delay the development of the tumor.

The use of surgical methods

Surgical methods of treatment are certainly used in diseases such as tumors, hernia, cicatricial stenoses, changes in the structure of the duodenum, obstruction, prolonged non-healing ulcers, acute bleeding. Inefficient conservative therapy necessitates consultation of the surgeon.

Benign neoplasms, hernial protrusions operate only if they grow to significant size and disrupt the passage of food. The most common types of operations are as follows:

• vagotomy - excision of the leading branch of the vagus nerve, is performed more often by laparoscopic method;
• removal of part of the stomach together with duodenum( resection) and formation of gastroenteroanastomosis with jejunum;
• removal of the hernial sac and suturing the wall.

When choosing a method, surgeons are guided by: the state of organ damage( erosion, deep bleeding ulcers), age and concomitant diseases of the patient, the predictive risk of postoperative complications.

In cases of breakthrough ulcers or acute bleeding operate on urgent indications to save the patient's life. Interventions are not equivalent in results. After vagotomy relapses of the disease occur in 1/3 of patients.

With malignant neoplasm of the duodenum, operative tactics are chosen depending on the location of the tumor. In addition to gut resection, it may be necessary to remove the head of the pancreas and duct.

Folk remedies for treatment

Phytotherapy in diseases of the stomach and duodenum should support the direction of the main drug treatment. Healers recommend:

• a decoction of oats, flaxseed;
• chamomile tea from flowers to drink daily in a warm form;
• insist collection from the root of althea and licorice;
• alcohol or water tincture of propolis;
• decoction from the bark of oak.

Sanatorium treatment fixes the results of therapy, restores the functions of the duodenum. For this purpose, the health resorts of Essentuki, Kislovodsk are suitable. Natural mineral water, mud in the form of applications contain a natural complex of medicinal substances.

Diseases of the upper intestine seldom occur in isolation, are more likely to accompany other lesions of the digestive system. Timely detection can prevent severe consequences.