Enteritis

Generality

Enteritis is inflammation of the first section of the intestine (otherwise known as the small intestine or small intestine).

In most cases, enteritis has infectious origins and arises as a consequence of the consumption of food and / or drinks contaminated with bacteria. More rarely, inflammation of the small intestine can be caused by the intake of certain drugs or drugs, by radiotherapy anticancer or certain inflammatory bowel diseases such as Crohn's disease.
The classic symptoms of enteritis are: diarrhea, stomach pain, abdominal cramps, vomiting and fever.
Given the clarity of the pathological manifestations, in general, enteritis is diagnosed with a simple physical examination. More in-depth checks may still be indicated to understand the triggering causes or when the disorder occurs in severe form.
Except for complications or the presence of very intense symptoms, healing takes place in a few days and without resorting to specific treatments.

What is enteritis?

Enteritis is inflammation of the small intestine.

WHERE IS THE SMALL INTESTINE FOUND?

The intestine is the portion of the digestive system between the pylorus and the anal orifice. From the anatomical point of view, it is divided into two main sectors: the small intestine, also called the small intestine, and the large intestine, also called the large intestine.

The small intestine is the first tract; it begins at the pyloric valve, which separates it from the stomach, and ends at the ileocecal valve, located on the border with the large intestine. The small intestine is made up of three sections (the duodenum, the jejunum and the ileum), is about 7 meters long and has an average diameter of 4 centimeters.
The large intestine is the terminal tract of the intestine and digestive system. It begins at the ileocecal valve and ends at the anus; it consists of 6 sections (cecum, ascending colon, transverse colon, descending colon, sigma and rectum), is about 2 meters long and has an average diameter of about 7 centimeters (hence the name of large intestine).

Table. subdivisions of the intestine.

Main sections of the intestine Length Average diameter Sections Small intestine or small intestine About 7 meters About 4 centimeters Duodenum
Fast
Ileus Large intestine or large intestine About 2 meters About 7 centimeters Blind
Ascending colon
Transverse colon
Descending colon
Sigma
Rectum

DIFFUSION OF THE ENTERITE

Not all enteritis remains confined to the small intestine: some, in fact, can spread elsewhere and reach the stomach (gastro-enteritis) or the large intestine.
This usually occurs when the inflammation of the small intestine arises in the vicinity of its initial tract (therefore near the stomach) or the final one (therefore near the large intestine).

Causes

Most of the time, enteritis is due to the ingestion of food (food and / or water) contaminated with bacterial infectious agents. In all these cases, we speak of infectious enteritis.
However, inflammation of the small intestine can also be caused by:

• an "improper intake of some non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
• The use of drugs, such as cocaine.
• Cycles of anticancer radiotherapy.
• Autoimmune inflammatory bowel diseases, such as Crohn's.

INGESTION OF CONTAMINATED FOOD AND DRINKS

Most cases of enteritis are explained by the "ingestion of food or drink contaminated with bacteria; in other words, by a" food poisoning.
Food contamination can occur for various reasons; usually, it occurs because of their improper treatment during the processing phase, or because of the non-sanitized environment in which they are stored, or because of the poor hygiene of those who handle them.

The bacteria that most frequently contaminate food and develop infections in humans are:

• Salmonella
• Escherichia Coli
• Staphylococcus aureus
• Campylobacter jejuni
• Shigella
• Yersinia enterocolitica

The foods most often associated with food poisoning are: all types of meat, unpasteurized milk and fresh products, such as fruit and vegetables.
People with food poisoning enteritis can infect healthy people through direct contact.

ENTERITE AFTER THE USE OF COCAINE

Cocaine intake can (rarely) cause enteritis, as it reduces the flow of blood to the cells of the intestine (intestinal ischemia); if the ischemia is severe, it can cause cell death and intestinal gangrene.
The most severe cases of cocaine enteritis result in perforation of the affected small bowel tract.

ENTERITE DUE TO RADIOTHERAPY

Radiation therapy is an anticancer treatment that uses ionizing radiation to destroy the cells of a tumor. When used against tumors in the abdomen or in the pelvic area, radiation therapy can damage not only malignant cells (which are the target), but also healthy intestinal cells. This damage involves the alteration of intestinal functions and the appearance of the so-called radiation enteritis (ER).

ENTERITIS DUE TO AUTOIMMUNE DISEASES OF THE INTESTINE

Enteritis is a classic symptom of some inflammatory bowel diseases of autoimmune origin, such as Crohn's disease.
In autoimmune diseases of the intestine, and in all autoimmune diseases in general, the patient's immune system attacks some healthy cells of the human body. The consequence of all this is damage to organs and tissues.

RISK FACTORS

An individual is more likely to get enteritis if:

• He drinks non-potable water.
• Has close relationships with people infected with salmonella, campylobacter jejuni, yersinia enterocolitica etc.
• Travel to countries where hygiene is poor and bacterial contamination of food and water is frequent (for example in some parts of Africa).

Symptoms and Complications

Typical symptoms and signs of enteritis are: watery diarrhea, abdominal pain, abdominal cramps, nausea, vomiting, loss of appetite, fever and, finally, the presence of blood or mucus in the stool.

WHEN TO SEE THE DOCTOR?

Enteritis generally heals within 3-4 days and without the need for specific treatment.
If, however, the symptoms last longer than expected, if the blood in the stool becomes noticeable or, again, if the fever does not seem to diminish, then it is good to contact your doctor and book an appointment.

COMPLICATIONS

When an individual suffers from severe or prolonged form of enteritis, they may lose a lot of fluids due to diarrhea, vomiting and fever (which causes sweating).
Excessive lack of water / liquids in the body is called dehydration. Therefore, a dehydrated individual is a person who does not take in enough water and / or loses it in excessive quantities. The sufferers of enteritis most at risk of dehydration are the children and adolescents.

Summary of the main symptoms of dehydration.

• Dry mouth
• Reduced amount of tears
• Sunken eyes
• Reduced volume of urine produced
• Dark urine
• Fatigue
• Sunken fontanelles (infants only)

Dehydration is considered a dangerous medical condition, so it should be treated as soon as it is known.

Diagnosis

To diagnose enteritis, a thorough physical examination may suffice, during which the doctor asks the patient what symptoms he feels and when he began to feel bad (for example, a trip to certain countries in Africa is particularly indicative and rich. meaning).
The need for more in-depth checks arises when the symptoms of enteritis are severe and show no sign of improving. The tests carried out in these situations are, in general, blood tests and the so-called coproculture.

BLOOD TESTS

Blood tests allow the doctor to clarify the causes of enteritis, as:

• If a state of anemia emerges, it can mean that the patient is suffering from Crohn's disease.
• If traces of cocaine emerge, the patient has used this drug.

Knowing the causes is not an end in itself, but allows you to plan the most appropriate treatment.

COPROCULTURE

Copro-culture is a microbiological examination aimed at the search for particular microorganisms in the faeces. It is performed when enteritis is suspected to be due to poisoning from contaminated food, in order to trace the exact type of bacterium involved and establish the best antibiotic treatment.

Treatment

Less severe cases of enteritis usually heal within a few days and without the need for special treatment. The only recommendation, in these situations, is to take plenty of fluids.
Severe and / or prolonged cases, on the other hand, require various attentions: first of all, appropriate rehydration and the administration of antidiarrheal drugs are required; secondly, the triggering causes must be adequately treated.

FUNDAMENTAL POINTS

• 

  Figure: example of a home rehydration solution proposed by the ehydrate.org site How to rehydrate? To remedy dehydration, the patient should take rehydrating electrolyte solutions, based on water, sodium and potassium or based on water and glucose (glucose solution). The method of administration of these preparations depends on the intensity of the vomiting: in fact, in case of repeated episodes of vomiting, it is preferable to use the intravenous route rather than the oral route.
  (N.B: glucose solutions also represent a means of nutrition).
• When is the patient hospitalized? In case of severe enteritis, hospitalization may be required, as the patient needs to be rehydrated and fed intravenously. Furthermore, with hospitalization, the patient is continuously monitored, in order to prevent any worsening of his health conditions.
  
• The most suitable drugs. The drugs most administered in case of enteritis are antidiarrheals (ie medicines against diarrhea). They are prescribed in case of severe enteritis and when diarrhea does not seem to pass. The best known antidiarrheal is loperamide.
  
• Treatment of the triggering causes. When enteritis is severe or prolonged, treating the causes that triggered it is also important and, sometimes, essential for healing. In case of severe food poisoning, the expected therapeutic treatment is based on antibiotics; in the case of Crohn's disease or other autoimmune diseases that cause enteritis, immunosuppressive drugs are needed; in the case of radiation enteritis, the interruption (at least temporarily) of radiotherapy is required; finally, if the patient is taking drugs that promote enteritis or drugs such as cocaine, they must immediately stop (or prevent) their use.

Prevention

Premise: the preventive measures that will be reported below refer to enteritis caused by the ingestion of contaminated food, as they are the most frequent pathological forms and which can potentially affect anyone.

To prevent food poisoning enteritis, good personal hygiene and safe food handling are essential. In the absence of these two conditions, in fact, any food runs the risk of being contaminated by bacterial pathogens.

HYGIENIC COUNTERMEASURES

First of all, it is good practice to wash your hands with soap and water or (if these are not available) with special cleaning wipes; this operation must be repeated several times during the day, in particular in the following moments: before cooking, before starting a meal and after being in the bathroom.

Tips for good personal hygiene.

• Whenever possible, wash your hands with soap and water several times a day.
• Wash your hands after each use of the bathroom
• Wash your hands whenever you are preparing to cook
• Wash your hands before starting a meal
• If you do not have running water and soap, use special cleaning wipes

PREPARATION, COOKING AND STORAGE OF FOOD

When preparing food and drinks, use clean kitchen utensils. If you have any doubts about it, it is better to re-wash the tool in question.

In addition, it is advisable to keep certain foods separate, such as meat from fresh vegetables, and wash the kitchen surfaces quite frequently.
When cooking, you must do it at the right temperatures: meats, in particular, must be cooked properly, to avoid the survival of some bacteria.
Finally, when you want to keep leftovers, it is advisable to put them in the freezer in a timely manner; if they remain in the open air for too long, they can collect bacteria and other dangerous pathogenic microorganisms.

Table. Hygiene in the kitchen

Preparation:

• Before starting, make sure your kitchen utensils (plates, cutting boards, knives, etc.) are clean
• Separate raw meat from fresh foods, such as vegetables and fruit
• Wash kitchen surfaces often

Cooking:

• Cooking food at the correct temperature
• Learn how to properly cook meat (each type of meat has an ideal cooking temperature)

Storage:

• Promptly put leftovers and foods that you want to keep in the freezer for a few days.
• Write down the expiration dates if food placed in the freezer is transferred to a container other than the original.

Prognosis

Most cases of enteritis resolve without special treatment and within a few days.
Hospitalization and intravenous administration of rehydrating and nutrient solutions are provided only in case of severe enteritis; the same goes for antidiarrheal drugs, which otherwise could be even contraindicated.
In some unfortunate cases, radiation enteritis can cause serious damage to the bowel, so much so that surgery may be required.