Necrotizing enterocolitis

Have you heard of necrotizing enterocolitis? It is an inflammation caused by damage to the intestinal mucosa. Its consequences are very serious. If not treated in time, serious illness can lead to peritonitis and intestinal perforation. This disease is most common in premature infants. The cause is not very clear at present. If necrotizing enterocolitis occurs, you must go to a regular hospital for treatment in the early stage to avoid complications.

Symptoms of necrotizing enterocolitis include abdominal distension, diarrhea, acute abdominal pain, vomiting, and bloody stools. Severe cases can cause shock and endanger the patient's life. It is especially common in children, so we must prevent it.

Etiology and pathogenesis of necrotizing enterocolitis

In neonates who develop necrotizing enterocolitis, three factors are usually present in the small intestine: persistent intestinal ischemic damage, bacterial colonization, and intraluminal substrate (such as enteral feeding).

The cause of necrotizing enterocolitis is unknown. It is believed that intestinal ischemic damage can disrupt intestinal mucus production, making the intestine susceptible to bacterial invasion. Once feeding begins, sufficient substrate is provided for the reproduction of intestinal bacteria, and the bacteria can penetrate the intestinal wall, produce hydrogen and accumulate, resulting in characteristic intestinal wall gas on X-ray. The gas can also enter the portal vein, and portal vein gas above the liver can be seen by abdominal X-ray or liver ultrasound. As the disease progresses, it can lead to necrosis of the entire intestinal wall, perforation, peritonitis, sepsis and death.

Ischemic damage can result from spasm of the mesenteric artery caused by the primitive diving reflex triggered by hypoxic damage, leading to a significant decrease in intestinal blood flow; during exchange transfusion, during sepsis, or when feeding with high-tension formula, decreased intestinal blood flow leads to intestinal ischemic damage. Similarly, congenital heart disease can reduce systemic blood flow or arterial oxygen saturation, leading to intestinal hypoxia/ischemia and necrotizing enterocolitis.

Causes

1. Dietary factors, such as hypertonic milk or hypertonic drug solutions, can damage the intestinal mucosa. Nutrients in food are conducive to bacterial growth and carbohydrate fermentation to produce hydrogen.

2. Insufficient intestinal blood supply, such as neonatal asphyxia, hyaline membrane disease, umbilical artery catheterization, polycythemia, hypotension, shock, etc.;

3. Bacterial infection, such as excessive growth of Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Salmonella, Clostridium, etc., invade the intestinal mucosa and cause damage, or cause sepsis and toxic shock, aggravating intestinal damage.

Exploration of the pathogenesis: Traditional Chinese medicine believes that the occurrence of this disease is due to internal deficiency of vital energy and the invasion of heat evil. Internal accumulation of heat and toxicity moves down to the large intestine, burning the yin meridians, causing blood to not flow through the meridians, causing rash movements and gastrointestinal dysfunction, and blood to pass out in the stool. Evil heat consumes body fluid and blood, causing blood deficiency and dryness, which affects the circulation of blood, and causes blood to block the blood vessels and form blood stasis. After a long illness, the Qi and blood are depleted, and symptoms of Qi deficiency appear. The disease is located in the intestines and is related to the spleen and stomach.

symptom

1. Vomiting: The vomitus contains bile or coffee-like substances. Children who do not vomit can often have bile-containing or coffee-like gastric contents aspirated from the stomach.

2. Abdominal distension: often the first symptom, accompanied by weakened or disappeared bowel sounds.

3. Blood in stool: In mild cases, there is only positive occult blood in the stool, while in severe cases, there is jam-like or fresh blood in the stool.

4. Systemic symptoms: In the early stages, there may be poor response, drowsiness, unstable body temperature, apnea, bradycardia, etc. Most children's illness progresses rapidly and they soon develop severe symptoms of infection and poisoning, including mental depression, low body temperature, cyanosis or pallor, cold limbs, shock, acidosis, and even death from frequent respiratory apnea, respiratory failure, DIC, sepsis, and intestinal perforation.

Disease diagnosis

1. Diagnosis of TCM Diagnosis and Syndrome Differentiation:

The disease is mainly caused by evil at the beginning, but it will cause deficiency of Qi and blood after a long time of illness. The severity of the disease varies greatly and progresses rapidly. The first thing to do in clinical practice is to distinguish between deficiency and excess. According to its different clinical manifestations, it is often divided into the following two syndrome types.

1. Main symptoms of heat and toxic accumulation: diarrhea, bloody stool, fever, abdominal distension, abdominal pain, vomiting, mental depression, pale complexion, red or dark purple tongue, and greasy yellow tongue coating.

Analysis: This syndrome is mostly caused by pathogenic heat accumulating in the large intestine, which damages the blood vessels. Heat is accumulated inside, so fever occurs. Heat damages the yin meridians, and blood cannot flow through the meridians, so blood in the stool occurs. There is dampness and heat in the gastrointestinal tract, and metabolism is abnormal, so symptoms such as diarrhea and abdominal distension occur. Blood overflows from the vessels and becomes blood stasis, which blocks the blood and causes symptoms of blood stasis such as abdominal pain.

2. Main symptoms of Qi and blood deficiency: In the recovery stage of the disease, the above clinical manifestations are significantly alleviated, with sallow complexion, fatigue, abdominal distension, pale lips and tongue, thin white fur, thready pulse, and steady and light fingerprints.

Analysis: This syndrome is mostly caused by spleen and stomach dysfunction after illness. The spleen and stomach are unable to transport and transform, and the source of Qi and blood is insufficient, so there are symptoms such as sallow complexion, fatigue and weakness. Qi is the commander of blood. When Qi is deficient, blood will stagnate. Therefore, when Qi is deficient, blood stasis may also be seen.

Western medical diagnosis history: usually occurs 3 to 10 days after birth.

Necrotizing enterocolitis, after reading the above introduction, do you feel it is scary? If you have any abnormal symptoms, you must seek treatment in time. Don’t wait until the condition becomes very serious before seeking examination and treatment. The consequences will be very serious and will pose a greater threat to the patient’s health.