Enteritis in children: what is it, causes, symptoms, treatment, diagnosis, provoking factors, forms, prognosis

Enteritis is an inflammation of the small intestine. With this disease, the body loses a lot of water and nutrients. Chronic enteritis in a child leads to serious negative consequences - exhaustion, dehydration, hypovitaminosis, and in some cases even poses a threat to life.

The causes of enteritis in children

The most common causes of illness in children are the penetration of foreign pathogenic microorganisms into the intestines or their activation when their own beneficial microflora is weakened.

The contents of the stomach and intestines are far from sterile. There are many representatives of the microworld in it. But in a healthy body, there is a balance between positively and negatively influencing bacteria. In the final part of the intestine, there is more microflora and it is more diverse than at the beginning.

Useful microflora include bifidobacteria, lactobacilli, etc. They cause fermentation processes, promote the digestion of carbohydrate foods, produce vitamins B, K. They have antimicrobial effects by lowering the pH of the intestinal contents and by competing for nutrients.

Conditionally pathogenic flora - those microbes that are found in almost all people, but only in special conditions cause disease. These are Escherichia coli, streptococci, staphylococci, bacteroids.

Putrefactive bacteria decompose protein products, producing unpleasant odors and toxic substances. They are absorbed into the bloodstream through the intestinal wall and cause symptoms of poisoning - nausea, vomiting, weakness, headache.

Infectious enteritis

Microorganisms that cause enteritis:

1. Influenza viruses, rotaviruses, parvoviruses, enteroviruses.
2. Bacteria - Salmonella, Shigella, Escherichia coli, Vibrio cholerae, Bacteroids.
3. Mushrooms of the genus Candida.

At birth, a child does not have any bacteria inside the gastrointestinal tract, along with the food it receives the first microorganisms. Therefore, it is important to breastfeed whenever possible. Breast milk contains immune defenses against many pathogens. Also, when feeding on milk, lactobacilli develop, which colonize the intestines and participate in the digestion of food.

With artificial feeding, the introduction of complementary foods, all bottles, nipples, spoons, plates must be kept clean. It is useful to boil them or pour over them with boiling water. This helps to reduce the likelihood of developing enteritis in newborn babies. They are more sensitive to any outside invasion of microbes, react violently to infection and intoxication.

Fermentopathies

Another equally important cause of enteritis is the lack of enzymes necessary for digestion of food in the body. Lactose is broken down by lactase. With its insufficiency, a symptom of malabsorption develops. Each meal provokes flatulence, diarrhea, and abdominal pain. The result is that the nutrients necessary for the growth and development of the child are not absorbed.

Glucose and fructose accumulate inside the intestines, which attract water here and contribute to the development dysbiosis. The intestinal wall allows more protein to pass through, that is, the barrier function of the mucous membrane suffers. The production of enzymes is reduced.

Enzymes are produced in the pancreas and some in the intestines. The presence of bile is also important for the digestion of fats. It stimulates the work of the pancreas and prepares lipids for digestion and assimilation - emulsifies them.

The gray color of the child's feces (clay) indicates poor digestion of fats. When rotting, the contents are fetid, and when fermented, it is frothy.

Other reasons

Toxic enteritis in children occurs when accidentally or deliberately swallowing household chemicals, heavy metals, arsenic, mercury, phosphorus, lead, drugs in large doses.

Secondary enteritis develops against the background of another pathology of the organs of the gastrointestinal tract:

• pancreatitis;
• gastritis;
• hepatitis A;
• with chronic renal failure;
• with frequent overeating.

Among the causes of enteritis in a child are:

• food allergy;
• irradiation;
• unsuitable food;
• helminthiasis;
• abdominal trauma;
• the transferred surgical interventions;
• long-term antibiotic treatment;
• neuropsychic stress;
• chronic stress.

Many hereditary diseases lead to intestinal dysfunction and are manifested by enteritis.

Symptoms of enteritis in children

Acute and chronic processes are distinguished by the duration and severity of the manifestation of clinical symptoms. Acute enteritis proceeds violently, but ends quickly. With improper treatment or without it, it can become chronic.

The body temperature rises, diarrhea worries, there is vomiting. The general condition of the child is deteriorating. He is whiny, his appetite and sleep are disturbed. Attachment of signs of dehydration is a dangerous signal. Blood pressure may decrease, convulsions and impaired consciousness may appear.

Stool disorders are characteristic - liquid discharge, with particles of undigested food. By the appearance of the stool, an experienced physician already assumes the cause of the disease.

Symptoms of infectious enteritis in children depend on the pathogen:

1. Cholera is characterized by profuse, watery, white, rice-like stool. Strong dehydration is also observed - the skin becomes dry, wrinkled, its color is unhealthy, it acquires a cyanotic (blue) hue.
2. Salmonella - green-tinged stools, frothy, a lot of mucus.
3. Shigella affects the large intestine more, stool in small portions with impurities of blood, pus, there are false desires.
4. Escherichia coli - the stool is light yellow, orange, watery, there are mucus impurities.

Abdominal pain is often dull, there may be cramps. It intensifies when walking, jumping and other shaking of the body, when the child is turned from side to side. In some cases, there is no pain at all, which does not exclude the presence of an inflammatory process in the intestine.

After eating, the condition usually worsens, especially after dairy products, salty, pickled dishes. There may be nausea, palpitations, tremors in the arms and legs, weakness, salivation, the child is thrown into sweat. Inside the abdomen, the contents of the intestines rumble and overflow.

As a rule, there is diarrhea - 5 times a day or more. With viral enteritis, stool frequency can be up to 20 times a day. Stools runny or mushy, often frothy, offensive. Color from yellow to green, light brown. Sometimes there may be streaks of blood, mucus.

Malabsorption syndrome manifests itself with prolonged enteritis. It is characterized by insufficient intake of the necessary substances into the body. Because of this, children lose body weight, signs of hypovitaminosis appear:

• brittle nails;
• dry skin;
• increased hair loss;
• weakness, fatigue;
• frequent colds.

There may be ulcers and cracks on the oral mucosa. With pronounced disorders, hypochromic anemia develops, the liver, kidneys, heart are affected, all organs and systems suffer. Due to a lack of calcium, convulsions, fragility of bones and teeth, insufficient growth, osteoporosis are possible. Palpation of the abdomen is painful, more often the pain is diffuse or near the navel.

Read about the features of the course of the disease in adults in our separate article.

Treatment of enteritis in children

Almost all intestinal diseases - small and large - are accompanied by stool disorders. To distinguish them and prescribe the correct treatment, an examination is carried out.

Methods for diagnosing enteritis

To diagnose enteritis in children, the following examinations are prescribed:

1. Analysis of feces for microflora. Allows you to assess its sensitivity to antibiotics.
2. Coprocytogram. Normally, feces may contain residues of undigested food, fibers. The increased content of muscle fibers in the feces is called creatorrhea, fat - steatorrhea, starchy substances - amilorrhea. With a large number of them, they think about the lack of intestinal or pancreatic enzymes.
3. Analysis for the presence of phosphatase and enterokinase in the intestinal lumen. In acute and mild forms of enteritis, these enzymes are increased, with the development of atrophic processes, they decrease.
4. Biochemical and general blood test. Show the severity of the syndrome of insufficient absorption in the intestine.
5. Potassium iodine test. Allows you to assess the rate of absorption through the intestinal wall. Due to edema, dystrophic and inflammatory changes, it tends to decrease in comparison with the norm.

Additionally, an examination is carried out using FGDS, if in parallel there is damage to the stomach, duodenitis. According to the indications, fluoroscopy with contrast is prescribed, the video can be used to trace the passage of the colored contents through the intestines. Thus, ulcers, tumors, acute surgical pathology are excluded. The doctor may prescribe an ultrasound of the abdominal organs, colonoscopy.

Drug therapy

Treatment is prescribed taking into account the clinic and the pathogen.

General principles:

1. Peace.
2. Diet.
3. Prevention and treatment of dehydration.

It is important to give your child a drink often - every 10-15 minutes in small portions. It can be mineral water without gas, saline solutions - rehydron. The exact dose is calculated by the doctor based on body weight and the amount of fluid loss. In severe condition, rehydration is carried out intravenously - Trisol, Acesol.

Additionally, symptomatic drug therapy is carried out:

1. If you are worried about severe pain, give antispasmodics, means to reduce flatulence - activated carbon, Sorbex, Smecta, Polysorb.
2. With proven enzyme deficiency, the doctor selects a suitable enzyme preparation - Festal, Enzistal, Mezim, Creon.
3. If necessary, medications correct the deficiency of vitamins, protein, lipids, minerals. In severe conditions, tube feeding or parenteral nutrition is performed - ready-made nutrients are injected into a vein.
4. At temperatures above 38.5 ° C, antipyretic drugs are given.
5. With the allergic nature of enteritis, antihistamines are prescribed, products that provoke a reaction are excluded.
6. With the infectious nature of enteritis, antibiotics are prescribed. In parallel, eubiotics or probiotics are prescribed - useful microorganisms for the prevention and treatment of dysbiosis.

Nutritional therapy for enteritis

Proper nutrition is of particular importance in normalizing the condition. The diet is prescribed with restriction of coarse, heavy, fatty foods. They give slimy soups, porridge on the water, stewed vegetables - carrots, potatoes, zucchini, boiled low-fat varieties of fish, meat, eggs. Mashed low-fat cottage cheese, steamed omelets. You can jelly, jelly, liquid boiled rice. Unsweetened tea, white bread croutons are allowed.

Fresh bread, pastries, sweets, raw fruits and vegetables, and legumes are excluded. Carbohydrates are limited, proteins are increased, fats are given at the level of the age norm, and the amount of salt is reduced. Animal fats are replaced by vegetable fats by 1/3, they are limited only in case of severe enteritis.

At the beginning of acute enteritis in children, a hunger pause of 8-12 hours is maintained, during which they do not feed, but only give to drink. The smaller the child, the shorter this period.

Infants are given fermented milk-based formulas, lactose-free formulas or with a reduced lactose content. Up to 3 years of age, it is useful to give protein mixtures based on whey protein hydrolysates. The elders are assigned table number 4.

In order for food to be healthy, hygiene standards must be observed. It is important to ensure that the diet is consistent with the nutritional requirements of the child for age. Food must always be fresh. It is necessary to conduct an examination on time, start treatment if symptoms occur.

To restore the epithelium, medicinal enteral mixtures with a high content of protein, beneficial fatty acids, vitamins, and microelements are prescribed. They are easily digested, do not create a load on the liver, pancreas, and make up for the lack of substances in the body.

With the normalization of the stool, the diet is expanded gradually.

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In the video below, Dr. Komarovsky will talk about what the main danger in intestinal infections is and whether antibiotics are needed for treatment.

Sources:

• https://doc.ua/bolezn/enterit
• http://health-ua.com/pics/pdf/ZU_2014_Pediatr_2/41-42.pdf