The duodenum performs many different functions. It represents the initial section of the small intestine, however, it is connected with the stomach, and with the liver, and with the pancreas through special ducts entering the sphincter of Oddi. Therefore, diseases of this organ have their rudiments in impaired functioning of various departments of the digestive tract.
Statistics show a "rejuvenation" of patients who suffer from pathologies of the duodenal zone, as well as an increase in prevalence among adolescents. The relevance of the study of the structure and physiology of this organ is associated with the need to establish the causes of damage to the intestinal tract and the choice of optimal therapy techniques.
Favorable results of the treatment of the duodenum prevent dysfunctions and organ problems that, together with it, are involved in digestive processes. A separate classification of pathologies does not exist, and diseases, as a rule, fall into the same category with diseases of the esophagus and stomach.
Types of diseases
Clinical medicine, however, divides the diseases of the stomach and duodenum into the following:
- Dyskinesias, which are a variety of functional disorders.
- Inflammation, in the case of a relation to the gastrointestinal tract, they are called duodenitis.
- Peptic ulcer.
- Malignant tumors (cancer).
- All kinds of anomalies in the structure.
Anomalies in physiological development include congenital stenosis of the intestine and diverticulum (protrusion) of its wall. These phenomena are observed quite rarely and may be accompanied by some other digestive system defects. Before talking about inflammation of the duodenum, it is necessary to consider the anatomy.
Anatomy and functions
The name of this organ comes from its length, equivalent to 12 fingers, which is about 30 cm. This intestine is separated from the stomach by the pyloric sphincter. Given its bends, 4 sections are distinguished.
Sphincter of Oddi is the inner papilla in the lower zone. The ducts of the pancreas and gall bladder are also suitable here. The inner lining of the intestine is covered with special villi; goblet cells that are capable of producing mucus are located between the epithelial cells . The muscular layer of the duodenum provides its motility and tone.
The main tasks of this body are:
- Neutralization of gastric juice and contents of the pancreas, as well as chemical treatment of the incoming food lump.
- Further grinding of food particles, as well as the creation of the necessary conditions for the full access of bacteria that live in the intestine, into its underlying departments.
- Regulation with the help of feedback from the center of the brain of the volume of the necessary production, as well as the entry into the intestine of enzymes produced by the pancreas.
- Alignment with the stomach of juice synthesis.
Violation of these functions leads, as a rule, to the manifestation of clinical symptoms of common diseases of the duodenum.
Helicobacteria are able to pass from the stomach to the intestine through the pyloric department with antral gastritis and peptic ulcer.
Causes of pathologies
The causes of diseases of the duodenum are almost no different from the general factors that are prerequisites for the occurrence of lesions of other digestive organs. These include:
- Violation of the normal diet, as well as the quality of products, for example, too long breaks between meals, frequent overeating, fasting, diets, eating fatty, fried and spicy foods.
- Abuse of alcohol, as well as excessive stimulation of the functions of the mucosa, which occurs as a result of ingestion of nicotine breakdown products into the body.
- Eating poor quality food with expired dates, which causes frequent poisoning, which, in turn, contribute to damage to the mucous membrane.
- Ingestion of infection from nasal secretions, as well as carious teeth.
- Helminth and parasitic infestation from the lower intestine in the form of lamblia, roundworm, pinworms.
- Atony of the gatekeeper.
- As a result of metabolic and autoimmune diseases - gout, renal-hepatic insufficiency in cirrhosis, diabetes mellitus.
- Traumatization of the inner layer with hard or piercing objects, as well as fish bones.
- Violation of regulatory functions that can cause stressful situations and a variety of endocrine diseases.
- Long-term use of medicines with irritating properties (Analgin, Aspirin, some drugs to relieve headaches, as well as corticosteroids, ascorbic acid and anti-influenza mixtures).
- Congenital malformations of the structure.
- Hereditary factor.
A person who has two or more causes is susceptible to diseases of the stomach and duodenum. The main signs of such pathologies should be considered with examples of specific ailments.
Dyskinesia
Nervous breakdowns and various stressful conditions lead to such a disease. Innervation damage can also occur during surgery on the stomach. In another way, this phenomenon is called duodenostasis.
The main essence of violations of this nature is to delay the contents in the gut, which does not enter the following departments. The patient has the appearance of dull bursting pains in the epigastrium, as well as in the hypochondrium on the right. The phenomena of nausea and loss of appetite, prolonged constipation with exacerbations are also possible. The duodenum becomes inflamed quite often.
Duodenitis
This pathology is inflammation, which occurs, as a rule, in a chronic or acute form. Acute duodenitis occurs within a few days if the patient takes certain potent drugs or herbal tinctures. Pathology often accompanies infectious forms of gastroenteritis. Chronic duodenitis almost never occurs in an isolated form. It is usually accompanied by various diseases of the stomach, pancreatitis or cholecystitis.
Pathology is manifested by aching pain in the abdomen without determining the exact location, without irradiation. Patients feel very bad on an empty stomach, after sleep. After eating, improvement comes. With the development of this disease, constipation often occurs, and since it is a very lengthy process, it can be accompanied by blockage and cramping of the sphincter of Oddi, which occurs with the presence of cramping pains and vomiting. These are very unpleasant symptoms. Treatment of the duodenum will be considered later.
Bulbit
This disease is one of the varieties of duodenitis. The inflammatory process is localized in the upper intestine - in the bulb, so the disease often becomes a consequence of gastritis of various origins. In shape, catarrhal bulbitis and erosive are isolated. With catarrhal bulbitis, aching pains are noted, sometimes cramping, and they appear on an empty stomach. These symptoms are accompanied by heartburn, bad breath, sour belching, a feeling of bitterness in the mouth and nausea.
Duodenal erosion, or erosive bulbitis, is characterized by prolonged exhausting pain in the epigastrium, which appears, as a rule, some time after eating. In some cases, vomiting with bile and bitter belching may occur. Patients often complain of weakness, insomnia, excessive salivation, and cephalgia.
Morphological studies have shown that against the background of hyperemic intestinal mucosa, cracks and macerations are observed, which are located exclusively in the surface layer and do not penetrate the muscle wall. For the chronic form of the course of this disease, periods of exacerbations are typical when changing the seasons of the year and remission at other times. These are the main symptoms. The duodenum is often susceptible to peptic ulcer.
Ulcer
Duodenal ulcer is observed in the form of one of the forms of complications and the next stage of duodenitis or erosive bulbitis. The prevalence of this disease among women is higher than among men.
Morphological studies have established the difference between this type of pathology from erosion by deeper penetration into the muscle layers of the intestine, as well as vascular damage.
In severe forms of the disease, bleeding, perforation (perforation) of the wall, as well as penetration into neighboring organs can occur. An ulcer is most often localized in the area of ​​the bulb. It is possible to form two ulcers that lie on opposite walls (in the terminology of radiologists - “kissing” ulcers).
Symptoms are manifested in the following:
- Intense epigastric pain radiating to the back, hypochondrium, which occurs after eating or early in the morning (“hungry pain”).
- The feeling of "sucking under the spoon."
- Heartburn, which troubles, as a rule, the bulk of patients, and is associated with reflux of gastric juice into the esophagus.
- Vomiting, which significantly alleviates the condition of the patient.
- Bouts of nausea.
- In the vomit, an admixture of blood may be noted, less often it is detected in the feces.
- Oddly enough, patients do not suffer from appetite. Sometimes an aversion to food may be noted. Weight loss is not observed. Treatment of the duodenum should be comprehensive and timely.
Parasitic diseases
The following parasites can live and multiply in the small intestine: roundworm, pinworm, giardia, fluke, trichinella, tapeworm. Infection occurs through unwashed vegetables, dirty hands, ponds during bathing, etc. The presence of helminths in the body can be judged by the following characteristic signs:
- Itching of the skin, the appearance of acne and acne.
- Frequent constipation or diarrhea.
- Dryness and pigmentation of the skin.
- Frequent bloating and rumbling in the stomach.
- Pain in joints and muscles.
- Tendency to allergic reactions.
- Weight loss.
- Restless sleep with frequent awakenings.
- Increased colds due to decreased immune defense.
Parasites feed on intestinal contents, and some of them are able to penetrate through the walls of this organ into the bloodstream.
Malignant and benign tumors
Neoplasms in the duodenum are extremely rare. Nevertheless, they arise, and from benign various adenomas, papillomas, fibroadenomas, lipomas, hemangiomas, neurofibromas can be noted. There are also tumor formations of the duodenal papilla. Visually, they can resemble multiple or single polyps growing on a stem. Similar pathological processes occur asymptomatically and are detected, as a rule, by accident. If they reach large sizes, they can cause symptoms of bowel obstruction, compression of the bile ducts and, as a result, obstructive jaundice.
Oncology is only a small part of all possible tumors of the digestive system. In most cases, cancer occurs in the descending areas above the duodenal papilla, as well as around it and, most rarely, on the bulb.
Most often, the disease occurs in older men. Cancerous neoplasm belongs to the category of late metastatic. A tumor grows, usually in the nearest lymph nodes, as well as in the pancreatic tissue and liver. Other metastases are extremely rare.
Clinical signs of cancer of this organ:
- Aggressive pains.
- Decrease in appetite and weight loss.
- Symptoms of obstruction in the intestines (persistent vomiting and dehydration).
- With the decay of the tumor, severe bleeding occurs.
- Yellowness of the skin.
What other duodenal diseases are there?
Intestinal obstruction
Symptoms of this disease can be caused by the following factors:
- Congenital malformations of the structure.
- Atypical turn.
- Increased mobility.
- Inverted form.
- Blockage by a neoplasm of the duodenum or compression of the pancreas by it.
- Stone migration.
Hernias
Hernia - protrusion of the intestinal wall. This phenomenon is found in people after 50 years with a sedentary lifestyle. A hernia is formed as a result of a decrease in the tone of the muscle layer. The disease occurs with the occurrence of reflux acid reflux into the esophagus, while patients often complain of heartburn, belching and flatulence.
Treatment of the stomach and duodenum
Therapy of this pathology is carried out with the help of certain medications or, in case of their inefficiency, by the surgical method.
The first step is to undergo the necessary diagnostics, which includes not only laboratory, but also instrumental techniques, after which treatment of these pathologies should be carried out exclusively by a specialist with a narrow profile.
In treatment, several groups of drugs are used.
- Antisecretory drugs - inhibit gastric secretion and reduce the aggression of gastric juice. These include proton pump inhibitors, H2-histamine receptor blockers, anticholinergics.
- Bismuth-based drugs are effective for ulcers caused by Helicobacter pylori. As a result, the vital activity of bacteria is inhibited, a film is created on the surface of the intestinal mucosa that protects it from aggression of the gastric juice. This group of medicines includes Vicalin, De-Nol, Vicair, etc.
- Antibiotics and antiprotozoal medicines inhibit the life of Helicobacter pylori. Most often prescribed are Clarithromycin, Amoxicillin, Metronidazole, Tetracycline, etc.
- Prokinetics - improve duodenal motility, and also relieve nausea and vomiting. Applied with a feeling of heaviness and overflow of the stomach, heartburn, early satiety.
- Antacids are taken symptomatically for heartburn. They have an absorbent and astringent effect.
- Gastroprotective drugs cover the affected mucous membrane of the duodenum, inhibit the aggression of hydrochloric acid and digestive enzymes.
- Other medicines (analgesics, antispasmodics, drugs that improve the nutrition of the intestinal mucosa).
Duodenal Diet
The diet is used sparingly, aimed at protecting the body from mechanical, chemical and thermal effects. A special group of therapeutic diets No. 1 was developed, they are recommended at the stage of exacerbation of the disease.
Partial nutrition is important (up to six times a day in small portions). The products include boiled meat, fish, heavily boiled cereals, non-acidic dairy products, mashed vegetables without coarse fiber, dried white bread, mashed non-acidic fruits and berries, coffee and cocoa with milk, weak tea, rosehip broth.
Fried, pickled, spicy, salty foods, vegetables with coarse fiber, smoked meats, canned foods, all sour, fatty meat and fish, mushrooms, strong coffee, sour juices, carbonated drinks should be completely eliminated.