enteritis

Key Terms: Acute, Chronic, Gastrointestinal tract, Intestinal villi, Ionizing radiation, Lactose, Parenteral alimentation.

Description

Enteritis is an inflammation of the intestine; the term applies chiefly to the small intestine. In the context of cancer, enteritis is a functional disorder of the large and small bowel that occurs as a result of radiation therapy applied to the abdomen, pelvis, or rectum. It occurs at the onset of radiation therapy (acute radiation enteritis) and may also reappear after completion of the radiation treatment (chronic enteritis).

Enteritis also occurs in connection with such disorders as Crohn's disease and infection by such pathogens as Helicobacter pylori. Patients who receive hemodialysis for kidney disorders as well as cancer patients have an increased risk of enteritis.

Causes

Radiation enteritis occurs because the large and small intestines are sensitive to all forms of ionizing radiation. Some areas of the gastrointestinal tract are more sensitive to radiation than others; the colon is more sensitive to the effects of radiation than the small intestine, for example. Although the probability of tumor control increases with the radiation therapy dose, so does the probability of damage to normal healthy tissues. Since the doses required to destroy many tumors are very high, acute side effects to the intestines also occur, chief among which is enteritis. Thus, the majority of patients undergoing radiation to the abdomen, pelvis, or rectum will show signs of acute enteritis.

Symptoms of the disorder are observed during the first course of radiation treatment and take about eight weeks to become acute. Chronic radiation enteritis may also occur months to years after a patient has undergone a course of radiation therapy. The symptoms include colicky abdominal pain, bloody diarrhea, tenesmus, weight loss, nausea and vomiting, bowel obstruction and rectal bleeding, sometimes very severe.

Several factors influencing the occurrence and extent of radiation enteritis have been identified. They include the dose of radiation given to the patient, the size of the tumor being treated, the concomitant prescription of chemotherapy and the general state of the patient's health. For example, enteritis will be more severe in patients with a history of hypertension, diabetes or inadequate nutrition.

Treatments

Some symptoms of radiation enteritis are caused by an overgrowth of bacteria. In these cases, antibiotics may be prescribed. Patients who develop acute enteritis report nausea, vomiting, abdominal cramping, and diarrhea. Diarrhea impairs the digestive and absorptive functions of the gastrointestinal tract, resulting in malabsorption of fat, lactose, bile salts, and vitamin B12. Patients also complain about rectal pain and bleeding. Treatment of acute enteritis accordingly includes treating diarrhea, dehydration and abdominal and rectal pain or discomfort. Antidiarrheal drugs are usually prescribed, such as Kaopectate, Lomotil, Paregoric or Imodium. Additionally, bile salt–retaining drugs may also be indicated, such as cholestyramine. Bowel cramps may be alleviated with antispamodic drugs, such as Donnatal.

Some patients with radiation enteritis can be fed through a tube leading into the stomach provided the small intestine is functioning normally. Otherwise, they may require parenteral alimentation, which means that a nutrient solution is given intravenously.

Approximately 5%–10% of patients having received radiation therapy for abdominal or pelvic cancers develop chronic enteritis. In some cases, surgery may be indicated. There is at present no agreement as to the proper timing and choice of surgical intervention in such cases. Surgery is thus only undertaken after careful assessment of individual patient conditions and health status.

Surgery may also be indicated for patients who have developed radiation enteritis–induced strictures. (Strictures are narrowing of passages or canals.)

Alternative and Complementary Therapies

An important complementary therapy is nutrition management. Another side effect of radiation is to destroy the intestinal villi, which impairs the body's capacity to absorb nutrients and also destroys enzymes required for digestion, such as lactase, required to digest milk and dairy products. Thus a lactose-free diet is often recommended.

Besides milk and dairy products, it is often recommended to avoid foods such as whole bran bread and cereals, nuts, seeds and coconuts, fried and greasy foods, fruit and some fruit juices (prune juice especially), uncooked vegetables, potato chips, pretzels, strong spices and herbs, chocolate, coffee, tea, alcohol and tobacco.

Recommended foods include fish, poultry, and cooked, broiled, or roasted meat, bananas, apple sauce, peeled apples, apple and grape juices, white bread, noodles, baked, boiled, or mashed potatoes, cooked vegetables such as asparagus tips, green and waxed beans, carrots, spinach, mild processed cheese, eggs, smooth peanut butter, buttermilk, yogurt and nutmeg.

Additionally, patients with radiation enteritis may be helped by eating their food at room temperature and by drinking plenty of water every day. Carbonated sodas should be allowed to lose their carbonation prior to drinking.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Principles of Cancer Therapy: Management of Adverse Effects." Section 11, Chapter 144 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Periodicals

Gore, J. I., and C. Surawicz. "Severe Acute Diarrhea." Gastroenterology Clinics of North America 32 (December 2003): 1249–1267.

Koffeman, G. I., W. G. van Gemert, E. K. George, and R. A. Veenendaal. "Intestinal Failure: Classification, Epidemiology and Aetiology." Best Practice and Research: Clinical Gastroenterology 17 (December 2003): 879–893.

Tsukada, K., T. Miyazaki, H. Katoh, et al. "Helicobacter pylori Infection in Hemodialysis Patients." Hepatogastroenterology 50 (November-December 2003): 2255–2258.

—Monique Laberge, Ph.D.; Rebecca J. Frey, PhD

Inflammation of the mucosal lining of the small intestine, usually resulting from infection. Regional enteritis is Crohn's disease.

An inflammation of the mucosal lining of the small intestine.

Inflammation of the intestinal mucosa resulting in clinical signs of diarrhea, sometimes dysentery, abdominal pain and dehydration and electrolyte loss and imbalance. In more severe cases there is much mucus in the feces and in the worst ones there are shreds or even sheets of exfoliated mucosa. Gastritis is commonly an accompanying lesion. Vomiting may be a concurrent sign in monogastric animals. The causes are many and include bacteria, viruses, chemicals, damaged feedstuffs and nematode parasites and protozoa. Descriptions of those diseases will be found under the headings of their causative agents, e.g. rotavirus, coronavirus, enterovirus, Salmonella. There is a further list of diseases in which diarrhea is the cardinal sign but in which there are no lesions of enteritis. These are the enteropathies. See also enteropathy.

• canine viral e. — common causes in dogs are canine parvoviruses, coronavirus and rotavirus. Other viruses isolated from dogs with enteritis but of unknown clinical significance are astrovirus, calicivirus and parainfluenza virus.
• equine chronic eosinophilic e. — part of a multisystemic epitheliotropic syndrome including pancreatitis and dermatitis.
• feline e. — see feline panleukopenia.
• granulomatous e. — horses with this disease continue to lose condition over a long period and most have diarrhea and edema. There is a hypoproteinemia and protein loss in the feces. In dogs, the changes are similar, but may be segmental and can be the cause of partial obstruction.
• hemocytic e. — enteritis of shrimps associated with blooms of some blue-green algae.
• lymphocytic–plasmacytic e. — infiltration of the lamina propria with lymphocytes and plasma cells can be a nonspecific response to chronic inflammation, but is classified by some as a primary, immune-mediated disease of the intestine causing malabsorption, chronic watery diarrhea and sometimes a protein-losing enteropathy.
• mink e. — see mink enteritis.
• necrotic e. — see necrotic enteritis.
• parvoviral e. — canine parvovirus.
• phlegmonous e. — a condition with clinical signs resembling those of peritonitis, which may be secondary to other intestinal diseases, e.g. chronic obstruction, strangulated hernia, carcinoma.
• proximal e. — duodenitis.
• regional e. — see terminal ileitis.
• turkey coronaviral e. — acute, highly infectious disease of turkeys of all ages characterized by inappetence, wet droppings, weight loss and heavy mortality is caused by a coronavirus. Called also bluecomb disease.
• turkey hemorrhagic e. — caused by an adenovirus this disease affects turkey poults over 4 weeks old and is characterized by bloody droppings and sudden death. An epidemic disease now very widespread.
• ulcerative e. — an acute disease of chickens, poults and game birds caused by Clostridium colinum. It is characterized by rapid spread of an acute symptomless disease. Quail show watery white droppings. Lesions include hemorrhagic enteritis in acute cases with ulceration the major finding in subacute cases. The morbidity in quail may be 100%, in chickens it is nearer 10%. Called also quail disease.

Enteritis
Classification and external resources
ICD-10	A02.-A09., K50.-K55.
ICD-9	005, 008, 009, 555-558
MeSH	[1]

In medicine, enteritis refers to inflammation of the small intestine. It is most commonly caused by the ingestion of substances contaminated with pathogenic microorganisms.^[1] Symptoms include abdominal pain, cramping, diarrhea, dehydration and fever.^[1] See also inflammation of related organs of the gastrointestinal system: gastritis (stomach), gastroenteritis (stomach and small intestine), colitis (large intestine), and enterocolitis (large and small intestine).

See also

• Enteropathy

References

1. ^ ^{a b} Dugdale, David C., III, and George F Longstreth. "Enteritis". MedlinePlus Medical Encyclopedia, 18 October 2008. Accessed 24 August 2009.

v • d • e Digestive system · Digestive disease · Gastroenterology (primarily K20-K93, 530-579) Upper GI tract Esophagus Esophagitis (Candidal) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD) · Esophageal stricture · Megaesophagus Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus Intestinal/ enteropathy Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease Large intestine (appendix/colon) Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis Large and/or small Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) Rectum Proctitis (Radiation proctitis) · Proctalgia fugax · Rectal prolapse Anus Anal fissure/Anal fistula · Anal abscess  · Anal dysplasia  · Pruritus ani Accessory Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis Gallbladder Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia) Pancreatic Pancreatitis (Acute, Chronic, Hereditary) · Pancreatic pseudocyst · Exocrine pancreatic insufficiency · Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic · Hiatus — Abdominal hernia: Inguinal (Indirect, Direct) · Umbilical · Incisional · Femoral — Obturator hernia · Spigelian hernia · Internal hernia Peritoneal Peritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum GI bleeding/BIS Upper (Hematemesis, Melena) · Lower (Hematochezia) See also: congenital and neoplasia

v • d • e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

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Dansk (Danish)
n. - tyndtarmskatar

Nederlands (Dutch)
darmontsteking

Français (French)
n. - entérite

Deutsch (German)
n. - Dünndarmentzündung

Ελληνική (Greek)
n. - (παθολ.) εντερίτιδα

Italiano (Italian)
enterite

Português (Portuguese)
n. - enterite (f) (Med.)

Русский (Russian)
энтерит

Español (Spanish)
n. - enteritis, infección intestinal

Svenska (Swedish)
n. - enterit, tarmkatarr

中文（简体）(Chinese (Simplified))
肠炎

中文（繁體）(Chinese (Traditional))
n. - 腸炎

한국어 (Korean)
n. - 장염

日本語 (Japanese)
n. - 腸炎

العربيه (Arabic)
‏(الاسم) التهاب الأمعاء‏

עברית (Hebrew)
n. - ‮דלקת המעיים‬

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