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Dyspepsia in infectious diseases
Last reviewed: 23.04.2024
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Currently, in accordance with the recommendations of the conciliatory meeting of the International Working Group on the Improvement of Diagnostic Criteria for Functional Gastrointestinal Disorders (Roman Criteria II, 1999), dyspepsia is a feeling of pain or discomfort (heaviness, overflow, early saturation) localized in the epigastric region closer to the median line.
Symptoms of dyspepsia
Dyspeptic syndrome is typical for acute food-borne infections, salmonellosis, escherichiosis, gastrointestinal forms of yersiniosis, rotavirus gastroenteritis and other viral diarrhea, the initial period of botulism, is possible in the pre-jaundiced period of viral hepatitis.
The syndrome of dyspepsia is also observed in various organic lesions and functional disorders of the gastrointestinal tract. In those cases when the symptoms of dyspepsia are caused by diseases such as peptic ulcer, gastroesophageal reflux disease, malignant tumors, cholelithiasis and chronic pancreatitis, it is customary to talk about the syndrome of organic dyspepsia. If, with a thorough examination of the patient, these diseases are not identified, it is legitimate to diagnose functional (non-ulcer) dyspepsia.
Stomach ache
Abdominal pain is one of the main symptoms of acute diarrheal infections. Localization and character of them depend on the primary localization and prevalence of the inflammatory process in the intestine. Acute enteritis is characterized by cramping pains throughout the abdomen. In acute colitis, cramping pains are localized in the iliac regions. In distal colitis (proctosigmoiditis), typical of a typical colitis variant of shigellosis, patients are concerned about pain in the left ileal region, palpable painful spasmodic sigmoid colon.
Differential diagnostics
In the differential diagnosis of pain, the most important is the recognition of acute surgical and gynecological pathology, in which the patient's stay in the infectious hospital and the delay in surgical intervention can irreparably affect the outcome of the disease. Under the guise of acute intestinal infections, acute appendicitis, cholecystitis, pancreatitis, intestinal obstruction, mesenteric vascular thrombosis, hollow organ perforation, abnormal ectopic pregnancy, tibial ovary cicatrix, pelvic peritonitis, ovarian apoplexy can occur.
Pain in the epigastric region, similar to those in the gastritic and gastroenteric variant of acute foodborne infections, is possible with myocardial infarction, most often when it is localized in the back wall of the left ventricle, with pneumonia, especially the lower lobe. Unlike the pain in the abdomen of another etiology in acute diarrheal infections, the pain is cramping, there is no clear local soreness and symptoms of irritation of the peritoneum.
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Vomiting
Vomiting in acute diarrheal infections is observed quite often. It can be single, repeated or multiple; scanty or plentiful ("vomiting full mouth"); eaten food, with bile, with blood. Vomiting in acute diarrheal infections occurs as a result of inflammatory changes in the mucosa, increased permeability of cell membranes due to the action of endotoxin-LPS of the pathogen and a significant discharge of fluid into the lumen of the upper gastrointestinal tract, reverse peristalsis. An important role in the development of vomiting is played by the intoxication syndrome, which is characteristic of most acute diarrheal infections. Vomiting due to intoxication is often noted in the initial period of infections not belonging to the group of acute diarrhea (mug, meningococcal infection, tropical malaria). Vomiting can be a symptom of acute surgical and gynecological diseases, toxicosis of the first half of pregnancy, decompensation of diabetes mellitus, withdrawal syndrome in patients with chronic alcoholism and drug addiction, poisoning with salts of heavy metals, poisonous fungi, organophosphorus compounds and alcohol substitutes. The account of previous nausea and immediate relief after vomiting makes it possible to distinguish gastritis from cerebral genesis when these two traits are absent. Cerebral vomiting is characteristic for hypertensive crisis, subarachnoid hemorrhage, acute disturbance of cerebral circulation.
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Treatment of dyspepsia
The basis for the treatment of acute infections, accompanied by dehydration, is rehydration therapy. It is carried out in order to restore the water-electrolyte and acid-base state of the organism.
Rehydration is carried out by polyionic crystalloid solutions (trisol, chlosol, acesol). Colloidal solutions (gemodez, reopoliglyukin) can be used for the purpose of detoxification only in the absence of dehydration. In most patients with I-II degrees of dehydration, solutions of oral rehydration salts are used: citraglucosolane, glucosolan, rehydron, rehydration therapy is the basis for the treatment of acute infections accompanied by dehydration syndrome.