Intestinal examination

Complaints. Abdominal pain often bothers patients with intestinal diseases. It is especially pronounced in intestinal colic, is paroxysmal, localized near the navel or in other areas and depends on contractions of the smooth muscles of the intestinal wall due to its irritation by the contents, especially gases. Pain can be caused by an inflammatory process in the intestine, the presence of helminths, fecal plugs, damage to the nervous system. Pain can occur during defecation as well as tenesmus - false painful urges to defecate.

Bloating (flatulence) is associated with the accumulation of gas in the intestines.

Bowel movements disorders in the form of diarrhea or constipation are characteristic of pathology of both the small intestine and the large intestine.

Diarrhea is frequent bowel movements, usually with an increased amount of feces, often liquid. In general, approximately 9 liters of fluid pass through the intestines per day, including secreted fluid from the salivary glands, stomach, bile, pancreatic and small intestinal juice. Most of the fluid is absorbed in the small intestine, 3-4 liters per day enter the large intestine, where 3/4 of it is also absorbed. An increase in feces (more than 200 g per day) is considered a pathology. It is important to clarify the nature of the stool: admixture of blood, mucus, consistency of feces, connection of urges with food intake.

Symptoms characteristic of diseases of the small and large intestines are closely related to the pathology of other organs and systems.

Physical methods of examination of the intestine

A general examination of patients suffering from malabsorption in the small intestine for a long time reveals a decrease in body weight up to exhaustion, changes in the skin (paleness, dryness) as a result of vitamin deficiency.

The abdomen may be enlarged due to ascites or severe flatulence, which is clarified by percussion. The presence of a dull sound in the lateral parts of the abdomen is characteristic of ascites. If there is a suspicion of fluid in the abdominal cavity, percussion should be repeated with the patient lying on his side and standing. In this case, the fluid accumulates in the lower parts of the abdomen. A tympanic sound throughout the abdomen is typical of flatulence, which occurs as a result of increased gas content in the loops of the small intestine.

Palpation is first carried out superficially, approximately, which allows identifying painful areas, resistance, and muscle tension of the anterior abdominal wall. The development of acute appendicitis is indicated by pain and muscle tension of the abdominal wall in the right iliac region.

Deep sliding palpation of the colon sections is performed according to general rules.

Palpation allows in some cases to detect a colon tumor. However, such a diagnosis should always be confirmed by instrumental methods.

During auscultation of the abdomen, intestinal noises associated with peristalsis are also heard in the norm. Pronounced peristalsis ("rumbling") is observed in acute enteritis. In paralytic intestinal obstruction and diffuse peritonitis, peristalsis and noises disappear.

Additional methods of bowel examination

Endoscopy and intestinal biopsy. Proctosigmoidoscopy is of great importance in diagnostics, first of all, of inflammatory, tumor diseases, as well as for specifying the cause of intestinal bleeding. Bacteriological and microscopic examination of the inflammatory exudate of the mucous membrane of the colon, obtained during sigmoidoscopy, is carried out.

Endoscopy and biopsy of the initial section of the small intestine are of particular diagnostic value in patients with malabsorption and chronic diarrhea.

X-ray examination of the intestine. On a general X-ray of the abdominal cavity, it is sometimes possible to detect distension of the small intestinal tract with levels of fluid separated from gas, which allows one to assume obstruction, obstruction of the small intestine.

To conduct an X-ray examination of the intestine, barium sulfate is used as a contrast agent, which is administered orally (for examining the initial section of the small intestine) or by enema (for examining the large intestine). Under normal conditions, a barium suspension administered orally enters the small intestine after 30-45 minutes, after 3-6 hours it is found in the ascending colon, and after 24 hours - in the descending colon.

In cases of malabsorption and diarrhea, diffusely thickened, coarse folds of the mucous membrane suggest the presence of an infiltrative disease of the small intestine. Localized damage to the mucous membrane may be inflammatory in nature, such as in Crohn's disease.

This study, using barium sulfate, is necessary for the diagnosis of colon tumors, as well as inflammatory lesions such as ulcerative colitis and Crohn's disease.

Intestinal absorption study. This process is studied in chronic diarrhea of unknown origin and especially when absorption disorder (malabsorption syndrome) is suspected. The most commonly used test is the D-xylose test, which allows one to differentiate between digestive disorder in the stomach and intestine and absorption disorder. After taking 25 g of D-xylose for 5 hours, at least 5 g of it is excreted in the urine. Since D-xylose does not undergo any special transformations during digestion, its low content in the urine indicates absorption disorder due to damage to the mucous membrane of the small intestine.

It is also possible to study the absorption of vitamin B ₁₂. The excretion of vitamin B ₁₂ in the urine, labeled with a radioactive isotope, can be studied after its ingestion. In patients with pernicious anemia or severe pancreatic insufficiency, free vitamin B ₁₂ is poorly absorbed. With resection of the jejunum, severe infiltrative lesions and impaired intraintestinal digestion, the absorption of free vitamin B ₁₂ is impaired.

Examination of feces and urine. Examination of feces can provide significant information. In addition to consistency, attention is paid to the presence of blood and mucus. The stool may be runny, with a dirty gray tint and an unpleasant odor. Examination for occult blood is an important element of a general medical examination. Detection of polymorphic leukocytes during microscopic examination is important for the differential diagnosis of acute and chronic diarrhea. Examination for helminth eggs is important. Coproscopy allows for the rapid detection of steatorrhea. The presence of undigested muscle fibers of meat in the feces also suggests a violation of the absorption process.

Determination of stool volume, electrolytes and osmolarity is useful in differentiating between secretory and osmotic diarrhea.

Bacteriological examination of feces is important in the diagnosis of specific bacterial enterocolitis.

Urinary excretion of 5-hydroxyindoleacetic acid and histamine is increased in carcinoid syndrome and mastocytosis, respectively.

Blood test. Serious bowel diseases always occur with changes in the blood.

Anemia occurs in many diseases that involve intestinal damage. It can be microcytic with impaired iron absorption or blood loss, but it can also be macrocytic with impaired absorption of folic acid and vitamin B ₁₂.

Leukocytosis with an increase in the number of neutrophils accompanies various bacterial intestinal infections (dysentery, salmonellosis, yersiniosis), as well as other severe inflammatory lesions of the small and large intestine. Eosinophilia is characteristic of eosinophilic enteritis, including that caused by helminths. Lymphopenia, thrombocytosis and other shifts are possible. Biochemical blood tests reveal various changes. Electrolyte imbalances are characteristic of prolonged diarrhea. First of all, it is worth mentioning the presence of hypokalemia, which predisposes to the development of alkalosis; it may not correspond to the severity of diarrhea in patients with constant use of laxatives.

A decrease in the content of serum calcium, magnesium, and zinc reflects an increase in fecal losses and occurs in cases of impaired absorption due to extensive intestinal resection, Crohn's disease, and sprue.

In severe malabsorption, serum protein levels, including albumin, globulin, and transferrin, are reduced. Cholesterol levels are also reduced in these conditions. Prothrombin levels in the blood may be reduced.

Serum levels of a number of hormones, including gastrin, vasoactive intestinal polypeptide (VIP), somatostatin, and thyroxine, may be helpful in diagnosing the cause of persistent diarrhea or malabsorption. In some cases, gastrinomas present with severe diarrhea and malabsorption in the absence of peptic ulcer disease. VIP-secreting tumors also cause severe diarrhea without steatorrhea. Increased levels of somatostatin and calcitonin may also reflect the occurrence of tumors of various localizations that cause frequent stools.

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