Intestinal examination
Last reviewed: 23.04.2024
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Complaints. Pain in the abdomen often disturbs patients with bowel diseases. Especially they are expressed in intestinal colic, they are paroxysmal, localized around the navel or in other areas and depend on contractions of the smooth muscles of the intestinal wall due to its irritation with the contents, especially gases. Pain can be caused by the inflammatory process in the intestine, the presence of helminths, feces, and damage to the nervous system. Pain can occur with defecation as well as tenesmus - false painful urge to defecate.
Bloating (flatulence) is associated with the accumulation of gas in the intestine.
Disorders of bowel evacuation in the form of diarrhea or constipation are characteristic for the pathology of both the intestine and the large intestine.
Diarrhea - rapid defecation, usually with an increased amount of feces, often liquid. In general, about 9 liters of fluid passes through the intestine a day, including the secreted fluid of salivary glands, stomach, bile, pancreatic and enteric juice. Most of the fluid is absorbed in the small intestine, 3-4 liters per day enters the large intestine, where 3/4 of it is also absorbed. The increase in fecal masses (more than 200 g per day) is considered pathology. It is important to clarify the nature of the stool: an admixture of blood, mucus, the consistency of feces, the connection of urges with food intake.
Symptoms characteristic of diseases of the small and large intestine are closely related to the pathology of other organs and systems.
Physical methods of intestinal examination
A general examination in patients with long-term impaired absorption in the small intestine, reveals a decrease in body weight until exhaustion, changes in skin (pallor, dryness) as a result of a deficiency of vitamins.
The abdomen can be enlarged in volume due to ascites or pronounced meteorism, which is specified in percussion. The presence of blunt sound in the lateral parts of the abdomen is characteristic of ascites. If there is a suspicion of the presence of fluid in the abdomen, percussion should be repeated in the patient's position on the side and standing. This fluid accumulates in the lower abdominal parts. The tympanic sound throughout the abdomen is typical for flatulence, resulting from an increase in the gas content in the loops of the small intestine.
Palpation is first carried out superficially, roughly, which allows to identify painful areas, resistance, tension of the muscles of the anterior abdominal wall. The development of acute appendicitis is indicated by the soreness and tension of the muscles of the abdominal wall in the right iliac region.
Deep gliding palpation of the colon is performed according to general rules.
Palpation allows in some cases to reveal a colon tumor. However, such a diagnosis must always be confirmed by instrumental methods.
With auscultation of the abdomen and in the norm, intestinal noises associated with peristalsis are heard. Pronounced peristalsis ("rumbling") is observed in acute enteritis. With paralytic obstruction of the intestine and with diffuse peritonitis, peristalsis and noise disappear.
Additional methods of intestinal examination
Endoscopy and intestinal biopsy. Proctosigmoidoscopy is of great importance in the diagnosis of primarily inflammatory, neoplastic diseases, as well as to clarify the cause of intestinal bleeding. Bacteriological and microscopic examination of the inflammatory exudate of the mucous membrane of the colon, obtained with sigmoidoscopy, is carried out.
Endoscopy and biopsy of the initial section of the small intestine have a special diagnostic value in patients with impaired absorption and chronic diarrhea.
X-ray examination of the intestine. On a survey X-ray of the abdominal cavity, one can sometimes find the stretching of the small intestine rectum with the levels of liquid separated from the gas, who can suggest obturation, obstruction of the small intestine.
For the X-ray study of the intestine, sulfuric acid barium is administered as a contrast agent, which is injected through the mouth (in the study of the initial section of the colon) or with an enema (for colon examination). Under normal conditions, the barium suspension introduced through the mouth enters the small intestine after 30-45 minutes, after 3-6 hours it is found in the ascending colon, in a day - in the descending colon.
With a violation of absorption and diarrhea diffuse thickened, gross folds of the mucosa suggest the presence of infiltrative disease of the small intestine. Localized mucosal lesions can be inflammatory, for example, in Crohn's disease.
This study using barium sulphate should be performed for the diagnosis of colon tumors, as well as inflammatory lesions such as ulcerative colitis and Crohn's disease.
Research of intestinal absorption. This process is studied in chronic diarrhea of unknown origin and especially when suspected of impaired absorption (malabsorption syndrome). The most frequently used test is D-xylose, which allows one to distinguish between digestive disturbances in the stomach and intestines from impaired absorption. After taking 25 g of D-xylose for 5 hours at least 5 g of it excreted in the urine. Since D-xylose does not undergo special transformations during digestion, its low urine content indicates a malabsorption due to damage to the small intestinal mucosa.
It is also possible to study the absorption of vitamin B 12. Urinary excretion of vitamin B 12, labeled with a radioactive isotope, can be investigated 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 intestinal digestion, absorption of free vitamin B 12 is impaired.
Examination of feces and urine. Considerable information can provide an examination of stool. In addition to consistency, attention is drawn to the presence of blood, mucus. The chair can be liquid, with a dirty gray tinge and unpleasant odor. The study on occult blood is an important element of general medical research. Detection during microscopic examination of polymorphic leukocytes is important for the differential diagnosis of acute and chronic diarrhea. Of great importance is the study of helminth eggs. Copyscopy allows you to quickly identify steatorii. The presence in the stools of undigested muscle fiber meat also allows you to assume a violation of the suction process.
Determining the volume of feces, electrolytes and osmolarity is useful in differentiating 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, respectively, in carcinoid syndrome and mastocytosis.
Blood test. Serious bowel diseases always occur with changes in the blood.
Anemia occurs in many diseases accompanied by intestinal damage. It can be microcytic iron malabsorption or blood loss, but may be in violation of macrocytic folic acid and vitamin B intake 12.
Leukocytosis with an increase in the number of neutrophils accompanies various bacterial intestinal infections (dysentery, salmonella, 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. Possible lymphopenia, thrombocytosis and other changes. A biochemical blood test reveals a variety of changes. The violation of the electrolyte content is typical for prolonged diarrhea. First of all, the presence of hypokalemia, which predisposes to the development of alkalosis, deserves mention, it may not correspond to the severity of diarrhea in patients with the constant use of laxatives.
The decrease in serum calcium, magnesium, and zinc reflects an increase in fecal loss and occurs when the absorption is violated with extensive bowel resection, Crohn's disease, sprue.
With severe impairment of absorption, the protein content in the blood serum, including albumin, globulin and transferrin, decreases. Under these conditions, the level of cholesterol is lowered. It is possible to reduce the content of prothrombin in the blood.
Determination of the serum content of a number of hormones, including gastrin, vasoactive intestinal polypeptide (VIP), somatostatin, thyroxine, can be useful in diagnosing the cause of prolonged diarrhea or impaired absorption. In a number of cases, gastrinomas are manifested by severe diarrhea and impaired absorption in the absence of peptic ulcer. Viral tumor secreting also leads to severe diarrhea without steatorrhea. An increase in the somatostatin and calcitonin content may also reflect the occurrence of tumors of various locations leading to a rapid chair.
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