Catarrhal Enteritis.
Definition:—Catarrhal enteritis is a condition in which a portion of the intestinal canal is the seat of a catarrhal inflammation, and is characterized by diarrhea, colicky pains and rumbling in the bowels.
The classification of the inflammations of the tract, according to its anatomical divisions, as jejunitis, ileitis, typhlitis, colitis, and proctitis, is only occasionally correct, as in the majority of cases several of these portions are simultaneously involved, sometimes the large bowel and at other times the small bowel being the principal seat of the attack.
Etiology:—The etiology of catarrhal enteritis is varied. Usually attacks are caused by indiscretions in diet, as overeating and the ingestion of unripe fruit and tainted or decomposing articles of diet. Sudden changes in the weather will bring on attacks, especially in spring and autumn, when a fall in the temperature of 20° or 30° takes place in a few hours.
A marked diminution in the secretions of the liver and pancreas will predispose to catarrhal enteritis, giving rise to diarrhea. Inorganic irritants, as arsenic and mercury, will excite an intestinal catarrh.
The above applies more especially to the acute type of the disease. We may recognize a chronic type, which may be secondary to the acute type, or may arise independently, or be secondary to organic diseases, especially of those organs directly influencing the terminal branches of the portal circulation (heart, lungs, liver) to infectious diseases, cachectic states, and by extension from inflammatory foci in the abdomen.
Symptomatology:—The cardinal symptom of catarrhal enteritis is diarrhea. Occasionally it is possible to recognize clinical types according to the anatomical divisions of the intestinal tract. The usual type, however, is ileocolitis, which in addition to diarrhea presents colicky pains and rumbling in the abdomen, sometimes a rise of temperature to 100° to 101° F., occasionally nausea and vomiting. The urine is scanty, the tongue furred; there is thirst and loss of appetite.
If the duodenum be solely involved, there is constipation instead of diarrhea. There may be jaundice from extension of the catarrhal process to the common duct. There may be local tenderness, and there are usually gastric symptoms, as nausea and vomiting.
In catarrh limited to the small intestine the stools are flocculent and contain particles of undigested food. Diarrhea is not so marked, though present, but there are colicky pain and noises in the abdomen and unchanged bile is found in the discharges.
In colitis the stools are thin and frequent and contain considerable amounts of mucus. Pain and tenderness along the course of the colon are marked. Proctitis is characterized by tenesmus and the passage of mucus and pus. Eventually emaciation and anemia develop.
Diagnosis:—The symptoms and brief course of this disorder usually make diagnosis easy. It is distinguished from typhoid fever by the slight and non-characteristic fever, brief duration, non-development of the rash and normal size of the spleen.
Severe cases may be differentiated from peritonitis by the presence of the diarrhea and the absence of abdominal rigidity and extreme meteorism.
In catarrhal enteritis the character of the stools will differentiate it from dysentery, in that in the latter, the discharges are composed wholly of mucus and blood, and are accompanied by severe tenesmus.
Prognosis:—In the acute type the prognosis is good as to both life and early recovery. In the chronic variety complete recovery is not common, but the prognosis is good as to life.
Treatment:—These patients should be put to bed at once and warm applications should be applied over the abdomen. If there are acute colicky pains, a large mustard poultice will be of service; if there is diffused soreness, hot antiphlogistine will do much good. In order to allay undue peristalsis the patient should not be permitted to get up to go to stool, but should use the bed pan. After a large bowel movement a colonic flush should be given, and this may be repeated in severe cases two or three times in as many hours, preferably in the early part of the day, although if given in the evening it produces an amelioration of the symptoms which will conduce to quiet and rest. To this I often add an antiseptic, usually hydrogen peroxid.
To relieve intestinal irritation aconite and ipecac should be given. They must be given in small, frequently repeated doses. If there are evidences of local congestion, belladonna may be added during the first twenty-four hours to good advantage. If there are sharp, cutting pains with diffused soreness, bryonia will be indicated for a short time.
At the onset of the treatment excessive acidity of the stomach, if present, must be neutralized. This must not be overlooked, as the condition materially interferes with the action of specific remedies. This may be accomplished with the syrup of rhubarb and potassium compound, or with lime water.
If vomiting or persistent nausea be present, equal parts of bismuth sub-nitrate and ingluvin should be given; five grains of the mixture in a little cinnamon water every two hours will usually be sufficient. If the mucous membranes are pallid and the tongue is broad and thick, with other evidences of atonicity, a teaspoonful every hour or two of a mixture of eight or ten drops of specific nux vomica in four ounces of water is specifically indicated, especially if there are little colicky pains in the region of the umbilicus. Colocynth is specific for these pains, and in infants chamomile is a good remedy. Five or ten drops of the tincture of either of these in a four ounce mixture may be given in half teaspoonful doses every twenty or thirty minutes. When with colic, as may occasionally be the case, there are large, watery movements with greenish particles in the feces, arsenite of copper may be given, as advised in serous diarrhea.
It will be seldom that astringents are needed if the specific indications have close attention. Where there is nervous irritation, especially if tenesmus be present, gelsemium should be given; where there is restlessness and insomnia, the monobromate of camphor is a good remedy.
There is an occasional case in which, with the diarrhea, the mucous membranes of the mouth and tongue are dark, and the tongue is inclined to be dry, with a brown coat. In these cases acids will be indicated, and among the best is the aromatic sulphuric acid, which exercises an astringent influence, in addition to its influence as an acid. If there is an inclination to tympanites, turpentine should be given in two or three drop doses.
During the course of the disease the intense thirst should be allayed with small particles of ice, and the patient may be permitted a half teaspoonful of ice-cream occasionally. But a large quantity of water should not be drunk at once, as it is apt to increase the irritation.
The convalescence of these patients should be conducted with much care. They should be nourished with milk and dry toast at first, or may be allowed buttermilk, if they so desire. Later, predigested milk with thoroughly cooked rice can be given. As the irritation seems to abate, they may be allowed an increase in starchy foods and some little meat. Scraped beef at first is good; later a small piece of rare steak. Fruits, highly seasoned, and preserved foods, should be taken with great caution.
