Celiac enteropathy in children: symptoms, diet, treatment. Changes in the γ-globulin fraction. Clinical manifestations of nephrotic syndrome

The most common congenital enteropathies are celiac disease (celiac disease) and disaccharidase deficiency. From this article you will learn the main causes and symptoms of celiac enteropathy in children, as well as how celiac enteropathy in a child is treated.

Symptoms of Celiac Enteropathy

Gluten enteropathy (celiac disease) - congenital disease, caused by a deficiency of enzymes that break down gluten (cereal protein) into amino acids, and the accumulation in the body of toxic products of its incomplete hydrolysis. Symptoms by which you can recognize celiac enteropathy in a child appear more often from the moment complementary foods are introduced (semolina and oatmeal) in the form of abundant foamy stool. Then enteropathy symptoms such as anorexia, vomiting, symptoms of dehydration, and a picture of false ascites are added. Severe dystrophy develops.

At x-ray examination intestines with the addition of flour to the barium suspension, sharp hypersecretion, accelerated peristalsis, changes in intestinal tone and the relief of the mucous membrane are observed (the “snow blizzard” symptom).

Disaccharidase deficiency in children early age more often it is primary, caused by a genetic defect (p) in the synthesis of enzymes that break down lactose and sucrose. In this case, lactose intolerance manifests itself as diarrhea after the first feedings. breast milk, sucrose intolerance - from the moment sugar is introduced into the child’s diet (sweet water, supplementary feeding). Symptoms such as flatulence, watery stool With sour smell, gradual development of persistent malnutrition. As a rule, stool quickly returns to normal after eliminating the corresponding disaccharide.

Diagnosis of celiac enteropathy

Diagnosis is based on a set of clinical and laboratory data, the results of endoscopic and morphological studies. Used in diagnostics stress tests(for example, dxylose absorption test, etc.), immunological methods (determination of gliadin AT, etc.), as well as methods for determining the content of protein, carbohydrates, lipids in feces and blood.

How is celiac enteropathy diagnosed?

When conducting differential diagnosis It is important to take into account the age of the patient at which the first symptoms of the disease appeared.

The organization of individual therapeutic nutrition, in particular the prescription of elimination diets depending on the period of illness, general condition and the age of the patient, the nature of the enzyme deficiency.

Diet for the treatment of celiac enteropathy

1. For celiac disease, the diet should be gluten-free (exclude foods rich in gluten - rye, wheat, barley, oatmeal) with milk restriction.
2. In case of disaccharidase deficiency, it is necessary to avoid consuming sugar, starch or fresh milk (if lactose intolerant).
3. For exudative enteropathy, a diet is prescribed rich in proteins, with limited fat (use medium chain triglycerides).

According to indications, in severe cases, prescribe parenteral nutrition during treatment. Shown enzyme preparations, probiotics, vitamins, symptomatic therapy.

Treatment prognosis: with strict adherence to the elimination diet and careful prevention of relapses in patients with celiac disease and some enteropathies, it is generally favorable; with exudative enteropathy, only achieving clinical remission is possible.

Exudative enteropathy

Exudative enteropathy syndrome is characterized by loss of large quantity blood plasma proteins through the intestinal wall. As a result, children experience persistent hypoproteinemia and a tendency to edema.

1. Primary syndrome of exudative enteropathy is associated with birth defect lymphatic vessels intestinal wall with the development of lymphangiectasia, detected during morphological examination.
2. Secondary syndrome exudative enteropathy is observed in celiac disease, cystic fibrosis, Crohn's disease, nonspecific ulcerative colitis, liver cirrhosis and a number of other diseases.

Now you know everything about the symptoms and treatment of celiac enteropathy in young children.

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Enteropathy with increased losses the squirrel is called clinical syndrome, resulting from increased permeability blood capillaries mucous membrane gastrointestinal tract for blood plasma proteins or due to loss of lymph into the gastrointestinal tract from dilated lymphatic vessels. Diagnostic signs its are: increased content of blood plasma proteins in the feces, anasarca, hydrocele, emaciation, often masked by edema. Enteropathy with increased protein loss is often combined with diarrhea and malabsorption syndrome. Clinical picture V similar cases consists of symptoms and signs characteristic of all three syndromes.
Blood plasma proteins are synthesized in the liver and cells of the reticuloendothelial system. They are lost from the body with urine, digestive juices, tracheobronchial and genital secretions, milk, sperm, and sweat. The content of proteins in blood plasma is highly constant, which indicates the existence of a mechanism whose activity explains the correspondence of the rates of their synthesis and decay. Every day, 20-25 g of blood plasma proteins are destroyed, and therefore synthesized, which is about 10% of their total content in the body.
Albumins make up the majority of blood plasma proteins, and they mainly determine the height of the colloid osmotic pressure of the blood. About 10-15 g of albumin are broken down in the body every day. Approximately 70% of this amount is broken down in the gastrointestinal tract, 15% in the liver and 10% in the kidneys. Endogenous breakdown of blood plasma proteins also occurs in the cells of other organs and tissues, but the quantitative side of this process has not yet been sufficiently studied.
The constancy of the composition of blood plasma proteins is regulated as follows: when the albumin content in the intravascular space decreases, a mechanism is activated that slows down the rate of albumin breakdown in the cells of all organs. Albumins from the interstitial space begin to enter the blood, thereby ensuring their constant concentration in vascular bed. The same mechanism acts to slow down the rate of albumin synthesis in the liver. Under its influence, simultaneously with a decrease in the rate of albumin synthesis, the rate of their decay also decreases. The equilibrium between the rates of synthesis and decay is restored, but at a lower level. Total albumin in the intravascular and extravascular spaces is reduced.
Slowing down of synthesis processes is the main cause of hypoproteinemia during fasting, anorexia, which often develops in mental illness and organic diseases gastrointestinal tract, with kwashiorkor, which is often found in tropical and subtropical countries, with marasmus, which develops under the influence of severe malnutrition in children of the first year of life.
IN special studies It has been shown that the rate of albumin breakdown is markedly reduced within 3-5 days after the administration of a low protein diet. After switching to a normal diet Albumin catabolism begins to increase and becomes normal after 3 weeks. The protein content in blood plasma decreases during fasting. The albumin content decreases especially sharply. Although the concentration of beta globulins decreases, it is to a much lesser extent than albumin. The weight content of alpha-1, alpha-2 and gamma fractions of globulins in the blood remains normal, but their percentage is slightly increased. The concentration of fibrinogen in the blood decreases.
The colloid osmotic pressure of blood plasma is determined mainly by the content of albumin. Hypoalbuminemia, characteristic of fasting, when sufficiently severe, leads to the development of edema and edema of the cavities. First of all, hypoproteinemic edema develops around the eyes and in other areas with well-defined subcutaneous tissue. If they exist for a long time, their distribution obeys the laws of gravity.
The rate of albumin synthesis also decreases when the number of liver cells decreases, when their function is damaged under the influence of inflammation or medicines, when the function of the hepatocyte operon or the gene that controls its activity is impaired. A slowdown in the rate of albumin synthesis can also develop due to impaired ribosome function. These mechanisms are responsible for hypoproteinemia and hypoalbuminemia in liver diseases.

Hypoproteinemia in many diseases develops not due to a slowdown in the synthesis of blood plasma proteins, but due to an increase in their losses from the blood capillaries into the lumen of the gastrointestinal tract. In the stomach and small intestine Blood plasma proteins are exposed to digestive juices and break down into amino acids. Subsequently, some of them are lost in feces, some are absorbed and, like amino acids of dietary origin, are utilized by the cells of organs and tissues. The constant leakage of proteins from the bloodstream is to some extent compensated by the acceleration of their synthesis.

According to our data, the rate of albumin synthesis in enteropathies with increased protein loss is sometimes 2.5-3 times higher than the rate of its synthesis in healthy person(M. A. Vinogradova, 1968). However, with prolonged suffering or with particularly high permeability of the blood capillaries, the protein content in the intravascular space and in the interstitial spaces decreases. The albumin fraction decreases especially sharply. The content of the alpha-1 fraction of globulins in the blood serum is sometimes slightly increased, the content of the alpha-2 and beta fractions does not change.

Long-term losses of gamma globulins from the bloodstream are sometimes accompanied by the development of hypogammaglobulinemia. In some cases it is observed reduced content all, in other cases - a selective decrease in the concentration of individual immunoglobulins in the blood. Developing immunodeficiency state, which is no different from the same conditions studied in more detail in nephrotic syndrome and diseases of lymphoid tissues.

Inflammatory bowel diseases - common name For the whole group chronic bowel diseases characterized by persistent or recurrent gastrointestinal symptoms and inflammation. Variants of inflammatory bowel disease in dogs include conditions such as gluten-sensitive enteropathy, intestinal pathologies responsive to antibiotic therapy, and immunoproliferative disease. small intestine, protein-losing enteropathy, lymphangiectasia, atrophic gastiritis, gastric carcinoma, cyanocobalamin deficiency, granulomatous colitis.

It is generally accepted that inflammatory bowel disease occurs due to a complex interaction of a number of causes, such as genetic predisposition, intestinal microenvironment (mainly bacteria and food components), the immune system and components environment, causing intestinal inflammation. However, the exact sequence of events leading to IBD in dogs, as well as the variations in disease presentation and unpredictability of response to treatment, are still unknown.

This article will look at inflammatory bowel disease in dogs, Special attention will focus on the interaction between genetic factors and the gut microenvironment (bacteria and diet), prognostic criteria and standard treatment approaches.

Pathophysiology
Genetic predisposition
The most predisposed breeds are: Irish Setter, German Shepherd, Basenjis, Rottweilers, Yorkshire Terrier, Shar-Pei, boxers, French Bulldog. However, any specific genetic defect has not yet been identified.

Intestinal microflora
Bacteria
Despite the fact that bacteria in the intestines play a certain role, significant role in the development of IBD in both humans and animals, specific characteristics of these bacteria (factors leading to the development of IBD) still remain unknown. The most latest achievements molecular microbiology allows for in-depth analysis bacterial microflora without cultivation. Studies based on the cultivation of microflora in humans have shown that more than 70% of microorganisms contained in feces cannot be cultivated (cannot be grown on a nutrient medium). And that in healthy patients there was a significant variation in the composition of the microflora in different segments of the gastrointestinal tract, and differences were also revealed between the composition of the microflora in the intestinal lumen and on the intestinal mucosa. More and more research confirms that inflammation in the gut occurs due to a shift in composition
microflora from gram-positive to gram-negative.

Diet (components of the diet) for dogs
There is growing evidence that diet plays a significant role in the development of inflammatory bowel disease in dogs and cats. For example, Irish setters are susceptible to enteropathy associated with gluten intake. And West Highland white terriers show a reaction to corn, tofu, cottage cheese, milk, and lamb meat.
In a controlled study of 65 dogs with IBD and... chronic diarrhea(minimum 6 weeks), 39 dogs showed positive dynamics within 10 days of feeding a diet consisting of salmon and rice. Relapse occurred in only 8 dogs, after provocation by returning the previous diet. And not a single dog in this group was sensitive to beef, lamb, chicken, or milk.

Diagnostics
Diagnosis of inflammatory bowel diseases usually includes a thorough analysis of all symptoms, history, conditions of detention, clinical examination data, data laboratory research, conducting visual diagnostics(X-ray and ultrasound) and the results of histopathological examination of intestinal biopsy. Dogs with inflammatory diseases intestines usually present to the clinic with diarrhea, weight loss and/or vomiting. The initial approach to a patient with chronic diarrhea or vomiting is based on identifying the causes of these symptoms, determining their severity and specific or localized symptoms, which helps to clarify the location of the disease. For example, the differences between the small intestine and colon intestinal diarrhea, presence of melena with bleeding or ulcers upper sections Gastrointestinal tract, pain abdominal wall, difficulty breathing, peripheral edema in enteropathies leading to protein loss, help more accurately determine the localization of the inflammatory process.

If signs of both diarrhea are present, then the patient should be considered diffuse disease Gastrointestinal tract.

Chronic small intestinal diarrhea is the most common symptom in dogs with IBD, the diagnostic approach is described in the table:

Intestinal biopsy
A biopsy can be taken endoscopically or surgically. In patients without direct indications for surgical intervention(intestinal neoplasms, anatomical or structural changes, perforation) endoscopy is performed with an assessment of the esophagus, stomach and the condition of the intestinal mucosa and with taking a sample for a biopsy. Some studies, but not all, show a positive correlation appearance(endoscopic) picture of the small intestine with prognosis. If there is suspicion of involvement in pathological process ileum (low cobalamin level, ultrasound signs of the disease), then in addition to the standard endoscopic examination upper gastrointestinal tract, examination of the ileum is added. Techniques for taking intestinal biopsies have been described and published. The experience of the physician performing the endoscopy and specimen collection, as well as the quality and quantity of specimens collected, are critical to the histopathologic diagnosis. Surgical biopsy is performed in case of involvement inflammatory process submucosal and muscular layers of the intestine or about suspicion of these conditions, as well as if endoscopically taken samples do not allow adequate assessment clinical condition(or do not correspond to the clinical picture).

Expressiveness clinical symptoms and the severity of the disease can be assessed using a special index (including assessment of habitus, activity, appetite, vomiting, stool consistency, bowel movement frequency, weight loss). Measurement of serum protein levels correlates with clinical IBD activity and implies that severe IBD is accompanied by systemic inflammation. An initial assessment of disease activity may be useful in assessing therapy/response to treatment. Clinical researches showed that hypoalbuminemia is associated with a poor prognosis in dogs with chronic enteropathy. Serum cobalamin and folate concentrations can be determined to guide decisions about dietary or parenteral vitamin supplementation. Low performance Serum cobalamin (less than 200 ng|L) indicates the severity of the disease and poor prognosis. Blood coagulation assessment is recommended to determine both hyper- and hypo-coagulability that may develop due to intestinal protein loss.

In stable patients with chronic diarrhea (normal body habitus, appetite, moderate/minor weight loss, normal level serum proteins, without thickening of the intestinal wall or lymphadenopathy) and in those with no known weight loss, measuring serum cobalamin and folate levels can help determine the location and location of the disease in the intestine (because cobalamin is absorbed into ileum), which may be an indication of the need for additional administration of vitamin B12 and assessment of the prognosis.

Stable patients with chronic diarrhea and normal cobalamin concentrations can be treated with a trial diet followed by antibiotic therapy (if there is no response to the diet). Insufficient response to empirical therapy or deterioration of the condition is an indication for endoscopy and intestinal biopsy.
In stable patients with chronic diarrhea but with reduced performance cobalamin and folate, endoscopy with biopsy is preferred over empirical treatment.

The owner may mistake his pet for banal poisoning or indigestion, but sometimes these signs indicate that serious illness, like enterocolitis in dogs. Sometimes it is better to take your pet to the veterinarian, because only a doctor can make an accurate diagnosis.

Enterocolitis in dogs is characterized by inflammation of the walls of the small and large intestines, as a result of which harmful microorganisms cause necrosis of the mucous membrane and irritation of the organ.

Most common reasons The occurrence of pathology is as follows:

The doctor must determine the exact problem that caused the intestinal inflammation and, based on the diagnosis, therapy will be prescribed. Young and old individuals are most susceptible to enterocolitis; the disease is least often diagnosed in middle-aged and mature dogs.

The symptoms of the disease are pronounced and cannot be ignored. These include:

• Diarrhea mixed with mucus, if treatment is not carried out at this stage, then streaks of blood appear in the stool.
• A progressive disease characterized by false urges dogs to defecate.
• As a result loose stool irreversible processes occur muscle level, cases of intestinal prolapse are recorded.
• It is not uncommon for a dog to vomit.
• Against the background of diarrhea and vomiting occurs sharp decrease body weight.
• The pet's fur deteriorates, it begins to fall out, the appearance becomes dull, neglected - this is due to instant leaching from the body.
• The dog is suffering from abdominal pain; the owner may notice bloating and flatulence in his pet.
• In some cases, fever and increased symptoms are recorded.

In addition to such signs of enterocolitis, general symptoms ill health – lethargy, apathy, reluctance to go for walks.

Diagnosis of the disease

If one or more symptoms occur, you should go to veterinary clinic. But before this, the owner is able to independently provide first first aid to your pet. First of all, it is necessary to provide your pet with sufficient water, because diarrhea and vomiting indicate dehydration.

Restore in the body water-salt balance You can use diluted Polysorb. They should feed their pet small doses over an hour. Castor oil will help cleanse the dog's intestines, which will make it easier for the veterinarian to diagnose the disease.

Upon arrival at the clinic, the doctor will need to answer the following questions:

• Was there a sudden transition of nutrition from one type to another?
• Has the animal had contact with other animals?
• Have you ever taken long trips with your dog?
• Does the animal like to dig into trash cans and tanks?
• Is it possible to walk on a leash or without it?

The veterinarian should know about everyone painful symptoms animal, as well as about the affixed. After a conversation and examination of the dog, tests are prescribed.

A blood test for biochemistry will allow the doctor to assess the condition and possible violations in activities internal organs– kidneys, liver, pancreas. The results will show the level nutrients in organism. If there is a deficiency of any element, vitamins may be prescribed. Biochemistry also reveals dehydration. This analysis is given in the morning on an empty stomach, but in in case of emergency Blood sampling can be done in disregard of these rules.

If you suspect foreign object stuck in the gastrointestinal tract, an x-ray is prescribed. It is this study that can guarantee the presence or absence foreign bodies in organism. There is no need to specially prepare your dog for an x-ray.

The doctor may also order an ultrasound of your pet's abdomen. You need to prepare for this study:

• The dog should not eat for 10-12 hours, as possible flatulence in the stomach will affect the result.
• The intestines are cleansed activated carbon the day before the ultrasound.
• In some cases, a few hours before the examination - this makes it easier to examine the colon.

A modern method for diagnosing diseases associated with the gastrointestinal tract is endoscopy. During this test, the doctor has the opportunity to take tissue for a biopsy. The operation is low-traumatic and is performed under general anesthesia. IN abdominal cavity Micro cameras are introduced into the dog, while the doctor evaluates the picture visually on the monitor.

Based on the results of tests and studies, the veterinarian makes a diagnosis for the dog and determines subsequent treatment.

Treatment of enterocolitis in dogs at home

Therapy primarily depends on the type of causative agent of the disease. In most cases, the veterinarian prescribes special food sick dog. A day or two may be recommended therapeutic fasting, only drinking is allowed. The pet must receive a sufficient amount drinking water– this will prevent dehydration of the body.

If the animal has previously eaten, the doctor can advise special food for dogs with gastrointestinal problems. If the pet is accustomed to natural products, the veterinarian will provide a list of allowed products.

During rehabilitation the following are allowed:

• Lean meat, chicken, turkey.
• Cottage cheese with minimal fat content.
• Decoctions of cereals, oatmeal or rice are suitable.
• Egg yolks.

During rehabilitation the following are prohibited:

• Egg white.
• Products with increased content Sahara.
• Bones.
• Fatty meat and fish.

Prevention of enterocolitis

First of all, prevention consists of selecting a dog that is appropriate for the age and health of the dog. If the animal consumes natural products, then you should give up meat and fish fatty varieties, give preference to broths that are easily absorbed by the body.

Timely vaccinations will protect your dog from a number of infections and bacteria that cause intestinal inflammation.

It is necessary to monitor the dog during a walk, you should not allow the animal to dig through garbage cans, it is not advisable to allow it to come into contact with other animals, they can be carriers of diseases.

Prevention will reduce the risk of enterocolitis, and it is easier to prevent any illness than to treat it later.

In a dog constant diarrhea. Treatment is prescribed and treated, but the diarrhea does not go away. Protein is below normal. Trichopolum and fish food were prescribed. We've been treating it for half a month now, nothing has changed. Help save the dog.

Answer

Low protein levels in the blood (hypoproteinemia) are not a cause, but a symptom internal disease. Common causes of low levels total protein- damage to the kidneys, liver, gastrointestinal tract, pancreas. Diarrhea is common. It will be necessary to find out the sources of this condition.

Causes of hypoproteinemia

Diarrhea becomes a symptom of liver damage, for example, liver failure, hepatitis A. In this case, the liver does not synthesize proteins in sufficient quantities. Liver diseases include vomiting, refusal to eat, drooling, growth retardation in puppies, and disturbances in the urinary tract.

Protein levels decrease with pancreatitis. Other symptoms of the disease are intestinal upset (diarrhea or constipation, stool is either too dense or slimy), vomiting, lethargy, loss of appetite. Abdominal bloating, pain on palpation of the abdomen, dryness in the abdomen are noted. oral cavity, itching.

Protein-losing enteropathy (PLE)

Under the given name, conditions associated with malfunction are combined digestive system and accompanied by a decrease in protein levels in the blood due to poor absorption in the intestines.

The main manifestation of enteropathy is loss of body weight. Intestinal disorders occur, vomiting - not all dogs, sometimes anorexia. IN biochemical analysis blood shows a reduced content of calcium, magnesium, hemoglobin, albumin, globulin. Sometimes in severe cases, ascites begins - accumulation of fluid in the abdominal cavity.

The disease is life-threatening. Sometimes accompanied by coagulation disorders and thrombosis. With the right and timely treatment the animal's condition improves sharply, with the exception of rare cases. An early response to therapy (within two weeks) is important for the prognosis - if the condition has improved, the prognosis is favorable.

For diagnosis, blood, urine, stool tests, liver function tests are performed, and pathologies that give rise to similar symptoms, do a biopsy. It is important to quickly diagnose and begin treatment.

Treatment

Additional reason low level protein and diarrhea, eosinophilic enteritis occurs - chronic illness intestines. This rare disease in dogs, animals suffer from it different breeds, but most often German Shepherds.