small bowel crisis
Introduction
Introduction Intestinal radiation sickness occurs in the intestinal tract in about 1 week. Acute radiation disease is a systemic disease caused by large doses (>1 Gy) of ionizing radiation in a short period of time. Both external and internal exposures may cause acute radiation sickness, but external radiation is dominant. The rays causing acute radiation sickness caused by external irradiation include -rays, neutrons, and X-rays. The changes of lymphocytes (mainly spleen and lymph nodes) are similar to those of bone marrow. They are also caused by cell division inhibition, cell necrosis, reduction and hemorrhage. Their development is faster than bone marrow and recovery is earlier than bone marrow, but full recovery requires longer time. With the development of hematopoietic organ diseases, the clinical process of myeloid radiation sickness has obvious stages, which can be divided into initial stage, pseudo-healing period, extreme period and recovery period. Especially the medium and severe stages are obvious.
Cause
Cause
(1) Nuclear war
Exposure and shielding personnel at nuclear explosions below 101 kt, shielded personnel at the time of explosion above 101 kt, persons who have passed and stayed in the severely contaminated area, exposed to early nuclear radiation or radioactive contamination, a large number of acute radiation sickness The main factor of the wounded.
(two) usually
1. Nuclear radiation accident
There are currently more than 430 nuclear power plants in operation around the world, and new nuclear power plants are still increasing. There have been several accidents since the 1950s. The largest of these was the 1986 Chernobyl nuclear power plant accident, in which more than 200 cases of acute radiation sickness occurred and 29 people died. Various types of radiation sources are increasingly used in various fields of production and medical treatment. Due to improper use or storage, hundreds of types of radiation accidents have occurred. Since the 1960s, there have been many incidents of radiation sources in China, and many people have suffered casualties.
2, medical accidents
Medical applications of radionuclides and radiation devices are also likely to cause medical malpractice. For example, there have been accidents involving the use of excessive radionuclide treatment in foreign countries to produce acute radiation-induced death from internal radiation. There have also been accidents in which the patient was exposed to excessive radiation due to malfunction of the radiation device.
3. Therapeutic irradiation
A large dose of radiation to a patient for treatment needs can result in a therapeutic acute radiation sickness. For example, high-dose (>6Gy) whole body irradiation or systemic lymph node irradiation is usually used as a pre-treatment before bone marrow transplantation.
Hematopoietic damage is a hallmark of bone marrow-type radiation sickness, which runs through the entire process of the disease. The bone marrow showed a decrease in cell division index within a few hours after irradiation, and the sinusoids were dilated and congested. Followed by bone marrow cell necrosis, hematopoietic cell reduction, blood sinus bleeding and rupture, bleeding. The erythrocyte erythrocyte is earlier than the granulocyte, initially the immature cells are reduced, and the mature cells are also reduced. The extent of bone marrow changes is related to the dose of radiation. In small doses, blood cells are only slightly reduced, and bleeding is not obvious. In the case of large doses of radiation, hematopoietic cells are severely deficient and even disappear completely. Only fat cells, reticular cells and plasma cells remain, and lymphocytes can be relatively increased. Others such as tissue basophils, osteoclasts and osteoblasts also increase, and there is severe bleeding, which is a serious inhibition of bone marrow. After the bone marrow is destroyed, if you have enough hematopoietic stem cells, you can rebuild the blood. Recovery of bone marrow hematopoiesis can begin in the third week after irradiation, and significant regeneration is restored 4 to 5 weeks after irradiation. If the dose is large, the hematopoietic function often cannot be recovered by itself.
The changes of lymphocytes (mainly spleen and lymph nodes) are similar to those of bone marrow. They are also caused by cell division inhibition, cell necrosis, reduction and hemorrhage. Their development is faster than bone marrow and recovery is earlier than bone marrow, but full recovery requires longer time. With the development of hematopoietic organ diseases, the clinical process of myeloid radiation sickness has obvious stages, which can be divided into initial stage, pseudo-healing period, extreme period and recovery period. Especially the medium and severe stages are obvious.
Examine
an examination
Related inspection
Oral small bowel angiography
1. Peripheral blood
(1) The changing law of white blood cells indicates the stage of development of the disease. There are seven stages in the change in peripheral blood leukocyte count throughout the course of the disease. According to the process of white blood cell changes, the development of the disease can be predicted.
1. Increase;
2, down;
3, setbacks rebounded;
4, the lowest value;
5, recovery;
6. Excessive increase;
7, return to normal.
(2) The rate and minimum value of leukocyte decline can reflect the severity of the disease, and the speed of index reduction (×109/L?d) is 7d after the photo (×109/L) and 10d after the photo (×109/L)<1 ×109/L Time (after d) The lowest value (×109/L) minimum value time (after d).
Mild 4.54.0 >3.0
Moderate <0.253.53.020321.03.03545
Severe 0.25 ~ 0.62.52.08 ~ 20 < 1.025 ~ 35
Extremely severe >0.61.51.0<8<0.5<21
(3) Those with granulocyte/lymphocyte ratio inversion are moderate or above, and those who do not appear are generally mild.
(4) In addition to the quantitative changes, white blood cells also have morphological changes. Neutrophils can be seen in nucleus, plasma vacuoles, cytoplasmic poisoning particles, excessive nuclear lobes, large cells or large nuclei, as well as nuclear spines, nuclear pyknosis, nuclear dissolution and so on. Lymphocytes showed nuclear chromatin condensation, nuclear pyknosis, nuclear fragmentation, nuclear lobulation or binuclear, and atypical lymphocytes were seen during recovery.
The morphological changes of platelets can be seen as disappearance of pseudopods, vacuolar degeneration, reduction of dense bodies (5-HT organelles), and dissolution of particles. Giant or abnormal platelets can be seen during the recovery period.
Erythrocytes also have morphological changes, such as uneven cell size, heterotypic and multi-staining cells, and red blood cells can be seen in the peripheral blood during recovery.
2, bone marrow examination
(1) Bone marrow cell division index: Early detection of bone marrow cell division index (number of dividing cells / 1000 bone marrow nucleated cells) is also helpful in judging the condition. The normal male bone marrow cell division index averaged 8.8 (6.3 to 10.0 ). The degree of decrease in bone marrow cell division index on day 4 after exposure to 0.5 to 3 Gy was significantly correlated with the dose of irradiation. It is generally believed that the bone marrow cell division index is still higher than 1.8 3 to 4 days after irradiation, which may be mild radiation sickness; the decrease to 1.80.9 may be moderate; the decrease to 0.80.2 may be severe ; descending to 0 is extremely severe.
(2) Bone marrow image: The bone marrow image can be examined once a week during the course of the disease. The bone marrow is basically normal and is mild radiation sickness. "Severe bone marrow suppression" occurred 20 to 30 days after irradiation, but the degree was milder. The "severe bone marrow suppression phenomenon" appeared severely 15 to 25 days after irradiation. It appears to be extremely severe within 10 days after irradiation.
3, biochemical examination
(1) Increased blood and urine amylase content: The amylase content in normal human blood is 40-180 u. When the parotid gland is irradiated, the content of blood and urine amylase can be significantly increased, and the degree of elevation is related to the dose of radiation. The serious injury to the Chernobyl nuclear power plant accident increased to 10 to 100 times normal after 36 to 48 hours after irradiation.
(2) Increased urinary amino acid excretion: the emission of certain amino acids in the urine increased after irradiation, and proline, cystine and tryptophan were more obvious. Taurine is a metabolite of sulfhydryl compounds (such as cysteine, glutathione, etc.) in the body and is one of the amino acids excreted in the urine of normal people. The amount of urine discharged after irradiation can be several times higher than the normal value, and is discharged most frequently after 1 to 4 days after irradiation, and is related to the irradiation dose within a certain range.
(3) Increased creatine output, increased creatine creatinine ratio: creatine is synthesized in the liver, converted to creatine phosphate in the muscle, most of which is excreted by the urine, and a small part of dehydration is excreted by urinary creatinine. After the irradiation, the amount of creatine excretion increased, and the amount of creatinine discharged was relatively constant, so the ratio of creatine/creatinine increased.
(4) Excretion of catabolic products of urinary DNA: such as deoxycytidine (CdR) and -aminoisobutyric acid (BAIBA), the amount of excretion increased after irradiation.
Diagnosis
Differential diagnosis
Changes in the hematopoietic system should be differentiated from chronic benzene poisoning, thrombocytopenia, iron deficiency anemia, infection, certain diseases (hepatitis, hypersplenism, etc.), and hematological changes caused by certain drugs and chemicals. The phenomenon of hematopoietic inhibition can be recovered after the detachment of radiation. After the radiation is removed and the treatment is actively treated, the hematopoietic inhibition of long-term unhealed needs to consider the possibility of (or combining) other causes. Clinical symptoms should be differentiated from diseases such as neurasthenia, inner ear vertigo, and menopausal syndrome. Radioactive cataract should be differentiated from cataracts associated with concomitant (retinal pigmentosa, high myopia, etc.), senile, congenital, and systemic metabolism.
