小腸疾患の症候と診断手順

Symptoms of the Small Intestinal Disorders and Diagnostic Procedures

要旨　カプセル内視鏡，ダブルバルーン内視鏡が開発され選択肢の広がった小腸疾患の診断について，小腸疾患と関連のある症候を，下血，腹痛，便通異常，腹部膨満，るいそうに分類し，鑑別手順，疾患につき概説した．下血に関しては上部・下部消化管の検索をしたうえでの小腸検索が基本であるが，出血の種類によっては早目の小腸検索も良いと考えられる．腹痛は部位からの同定や，様々な検査の複合的施行により迅速に診断されるべき症候である．便通異常のうち下痢は小腸疾患と関連するものが多く注意を要する．腹部膨満は腸閉塞なども疾患として含まれ，膨満の原因を見い出すことが早期診断に繋がる．るいそうは悪性疾患や精神疾患も含まれ，適切な鑑別が必要である．

　Recently developed capsule endoscopy, and double balloon endoscopy have extended the choice of equipment for the diagnosis of small bowel diseases. Symptoms related with small intestinal diseases are divided into bloody stool, abdominal pain, abnormal bowel movements, abdominal bloating and malnutrition. Outlined for each symptom are differential examinations and diagnoses. Usually the surveillance of the small intestine is performed after endoscopical examinations of the upper and lower bowel, but sometimes, for evaluating bloody stool (including obscure blood intestinal bleeding), small intestinal examinations may be performed prior to upper or lower endoscopic examination.

　The cause of abdominal pain should be diagnosed quickly by the site of the abdominal pain or a variety of suitable tests. Abnormal bowel movements, especially diarrhea are often related to small bowel disease.

　About abdominal bloating, detection of the cause of bloating leads to early diagnosis. Malnutrition is given rise to by a variety of diseases, so appropriate differential diagnosis is needed.