Colitis

Colitis is an inflammation of the mucous membrane of the large intestine.

Colitis granulomatous see Surgical diseases - Crohn's disease.

Colitis ischemic is a segmental lesion of the colon caused by a violation of its blood supply. More often affects the area of ​​splenic curvature, rarely - transverse colon, descending and sigmoid colon.

Etiology and pathogenesis: atherosclerotic lesion of the inferior mesenteric artery in elderly people suffering from atherosclerosis; Predisposing factor is the anatomical feature of the passage of this artery at an acute angle from the aorta.

Symptoms, course. Gangrenous (necrotic) form occurs with complete blockage of the inferior mesenteric artery, manifested by a bout of severe pain in the left half of the abdomen, signs of intestinal obstruction, rectal bleeding and then - peritonitis. The passing episodic form - "intermittent claudication of the intestine" - is observed with partial blockage of this artery; Is manifested by pain in the left half of the abdomen or epigastrium, occurring immediately or soon after eating, diarrhea, bloating, sometimes vomiting. Gradually may develop thinning. When palpation of the abdomen is determined by soreness, respectively, the location of the lesion site of the colon, sometimes the protective muscle tension of the anterior abdominal wall.

The diagnosis is confirmed by irrigo-, rectomomano- and colonoscopy. Irrigoscopy in the lesion zone reveals a picture of "pseudotumor" with a filling defect in the form of a "thumbprint". Endoscopic examination reveals puffiness of the mucous membrane of the affected area, submucous hemorrhages, in chronic cases - inflammatory infiltration of the mucous membrane, ulceration and as a result of scarring of ulcers - strictures of the affected bowel area. Selective mesenteric angiography allows to confirm violation of patency of the mesenteric artery.

The course of the chronic form is progressive, the prognosis in most cases is unfavorable. Complications: acute intestinal profuse bleeding, necrosis of the intestine with the development of peritonitis, gradual narrowing of the affected segment due to inflammatory-scar processes in the intestinal wall.

Treatment. Patients with a gangrenous form of ischemic colitis are urgently hospitalized in a surgical hospital. Gangrenous and structural forms require surgical treatment.

In the chronic form of the disease, antispasmodic and anticholinergic drugs are prescribed.

Colitis acute is usually common, often combined with simultaneous acute inflammation of the mucous membrane of the small intestine (acute enterocolitis), and sometimes the stomach (gastroenterocolitis).

Etiology, pathogenesis. The causative agents of acute colitis shigella (dysentery bacterial), salmonella, less often other pathogenic bacterial flora, viruses, etc. Its cause can be food non-bacterial poisoning, gross errors in nutrition. A significantly smaller role belongs to some common infections, food allergies, toxic substances. Inflammatory process in the large intestine occurs as a result of local action on the mucous membrane of damaging factors that are in the contents of the intestine, or (toxins, bacteria, etc.) enter the hematogenous way and exert an effect in mucosal secretion (excretory function of the intestine).

Symptoms, course. Acute pain of drawing or spastic nature, rumbling in the abdomen, loss of appetite, diarrhea, general malaise occurs. The stool is liquid with an admixture of mucus. In more severe cases, the stools are watery, contain a large amount of mucus, sometimes blood; Stool frequency up to 15-20 times a day; May be accompanied by imperative urges for defecation, painful tenesome arise. The body temperature rises (up to 38 ° C and higher). In especially severe cases, the symptoms of general intoxication are sharply expressed, the tongue is dry, covered with gray or dirty-gray bloom; The stomach is slightly swollen, and with strong diarrhea it is involved. When palpation is noted tenderness along the course of the colon, in various parts of it - rumbling.

With sigmoidoscopy, hyperemia and edema of the mucosa of the distal parts of the colon are determined, a large amount of mucus is seen on the walls of the intestine, and in more severe cases - pus; Can be erosion, ulceration and hemorrhage. A blood test reveals a mild leukocytosis with a stab shift, an increase in ESR.

In mild cases, the patient's condition quickly improves; In severe cases, the disease becomes protracted. Complications: abscesses of the liver, pyelitis, peritonitis, sepsis.

Treatment. Patients with acute colitis are hospitalized (if suspected of the infectious nature of the disease - in infectious hospitals). Assign antibacterial or antiparasitic therapy, with toxic colitis, salt laxatives. On the first day, only a plentiful drink (unsweetened or semisweet tea) is allowed, then on day 2-5, diet No. 4, then No. 4b and 4c. When dehydrating drip p / k or iv, 0.9% solution of sodium chloride, 5% glucose solution or hemodesum is administered. Inside appoint enveloping and astringent means (bismuth nitrate basic for 1 g4-6 times a day, tanalbine, kaolin, etc.), preparations of digestive enzymes (abomin, polizim, etc.), holinoliticheskie funds. For the normalization of the intestinal flora, enteroseptol, intestopan, colibacterin, bifikol, etc. are prescribed. Patients with acute non-infectious colitis are subject to subsequent clinical examination for 6 months.

Prevention is the same as with acute enteritis (see).

Colitis chronic is one of the most common diseases of the digestive system. It is often combined with an inflammatory lesion of the small intestine (enterocolitis) and stomach.

Etiology, pathogenesis. Colitis of infectious origin can be caused by pathogens of intestinal infections, first of all shigella and salmonella, causative agents of other infectious diseases (mycobacterium tuberculosis, etc.), opportunistic and saprophytic flora of the human intestine (due to dysbacteriosis). Protozoal colitis is caused by the action of causative agents of amoebiasis, balantidiasis, giardiasis, etc. Helminths can support the inflammatory process in the intestines caused by another cause. In therapeutic practice, colitis of non-infectious origin is most widespread. Alimentary colitis occurs due to prolonged and gross violations of diet and a rational diet. Associated colitis, accompanying achilles gastritis, pancreatitis with exocrine pancreatic insufficiency of the pancreas or chronic enteritis, develop as a result of systematic irritation of the mucous membrane of the colon with products not fully digesting food, as well as as a result of dysbacteriosis. Toxic colitis occurs due to prolonged exogenous intoxications with compounds of mercury, lead, phosphorus, arsenic, etc. Medicinal colitis is associated with prolonged uncontrolled use of laxatives containing anthroglycides (preparations of rhubarb root, buckthorn, fetus, senna leaf, etc.), antibiotics and some Other medicines. Toxic colitis of endogenous origin occurs as a result of irritation of the intestinal wall by the products derived by it, formed in the body (with uremia, gout).

Colitis of allergic nature is observed with food allergy, with intolerance of certain medicinal and chemical substances, increased individual sensitivity of the organism to certain types of bacterial flora of the intestine and the products of the disintegration of microorganisms. Colitis due to prolonged mechanical irritation of the colon wall occurs with chronic coprostasis, abuse of laxative enemas and rectal suppositories, etc. Often, chronic colitis has several etiological factors that mutually reinforce action.

Symptoms, course. More often there is a total defeat of the entire colon (pancolitis). The main symptoms are stool disorders (chronic diarrhea or constipation), pain in various parts of the abdomen, sometimes painful tenesmus, flatulence, dyspeptic disorders. In most cases, especially with right-sided colitis, diarrhea prevails - defecation occurs up to 10-15 times or more per day, often alternating diarrhea and constipation. Characteristic of a lack of emptying of the intestine: after defecation, the patient has a feeling of incomplete emptying. When the process worsens, false urge to defecate appears, accompanied by the escape of gas and individual lumps of fecal matter covered with strands or flakes of mucus, or mucus with blood veins, or the periodic withdrawal of mucus in the form of films (colitis pseudomembranous). With spastic colitis, especially involving the distal parts of the colon, the stool masses are fragmented ("sheep feces"). Pain in colitis usually dull, aching, is localized mainly in the lateral and lower abdomen, is strengthened after eating and before defecation. Sometimes the pain becomes spasmodic (with spastic colitis), subsides from the use of heat (hot-water bottle, compress), after taking holino-and antispasmodics; An attack of pain can be accompanied by the escape of gases or the occurrence of a urge to defecate. With the spread of the inflammatory process to the serous membrane of the colon (pericolit), the pain, which has a permanent character, increases from shaking, while walking and is eased in the prone position. Persistent aching pain throughout the abdomen or predominantly in the epigastric region, not associated with eating, a defecation act that is difficult to treat, is observed with the accompanying ganglionitis, especially the solaris.

Flatulence in colitis is due to a violation of digestion of food in the small intestine and dysbiosis. Often there are anorexia, nausea, belching, a feeling of bitterness in the mouth, rumbling in the abdomen, etc. There may be weakness, general malaise, decreased ability to work, asthenoneurotic syndrome, weight loss, indistinctly expressed symptoms of polyhypovitaminosis and anemia.

With superficial palpation, areas of tenderness of the abdominal wall that are located in the course of the colon are often revealed, with chronic perivistercite the resistance of the muscles of the anterior abdominal wall is noted in the corresponding areas. With deep palpation, the affected areas of the colon are usually painful and spasmodically reduced, alternating spasmodically reduced and enlarged areas filled with dense or liquid contents, severe rumbling and even splashing in the corresponding gut section may occur. With pericolitis, ganglionitis and mesagenism, the soreness of the abdominal wall is not limited to the area of ​​the colon, but may be observed in the epigastric region and lower along the midline (zones of localization of the solar, upper and lower mesenteric plexuses), near the navel (localization of the mesenteric lymph nodes).

The eruptions are often offensive: a large amount of mucus and leukocytes is determined during a coprological examination, and a large number of iodophilic flora, undigested fiber and intracellular starch, as well as erythrocytes (with erosive and ulcerative forms) are often detected.

Irrigoscopy with chronic colitis does not reveal any special changes; There are functional disorders (acceleration or slowing of intestinal motility, increased gaustration, spastic contractions or, conversely, atony of the intestinal wall). In severe forms of colitis, changes in the relief of the intestinal mucosa due to inflammatory edema and infiltration are revealed, in some cases, sites of cicatricial-inflammatory narrowing of the lumen of the intestine.

Rectoromanoscopy, sigmoidoscopy and colonoscopy most often reveal catarrhal inflammation of the mucous membrane of the colon, in rare cases - purulent, fibrinous or necrotic ulcerative lesions.

With exacerbations of colitis there may be a moderate neutrophilic leukocytosis with a shift to the left, an increase in ESR, a subfebrile condition. Exacerbation of allergic colitis, in addition to a pain attack, is often accompanied by fever, eosinophilia, the appearance of Charcot-Leiden crystals in feces. Purulent, fibrinous and necrotic-ulcerative colitis proceeds with a much more severe clinical picture. A special form of colitis is nonspecific ulcerative colitis (see Surgical diseases).

Segmental colitis. Chronic tiflites are more likely to accompany chronic enteritis and appendicitis, are often of alimentary origin or the cecum is involved in the process with chronic right adnexitis. Flows with persistent pain in the right ileal region, radiating to the groin, lower back; Swelling and rumbling in the right side of the abdomen in most cases with an abundant semi-liquid stool 3-5 times a day ("cow feces"). In the region of the cecum and the ascending department of the colonic-soreness, sometimes they are spasmodically reduced, sometimes relaxed, with their palpation there is a strong rumbling. With peritiflite during the period of exacerbation of the inflammatory process, the blurred symptom of Schetkin-Blumberg can be determined, which can simulate the exacerbation of chronic appendicitis.

Isolated transversitis occurs relatively rarely and in many cases is combined with coloptosis. The defeat of the transverse colon and especially of its distal part is in many cases caused by the difficulty of passing its contents through an unusually pointed left bend to the descending colon (due to a significant lowering of the transverse colon, formation of adhesions, anomalies in the development of the large intestine and other causes) - the so-called splenic syndrome Curvature. It is manifested by dull pain in the epigastric, near-pustular regions and the left hypochondrium, often worse after eating, flatulence, a feeling of belly distension, which are relieved after defecation, with stool disorders. With palpation, a painful, often omitted and unevenly spasmodic transverse colon is identified. With pronounced periprocess phenomena in the area of ​​the splenic flexure, symptoms of a partial, and in rare cases, complete intestinal obstruction, may occur.

Proctitis and proctosigmoiditis are the most frequent forms of chronic colitis. In their origin, a special role is played by bacterial dysentery, chronic constipation, systematic irritation of the rectal mucosa with abusings of laxatives and curative enemas, candles. They show pain in the left ileal region and in the anus, painful tenesmus, flatulence; Pain may persist for some time after defecation, arise during the purgative enema. Constipation is often observed in combination with tenesmus; A chair uninvited, sometimes of the "sheep feces" type, contains a lot of visible mucus, and often blood and pus. When palpation, soreness of the sigmoid colon is noted, its spastic contraction or rumbling (with diarrhea). In some cases, an additional loop of the sigmoid colon "dolichosigma" (congenital anomaly of development) is revealed. Examination of the anal area and finger examination of the rectum allow us to assess the condition of its sphincter, to reveal the often occurring concomitant pathology developing against a background of chronic proctitis (hemorrhoids, anal fissure, paraproctitis, prolapse of the rectum, etc.). A great diagnostic value is given by sigmoidoscopy.

Differential diagnosis. First of all, colitis of infectious or parasitic origin should be excluded. The appearance of chronic colitis after acute proctosigmoiditis makes one suspect the most frequent form of infectious colitis-the dysenteric. The presence of shigella in bacteriological research allows us to confirm the diagnosis. For the diagnosis of chronic colitis, resulting from parasitic infestations, the main importance is the detection of the corresponding pathogens, cysts, joints or testicles of helminths in feces (see Infectious Diseases).

Chronic colitis must be differentiated from dyskinesia of the colon, although prolonged functional bowel disorders can eventually lead to the development of chronic colitis. The main importance is the analysis of clinical symptoms, in necessary cases - sigmoidoscopy or colonoscopy with mucosal biopsy.

Chronic colitis should be differentiated from chronic enteritis, pancreatitis, anacid gastritis, but very often there is a combination of these diseases with chronic colitis. Tumors of the large intestine can flow under the mask of chronic colitis, therefore in suspicious cases it is always necessary to perform irrigoscopy, and if the picture is not clear enough, endoscopy with biopsy.

The course of chronic colitis in some cases is long, mild, in others it gradually progresses with alternation of periods of exacerbation and remission, development of atrophic changes in the intestinal wall. With timely treatment, the prognosis is favorable. Complications: perforation of ulcers in severe ulcers, intestinal bleeding, narrowing of the gut lumen (with cicatrization of ulcers), adhesive process.

Treatment during an exacerbation is spent in a hospital; Patients with infectious and parasitic colitis are treated in the respective infectious departments of hospitals. Frequent fractional meals are shown (4-6 times a day), the diet is mechanically sparing (mucous soups, mashed potatoes, meat balls, steamed meat and fish cutlets, etc.). Food should contain 100-120 g of protein, 100-120 g of easily assimilated fats (creamy, vegetable oils), about 400-500 g of carbohydrates. During the period of greatest process severity, the intake of carbohydrate products (up to 350 and even 250 g) and fats is temporarily restricted. Fats are transferred and absorbed by patients with chronic intestinal diseases better if they enter the body not in pure form, but in connection with other food substances (in the process of cooking food). The tolerance of carbohydrates and plant fiber is significantly increased with their appropriate cooking (rubbing, steaming, in the most severe cases - homogenized vegetable purees, etc.).

Vitamins are administered orally in the form of multivitamins or parenterally (C, B2 B6, B12, etc.). Fruits are used in the form of kissels, juices, mashed potatoes, in liver form (apples), and in the period of remission - in a natural form, with the exception of those that enhance the processes of fermentation in the intestine (grapes) or have a laxative effect, which is undesirable in diarrhea Prunes, figs, etc.). Cold food and drinks, low-molecular sugars, lactic acid products with acidity above 90 g. On Turner strengthen intestinal peristalsis, so they should not be prescribed for exacerbations of colitis and diarrhea. Exclude spicy seasonings, spices, refractory fats, black bread, fresh bread products from butter or yeast dough, cabbage, beets, sour varieties of berries and fruits, limit table salt. The main diet in the period of exacerbation - № 2,4 and 4а (with the predominance of fermenting processes), as the inflammatory process subsides, diet No. 46 and more extended, approaching the normal-diet No. 4b (food is prescribed unprotected). It is useful acidophilic milk (150-200 g 3 times a day). In the presence of concomitant diseases (cholecystitis, pancreatitis, atherosclerosis) in the diet introduce the necessary adjustments.

In the period of exacerbation of chronic colitis, antibiotics of a wide spectrum of action (tetracyclines, levomycetin, aminoglycosides, etc.) or sulfanilamide preparations (sulgin, phthalazole) in usual doses are prescribed for a short time. The most effective in many cases is the appointment of enteroseptol (0.25-0.5 g 3 times a day), mexa- form, intestopane, which exert a depressant effect primarily on the pathogenic flora of the intestine, reduce fermentation and putrefactive processes. Useful colibacterin, bifidumbacterin, bifikol, lactobacterin, which appoint 5-10 doses per day (depending on the severity of the disease).

In order to increase the reactivity of the body, subcutaneously aloe extract is prescribed (1 ml once a day, 10-15 injections), pelloidin (inside 40-50 ml 2 times a day 1-2 hours before meals or in enemas of 100 ml 2 Once a day for 10-15 days), autohemotherapy is carried out.

With proctosigmoid, microclysters are prescribed (chamomile, tannic, protargolov, from bismuth nitrate suspension), and for proctitis - astringents (xerobes, dermatol, zinc oxide, etc.) in candles, often in combination with belladonna and anesthetics (Anesteol, Anuzol "and" Neoanusol ", etc.).

In case of diarrhea, astringents and enveloping agents are recommended (tanalbin, tansal, bismuth nitrate basic, white clay, etc.), infusions and decoctions of plants containing tannins (decoctions 15: 2000 rhizomes of serpentine, tentacle or 1 to 3 tablespoon of spoonfuls Per day, infusion or decoction of cherry fruit, bilberry fruit, aplicata alder, St. John's wort, etc.), anticholinergics (preparations of belladonna, atropine sulfate, metacin, etc.). Holino-spasmolytics is prescribed for spastic colitis.

At the expressed meteorism the charcoal activated (on 0,25-0,5 g 3-4 times a day), infusion of a sheet of mint pepperum (5: 200 on 1 table spoon several times a day), flowers of a camomile (10: 200 on 1 -2 tablespoons several times a day) and other means. If diarrhea is caused primarily by secretory deficiency of the stomach, pancreas, concomitant enteritis, preparations of digestive enzymes - pancreatin, festal, etc., are useful.

The physiotherapy methods (intestinal irrigation, mud applications, diathermy, etc.) and sanatorium treatment (Essentuki, Zheleznovodsk, Druskininkai, local sanatoria for patients with diseases of the intestinal tract) take a big place in the therapy of exacerbation of chronic colitis.

The incapacity of patients with moderate severity and severe forms of chronic colitis, especially accompanied by diarrhea, is limited. They do not show types of work related to the inability to comply with the diet, frequent business trips.

Prevention. Prophylaxis and timely treatment of acute colitis, convalescence of convalescents, sanitary and educational work aimed at explaining to the population the need to adhere to a rational diet, a full-fledged diet, thorough chewing food, timely sanitation of the mouth, and if necessary - denture, physical training and sports , Strengthening of the nervous system. It is necessary to strictly observe the safety rules in industries related to chemicals that can cause damage to the colon.