Chronic non-ulcer colitis (KNK) is a chronic polyetiological disease characterized by inflammatory-dystrophic, atrophic changes in the mucous membrane of the large intestine, and functional disorders. The process can capture the entire colon (total colitis), and its departments (right-sided, left-sided colitis, sigmoiditis). In clinical practice, sigmoiditis is more common.
Etiology and pathogenesis.
Factors that cause CNK include:
- Previous acute intestinal infections
- Helminth infestations and protozoa
- Dysbacteriosis
The imbalance between the immune status of the body and the microbial associations that colonize the intestine is disturbed, which affect the macro- and microstructures of the intestinal mucosa, the rate of renewal of the epithelial cover and the metabolic processes in it.
As a result, the motor and secretory function of the intestine is disturbed. The dysbacterial intestinal microflora causes fermentation and putrefactive processes in the intestine with the formation of a large amount of organic acids and gas, and also release toxins, which are irritating to the mucous membrane and nerve endings in it, contributing to the development of inflammation, dyskinetic disorders and hypersecretion of mucus. All this leads to the development of chronic inflammation of the mucous membrane and its atrophy.
Clinic.
- Violation of the stool, alternating diarrhea (2-10 days) and constipation (5-7 days).
- Feeling of incomplete bowel movement, feces with mucus, occasionally there may be blood, false urge to defecate, feces fragmented, sheep.
- The most typical aching pains in the lower and lateral parts of the abdomen, aggravating 7-8 hours after eating, sometimes in the middle of the night or in the morning (“symptom of the alarm”) and decreasing after defecation and discharge of gases, heat, anticholinergics and antispasmodics. When serous membranes, ganglia are covered, the pain is persistent and intensifies with heat, shaking, after enemas and thermal procedures. Diarrhea occurs mainly in the morning or immediately after a meal.
The diagnosis is made on the basis of an anamnesis, bacteriological examination of feces, x-rays, irrigoscopy, colonoscopy with a biopsy to exclude ulcerative colitis and Crohn’s disease . More often diagnosed with sigmoiditis .
TREATMENT OF COLIT.
- Normalization of intestinal microflora (treatment of intestinal dysbiosis).
- Stopping motor disorders of the colon.
- The appointment of local (non-absorbable) anti-inflammatory drugs.
- Treatment of concomitant diseases.
Diarrhea is treated as Enteritis (see enteritis treatment). Constipation is treated primarily by Diet and, if necessary, medications (see treatment of constipation) .
- At the same time, foods rich in dietary fiber and having a laxative effect are shown (bread with bran, vegetable vinaigrettes, buckwheat porridge with milk, one-day kefir, daily yogurt, raw juices from berries and vegetables, raw mashed beets and carrots with the addition of wheat bran).
- In the morning you can eat fried beetroot or salad.
- Fasting take Cold honey water (1 table. Spoon to 1 glass of water) if there is no concomitant gastritis.
- You can take the following mixture: mix 100 g of figs with 200 g of prunes, pour boiling water, drain water, separate the seeds, pass through a meat grinder, add 0.5 cups of honey (for diabetes, olive oil) and 1-2-4 tablespoons. tablespoons of senna leaf. The mixture is mixed, take 1/3 cup at night.
- It helps Glass of Matsuni or Kefir with 1-2 tablespoons of olive oil daily.
medicinal preparations
- Annoying: Castor oil, Purgen, buckthorn bark, Rhubarb, Bisacodyl.
- Regulating motility: Duspatalin, Motilium, Raglan, Depridate, Peridis, Dietetel.
- It can also be taken as a laxative Lactulose, which is not addictive, and also improves the intestinal microflora.
- Strengthening swelling of feces — Flax family.
- Improving the gliding of feces — 2-5 table. tablespoons of vegetable oil a day before meals.
- An additional intake of 20-30 g of dietary fiber (bran) softens the feces, increases its volume and the speed of passage through the intestine. But in a significant proportion of patients, dietary fiber can cause bloating and increased gas discharge.
With constipation in sufficient quantities you need to drink water.
During a period of sharp exacerbation, a diet with the most pronounced sparing is necessary: white crackers, low-fat, weak meat and fish broths with the addition of mucous broths, dumplings, meatballs, steamed meat and fish dishes in chopped form, mashed cereals on water, jelly, jelly, fresh cottage cheese , tea, coffee, cocoa on the water. In the future, when prescribing a diet for a long period, you need to take into account the symptoms and condition of other digestive organs.
Nonspecific ulcerative colitis ( ULC ).
Nonspecific ulcerative colitis (ULC) is a chronic disease with poorly studied etiology, complex autoimmune pathogenesis, characterized by an inflammatory process , accompanied by the development of hemorrhages, ulcers, and suppuration in the colon. Pathogenesis. Autoantibodies are detected in the blood, in colonobioptates too. A large number of pathological microorganisms in various parts of the colon, which healthy people do not have, interferes with recovery processes and serves as a source of intoxication of the body. Mostly the mucous membrane is affected, ulcers merge – the process is superficial and widespread. Perforations are rare, only in very advanced cases. Clinic. The first group of symptoms — Local. 2nd group of symptoms — General reaction of the body. 3rd group of symptoms — Complication.
Classification by clinic. 1. Acute form 2. Chronic recurrent form 3. Chronic continuous form.
By prevalence. 1. Total defeat 2. Segmented defeat
By the nature of the lesion. 1. Superficial lesion 2. Deep: deep ulcers, pseudo-polyps, wall sclerosis.
By complications. 1. Local: massive bleeding, toxic dilatation, perforation, peritonitis, polyposis. 2. General: anemia, endogenous dystrophy, arthritis, phlebitis, skin lesions, sepsis. Examples of diagnosis: UC, acute form, deep total lesion of the colon, diffuse peritonitis.
Clinical symptoms consist of a triad.
- pain
- diarrhea,
- rectal bleeding.
The pain is often in the left half of the abdomen, worse before defecation. First, the chair can be decorated, then half-formed, at the end – diarrhea. Rectal bleeding can be from a drop to 0.5 liters. At first, the general condition hardly suffers. Palpation reveals soreness, stiffness and stiffness of the intestine.
Pain form.
- Cramping pain before defecation.
- Hemarrhoidal onset.
- Dysentery-like onset.
- Regardless of the act of defecation, there are purulent discharge.
Acute form. The onset is rapid, stool up to 20-30 times a day, vomiting, bleeding of the intestinal mucosa. May go into fulminant form: exitus letalis.
Chronic relapsing form – – Often recurring relapses without a special rhythm (can begin due to stress, infections). It has 2 options: constant and stormy. Chronic continuous form is less common. Symptoms of the disease and activity last a long time, no remission. With the abolition of treatment progresses. Diagnostics. Based on clinic and colonoscopy. Endoscopically distinguish 3 degrees of severity:
- Mucous swollen, loose, bleeding.
- 1st degree + erosion and shallow ulcers.
- 1st and 2nd degrees + deep ulcers, necrosis, purulent films.
Pseudo -polyps are the results of protrusion of a weak mucous membrane after healing of ulcers. With multiple pseudo-polyps, surgical treatment is indicated.
TREATMENT OF Nonspecific ulcerative colitis.
- Increasing the protective background of the body – a full-fledged treatment with the introduction of proteins of animal origin and vitamins, protein hydrolysates: plasma, saline solutions, amino acid mixtures.
- Plasmapheresis 3-4 times.
- The suppression of the autoimmune aggression to give Mr. Ormonov. Start with small doses of prednisone., Bring up to 60 mg per day, keep for a month, then gradually reduce to 1/2 tablet prednisolone. You can start with a large dose, add, if necessary, then reduce, and keep small doses for a long time.
- Antipyretic drugs, Salazopyridosine group. Give 0.5 g 4 times a day. It is recommended to start with small doses. It is recommended to start with small doses (up to 3 g / day), increase to 10-15 times a day, then gradually reduce, sometimes keep up to 2 months.
- Immunosuppressants 0.5-3 g per day, 10 days. Break 7 days, then take another 5 days in the same dose. Azathioprine, Imuran, Mercapturin, T-activin increases immunogenesis in sepsis, purulent processes, after removal of the tumor. 1 ampoule 2.0 subcutaneously, 5-14 days at night. Methyluracil, Pentoxyl 1-2 tab 3 times a day
- Methyluracil, Pentoxyl 1-2 tab 3 times a day
CROHN’S DISEASE.
This is a chronic recurrent bowel disease , which is accompanied by granulomatous-inflammatory , ulcerative-necrotic, cicatricial-stenotic changes. The pathological process can be in any department (from the oral cavity to the anus) of the digestive tract. In most cases, the process begins in the terminal ileum (terminal ileitis). The extent of the lesion in CD can be different: from 3-4 cm to 1 meter or more. Etiopathogenesis . In the effect of viruses and bacteria on the sensitized mucous membrane of the large and small intestines. Pathanatomy: deep damage to the mucosa. Lesions can be detected at different levels ( “kangaroo jumping” ).
Diagnostics.
R-examination, sigmoidoscopy with biopsy.
There are ulcerations in different areas, stenotic changes in the lumen of the intestine, a symptom of a scab (lace) , the intestines are narrowed. On macroscopic examination, the intestinal wall is swollen, thickened, with the presence of whitish tubercles under the serous cover. The mesentery of the intestine is thickened due to the deposition of fat and proliferation of connective tissue. Regional lymph nodes are enlarged. In the affected area, the mucosa looks like a “cobblestone pavement” , where sections of the preserved mucosa alternate with deep slit-like ulcers penetrating the submucosal and muscle layer. Fistulas, abscesses and strictures of the intestine are also revealed here. There is a clear boundary between the affected and healthy parts of the intestine.
Clinic.
The appearance of pain, diarrhea, melena (an infrequent symptom). Palpation revealed tuberous areas of the intestine, conglomerates, you can think of a tumor. The early formation of fistulas towards the urinary tract and genitals is characteristic . Urine may be mixed with feces. The anus is affected, often an increase in t, white blood cells, ESR, anemia, a decrease in albumin .
TREATMENT OF CROWN DISEASE
General principles. The basic principles of treating patients with CD are certainty recommendations for lifestyle, nutrition, drug treatment for exacerbation of the disease. Diet for Crohn’s Disease.
- Excessive sugar intake may be one of the reasons contributing to the exacerbation and occurrence of CD.
- In order to eliminate diarrhea during adequate therapy, a lactose-free diet should be prescribed .
- After operations, you need to switch to parenteral nutrition.
- In case of short bowel syndrome (less than 100 cm of the gut), herule or ileostomy, enteric supplements and citraglucosolan are indicated to restore the loss of fluid, trace elements, and minerals.
- With steatorrhea, a diet low in fat is prescribed .
- With an exacerbation of the disease that cannot be treated with steroids, a basic diet with enteral supplements is prescribed (an amino acid solution can be administered through a nasogastric tube, since their ingestion is difficult to use due to poor tolerance).
- Specific deficiencies ( iron, folic acid, fat-soluble vitamins, zinc , etc.) are made up by prescribing appropriate drugs.
Drug treatment.
For severe exacerbation , the following symptoms are characteristic :
- The appearance of the patient,
- Vomiting
- Febrile fever
- Tachycardia over 90 beats per minute,
- The severity of laboratory signs (albumin less than 35 g / l, an increase in C-reactive protein, ESR, white blood cells).
In the presence of such manifestations of CD, the patient needs urgent hospitalization for urgent medical measures:
- In / in the introduction of fluid and electrolytes, especially potassium, as patients are often dehydrated.
- In / in the introduction of hydrocortisone (initial dose of 100 mg 3 times a day).
- Inside, metronidazole ( Trichopolum , etc.) 500 mg 3 times a day to eliminate intestinal infections with conditionally pathogenic microflora inherent in this disease.
- Blood transfusion in order to eliminate anemia, which is often quite significant (the level of hemoglobin should be raised to 10 g%).
- The intravenous administration of hydrocortisone continues for 5 days, and as soon as vomiting ceases and oral medication is available, the intravenous administration of hydrocortisone is immediately replaced with 40 mg of prednisolone per day.
- The treatment results are evaluated according to the terms ( stool frequency, abdominal pain, anorexia, dyspepsia, abdominal palpation tenderness, fever, tachycardia ), laboratory parameters ( hemoglobin, red blood cells, ESR, C-reactive protein, albumin, electrolytes ).
- If against the background of hydrocortisone and other drugs there is no improvement, then surgical treatment is probably indicated.
- If the patient has anorexia and severe dyspepsia (nausea, etc.), then from a violent meal you need to abstain, but ensure the intake of fluid.
The mild form is characterized by the presence of intestinal discomfort, pain on palpation of the abdomen, a moderate increase in ESR and / or the appearance of a C-reactive protein.
- Treatment is carried out on an outpatient basis (patients, if necessary, can be hospitalized mainly for further examination and treatment initiation).
- Oral prednisolone at 30 mg per day for a week, then at 2 weeks the dose is reduced to 20 mg per day.
If abdominal pains persist on this background, then the patient is recommended to switch to a wiped diet for a long time.
With the onset of persistent remission, the daily dose of prednisone decreases by 5 mg per day every 2-4 weeks. Prednisone is discontinued when persistent clinical remission occurs and laboratory parameters return to normal. Patients with CD on an outpatient basis are subject to regular medical supervision and examination (every 2-4 weeks, sometimes less).
Supportive therapy for a long time with CD is not carried out, but in some patients, when the drug is canceled, an exacerbation occurs, so taking the drug is maintained for a long time.
Non- steroid therapy (alternative treatment for steroid therapy).
- Sulfasalazine 2.0 g per day. The drug can be combined with corticosteroids if the process is localized in the colon. Maintenance therapy with sulfasalazine is needed only if remission has occurred under its influence.
- Mesalazine (mezacol, salofalk, etc.) 1200 mg per day is prescribed instead of sulfasalazine, if the process in CD is localized in the small intestine.
- Azathioprine (imuran, etc.) at a rate of 2-2.5 mg per kg MT per day is prescribed in combination with steroid hormones.
- Metronidazole (nidazole, trichopolum, etc. syn) 400 mg 3 times a day with perianal lesions or infections ( dysbiosis , etc.). Metronidazole can be combined with other antibacterial drugs, for example, ciprofloxacin (500 mg 2 r per day).