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Organic Colonic Disorders



Chronic colitis. Classification of chronic colitis.

1. By process localization:

1) right-sided;

2) left-sided;

3) transverse;

4) total.

2. The phase of the process:

1) exacerbation;

2) remission.

3. Type of intestinal dyskinesia:

1) hypomotor;

2) hypermotor;

3) mixed.

Diagnosis of chronic colitis.

1. Sigmoidoscopy (catarrhal or catarrh-follicular proctosigmoiditis).

2. Irrigography, irrigoscopy (thickening and expansion of folds and their discontinuity; smooth haustra; narrowing of the intestine).

3. Colonofibroscopy (hyperemia, edema and hypertrophy of the folds of the mucosa, expanded vascular pattern; the mucosa, as a rule, lacks luster, may be whitish).

4. Morphology (dystrophic changes, plethora of blood vessels and hemorrhages, edema, etc.).

Treatment of chronic colitis.

1. Diet number 4 (for 3-5 days), then diet number 4b.

2. Anti-inflammatory: sulfonamides; azo compounds (sulfasalazine), salofalk and salosinal; intetrix; 5-NOC (nitroxoline), nicodine.

3. Correction of intestinal dysbiosis.

4. Antispasmodic and myotropic (atropine, no-spa, papaverine, etc.).

5. Vitamin therapy.

6. Herbal medicine.

7. Physiotherapy.

8. Local treatment.

9. Therapeutic exercise.

10. Mineral waters.

Nonspecific ulcerative colitis. Nonspecific ulcerative colitis is an autoimmune inflammatory-dystrophic lesion of the mucous membrane of the colon with the development of hemorrhages and erosion, the formation of extraintestinal manifestations of the disease and local and systemic complications.

The main reasons for the development of NUC:

1) viral or bacterial;

2) milk intolerance;

3) emotional stress reactions;

4) violation of the intestinal biocenosis and the environment;

5) hereditary predisposition;

6) immunological changes and allergic reactions to

food products (most often for cow's milk).

Diagnosis of ulcerative colitis. In a blood test (anemia, accelerated ESR, leukocytosis, hypoproteinemia, dysproteinemia).

Coprogram (mucus, leukocytes, erythrocytes, sometimes feces looks like “raspberry jelly”).

Bacteriological examination of feces (manifestations of intestinal dysbiosis).

Sigmoidoscopy (hyperemia, edema, bleeding, erosion, ulcers, mucus, fibrin, pus).

Irrigoscopy, irrigography (diffuse granularity of the mucosa, lack of gaustra; serration of the contours of the colon, filling defects).

Endoscopy in UC: active stage - redness, loss of vascular pattern; granularity of the mucous membrane; vulnerability to contact, petechiae, bleeding; mucus, pus; ulceration of the mucous membrane, flat, drain, superficial; pseudo-polyps (inflammatory, not tumorous); continuous proliferation from the rectum; "Returnable ileitis." Inactive stage - pale, atrophic mucous membrane.

Morphological picture of UC: continuous infiltration by polymorphonuclear leukocytes limited by the mucous membrane.
Crypt abscesses. Reducing the number of goblet cells.

X-ray picture with UC: the mucous membrane is covered with granulations, “needle-like” (spicules). Ulceration, "button ulcers." Pseudo-polyps. The loss of haustration, "the phenomenon of the garden" hose "." Minor erosion on the background of a rebuilt mucosal relief in ulcerative proctosigmoiditis. The dentate contours of the colon, due to the many edges that form ulcers, with ulcerative colitis. In the transverse colon, a large number of ulcers on the relief. Fringing of the contours of the colon with ulcerative colitis. Symptom of "cobblestone pavement." In the left half of the intestine - pseudopolyposis. Pseudopolyposis with total ulcerative colitis.

Treatment. Crohn's disease is a granulomatous inflammation of any part of the digestive tract with the development of ulcerations of the mucous membrane, narrowing of the lumen, fistula and extraintestinal manifestations of the disease.

Treatment of UC and Crohn's disease.

1. A rational diet: frequent, fractional nutrition.

2. Basic drug therapy: azo compounds (sulfasalazine, salazopyrine, salazopyridazine; salofalk, salosinal); angioprotectors (trental, parmidin); multivitamins. With Crohn's disease (azathioprine, cyclosporine, methotrexate).

3. Corticosteroids (prednisone). With Crohn's disease (budesonide).

4. Eubiotics (Intetrix, Trichopolum, Ercefuril, Enterol, etc.).

5. Treatment of intestinal dysbiosis.

6. Infusion therapy. Hemosorption and plasmapheresis.

7. Anabolic hormones (nerabol, retabolil, etc.) - according to strict indications.

8. Treatment of anemia: iron preparations (ferrumlek, ectofer, etc.) parenterally.

9. Antihistamines (diazolin, suprastin, tavegil, etc.).

10. Normalization of bowel function antispasmodics and analgesics (papaverine, no-spa, halidor); enzymes (pancreatin, panzinorm, digestal, mezim-forte); imodium; fight against constipation (bran, liquid paraffin).

11. Sedatives (relanium, broth of valerian root, tincture of motherwort, seduxen).

12. Dimephosphon (membrane-stabilizing, immunomodulating, bactericidal action).

13. Sandostatin - an analog of somatostatin.

14. Herbal medicine (chamomile, calendula, St. John's wort, gray alder, motherwort, mint, plantain).

15. Physiotherapy.

16. Local treatment.

17. Surgical treatment (subtotal one- or two-stage colectomy).

Amyloidosis of the colon. Colon amyloidosis is a partial or complete paralytic intestinal obstruction.

Gastrointestinal bleeding. Ulcers of the intestinal mucosa. Syndrome of impaired absorption.

Treatment for colon amyloidosis.

1. Derivatives of 4-aminoquinoline (chloroquine, delagil, plaquenil); corticosteroids (prednisone); immunocorrectors (T- and B-activin, levamisole).

2. Means of stimulating the resorption of amyloid: ascorbic acid, anabolic hormones.

3. Colchicine, dimethyl sulfoxide, prednisone.

With secondary amyloidosis, treatment of the underlying disease should be carried out first of all.

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