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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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Organic Colonic Disorders
- FORMATION OF A J-SHAPED TANK FROM A HIGH GUT FOR REPLACEMENT OF A DIRECT GUT
In the surgical treatment of cancer of the female genitalia, the rectosigmoid colon is often removed. Then, reconstructive operations are performed, such as the removal of the final section of the sigmoid colon or very low colorectostomy. After these operations, patients may experience undesirable frequent bowel movements, up to 6-8 times a day. Assigning opiates to solve this problem may
- P. POLYPES AND Tumors of the Large Intestine
1. Benign polyps, polyposis and tumors. The etiology and pathogenesis, as well as tumors, in general, have not yet been sufficiently studied. Benign tumors (according to WHO, Geneva, 1981) are divided into three groups: 1). epithelial; 2). carpinoid; 3). non-epithelial tumors. Among the epithelial tumors of the colon, which make up the vast majority of all its tumors, distinguish
- Colon cancer
The end of the twentieth century. was marked by a significant change in the structure of cancer incidence. In Russia, colon cancer (colorectal cancer) came in third place. The incidence of malignant neoplasms of the cecum and colon among men is 11.6, among women - 9.2 per 100 thousand adults, and rectal cancer - 11.0 and 7.1, respectively. Colorectal cancer is
- Colon cancer
The main principles of carcinogenesis of solid tumors were established by the example of colon tumors and form the basis for the study of tumors of other localizations. But even in the development of these quite well-studied tumors, various options are possible. In the case of hereditary adenomatous polyposis, the patient has a mutation of the APC gene in stem cells, the formation of a clone of mutated
- Tumors of the small and large intestine
Epithelial tumors make up the majority of intestinal neoplasms. Moreover, the colon, including the rectum, is one of the most common organ localizations of primary tumors. As an oncological cause of death for both sexes, colorectal cancer takes second place after bronchogenic carcinoma. The vast majority of cases of colon cancer are
- LECTURE No. 10. Chronic diseases of the colon in children. Clinic, diagnosis, treatment
Chronic non-specific diseases of the colon. 1. Functional disorders: 1) chronic constipation; 2) irritable bowel syndrome; 3) diverticular disease. 2. Organic disorders: 1) chronic colitis; 2) ulcerative colitis; 3) Crohn's disease; 4) intestinal amyloidosis. Classification of functional bowel disorders. 1. Intestinal upset: 1) irritable syndrome
- FRONT BODY RESECTION WITH GAMBEE LOW ANASTOMOSIS
The purpose of this operation is to resect the rectosigmoid colon and to reanastomose the colon and rectum with a single-row suture according to Gambi. The physiological consequences. After removal of the rectosigmoid colon, the physiological consequences are minimal. If the patient received a course of radiation therapy in the pelvic area, then before performing a low anastomosis, it should be applied for 8-10 weeks
- FRONT BODY RESECTION WITH A LOW ANASTOMOSIS BY STRASBOURG-BAKER
The Strasbourg-Baker method involves applying a side-to-end anastomosis between the sigmoid colon and the rectal stump without shutting down the inferior mesenteric artery from the blood supply. It is also commonly used to preserve the anterior hemorrhoidal artery. An anastomosis according to Strasbourg-Baker can be formed with a manual seam or using a modern stapler (ACC). If
- Colon Cancer Screening Tests
Screening tests are used to detect the asymptomatic course of the disease in apparently healthy people. To some extent, these tests are designed to increase a person’s life expectancy and improve its quality. An effective test should have sensitivity (optimal detection of patients), specificity (give a minimum of false positive results) and be accessible to a wide range of patients.
- Colon Syndromes
Violation of the stool (frequent urge to defecate with small portions of feces containing mucus, sometimes blood, diarrhea can be replaced by constipation). • Pain (aching pain in the lower abdomen, less often colicky pain, lessening after defecation, gas discharge, worse after eating rough, greasy, fried foods). • Dyspeptic (bad taste in the mouth, belching with air, bloating).
- The structure and functions of the small and large intestine. Congenital malformations of the intestine
In an adult, the length of the small intestine reaches about 6 m, and the large - 1.5 m. In addition to the width and structure of the outer shells, the small intestine differs from the thick structure of the mucous membrane, in which circular folds, intestinal villi and crypts (intestinal glands). The villi protrude into the lumen in the form of finger-shaped outgrowths covered with a cylindrical epithelium. Similar to