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Chronic colitis

Chronic colitis — one of the most widespread diseases of intestines which is characterized by inflammatory and dystrophic changes and disorders of functions of a large intestine. It is quite often combined with inflammatory defeat of a small bowel (coloenteritis).
For the first time allocated chronic colitis in an independent nosological form V.P. Obraztsov (1895).

Epidemiology
Over 50% of the patients asking for medical care concerning various digestive frustration have chronic colitis. At women the disease is observed more often at the age of 20 — 60, at men incidence sharply increases by 40 — 60 years.

Etiology and pathogeny
Approximately at 30% of patients chronic colitis develops after acute intestinal infections and first of all dysentery and salmonellosis. The disease is quite often preceded disbioz, arising after long antibacterial therapy, and also by the irrational food, an alcohol abuse, slow-moving way of life and other factors breaking normal function of intestines.

Classification
Classification of chronic colitis is given in the table.

Classification of chronic colitis

Etiology

Characteristic

anatomo-morphological

clinical

functional

Infection (dysentery,
salmonellosis)

Superficial colitis Atrophic colitis
Typhlitis

1. Illness phase: aggravation, remission

Motility disturbances (hyper - and hypomotor dyskinesia)

Alimentary factors (unbalanced food, etc.)

Proctosigmoiditis
Total colitis

2. Complications: solar plexitis, nonspecific mesadenitis, coprostasis, intestinal impassability

Disturbances of transport (the hypersecretion of ions and water raised and the lowered absorption of ions and water in a large intestine)

Physical and chemical factors (exogenous intoxications compounds of mercury, lead, phosphorus, arsenic, etc., uncontrolled use of antibiotics, laxative)

 

 

Slime secretion disturbances (excess and reduced secretion of slime)

Diseases of digestive organs

 

 

 

Neurogenic factors

 

 

 

 

Approximate formulation of the diagnosis:
1. Chronic post-dysenteric colitis (mainly a proctosigmoiditis) with atrophic changes of a mucous membrane of a large intestine and the expressed hyper motor dyskinesia with a syndrome of locks, an aggravation phase.
2. Chronic typhlitis of a yersinia etiology, mainly painful form, aggravation phase.
Secondary chronic colitis (cholelithiasis; a cholecystectomia in 2005) with the expressed mucosal atrophy and hyper motor dyskinesia of a large intestine with the phenomena of hologeniy diarrhea, an aggravation phase.

Preliminary diagnosis
The clinical picture of a disease has much in common with functional disorders of intestines. Are characteristic pain of the aching or spastic character in a stomach, disturbances of a chair are more often in the left ileal area. General condition of patients quite satisfactory. At a palpation of a stomach the painful, spastic reduced or expanded sites of a large intestine are defined. Abdominal distention, rumbling in it, the increased formation of gases belong to frequent symptoms. Long locks are replaced by the frequent scanty liquid or semi-issued chair. The periods of a so-called "locking diarrhea" when after the first dense portions the calla appears plentiful liquid fetid kcal are characteristic.

By means of endoscopic methods (a rektoromanoskopiya, a kolono-fibroskopiya) reveal signs of an inflammation, dystrophy and an atrophy of a large intestine. Walls of a gut are hyperemic, edematous, with a slime plaque. At the expressed aggravation it becomes friable, easily vulnerable, with single erosion, petechias. In these cases the careful differential diagnosis with a latent form of nonspecific ulcer colitis is required. At an atrophy a mucous membrane pale with a network of the small vessels translucent through it, due to the lack of slime the wall of a gut looks dry, the tone of a gut is often lowered.

Verification of the diagnosis, differential diagnosis
Histologic research of a mucous membrane of a large intestine allows to reveal diffusion inflammatory or atrophic changes. The listed above symptoms of chronic colitis are not pathognomonic and can be observed at all diseases of the digestive system.

First of all, difficulties arise at differential diagnosis with functional disorders of a large intestine. The community of symptoms and lack of rough structural changes of a wall of a gut at chronic colitis were the basis for association of chronic colitis with functional diseases in one irritable colon. However most of the authors dealing with this problem argue the traditional point of view and differentiate colitis from functional disorders of a large intestine. Often it is necessary to be guided generally by data of survey of a mucous membrane during a rektoromanoskopiya as histologic research of bioptat in daily clinical practice is conducted insufficiently. In this regard it is recommended to supplement more widely endoscopic research histologic especially in cases when there are morphological changes seen by an eye. Considerable difficulties arise also in the course of differential diagnosis of chronic colitis with chronic enteritis. At patients with chronic colitis absorption is not broken and body weight often even exceeds normal. In difficult situations for an exception of diseases of a small bowel it is recommended to conduct histologic research of a mucous membrane of zalukovichny department of a duodenum, to appoint functional absorbing tests.
Differential diagnosis of chronic colitis with a tumor of a large intestine is especially responsible. Careful radiological and endoscopic inspection of patients with symptomatology of colitis is one of forms of active search of oncological diseases.

Treatment, prevention
In the period of an aggravation appoint a diet No. 4a. Include stale white loaf, the fat-free weak beef-infusion and fish broths, steam meat and fish dishes, the wiped porridges on water in its structure, soft-boiled eggs, steam omelets, kissels, broths and bilberry jelly, bird cherries, pears, a quince, a dogrose, tea, coffee and cocoa on water.

In process of subsiding of an aggravation add a dry biscuit, cookies, razvarenny grain, vermicelli and vegetables soups, boiled vegetables, porridge casserole with milk addition to a diet, not strong cheese, fresh sour cream, baked apples, jam, butter (diet No. 4b).

After approach of remission by the patient recommend the same diet, but less mechanically sparing: all dishes give in not wiped look, add low-fat ham, the soaked herring, crude vegetables and fruit, juice. Also fennel, parsley greens, a jellied fish, language and black caviar (table No. 4v) are resolved.

The products containing the increased amount of food fibers (vegetables, fruit, grain products, especially wheat bran) are shown to patients with the expressed lock. Bran should be filled in with boiled water for 20 — 30 min., then to merge water and to add them to porridges, soup, kissel or to use in pure form, washing down with water. A dose of bran from 1 to 9 tablespoons in day. After elimination of locks it is necessary to continue reception them in the quantities providing an independent chair of 1 times in 1 — 2 day. The use of bread with the increased content of bran is recommended.

At chronic colitis with dominance of a diarrhea appoint the knitting and adsorbing drugs (for example, white clay of 1 g; calcium carbonate of 0,5 g, Dermatolum of 0,3 g in the form of the talker before food 3 times a day).

In the absence of effect that is usually connected with the accompanying dysbacteriosis, appoint antibacterial drugs to 7 — 10 days (Enteroseptolum, Intestopanum on 1 tablet 3 times a day, Nevigramonum of 0,5 g 4 times a day, nitroxoline on 0,05 g 4 times a day or Biseptolum-480 on 2 tablets 2 times a day).

At a meteorism absorbent carbon on 0,25 — 0,5 g 3 — 4 times a day, infusion of a leaf of a peppermint, camomile flowers is recommended.

With atonic options of disturbance of motor function of intestines it is reasonable to patient to appoint a raglan (cerucal) on 0,01 g 3 times a day, at spastic forms of disturbance of motility — anticholinergic and spasmolytic drugs (Nospanum on 0,04 g 4 times a day, a papaverine a hydrochloride on 0,04 g 3 — 4 times a day, Platyphyllinum hydrotartrate on 0,005 g 3 times a day, Methacinum on 0,002 g 2 times a day).

At water diarrhea of various origin as symptomatic means it is possible to apply imodium 0,002 g 2 times a day, a clonidine (clonidine) on 0,075 mg 3 times a day, verapamil on 0,04 g 2 — 3 times a day. Due to the hypotensive action the clonidine should not be applied at patients with the lowered ABP.

For the purpose of increase of reactivity of an organism appoint under skin aloe extract (on 1 ml/days, 10 — 15 injections), Peloidinum (inside on 40 — 50 ml 2 times a day for 1 — 2 h to food).

Obligatory component of complex therapy — physical therapy. Sessions of an electrophoresis of analgesic mixes, calcium chloride and zinc sulfate are recommended. Diadynamic currents, amplipulsetherapy are shown to patients with hypomotor options of colitis. Easy heat (continuous wearing the warming belt "Variteks", "Meditreks", and also the warming compresses) is useful.

At a proctosigmoiditis appoint microclysters (camomile, tannin, protargolovy), at a proctitis — candles ("Anesthesol", "Neoanusolum", etc.).

After an extract from a hospital recommend reception of a bifikol or kolibakterin on 5 doses 3 times a day within 1 month, broths and infusions of medicinal plants. For example, at colitis with dominance of a lock use the following collecting: a) camomile, buckthorn bark, parsley; b) calendula, marjoram, leaf of Senna. At dominance of a diarrhea: a) alder compound fruits, mint, dogrose; b) sage, St. John's Wort, nettle, bird cherry; c) flax seed, bilberry, cinquefoil, fennel. Components of each collecting should be mixed in equal quantities, 2 tablespoons of mix to fill in 250 ml of boiled water, to insist 20 min. (it is desirable in a thermos). To filter and accept on? a glass in the morning on an empty stomach and for the night before going to bed. Each of collecting is accepted within a month, consistently. It is possible to repeat courses 2 times a year.
Working ability of patients at moderately severe and severe forms of the chronic colitis which is especially followed by a diarrhea is limited. The types of works connected with impossibility to observe a diet, frequent business trips are not shown them.

Sanatorium treatment is shown in specialized balneological sanatoria (Borjomi, Dzhermuk, Druskininkai, Yessentuki, Zheleznovodsk, Pyatigorsk, Truskavets).
An important role in therapy is played by psychotherapeutic methods of treatment.

 
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