Chronic enteritis and colitis Mohit

Chronic enteritis and colitis

1. . Name:- Mohit Rulaniya Topic:- Chronic enteritis and colitis

2. Chronic enteritis and colitis Chronic enteritis – poly – etiological disease of small intestine c haracterized by the: - development of inflammatory-degenerative processes; - atrophy of small intestine mucosa; violation of functions of the small intestine, primarily absorptive and digestive. Etiology infection ( salmonellosis, dysentery etc.) nutritional factors (long use of poor quality food, spicy food, abuse of alcohol); food allergy; toxic effects: chronic intoxication with medicinal and chemical substances; abuse of certain drugs; - exposure to penetrating radiation; - hereditary-constitutional factor: congenital deficiency of enzymes, in particular, involved in the cleavage of various carbohydrates; - diseases of the digestive tract - "secondary" enteritis.

3. Pathogenesis In the small intestine inflammation of the mucous membrane develops disorders of motility and a decrease in its barrier function violation of the integrity of the epithelium this leads to a violation of digestion ( maldigestion syndrome) and absorption (malabsorption syndrome) exudation of the liquid part of the blood and electrolytes in the cavity of the small intestine (exudative enteropathy syndrome).

4. Classification of Chronic Enteritis Flow: - easy flow; - moderate; - heavy; O n the nature of functional disorders: - syndrome of insufficiency of digestion; - syndrome of insufficiency of absorption; - syndrome of exudative enteropathy; Clinical phase: - phase of exacerbation; - the phase of remission.

5. Clinical manifestation Local symptoms: - diarrhea -4-6 and more times a day; - poly feces; f atty stool “toilet feces smears”; dull, spastic pain (at the navel); g astrointestinal bleeding (melena); Common symptoms: loss of weight; skin lesion (dry skin, hair loss, brittle nails); е dema (due to hypoproteinemia ); severe weakness, muscle tremor, hunger and sweating anemia (V12 and iron deficiency).

6. Clinical examination Diagnosis of c hronic enteritis still begins with the study of anamnesis, complaints and the results of physical examination (palpation, percussion and auscultation). A t palpation: it is possible to reveal local resistance and hyperesthesia on the left and above a navel; is often determined soreness in the mesogastric region; Loud rumbling at palpation of the cecum; D uring percussion, tympanic sound and splash sound are detected; A t auscultation there is a loud rumbling and gurgling.

7. Additional examination M icroscopy of feces on eggs of worms, lamblia and other parasites; S owing feces for salmonella, shigella , campylobacteria , iersenia ; A blood test : - a general blood test; - determination of the level of microelements of blood (potassium, sodium ); - albumin, gamma globulin levels; - thyroid hormones level; amylase of blood and urine. Sigmoidoscopy; Duodenoscopy; Colonoscopy; Irrigoscopy - is performed on special indications for differential diagnosis .

8. Treatment Drug-therapy Basic principles of treatment: - improvement of cavitary digestion (enzyme preparations ); - correction of disorders of the microflora of the small intestine (antibacterial preparations, probiotics and prebiotics ); - increased contact time of the food lump with the mucous membrane ( loperamide , diphenoxylad , codeine, sandostatin ); - reduction of intestinal secretion and stimulation of absorption ( sandostatin , corticosteroids ); - correction of metabolic disorders. To combat violations of water-electrolyte metabolism, rehydration therapy is used ( trisol , quartesol , acesol intravenously , orally- rehydron , citroglucosalan ).

9. The main syndromes and symptoms in the pathology of the large intestine In diseases of the colon, the main syndromes are : - Abdominal pain; - Flatulence; - Constipation; - Intestinal obstruction; - Intestinal bleeding.

10. Examination in the pathology of large intestine С o prological research . In patients with pathology of the colon, the daily amount of excreted feces is determined, its consistence and shape, color, odor,a presence of impurities (mucus, blood, pus and parasite ) . F inger examination of the rectum - an obligatory method of primary medical examination of a patient with diseases of the colon. Any instrumental research should be carried out only after a finger examination of the rectum . Rektoromonoskopiya (sigmoskopiya) allows you to assess the color and blood supply of the mucous membrane, to establish a source of bleeding or suppuration, to reveal signs of rigidity of the intestinal wall. Immediately before the study, the patient is treated with an enema . Radiologic examination of the large intestine involves the performance of an overview radiography of the abdominal cavity (with suspicion of pneumoperitoneum , intestinal obstruction); - simple irrigoscopy (shown to weakened patients); - irrigoscopy with double contrast allows to study in detail the state of the mucous membrane of the large intestine. Colonoscopy is the main method of diagnosing tumors, Crohn's disease, ulcerative colitis and intestinal tuberculosis .

11. Examination in the pathology of large intestine (cont.) Computed tomography - this method allows to detect such changes in the intestinal wall as: inflammation of diverticula, abscesses, fistulous passages, identify enlarged lymph nodes. Ultrasound examination makes it possible to assess the condition of the entire intestinal wall, to reveal changes in the external contours. E ndoscopic ultrasound of the colon is based on the study of the thickness of the intestinal wall, its structure and contours , allows to determine T and N stage of tumors of the large intestine. A radioisotope study is used only in certain clinical situations.

12. Non – specific ulcerative colitis U lcerative colitis - nonspecific diffuse, inflammatory-ulcerative lesion of the mucosa of the rectum and colon, often having a chronic recurrent course, clinically manifested by bloody diarrhea, the development of intestinal and extraintestinal manifestations . Epidemiology - the prevalence of ulcerative colitis varies from 28 to 117 patients per 100 000 of the population. In the southern countries of Europe, in Asia and Africa, the frequency of morbidity is low. The frequency of ulcerative colitis in large cities is about 1.5-4 times higher than in rural areas . I n general, people of both sexes get the same frequency, but ulcerative colitis is more common in men.

13. Etiology and pathogenesis E tiology is unknown. Pathogenesis - in the development of ulcerative colitis, an important role is played by immune disorders. Such factors as viruses, bacteria and bacterial products (endotoxin, cell wall peptidoglycan), food (proteins, milk) in combination with neuropsychological, information and physical overloads, often on the background of adverse environmental effects are considered as potential participants in the pathogenesis of ulcerative colitis.

14. Classification of ulcerative colitis symptom easy moderate severe stool frequency Less than 4 times a day 5-6 times per day More than 6 times per day rectal bleeding slight expressed abundant temperature normal subfebrile febrile number of leukocytes normal moderate increase leukocytosis Anemia Hemoglobin normal HB- 90-100 g/l Less than 90 g/l erythrocyte sedimentation rate normal 20-35 mm/h More than 35 mm/h

15. Classification of ulcerative colitis (cont.) P hase: a cute; with a gradual onset and a mild clinical symptomatology; relapsing form is characterized by a change in exacerbations and remissions; с ontinuous form is characterized by a lack of remission for 6-8 months, despite adequate therapy. By the extent of the defeat of the large intestine: - distal colitis ( proctitis , proctosigmoiditis); - left-sided colitis with affection of the descending colon to the splenic angle or to the middle of the transverse colon; - total colitis

16. Clinical manifestation The clinical symptoms are conventionally divided into 4 groups: - Intestinal symptoms - diarrhea of varying intensity with impurities of blood, pus in feces; Symptoms of endotoxemia - symptoms of general intoxication, fever, anemia, leukocytosis, increase in blood level of acute phase proteins (C reactive protein, seromucoid ); Metabolic disorders are due to impaired absorption, diarrhea, toxemia. They are manifested by loss of body weight sometimes till to cachexia, dehydration, electrolyte disorders (especially hypokalemia), edema; Е xtraintestinal systemic manifestations occur in 50-60% of patients with ulcerative colitis. These include arthritis, erythema nodosum , iritis, uveitis, sacroileitis , ankylosing spondylitis, primary sclerosing cholangitis, chronic active hepatitis, pancreatitis, hepatobiliary system damage in the form of liver steatosis with an increase in alkaline phosphatase, gamma- glutamyl peptidase.

17. intestinal complications of inflammatory diseases of the large intestine Intestinal bleeding . Intestinal bleeding is diagnosed if clots appear in the stool. Perforation . The frequency of perforations in patients with ulcerative colitis varies 2.8 to 3.2% of cases. Most often, perforation is localized in the transverse colon, rarely in the sigmoid colon. Toxic megacolon (toxic dilatation of large intestine). The frequency of this complication is 2-3% and increases with the severity of ulcerative colitis . Strictures with ulcerative colitis are rare and localized in the distal parts of the large intestine . Fistulas of the anus and rectal-vaginal fistulas are found in 3-4% of patients with ulcerative colitis. Cancer . The risk of colorectal cancer in patients with a duration of ulcerative colitis for more than 30 years is 10-12%.

18. Treatment of ulcerative colitis The purpose of treatment is to suppress the activity of inflammation, to model the proper immune response of the body . Basic drugs: stereoid hormones and salicylates; Additional drugs : immunomodulators , antispasmodics, antidiarrheal drugs, antibiotics, preparations for normalization of water-salt metabolism

19. 5 amynosalicylic acid drugs and their mechanism of action The mechanism of action of 5 aminosalicylic acid (salicylate ):- anti-inflammatory action, immunocorrective action. Aminosalicylates mainly act locally, suppressing many of the effector mechanisms involved in inflammation. Sulfasalazine : tablets - 0.5 g, daily dose - 3.0-5.0 grams, depends on the severity of the disease. Salofalk : tablets - 0.5 g., Daily dose of 2.0-4.0 grams, depends on the severity of the disease. microclysters - 2.0 grams; 4.0 grams, daily dose of 1.0-2.0 grams candles 0.5 grams, 0.25 grams; daily dose of 1.0 grams (500 mg 2 times) Pentasa : 0.5 g tablets, daily dose 4.0 grams candles 1.0 g.; enema 1.0g.

20. Other groups of drugs Immunosuppressants - second-line drugs in the treatment of ulcerative colitis and are prescribed in its severe forms, when the use of glucocorticoids and aminosalicylates is not effective. Azatioprin , 6-mercaptopurin – first week 50 m g per day, than increase the dose to: azatioprin - 2,5-3,0 mg/kg per day, 6-mercaptopurin – 1-1,5 mg/kg per day. Duration 12 weeks and more. Antibiotics are prescribed: - for the treatment of secondary infections against aminosalicylates and glucocorticoids; - with the development of purulent complications. Apply semisynthetic penicillins (methicillin, ampicillin, pentriksil) in doses of 0.5-1.0 g intravenously or intramuscularly every 4-6 hours. Duration 10-14 days.