Colitis. Symptoms and treatment of colitis

колит Colitis is an inflammatory, or inflammatory, dystrophic lesion of the mucous membranes of the large intestine. Colitis is distinguished for chronic, acute and ischemic (observed exclusively in the elderly). The cause of colitis can be: staphylococci, pathogenic colibacilli, bacterial dysentery, streptococci, bacteria of the proteus group, protozoa or viruses

Etiology, Pathogenesis

Acute colitis

Most cases of acute colitis are directly associated with infectious agents: Escherichia, Salmonella, Yersinia, Shigella, etc., and also much less often - other types of pathogenic flora and some viruses. Also, the cause of the development of acute colitis can sometimes be non-bacterial poisoning, various allergic reactions and very gross errors in proper nutrition. By the type of inflammation, colitis is divided into: erosive, catarrhal, fibrinous and ulcerative. Acute inflammation of the intestinal wall leads to various functional disorders of the large intestine.

Chronic colitis

The causes of chronic colitis can be parasitic lesions, infectious diseases (primarily dysentery) and some factors of non-infectious origin. Toxic colitis occurs as a result of exposure to various poisonous agents of industrial and domestic use (salts of mercury, arsenic, lead); alimentary colitis - due to systematic errors in quality and diet. The emergence of medicinal colitis is associated with uncontrolled long-term use of laxatives and antibiotics; associated colitis develop due to secretory deficiency of the pancreas and glands of the stomach. Also, chronic colitis is allergic in nature. In the mechanism of their development, the main role is played by atrophic, dystrophic and inflammatory changes in the mucous membrane of the large intestine, which are accompanied by disturbances in its motor and secretory functions.

Ischemic colitis

Violation of the intestinal circulation, which in most cases is associated with atherosclerosis of the branches of the abdominal aorta is the main cause of the development of ischemic colitis. This is due to the fact that due to complete or partial obstruction of the lumen of the inferior mesenteric artery by an atherosclerotic plaque, dystrophic or necrotic changes in the wall of the colon appear. Much less likely cause of impaired blood circulation of the intestine may be: hemorrhagic vasculitis, nodular periarteritis, etc. The lesion is predominantly localized in the region of the splenic node

Clinical picture

Acute colitis

In most cases, it occurs in combination with gastroenteritis, acute enteritis, or accompanies intestinal infections. The disease always begins acutely: body temperature rises to 38-39 * C, diarrhea occurs, thirst arises, acute spasmodic pain localizes in different parts of the colon, appetite disappears. The frequency of seizures can be from five to twenty times a day. When palpating the abdomen, painful sensations along the colon and rumbling are noted.

Chronic colitis

. One of the most common diseases of the digestive tract, which in most cases is combined with gastroenteritis or chronic gastritis . In its course, chronic colitis is divided into a low-symptomatic - long and chronically - recurrent. There are diarrhea, sometimes alternating with constipation; in fecal masses can be a large amount of mucus or blood veins. After defecation, there is a feeling of incomplete emptying of the intestine, the stomach is swollen, meteorisms are noted. Aching blunt pains do not have a clear localization, although they are mostly marked on the lower left of the abdomen (intensified before defecation and after eating). Because of inflammation of the mucous membrane of the sigmoid and rectum, it is possible to attach pains in the anus. When palpation of the abdomen is observed soreness along the entire large intestine and a strong rumbling.

Ischemic colitis

This type of colitis occurs in benign, stenosing or lightning-fast forms. The type of flow directly depends on the degree of disturbance of blood flow and the size of the affected vessel. In benign and stenosing form, in most cases immediately after eating, intense pain is noted in the upper half or left side of the abdomen, vomiting and meteorisms. (иногда с примесью крови), которая может чередоваться с запорами . Body temperature may increase, in 50% of cases, diarrhea (sometimes with a trace of blood) is observed, which can alternate with constipation . When palpation, there are pronounced painful sensations along the colon, and sometimes in the left part of the abdomen protective muscular tension

Treatment of colitis

Acute colitis

Depending on the degree of severity, treatment of this type of disease is performed in the laboratory, or in a hospital. A sparing diet is prescribed (table # 4), saline solutions (Oralit, Regidron, quartrel, trisel, etc.) are used to make up lost salts and liquids. As a symptomatic and pathogenetic therapy, enveloping agents, adsorbents and enzyme preparations (white clay, activated charcoal, etc.), as well as cardiovascular drugs, are used. In the event that the infectious nature of the onset of colitis has been established, antibacterial agents are prescribed. , без использования антибиотиков. In mild cases, treatment is limited to the possible use of symptomatic drugs and a specially designed diet , without the use of antibiotics.

Chronic colitis

The place of treatment for this type of colitis depends on the phase of the disease and the general condition of the patient and can be either polyclinic or stationary. In case of an exacerbation, fractional meals are prescribed from six to seven times a day and the appointment of a diet No. 4a, 4b or 4c. With a pronounced exacerbation in the first two days, a medical starvation is administered in a hospital. In case of home treatment, food should include light meat broths, boiled or steamed meat, boiled river fish, soft-boiled eggs, slimy soups, sweet tea and jelly. In the period of improvement, it is possible to add to the diet firstly the wiped and boiled, and then fresh fruit and vegetables. Antibacterial therapy (sulfonamides) is prescribed courses for five days, in the absence of improvement - prescribe antibiotics. At the expressed pains appoint platifillin and antispasmodics (no-shpa, papaverine). For general strengthening of the body, the intake of ascorbic acid (injectable) and vitamin B is prescribed. For diarrhea, adsorptive and astringent preparations, decoctions and infusions of medicinal herbs (sage leaf, oak bark, blueberry fruit, etc.), heated mineral still waters. In case of constipation, vegetable laxatives are prescribed (the fruits of the hopper, buckthorn bark, senna leaf, etc.), and mineral waters (Batalinskaya, Slavyanovskaya, Smirnovskaya, Essentuki No. 17). In cases of severe flatulence, medicinal herbs should be supplemented with chamomile flowers, dill seeds and centaury stems. In cases where the rectum is predominantly affected, therapeutic oily microclysters are prescribed. Also in the complex of therapeutic measures are: acupuncture, psychotherapy, physiotherapy procedures. During periods of improvement (remission), a deep abdominal massage is prescribed for normalizing intestinal motility. Also attributed to sanatorium treatment (Caucasian Mineral Waters, Truskavets, Druskininkai).

Ischemic colitis

When a lightning-fast form of this type of colitis occurs with the development of a concomitant clinic of an acute abdomen, emergency surgery is needed to remove the affected area of ​​the large intestine. When treating the stenosing form, cholinolytics, antispasmodics, angioprotectors and antisclerotic drugs are used. In the case of an infection, antibacterial agents are prescribed.