Colitis

Introduction to colitis Colitis, also known as non-specific ulcerative colitis, the onset of the disease is slow, the severity of the disease is different, the main clinical manifestations of diarrhea, abdominal pain, mucus and pus and bloody stools, urgency and heavy, and even constipation, can not pass stool within a few days, sometimes diarrhea Sometimes constipation, often accompanied by weight loss and fatigue, and more repeated attacks. Abdominal pain is usually pain or cramping, often located in the left lower abdomen or lower abdomen. Other manifestations include loss of appetite, bloating, nausea, vomiting, and large liver. The left lower abdomen may have tenderness and sometimes reach the sputum colon. Common systemic symptoms include weight loss, fatigue, fever, and anemia. A small number of patients in the chronic course, the condition suddenly deteriorated or the initial onset is fulminant, showing severe diarrhea, 10-30 times a day, excretion of blood, pus, mucus feces, and high fever, vomiting, tachycardia Speed, exhaustion, loss of water, electrolyte imbalance, conscious coma, and even colon perforation, can cause death if not treated in time. Most scholars believe that this disease is an autoimmune disease. Because the disease is complicated by autoimmune diseases (such as autoimmune hemolytic anemia), adrenal cortical hormone can relieve the disease, anti-colon epithelial cell antibodies can be found in the serum of some patients, so the occurrence of this disease may be considered Related to autoimmune reactions. basic knowledge The proportion of sickness: 0.05% (common in summer) Susceptible people: no special people Mode of infection: non-infectious Complications: diarrhea colon cancer

Cause of colitis

Autoimmune response (20%):

Most scholars believe that this disease is an autoimmune disease. Because the disease is complicated by autoimmune diseases (such as autoimmune hemolytic anemia), adrenal cortical hormone can relieve the disease, anti-colon epithelial cell antibodies can be found in the serum of some patients, so the occurrence of this disease may be considered Related to autoimmune reactions. In addition, some patients may be infected with intestinal bacteria, and may immunoreact with colonic epithelial cell antigen, damage the colonic mucosa, and the patient's lymphocytes have cytotoxic effects on fetal colonic epithelial cells, suggesting that the occurrence of colitis may also be associated with cells. Immune abnormalities are related.

Infection (35%):

The pathological changes and clinical manifestations of this disease are similar to some colonic infectious diseases (such as bacterial dysentery), so some people believe that infection is the cause of this disease. Among the many factors such as bacteria, fungi and viruses, current research indicates that the virus is more likely.

Genetics (20%):

The incidence of blood relatives in this disease is high. According to European and American literature statistics, about 15-30% of the immediate blood relatives of patients with ulcerative colitis are affected. In addition, studies in twins have shown that monozygotes are more susceptible to disease than doublets, which means that the occurrence of this disease may be related to genetic factors.

Neuropsychiatric factors (20%):

Some people think that mental factors play a certain role in the pathogenesis. Patients have certain personality traits. They have poor psychological ability and adaptability to major events in life. They are a kind of psychosomatic diseases. Psychosomatic diseases emphasize mental factors in the occurrence or course of disease. Played an important role, some people listed 7 diseases as psychosomatic diseases, namely: asthma, rheumatoid arthritis, ulcerative colitis, essential hypertension, neurodermatitis, hyperthyroidism and duodenal ulcer. More diseases may be classified as psychosomatic diseases.

Colitis prevention

Prevention of colitis requires attention to diet

1, to eat a regular diet, three meals a day to do regular quantitative, but not hunger, not overeating, this is conducive to intestinal digestive balance, to avoid intestinal dysfunction caused by uncontrolled diet.

2, the diet is light, easy to digest, less greasy as the basic principle, suitable for food: spleen food, yam, lentils, lotus, lily, red dates. Eat less cold drinks, eat less prone to food, such as watermelon, cantaloupe, leeks, onions, garlic, fried foods, coffee, carbonated drinks, etc.

3, eat high-fat foods, so as not to increase the burden of the stomach because of its inability to digest, such as eating low-fat snacks.

4. Avoid excessive drinking.

5, do not consume too much fiber food every day, you can choose whole wheat food, as well as citrus, spinach, carrots and so on.

6, avoid allergic foods, if you find that you have a similar reaction every time you eat a certain food, you must be careful whether it is allergic to this, you can choose other food instead.

Colitis care should pay attention to observe the condition

1. Observe the frequency of diarrhea and the traits of stool according to the condition.

2, violent patients due to frequent bowel movements, should observe whether there is thirst, skin elasticity weakened, weight loss, fatigue, palpitations. Water, electrolytes, acid-base balance disorders and nutritional disorders such as decreased blood pressure.

3, such as worsening of the disease, obvious toxemia, high fever with abdominal distension, abdominal tenderness, weakened or disappeared intestinal squeak, or peritoneal irritation, suggesting complications should immediately contact the physician to assist in the rescue.

Colitis general care

1, when continuous blood in the stool and diarrhea should pay special attention to prevent infection, then warm water bath or anal hot compress to improve local circulation. And partially rub the antibiotic ointment.

2, when the drug retention enema is required, it should be performed before going to bed at night, first defecate the patient, followed by low-pressure saline enema.

3, lighter rest, guide patients to sleep peacefully in the evening, pay attention to nap; heavy patients should rest in bed to reduce bowel movements and intestinal cramps.

Colitis symptomatic care

1, abdominal pain application of antispasmodic, the dose should be small to avoid causing toxic colon expansion.

2, serious authors, should follow the doctor's advice to timely add liquids and electrolytes, blood products to correct anemia, hypoproteinemia.

3, when you need colonoscopy or barium enema examination, the bowel preparation is done with low-pressure saline enema to avoid excessive pressure to prevent intestinal perforation.

4, to guide patients with less irritating, less cellulose, high-calorie diet; fasting when bleeding, after the transition to fluid and slag-free diet according to the condition, with caution with milk and dairy products.

In summary, colitis care should also be a health guide to explain the predisposing factors of the disease, the effect after treatment, and maintain emotional stability. Patients take the right medication on time, with treatment and care.

Colitis complications Complications, diarrhea, colon cancer

1. Toxic intestinal dilatation: This is a serious complication of this disease. It occurs in patients with total colitis. The mortality rate can be as high as 44%. The clinical manifestations are rapid deterioration of the disease, obvious symptoms of poisoning, accompanied by diarrhea and abdominal tenderness. And rebound tenderness, bowel sounds weakened or disappeared, white blood cell count increased, easy to have intestinal perforation.

2, intestinal stenosis: more common in lesions, duration of disease for more than 5-25 years, the site is more common in the left colon, sigmoid colon or rectum, clinically generally asymptomatic, can cause intestinal obstruction in severe, in this When there is intestinal stenosis, be alert to the tumor and identify benign and malignant.

3, intestinal perforation: mostly complication of toxic intestinal dilatation, can also occur severe, mostly in the left colon, the application of corticosteroids is considered a risk factor for intestinal perforation.

4, intestinal polyps, colon cancer: colitis for more than five years, the intestinal ulcer surface is prone to abnormal hyperplasia under the long-term stimulation of inflammation, causing intestinal polyps, the cancer rate of intestinal polyps more than one centimeter is extremely high; in addition, about 5% of cases of enteritis can be Carcinogenesis occurs more often in patients with lesions involving the entire colon, and onset and history of more than 10 years.

Symptoms of colonic symptoms Common symptoms of blood in the stool, diarrhea, urgency, heavy constipation, toxic megacolon, explosive watery diarrhea, left lower abdominal pain, mucus, fever, abdominal pain,...

Basic symptoms

(1) Diarrhea: Diarrhea is the main symptom of early colitis. Frequent recurrent episodes, mostly caused by improper diet, emotional excitement, and excessive fatigue.

(2) Abdominal pain: Mild patients have no abdominal pain or only abdominal discomfort. Generally, there is mild to moderate abdominal pain, which is pain in the left lower abdomen and may involve the whole abdomen. There is a law of relief after the event.

(3) Constipation: The stool is fixed once every 4-5 days, and the feces are like sheep's scorpion, and even if you don't take laxatives, you can't lax.

(4) Other symptoms: bloating, weight loss, fatigue, bowel, insomnia, dreams, cold, severe fever, rapid heartbeat, and weakness, anemia, loss of water, imbalance of electrolyte balance, nutritional disorders and mental weakness which performed.

Early symptoms

1, blood in the stool: is one of the main symptoms of this disease, light blood attached to the surface, heavy blood flow, and even shock.

2, other symptoms: loss of appetite, nausea, vomiting, abdominal distension, weight loss, fatigue, bowel, insomnia, dreams, cold, etc., severe cases can have fever, rapid heartbeat, and weakness, anemia, loss of water, nutritional disorders, etc. which performed.

Colitis examination

1. Blood test: Hemoglobin is normal or mildly decreased in mild cases, and moderate or severe cases have mild or moderate decline, or even severe decline. White blood cell counts may increase during the active period. Elevated erythrocyte sedimentation rate and increased c-reactive protein are hallmarks of activity. Serum albumin decreased in severe or persistent cases.

2, X-ray barium enema examination: see x-ray signs are mainly: 1, mucosal rough and (or, granular changes. 2, the colonic bag disappears, the intestinal wall becomes hard, the intestinal tube shortens, becomes thin, can be lead Tubular. Heavy or violent cases are generally not suitable for barium enema examination to avoid aggravating the condition or inducing toxic megacolon.

3, colonoscopy: This examination is one of the most important means of diagnosis and differential diagnosis of this disease. Should be the end of the whole colon and ileum examination, direct observation of intestinal mucosal changes, biopsy, and determine the extent of the lesion.

4, stool examination: regular examination of the feces of the naked eye often have mucus pus and blood, microscopic examination of red blood cells and pus cells. The purpose of fecal etiological examination is to exclude infectious colitis, which is an important step in the diagnosis of this disease.

Diagnosis and diagnosis of colitis

Diagnostic criteria:

In daily life, colitis is better confirmed. If there is diarrhea, no stool, abdominal pain, bowel, constipation, mucus and pus and blood. The disease is just beginning to take sulfa and antibiotics to control the disease. After repeated recurrence, The efficacy of this drug will be very low, should go to the local hospital to ask a specialist to help diagnose. In 1993, the National Symposium on Chronic Non-infectious Intestinal Diseases, in conjunction with China's situation, developed a trial diagnostic criteria:

(1) Ulcerative colitis needs to first rule out colitis with obvious cause such as bacterial dysentery and abcolitis colitis.

(2) Typical clinical manifestations of recurrent diarrhea, abdominal pain, mucus, pus, etc., at least one of the characteristic changes of colonoscopy "X-ray".

(3) The clinical manifestations are not typical, but there are typical colonoscopy or X-ray findings or histological manifestations of mucosal biopsy.

diagnosis method

1. Ulcerative colitis needs to first rule out chronic bacteriological dysentery, amoebic dysentery, intestinal tuberculosis and other causes of colitis.

2. It has typical clinical manifestations such as recurrent diarrhea, abdominal pain, mucus, pus and bloody stools. Blood routine examination may have mild to moderate anemia, and white blood cell count and erythrocyte sedimentation rate are accelerated in severe patients. In severe cases, serum albumin and sodium, potassium and chlorine are reduced. Immunological examination of IgG, IgM can be slightly increased, anti-colon mucosal antibody positive. Feces were examined with red, white blood cells, mucus, and even macrophages. No specific pathogens were found in repeated stool culture and hatching.

Diagnosis of allergic colitis

(1) Intestinal stenosis of allergic colitis, the colonic bag disappears, and the linear sign is similar to ulcerative colitis.

(2) In addition to stenosis, the intestinal tract of ulcerative colitis is shortened into a dachshund tube.

(3) Allergic colitis is characterized by mucosal fold variability and can be used as one of the main points of differential diagnosis.

Inspection Method

1, radiological tincture examination: the acute phase is generally not suitable for tincture examination. Conventional barium enema X-ray examination can be seen:

1 mild ulcer patients, X-ray examination is negative, moderate and severe patients have typical performance.

2 The edge of the colon wall is a small serrated protrusion and a rail-like fold.

3 filling defects, false polyps formation, a small number of cases due to colonic fibrosis and polyp hyperplasia, can cause the intestinal lumen to narrow.

4 The colonic bag disappears or becomes shallow, and the colon shortens and is stiff, even like a water tube.

5 snowflake sign: due to tiny ulcers and erosion, attached to the tincture, sputum spots, gas sputum double angiography such as snowflakes.

6 rows of anomalies.

7 The posterior rectal space increased by more than 2 cm, indicating severe inflammation of the rectum and rectum.

8 should pay attention to the presence or absence.

2, endoscopy: most of the clinical lesions in the rectum and sigmoid colon, the use of sigmoidoscopy is very valuable, for patients with chronic or suspected whole colon, fiberoptic colonoscopy should be performed.

Differential diagnosis:

Colitis manifests as chronic diarrhea, blood in the stool, mucus, abdominal pain, etc., but these symptoms are not specific and easily confused with other diseases. Therefore, the following diseases must be identified at the time of diagnosis:

1, chronic bacterial dysentery: manifested as chronic diarrhea or mucus pus and blood, but often have a history of acute bacillary dysentery. The dysentery can be isolated by culturing the exudate obtained from stool, cecal swab or colonoscopy.

2, chronic amoebic bowel disease: often have a history of the epidemic, the lesion is mainly the right colon, mucosal ulcer can be seen under colonoscopy, the edge of the ulcer is sneak, the colonic mucosa between the ulcers is normal, in the feces Find a solution of amoeba cysts or trophozoites, effective with anti-amebic drugs.

3, schistosomiasis: can also have chronic diarrhea abdominal pain, but there is a history of contact with the epidemic area in the epidemic area, the feces can be tested for hemorrhagic eggs or hatching hair lice positive. Under colonoscopy, typical manifestations of submucosal yellow particles can be seen. The cecum or sigmoid mucosa biopsy can detect eggs. In addition, patients often have hepatosplenomegaly, ascites can occur in severe cases, and the symptoms are improved after effective anti-schistosomal treatment.

The above three infectious diseases have been the most common cause of chronic diarrhea in the past, so in the diagnosis of ulceration, the three diseases should be excluded.

The following are several non-infectious diseases. There are many similarities between symptoms and ulcerative colitis. The diagnosis should be noted.

1, Crohn's disease (crohn's disease): a wide range of lesions, from the esophagus to the anus of the gastrointestinal tract can occur lesions, more common in the terminal ileum and right colon. Clinical manifestations can be similar to ulceration, but often no bloody stools, abdominal pain, mucus is more common, intestinal obstruction can also occur. The lesions are segmental, the mucosa between the lesions is normal, and fiberoptic colonoscopy can confirm the diagnosis. Crohn's disease and ulceration are collectively referred to as inflammatory bowel disease. The lesions and clinical manifestations of the two diseases are different, but the therapeutic drugs are similar.

2, colon cancer: more common in middle-aged and elderly, constipation or diarrhea and other changes in bowel habits, at the same time can appear anemia, decreased appetite, blood in the stool and intestinal obstruction and other symptoms. X-ray barium enema can be found in the tumor, fiber colonoscopy, not only can be found in the tumor, but also biopsy pathological examination to determine whether there are malignant cells, and can further determine the degree of malignant mass. Colonoscopy is the best way to diagnose colon cancer.

3, intestinal tuberculosis: primary intestinal malabsorption syndrome: the typical symptoms of this disease is steatorrhea. The stool is light in color, and the amount is large. It is oily or foamy, and often has a foul smell on the surface of the water. More with abdominal distension, abdominal pain, fatigue, weight loss, bleeding and other malnutrition, long course of disease, light and heavy when the disease is a good diagnosis of X-ray barium meal examination.

4, primary intestinal malabsorption syndrome: the typical symptoms of this disease is steatorrhea. The stool is light in color, and the amount is large. It is oily or foamy, and often has a foul smell on the surface of the water. More with abdominal distension, abdominal pain, fatigue, weight loss, bleeding and other malnutrition, long course of disease, light and heavy when the disease is a good diagnosis of X-ray barium meal examination.

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