Ulcerative Colitis - Causes, Symptoms and Treatment .MF .
Ulcerative colitis - a chronic disease that affects only the large intestine, accompanied by its inflammation, edema and the formation of ulcers.Most often suffer from people aged 20 - 40 years old and after 55 years.
The figure shows the anatomy of the colon - in ulcerative colitis is affected throughout.
causes of ulcerative colitis
a generally accepted theory of the origin of ulcerative colitis at the moment does not exist.Puts forward a number of hypotheses, among them:
• ulcerative colitis - an infectious disease, but the pathogen is not known;
• ulcerative colitis - an autoimmune disease, when the body's own immune system produces antibodies against the epithelial cells of the colonic mucosa;
• ulcerative colitis - a hereditary disease, which triggers a series of adverse factors of the development environment.
Known trigger factors of disease:
• diet poor in fiber and rich in carbohydrates;
• Stress and trauma;
• sedentary lifestyle.
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Symptoms of ulcerative colitis
Ulcerative colitis occurs with periods of exacerbation and remission.The severity of exacerbations can range from mild to moderate to severe.
In acute mild to moderate disease severity of the common symptoms observed malaise, weakness, rise in temperature to 38 ° C.From the local signs of illness isolated frequent stools up to 5 times a day mixed with blood and cramping abdominal pain.
In the case of severe illness temperature can rise above 38 ° C, there is tachycardia (heart rate greater than 90 beats / minute), pallor of the skin due to anemia (anemia), dizziness, weakness.From the local characteristics: stool frequency more than 6 times / day with a lot of blood, can be released by blood clots, severe cramping abdominal pain before the act of defecation.
Similar symptoms may occur in infectious enterocolitis (acute dysentery, salmonellosis), Crohn's disease, ischemic colitis, pseudomembranous colitis, celiac disease (intolerance to wheat and barley), diverticular disease, blood in the stool may be present as a result of hemorrhoidal bleeding.It should be noted that Crohn's disease is very similar to ulcerative colitis, the main difference is that Crohn's disease infestation entire thickness of the bowel wall, not only the mucous membrane.
In any case, the presence of abdominal pain, do not stop for 6 hours and the allocation of blood from the rectum should consult a doctor-surgeon to exclude acute surgical pathology.Not recommended for use painkillers because they can distort the clinical picture of the disease and prevent the correct diagnosis.You can take antispasmodic drugs - no-spa or Buscopan (2 tablets once).When diarrhea development without signs of bleeding may use antidiarrheal agents such as loperamide, Imodium the initial dose of 4 mg followed by 2 mg after each defecation, a maximum of 16 mg per day should not take them more than 24 hours, with no effect should applyto the doctor.
survey of suspected ulcerative colitis
From laboratory tests required to pass blood tests to assess the extent and severity of blood loss anemia, blood clotting and bleeding, as well as the standard set of studies undertaken during hospitalization.
key instrumental methods allowing accurate diagnosis and to assess the degree of damage to intestinal mucosa is fibrocolonoscopy .This endoscopic examination, consisting in a visual evaluation of intestinal mucosa flexible device introduced into the lumen of the intestine through the anus.
Figure typical endoscopic picture of ulcerative colitis - inflammation, mucosal edema, ulcerative defects and overlay fibrin.
However, at the time of acute perform full colonoscopy is difficult due to the inflammatory bowel changes and the risk of perforation.
Irrigoscopy is a more secure method of research, though less informative.It consists in carrying out an enema with barium suspension and subsequent X-rays.Barium slurry, enveloping the inside wall of the intestine, allows you to get on the X-ray picture of the cast of the mucous membrane and on it to judge the extent and severity of ulcers.Also possible alternative barium suspension may be ordinary air, having been introduced into the lumen of the gut, it performs the function of contrast.
Survey abdominal radiography without the use of contrast agents needed to diagnose complications of ulcerative colitis (perforation of the colon).
Treatment of ulcerative colitis
main objective of treatment for ulcerative colitis is the rapid achievement of remission of disease resistant.The basis of treatment laid anti-inflammatory drugs: aminosalitsillaty (sulfasalazine, mesalazine), glucocorticoid hormones (metipred, dexamethasone, prednisolone) and cytotoxic drugs (methotrexate, azathioprine, mercaptopurine).Recent prescribed only for severe forms of the disease, because they inhibit the immune system, promoting the development of immunodeficiency.
Within the symptomatic treatment prescribed hemostatic agents (Dicynonum, aminocaproic acid, Tranexam), in the case of excessive bleeding may require transfusion of packed red cells and fresh frozen plasma.
To normalize intestinal peristalsis used antispasmodics (no-spa, papaverine), and antidiarrheals (loperamide).
antibiotic therapy prescribed for the development of complications.
In marked depletion prescribe parenteral nutrition (intravenous nutrient mixtures - solutions of amino acids, carbohydrates, and fat emulsions).
If these conservative measures are ineffective and continued rectal bleeding more than 100 ml / day of surgical treatment.The only effective method of surgical treatment - is the fulfillment of colectomy with abdominal-anal resection of the rectum, that is, removal of the entire colon.This mutilation is carried out strictly according to testimony from a limited group of patients.
Features nutrition and prevention of relapse in ulcerative colitis
Given that the current long-term inflammation in the body leads to weight loss and depletion, meals in ulcerative colitis should be a full, nutritious, contain foods rich in vitamins and proteins.Eating should be small portions, 6 times a day.It is necessary to exclude from the diet of sauces, spices, fatty and fried foods, coarse plant fiber as raw fruits and vegetables, because they contribute to the development of diarrhea.For the same reason, care must be taken relates to use of milk and dairy products.You can take in food fish, lean meats (beef, turkey, chicken, rabbit) in the liver and boiled, soups low fat-free meat and fish broth, porridge, eggs (up to 2 pieces per day boiled or in the form of steam omelet)potatoes, rice, jelly, jelly, blueberry, ripe pears and other fruits and berries, cheese soufflé, dried bread.As for drinks, you can drink tea, black coffee, cocoa, water, broth hips, wild cherry and blueberry.
After cupping of exacerbation of ulcerative colitis inflammatory drugs taken within six months.Next, perform a control colonoscopy.In the absence of inflammatory changes in the colonic mucosa treatment is terminated if the picture is stored endoscopic disease, prolong treatment for another 6 months before the next study.
need to prepare for the planned fibrocolonoscopy.Most simply do this using Fortrans drug.On the eve of the study need to stick to the diet mentioned above, immediately before the study can drink tea.On the day of study drug after dilution 1 sachet per 1 liter of water (quantity depends on your bags weight) of drink in divided portions over 4 hours.Chair terminated after 3 hours after the last dose.You can then perform a colonoscopy.
Complications of ulcerative colitis
In the absence of timely treatment may develop complications:
• life-threatening bleeding;
• toxic dilation of the colon - the excessive expansion of the diameter of the colon as a result of the termination of peristaltic contractions due to the pronounced inflammation of the mucosa.Thus there is a stagnation of the intestinal contents, which is absorbed into the bloodstream and has a toxic effect on the body as a whole.Eliminate this condition is possible by colonoscopy with removal of the contents of the intestine.In the absence of timely help you receive the following complication;
• perforation of the colon - a violation of the integrity of the gut wall, accompanied by the outpouring of intestinal contents into the free peritoneal cavity with peritonitis (inflammation of the peritoneum) and sepsis (blood poisoning);
• colon cancer can occur with prolonged duration of ulcerative colitis, so people over 50 years old, you must routinely undergo colonoscopy;
• extra-intestinal complications - ulcerative colitis can cause the development of arthropathy (swelling and pain in the large joints), liver disease, biliary tract, skin (pustular rashes - pyoderma).
prevention of ulcerative colitis
To date, no preventive measures are developed ulcerative colitis.Prevent the development of complications is possible only by prompt diagnosis and treatment of disease.
As the great scholar Hippocrates: "One must know how to help yourself in the disease, keeping in mind that health is the highest human wealth."Take care of your health.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS