Inflammatory Diseases Of The Small And Large Intestines Flashcards
Diarrheal-inflammatory syndrome
Characterized by morphofunctional abnormalities of the gastrointestinal tract in the form of diarrheas and by inflammatory disorders in the form of toxicoallergic manifestations.
The most common reasons of the diarrheal-inflammatory syndrome are ulcerative colitis and Chron’s disease.
Definition: Diseases with Diarrheal-inflammatory syndrome
Disfunction of the small and large intestines as a result of the topical chronic ulcerative granulomatous nonspecific inflammation and systemic dehydration, toxic and exhausting exposure.
Diarrheal-inflammatory syndrome causes:
А) Change of reactivity of the organism.
B) Psychoemotional stresses.
C) Influence of infection.
D) Allergization of the organism.
E) Pathologic inheritance.
Clinical signs of inflammatory diseases of the small and large intestines:
А) Complaints:
- pain in the abdomen along the large intestine;
- susceptibility to constipations;
- blood, pus and mucus discharge with feces;
- body temperature rise, fever;
- dehydratation;
- intoxication;
- emaciation.
B) Anamnesis: development of the disease may be acute or gradual.
C) Objective signs:
а) signs are distinctive for affection of the small and large intestines (indigestion);
b) generalized abdominal tenderness, local tenderness in the lesion focus or all along the large intestine;
c) digital examination of the rectum.
Making of primary diagnosis according to clinical findings.
inflammatory diseases of the small and large intestines
Primary diagnosis is made on the basis of patient’s complaints, anamnesis and objective signs of the disease that confirmed by physical examination methods.
To confirm or specify diagnosis the diagnostic program is formed, it includes digital and instrumental examination of the rectum and colon that influence on the diagnosis clarification.
Diagnostics of inflammatory diseases of the small and large intestines:
А) Laboratory diagnostics:
- CBC and urinalysis;
- blood chemistry;
- coagulogram;
- microbiological and immunobiological diagnostics.
B) Instrumental diagnostics:
- rectal speculum examination;
- sigmoidoscopy;
- colonoscopy;
- irrigoscopy and irrigography.
Definition: Ulcerative colitis
Chronic diffusive ulcerative-necrotic inflammation of the mucous and submucous membranes of the colon and rectum.
Causes of ulcerative colitis
Polyetiologic disease.
Signs and symptoms of ulcerative colitis:
А) Complaints:
а) non-expendable watery excrements:
- blood admixtures;
- pus in feces;
- mucus in feces;
b) tenesmus, false urges to defecate;
c) stomachache:
- intermittent pain;
- pain is localized along the colon;
d) general manifestations:
- fever up to 39–40 °С;
- weight loss;
- dehydration and intoxication of various intensity;
- edemas of the feet and shins.
B) Anamnesis: describes onset and development of the disease.
C) Objective signs:
а) visual examination:
- skin paleness;
- signs of intoxication;
b) palpation:
- spasm of the large intestine;
- palpatory tenderness in the projection of the colon;
- digital examination of the rectum.
Clinical signs of the ulcerative colitis depend on:
А) Course of disease: а) acute course: - sudden dysentery-like onset; - development of clinical presentation in the course of 1–3 days; - intoxication and dehydration;
b) chronic recurrent course:
- alternation of the exacerbation and remission periods;
c) chronic continuous course:
- frequent relapses of the disease or permanent exacerbation;
- aggravation of severity of the patient’s condition in the course of 6 months after the first attack.
B) Phases of the process:
а) exacerbation phase;
b) remission phase.
C) Degrees of the process activity according to colonoscopy:
а) minimal:
- hyperemia, swollen mucous membrane;
- absence of the normal vascular pattern of the mucosal membrane of the bowel;
- contact bleeding of the mucosal membrane of the bowel;
- absence of erosions and ulcers in the mucosal membrane of the bowel;
b) moderate:
- significant edema of the mucosal membrane of the bowel;
- spontaneous bleeding of the mucosal membrane of the bowel;
- multiple erosions and ulcers of the mucosal membrane of the bowel;
- bloody discharge from the bowel and purulent mucus;
c) pronounced:
- significant contact and spontaneous bleeding of the bowel mucosa;
- multiple erosions, ulcers, pseudopolipus of the bowel mucosa;
- blood and pus in the intestinal mucosa.
D) Degrees of severity of the disease:
а) mild:
- general condition of the patient is satisfactory;
- normal body weight;
- normal body temperature;
- predominant complaints of the dyspeptic occurrences;
- periodical moderate abdominal pain;
- constipation or diarrhea with frequency of defecation up to 5 times per day;
- loss of blood with с feces up to 20 ml per day; feces with mucus and blood;
b) medium:
- asthenization of the patient;
- 10% weight loss;
- body temperature rise up to 37,8 °С;
- signs of hypovitaminosis;
- constant abdomen pain;
- swelling, rumbling, tenesmus, diarrhea up to 6–10 times per day;
- in feces – blood, mucus, pus;
c) severe:
- general weakness, fatigability, absence of appetite;
- weight loss more than 20%;
- body temperature rise up to 38,5 °С and above;
- symptoms of intoxication;
- malabsorption, indigestion;
- abdominal pain;
- often vomiting, tenesmus, false defecation urges, diarrhea occurs oftener than 10 times per day;
- loss of blood with feces exceeds 50 ml per day;
- blood, mucus and pus admixtures in feces.
E) Presence of complications: а) local: - perforation of the bowel; - intestinal bleeding; - stricture of the bowel; - pseudopolyposis of the large intestine; - toxic dilatation of the colon; - intestinal fistula; - malignization;
b) systemic:
- sepsis;
- secondary immunodeficiency;
c) extraintestial:
- hepatitis;
- sclerosing cholangitis;
- stomatitis;
- erythema nodosum;
- pyoderma gangrenosum;
- episcleritis;
- polyarthritis.
Diagnosis:
ulcerative colitis
А) Instrumental methods of examination:
- rectal speculum examination;
- sigmoidoscopy;
- colonoscopy
- irrigoscopy and irrigography
B) Laboratory tests:
- CDC and urinalysis;
- blood chemistry;
- coagulogram;
- microbiological and immunobiological examinations.
Differential diagnosis:
ulcerative colitis
- Crohn’s disease;
- cancer of the large intestine;
- acute dysentery.
Clinic-statistical classification of ulcerative colitis:
ICD10 Diagnosis Code К 51 Ulcerative colitis
Layout of clinical diagnosis: {XX} Ulcerative colitis {with lesion of LX} {FX phase,}
{IX degree of activity} {TX} {complicated by OX}
Course of disease:
X1 acute
X2 chronic recurrent
X3 chronic continuous
Localization: L1 rectum L2 rectum and the sigmoid colon L3 subtotal lesion of the colon L4 total lesion of the colon
Phase of disease:
F1 exacerbation (acute condition)
F2 remission
Degree of activity (according to colonoscopy):
I1 minimal
I2 moderate
I3 pronounced
Degree of severity:
T1 mild
T2 medium severity
T3 severe
Complications:
O1 local in the form of {RX}
(R1) perforation
(R2) bleeding
(R3) stricture
(R4) pseudopolyposis
(R5) toxical dilatation of the bowel
(R6) intestinal obstruction
(R7) malignization
O2 systemic in the form of {RX}
(R1) sepsis
(R2) secondary immunodeficiency
O3 extraintestinal manifestations in the form of {RX}
(R1) hepatitis
(R2) sclerosing cholangitis
(R3) stomatitis
(R4) erythema nodosum (nodal fever)
(R5) pyoderma gangrenosum
(R6) episcleritis
(R7) polyarthritis
Treatment of ulcerative colitis:
А) In remission phase outpatient maintenance(supportive) therapy (preparations of 5-aminosalicylic acid).
B) In exacerbation phase inpatient treatment:
а) medical/therapeutic treatment (depending on the degree of severity of the disease and activity
of the process in the intestine):
- dietic food (in mild or moderate course of the disease split meals 56 times a day, a little at a time, exclusion from the dietary intake of the whole milk, fruits, vegetables, white bread, in severe course parenteral nutrition);
- antimicrobials (preparations of sulfasalazine with oral administration, in enemas up to 12 month);
- antidiarrheal drugs (smecta, loperamide);
- steroid hormones (prednisolone, hydrocortisone);
- systemic medication (parenteral introduction of vitamins В, С, А and folic acid);
b) surgical treatment:
• Absolute indications for surgical treatment:
- perforation of the bowel;
- toxic dilatation of the large intestine;
- colonic stenosis;
- profuse bleeding;
- malignization.
• Relative indications for surgical treatment:
- severe disease course;
- ineffectiveness of the performed complex therapy.
• Choice of the surgical method;
- at absolute indications – colproctectomy, colectomy with formation of single-barreled or doublebarreled ileostomy;
- at relative indications – colproctectomy, colectomy with formation of single-barreled or double-barreled ileostomy or with bringing of the small intestine or remains of the colon down into the anal canal.
Work capacity examination and rehabilitation of patients:
ulcerative colitis
А) Patients suffering from ulcerative colitis have to be under the constant dynamic observation with performance of antirelapse treatment courses and, in case of the slightest signs of exacerbation, patient requires hospitalization for performance of complex therapy.
B) For patients after surgery, their degree of disability is to be determined.
C) Performed treatment gives temporary effect and patient requires periodic treatment.
