What it means to be affected by colitis?
- Gastroepato
- Gastroenterology
- Colitis
- Constipation and diarrhea
- Constipation
- Constipation, the causes
- Constipation, diets for constipation
- Laxative abuse, melanosis coli
- Why acute and chronic diarrhea?
- Malabsorption syndrom
- Food allergy
Doctor, have I a colitis?
There
is a lot of confusion around the topic "colitis" . In fact the
subjects that report occasional diarrhea discharges, perhaps connected to
stressful events (for example, discharges during an exam or a lite!), They
certainly do not suffer from colitis, that is a specific process of inflammation
of the colonic mucosa, particularly located at the rectum-sigma in most cases,
ie they do not suffer from an inflammatory bowel disease. In most cases, it is a
common irritable bowel syndrome which, however annoying, recognizes a motor
disorder of the colon, with painful spasms, even if in recent years the theory
that an inflammation, though modest, is at the base of irritable bowel syndrome.
It is expressed in the varieties with constipation and / or diarrhea, and can be
associated with crampiform pains of the "a colic" type, that is accentuated and
reduced, referring to the lower abdomen, in the left iliac fossa, mainly, that
is at the bottom of the left flank, generally correlable with gas and lumen
dilations; for this purpose we have spoken extensively about our site of
important intestinal symptoms, including abdominal pain and surgical abdominal
pain.
Classification of colitis
The intestinal colitis inflammations of the mucosa are determined by specific causes
(for example, infections) and from non-specific causes as well as in inflammatory
bowel disease. Infectious colitis are characterized by diarrheal discharges and
depend from a bacterial etiology in 50% of cases, eg. Campylobacter jejuni, Salmonella
spp and some pathogenic bacteria such as E. coli. But in other cases the etiology
is viral, such as in infections with rotavirus.
infectious colitis
Typhoid and Paratyphoid fever
Are caused by Salmonella typhi and paratyphi, A and B, bacterial diseases that people
contracted orally through contaminated food (eg. Vegetables grown with sewage, mussels
grown in standing water, etc ..). After Incubation of 7-20 days, the first symptoms
are fever, anorexia, bradycardia. After other symptoms appear, a macular rash of
pink, splenomegaly, vomiting and diarrhea, with the involvement of the lymph tissue
Peyer's patches along the longitudinal axis of the intestine that can give ulcerations
oval. Diarrhea is a characteristic color that defines the color of pea puree, greenish
and is accompanied by abdominal bloating, leukopenia (that is another sign of the
disease is the decrease of white blood cells).
Diagnosis.
The diagnosis provides the positive Widal test, at the end of the 2nd week, that
is, after the incubation period, whereas the blood culture can be positive in the
first 7-10 days and the coproculture after the third week.
Therapy
Chloramphenicol in 4 doses / day, at doses up to 1 mg x kg. The therapy should
be continued for nearly 15 days. Clinical recovery is characterized though 3 stool
cultures are negative. Alternatively, you can use Thiamphenicol, or ampicillin 100
mg / kg / day or clotrimoxazolo. And '' Clearly, you need to provide intravenous
fluids to the patient dehydrated. To tell if a patient is dehydrated must observe
the tongue of the patient, who appears sharp and dry, like a parrot); You will,
therefore, be administered into a vein fluids, saline and glucose solutions. If
there is a enterorragia, you need to put an ice bag on the abdominal surface and
if there is a severe toxemia treatment with cortisone, for example predisone 40
mg IV is indicated. The typhoid bacillus carriers should be treated with ampicillin.
Prophylaxis for those who came into oral contact obtained by vaccines, even with
agents live and attenuated.
YERSINIA.
Y. enterocolitica or pseudotubercolosis infections can cause gastrointestinal disease.
It is a gram negative bacterium, anaerobic optional that can cause infections in
humans and in animals. It is transmitted by the fecal oral route. The Y. enterocolitica
can make in children and young adults a syndrome similar to appendicitis and is
responsible for most cases of gastrointestinal disease in temperate climates. In
adults you can have nodouses erythema and reactive arthritis, and toxic megacolon,
myocarditis, and glomerulonephritis. The symptoms may last for several months. The
diagnosis is difficult and is done by coproculture. The survey RX direct examination
of the small intestine shows nodularity and superficial ulcers. The infection occurs
mainly in children and is responsible for adenites; test used to diagnose is that
the cultural and serological tests.
Abdominal tuberculosis.
The tuberculous enteritis can develop as a primary intestinal lesion or as a secondary
lesion in from another location. The enteritis tubercolaris is often secondary to
pulmonary location; Mycobacterium infection with bovine tuberculosis is rare, thanks
to treatments for the central milk pasteurization. The symptoms are nonspecific:
fever, night sweats, weight loss and anorexia, nausea, and intestinal discomfort
or diarrhea affecting half of the patients. The ileocecal region is the most frequently
affected; sometimes there is a palpable mass in the right iliac fossa, a positive
Mantoux reaction (ie for TB) may be useful for diagnosis. Radiological images remind
us of Crohn's disease with ulceration and stenosis of the distal small intestine.
There may be lesions of the intestinal mucosa similar to Crohn's disease, such as
ulceration and stenosis, and ipertrophia. There are other features mucosal lesions:
confluent granulomas, expression of a chronic inflammatory process that attracts
the cells of the white line in epiteliod transformation. Granuloma, as a result
of the chronic inflammatory process with deposition of fibrous tissue that determines
stenosis and inflammation.
Colitis by shighelle and entoameba histolytica.
These diseases are characterized by acute diarrhea and blood in the stool, with
leukocytes. Rectal biopsy performed endoscopically shows specific injuries as marked
edema, mucosal erosion, which is friable and bleeding, infiltrates with leukocytes
and presents destruction of the epithelium and crypts rarefied. In ulcerative amebical
the infection is caused by Entamoeba histolytica, and is a feature tropical areas
infection, due to poor hygienic conditions, which can also infect the liver, by
a cyst, called amebical cysts. The cystic amebical is the most widespread form of
cysts in the environment; it reaches the human intestine being contained in contaminated
food. In the intestine it becomes movable trophozoita, which represents the vegetative
form: it is possible, however, that these cysts do not cause symptoms. Amebic disease
has several clinical aspects; we can have the condition of asymptomatic carrier,
or the form of severe and acute colitis. Colitis is characterized by abdominal pain
with spasmodic emission of your diarrhea, watery and bloody stools and mucus. It
'also possible to obtain the intestinal perforation in the more severe forms. Sigmoidoscopy
show in 80% of cases, the typical sores, represented by bleeding ulcers with multiple
surfaces, usually located blind intestine and / or the rectum, are the circular
ulcers that can penetrate the muscular layer of the intestinal tube, with thin edematous
edge.
Diagnosis. Amoebas are evident in fecal smear too. However, the diagnosis is made
by serological tests, in order to make a differential diagnosis with chronic inflammatory
bowel disease. With the chronic form can be determined stenosis and amoeboma, due
to large masses granulomatoses (result of chronic inflammation). The quick answer
metronidazole, 500 mg 3-4 / day for 7-10 days to make a difference with cancer lesions.
During the histological examination of amoebomi, however, amoebae are easy distingued
by color PAS.
Cytomegalovirus colitis.
CMV is not responsible for the symptomatic colitis in immunocompetent individuals,
but in AIDS patients or cyclosporine therapy immunosuppressed. CMV is responsible
for a life-threatening illness, because the therapy is limited. The virus is responsible
for ischemic heart shape with deep mucosal ulcerations and bowel perforation.
Schistosomiasis
The S. affects more than 200 million people in developing countries; Schistosoma
mansoni and S.japonicum can induce proctocolitis because they lay their eggs in
the venous system of the superior mesenteric vein system (female S. japonicum),
while S. mansoni in the inferior mesenteric vein system. The affected intestinal
mucosa ulceration has raised, with polypoid lesions and granulomatous reactions.
Schistosoma can also go to the liver by the portal system to a presinusoidal position,
where it is responsible for a granulomatous reaction, as a result of obstruction
and portal hypertension flow presinusoidal portal. Constant is the identification
of peripheral eosinophilia, hepatosplenomegaly, lymphadenopathy, and proctitis with
friable mucosa.
ASPECIFIC And ULCERATIVE IDIOPATHIC
Pseudomembranous colitis.
Training pseudomembranous on colonic mucosa is an event that can occur in cases
such as highly variable in mercury poisoning, intestinal ischemia or broncopolmonitis,
but especially in antibiotic-associated colitis. In one third of the subjects symptoms
resolve with discontinuation of antibiotic therapy, even when it was used metronidazole,
which is generally used for its resolution. It seems that the Clostridium diffcult
is the patogeneticoi agent, because you lose the normal intestinal flora, microbiota.
The secretes C. diffcult least three heat-labile toxin, and even if the toxin A,
B and C all lead to the accumulation of fluid in the small intestine, toxins A and
C also cause disepiteliation, but only A is responsible for the necrosis and serious
bleeding. The clinical picture is represented by profuse diarrhea, abdominal cramps
and abdominal sedabile not, because of the widespread use of antibiotics. Abdominal
RX shows nonspecific signs: swelling bowel loops. The pseudomembrans are formed
by a series of small yellowish plates, with many foci and crypts destroyed.
Crohn's disease and UC
The non-specific inflammatory processes (terminal ileitis) affecting the rectum,
sigmoid and ileum. The colonoscopic investigation in CD documents the presence of
severe, confluent, linear and serpiginous ulceration of the mucous membranes, sometimes
with pebbles appearance. The right colon is more interested than the left from Crohn's
disease. The appearance of fistulas is characteristic. Ulcerative colitis is generally
limited to the rectum-sigma; It affects the rectum and the proximal colon. The symptoms
are bloody diarrhea and rectal spasm. And 'possible association with skin lesions:
pyoderma gangrenosum. The mucosa of the rectosigmoid endoscopic appears finely granular,
hyperemic, bleeding and friable, up to the third degree of proctitis framework characterized
by severe ulcers, bleeding from contact when passing the instrument. Ulcers are
in the shape of circular craters in the rectum and radiological examination of the
colon with barium shows a mucosa that sometimes takes aspects pseudopolipoidi (post-inflammatory
polyps). The risk of perforation is possible, or intractable bleeding, toxic megacolon
bowel cancer. With the coprocoltural examination you can rule out infectious inflammation.
ischemic colitis.
And 'it caused by lack of circulation of blood in the colon, in atherosclerosis
of elderly patients. And it is caused by arterial embolism, dissecting aneurysm
of the abdominal aorta and by a series of vasculitic processes. The most vulnerable
areas are the splenic flexure and rectosigmoid region. The mucosa of the colon loses
its luster, and the mucosa appears with narrow lumen and bleeding that is pathognomonic.
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