Transcript chronic enteritis and colitis

Department faculty and hospital
therapy of medical faculty and
department internal diseases of
medical prophylactic faculty.
• Chronic enteritis.
• Chronic colitis.
As a person digest food?
Chronic enteritis - poly etiological
disease of the small intestine
characterized by the development of
inflammatory-degenerative processes,
regenerative discrete changes, atrophy
of the small intestine mucosa of varying
degree, a violation of all functions of the
small intestine, primarily absorptive and
digestive.
The structure of the
digestive tract
The structure of the small
intestine
Etiology and pathogenesis
Main aetiological factors: infection,
nutritional factors, parasitic infestations,
toxic effects, the abuse of certain drugs,
radiation exposure, mechanical stress,
genetic factors, developmental
abnormalities of the intestine, etc.
Leading pathogenic mechanisms intestinal dysbiosis, allergies (microbial ,
food allergy, allergic tissue), congenital
and acquired enzymopathy.
Classification of chronic enteritis (AV Frolkis,
1996, as amended).
1. Etiology.
1.1. Infectious
1.2. Parasitic.
1.3. Toxic.
1.4. Medication.
1.5. Nutritional.
1.6. Radiation.
1.7. After operations on the small intestine.
1.8. Congenital anomalies of the intestine and
enzimopaty
1.9. In case of insufficiency ileocecal valve and
the major duodenal papilla.
1.10. Secondary (other diseases)
Classification (continued)
2. The preferential localization.
2.1. Chronic jejuunit.
2.2. Chronic ileitis.
2.3. Chronic total enteritis.
3. The character of morphological changes in thin
(lean) intestine.
3.1. jejunit without atrophy.
3.2. jejunit with moderate partial villous atrophy.
3.3. With subtotal villous jejunit atrophy.
4. clinical course.
4.1. Mild course.
4.2. Moderate.
4.3. Severe.
Classification (continued)
5 .Phase of the disease.
5 1. Phase of exacerbation.
5.2. Phase of remission.
6. Character of functional disorders of the small
intestine.
6.1. Deficiency syndrome digestion (maldigestion).
6.2. Deficiency syndrome intestinal absorption (malabsorption).
6.3. Exudative enteropathy syndrome.
6.4. Syndrome multifunctional failure of the small
intestine (enteral insufficiency).
7. The involvement of the colon.
7.1. Without a concomitant colitis.
7.2. With concomitant colitis.
8. extraintestinal disorders
CLINIC
Local
symptoms
Common
symptoms
Local symptoms
1. Diarrhea (diarrhea), 4-6 times a day
2. Poly feces
3. In the stool remnants of undigested food
4. Steatorrhea "toilet stool smears“
5. Flatulence and rumbling in the stomach
6. Abdominal pain (at the navel)
7. Abdominal distention
8. Tenderness
9. Deficiency syndrome ileocecal angle
10.Reflux enteritis
Common symptoms
(due to disturbances of intestinal absorption)
1.
2.
3.
4.
5.
6.
Epigastric pain
Dyspeptic disorders
Gastratrophia
Reactive hepatitis
Reactive pancreatitis
Symptoms of dumping syndrome, or
hypoglycemia
7. Loss of flesh
8. Trophic disorders (dry skin, hair loss, increased
fragility of the nails)
9. Metabolic disease, hypoproteinemia
Common symptoms
(due to disturbances of intestinal absorption)
10.
11.
12.
13.
14.
15.
16.
17.
18.
Hypopolyvitaminose
Hyponatremia
Hypokalemia
Atrophic stomatitis
Paradontapatiya
Anemia (by B12)
Neurodermatitis
OEdema
Decreased libido
Coprogram in chronic enteritis
• Physical properties: light brown color,
texture or dense pappy (cal decorated).
• Chemical properties: pH 6.5-7 (slightly
acidic - neutral), the reaction of bilirubin
in the positive or negative, reaction to
stercobilin - positive reaction to an
inflammatory protein and white blood cells
- positive.
• Microscopy: a combination of soaps and
fatty acids or soap in large quantities
Diagnosis of chronic enteritis
I. To diagnose ch. Enteritis
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Signs of malabsorption:
test with a load of D-xylose
chemical study of the daily allocation of oil by van de
camera
radioisotope methods to load the isotope fatty acids, fat,
albumin, vitamin B12
Jodi kali tests
Sconoperphuse method
enteral scatological syndrome: steatorrhea, amylorrhea,
creatorea
in the intestinal juice: enterokinase () alkaline
phosphatase () in violation of food-cooking
cavitypeptidase,  -amylase ()
entero biopsy
DIFFERENTIAL DIAGNOSIS
chronic enteritis
1. Infectious intestinal diseases
(dysentery, typhoid, cholera, etc.)
2. Tumors of the intestine, sprue
3. Habitual constipation (spastic colitis)
tuberculosis of the intestine
4. Chronic pancreatitis, NUC
Treatment of chronic enteritis
1. Diet (diet options № 4)
2. Antibacterials (intestinal action)
3. Derivatives of 8-hydroxyquinoline
(intestopan, meksoferm,
meksaze),Bactrim
4. Nitrophuran Drugs (furazolidone,
furadonin)
5. Biologics (colibacterin, bifidum-bakterin,
bifikol, Linex, bacteriophages)
6. In severe cases - corticosteroids low rate
of 5-7 days of 20-40 mg per day, to
support. 5.10 mg
Treatment with ch. Enteritis (continued)
7. Protein preparations.
 Metiluratsil pentoksil (anti-inflammatory and
immuno respect to the stimulating effect)
 In severe cases – immunosuppressants
 Vitamins, anabolic hormones, salts of Ca, Mg,
Co, anemia - iron supplementation
 Enzymes, hydrochloric acid with pepsin
 With diarrhea - reasek, codeine, etc.
 To stimulate the intestinal absorption ephedrine Inderal, aminophylline
Chronic colitis
• Chronic inflammatory and
dystrophic disease of the colon,
leading to mucosal atrophy and
dysfunction of the bowel.
• Etiology and pathogenesis
Main aetiological factors: infection,
parasitic infestations, toxic effects,
the abuse of certain drugs, radiation
exposure, mechanical stress, genetic
factors, etc.
Leading pathogenic mechanisms intestinal dysbiosis, allergies
(microbial, food allergies, allergic
interstitial) congenital and acquired
enzymopathy.
• Classification of chronic colitis
by AA Askarov and WA Askarov (1969)
• I. On the etiology and pathogenesis:
• 1. Infectious colitis:
- Specific
- nonspecific
• 2. postinfectious colitis
•
3. Parasitic colitis: protozoan
helminthic
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4. colitis nutritional
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5. Toxic colitis: endogenous
exogenous
6. Colitis and allergic toxic allergic: medical
food
7. Neurogenic colitis – dyskinetic
8. colitis mechanical
9. Colitis on the basis of developmental abnormalities and
the
location of the colon.
•
10. colitis secondary
•
11. Colitis of unknown etiology
• II. By the nature of anatomical changes and the
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localization process:
1. By the nature of anatomical changes: catarrhal,
erosive, atrophic, mixed.
2.Po preferential localization process:
a) pancolitis
b) segmental colitis: right, transversitis, left-sided
c) enterocolitis
III. By the nature of functional disorders of intestinal
spasms, atonic, and combinations thereof.
IY. On the severity of the disease:
Mild form
Moderate - Severe
severe form
• Y. By stage of the disease:
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•
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1. phase exacerbation
2. phase damping
3. remission
YI. By type of course: a chronic, latent, recurrent,
rapidly progressing, and sharp, lightning-like in the cases
of ulcerative colitis.
YII. The presence of complications:
Uncomplicated forms.
Complications: a) colitis with local (from the intestine)
complications, and b) colitis with the overall system
complications
YIII. Outcome: complete recovery, clinical
improvement, significant improvement, deterioration.
Chronic colitis
CLINIC
Local
symptoms
Common
symptoms
Local symptoms
1. Diarrhea and constipation
2. Diarrhea are frequent in distal colitis
3. "Diarrhea - Alarm“
4. Pain in lower abdomen on the left more
5. Flatulence and rumbling in the stomach
6. Intestinal colic
7. In a lot of mucus stool, starch
8. The cecum is stretched, painful
9. Often tenesmus
10.Coprogram: leukocytes, red blood cells,
11.muscle cells of the epithelium, there is no
food residue
12.Sigmoid colon spasm, painful
Common symptoms
1. Irritability
2. Headaches
3. Poor sleep
4. Language with the imprints of the
teeth, swollen
1.
2.
3.
4.
5.
Diagnosis of chronic colitis
Sigmoidoscopy (with biopsy)
Colonoscopy
Scatological survey
Biochemical study of fecal
(enterokinase, alkaline phosphatase,
soluble protein)
X-ray investigation (a pariah by passage
colon irrigoscopy)
Coprogram in fermentation
dysbacteriosis (colitis)
• Physical properties: consistency pappy,
frothy, with mucus
• Chemical properties: pH 5-5.5 (the
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reaction is strongly acidic), an
inflammatory reaction to the protein and
white blood cells - positive reaction to the
bilirubin positive or negative reaction to
stercobilin - positive.
Microscopy: digestible fiber, starch
intracellular and extracellular,
pathological iodophilic flora.
Treatment of chronic colitis
1. Diet - Table № 4
2. Therapeutic enema
3. Normalizing the intestinal motility of
funds (salt laxative not shown)
4. Physiotherapy, exercise therapy
5. Effects on CNS