COLITIS (colitis; lat. colon a colon + - itis) — inflammatory and dystrophic damage of a large intestine.
An etiology and a pathogeny
Acute To. most often are caused by pathogenic microorganisms (dysenteric bacteria, salmonellas, stafilokokka, streptococci, Proteus, amoebas, balantidiya, etc.), actions of allergic factors, food, etc. result from allergens, some medicines, at alimentary disturbances, infectious and viral diseases (e.g., at flu, malaria, pneumonia, sepsis, etc.).
Hron. To. can be a consequence of acute insufficiently effective treatment in cases, and also at patients with the lowered general body resistance. Most often hron. To. is caused by dysenteric bacteria though other microbes (salmonellas, staphylococcus, proteas, pathogenic strains of colibacillus, an amoeba, a balantidiya, a trichomonad, a lyambliya) can also cause development hron. K. Neredko reason hron. To. helminthoses are. It can develop also in the presence of the centers of an infection in an organism, especially in the bodies anatomically connected with intestines (in a gall bladder, a pancreas, etc.); at women the reason To. there can be an inflammatory process of bodies of a small pelvis.
An infestant in a stage of development hron. To. can sometimes be absent, but remain and can amplify arisen at inf. damage of intestines of change in motive, secretory (enzymatic) functions of intestines, dysbacteriosis amplifies, form patomorfol. changes of a mucous membrane.
At some hron, infections (tuberculosis, a brucellosis, etc.) development To. it can be caused by influence of toxins, and also direct localization patol, process in intestines. At hron. To. an alimentary origin the disease develops owing to long uniform food, the systematic use in large numbers of food hard to digest, abuses of spicy food, alcohol. Frustration of digestive glands matter disturbance (rhythm) of food and connected with it funkts; to development To. the food poor fiziol, stimulators of motor and secretory function of intestines, and also protein and vitamins, especially V. Prichina's groups hron promotes. To. there can be also a receipt in intestines of not enough food masses prepared for intestinal digestion (as a result of disturbance of chewing, in connection with diseases of a stomach and a small bowel, a liver, bilious ways, a pancreas). Hron. To. develop at intoxication heavy metals, alkalis, nek-ry medicines (a digitalis, salicylates, Dimedrol, etc.), at treatment by antibiotics of a broad spectrum of activity, at a renal and liver failure, a hyperthyroidism, an adissonovy disease.
Hron. To. (so-called secondary) arise at inflammatory diseases of other bodies of the alimentary system — at gastritis, cholecystitis, hepatitis, pancreatitis, a duodenitis, etc. In these cases the large role is played by viscerovisceral reflexes. Hron. To. also can be a consequence of disturbance of blood circulation at patients with diseases of cardiovascular system and cirrhosis. Besides, hron. To. are observed at impact of ionizing radiation.
Anomalies in situation and a structure of intestines (a dolichosigma, a megasigmoid and megacolon, a divertuculosis, a coloptosia), commissural process in an abdominal cavity also promote development hron. K.
Opisana hron. To. allergic etiology. They meet seldom and are a consequence of a food, bacterial and medicinal allergy. An allergic origin To. is confirmed by the allergic anamnesis and special allergological tests. The large role is played also by a condition of dysbacteriosis.
In special group allocate ischemic To., the resulting disturbances of blood circulation in mesenteric vessels (see. Intestines ). Most often they occur at aged people of 60 — 70 years suffering from the stenosing sclerosis, slowly developing thrombosis of mesenteric arteries.
The biggest group is made To. the mixed etiology, most often a combination inf. a factor (the postponed dysentery) with alimentary disturbances.
The disease is characterized by disturbance of motor and tonic activity thick, and in some cases and a small bowel; disturbance of secretory, excretory and vsasyvatelny functions of a large intestine (decrease in absorption in the right department, disturbance of a dynamic equilibrium of absorption and secretion of water and electrolytes in the left department); development of dysbacteriosis (change of quantity and a ratio of groups of microorganisms in a large intestine and appearance of representatives of normal microflora with signs of the increased aggression and virulence, settling of upper parts of a small bowel by associations of representatives of microflora of a large intestine), the inflammatory and dystrophic changes of a mucous membrane of a large intestine which are not seldom extending to a submucosa; sensitization of the receptor device of intestines; weakening of reactions of natural immunity (fabric and humoral), development of allergic reactions. The listed displays of a disease can meet in various combinations and be shown in various sequence, creating a difficult complex of the cause and effect relations.
Depending on etiol, a factor allocate the following forms K.: 1) infectious, 2) invasive (parasitic), 3) toxic (exogenous and endogenous), 4) alimentary (owing to food allergy, alimentary dyspepsia, and also the dyspepsia connected with inborn or acquired by enzymatic insufficiency), 5) medicamentous, 6) neurotic and neurotrophical (diarrhea neurotic, a proctomyxorrhea), 7) owing to mechanical damage of intestines, 8) the mixed etiology, 9) beam, 10) secondary (at diseases of other bodies), 11) the obscure etiology.
Clarification of an etiology hron. To. has paramount value in their prevention and defines a right choice of methods of treatment. However in most cases wedge, picture hron. To. it is caused not by an etiology of a disease, and localization and weight morfol. changes, character funkts, disturbances of intestines, reaction of a macroorganism to a disease, involvement in patol, process of other bodies and systems.
On localization To. divide on the sir colitis, preferential left-side To., preferential right-hand To., segmented To. (angular stomatitis, ileotyphlites, transverzita, proctosigmoiditis).
On the basis of data of an endoscopic research K. divide on catarral, atrophic and erosive and ulcer.
On a wedge, mark out to a current the nature of a disease — acute and hron. To.; a phase of a disease — remission or a recurrence; type of a course of a disease — monotonous, recurrent, latent, progressing; weight of a course of a disease — a lung, moderately severe, heavy; character funkts. disturbances of intestines — with dominance of ponos or locks, change of ponos and locks.
Inflammatory process at To. it is localized preferential in a mucous membrane and a submucosa of a large intestine. It can extend to a mucous membrane of all gut at total forms K., to occupy only the right departments (is more often a caecum and ascending) or the left half (at a proctosigmoiditis). Tubercular To. it is found in ileocecal area, for ischemic more often To. defeat of the left corner of a colon is characteristic.
By types of inflammatory reaction (see. Inflammation ) allocate catarral, fibrinous, necrotic and ulcer To.
Mucous membrane of a large intestine at catarral To. unevenly plethoric, edematous, with single erosion. On its surface translucent or slightly yellowish slime, occasionally with small impurity of blood is found. Sometimes in a gleam of a gut plentiful white dense masses in the form of the tapes which are not soldered to a mucous membrane accumulates (tsvetn. fig. 3). Microscopically in a mucous membrane of a large intestine at catarral To. dystrophic changes in a cover epithelium and increase in quantity of scyphoid cells in an epithelium of crypts are noted. In a mucous membrane along with a plethora of capillaries and small hypostasis increase in cellular elements, hl is observed. obr. lymphocytes, plasmocytes and eosinophils (tsvetn. fig. 4). At hron. To. the mucous membrane most often happens atrophied. In some cases kataralnoatrofichesky process is followed by closing of escaping of a crypt that leads to accumulation of slime and cystous expansion of a crypt. The mucosal surface of a cover at the same time is covered with a set of small cysts. Such changes meet at so-called superficial cystous To., unlike deep cystous To., at Krom cystous and expanded glands are found in the depth of a submucosa. Occasionally against the background of a catarrh or even without it in a mucous membrane of a straight line, is more often than the blind and ascending colon, a large number of the increased lymphoid follicles which are sticking out a mucous membrane is found (follicular To.). The hyperplasia of lymphoid follicles is more often observed at children.
At a fibrinous inflammation of a mucous membrane of a large intestine fibrinous exudate is located in the form of a film on its surface. Very seldom at the same time the croupous inflammation is observed, at Krom the fibrinny film lies on a mucous membrane and easily from it is removed (tsvetn. fig. 5). Sometimes such picture is observed at so-called pseudomembranous To., arising after reception of high doses of antibiotics, especially tetracycline row. The cover epithelium on a bigger extent is desquamated, and in those places where the mucous membrane remains, clots of fibrin are located over it in the form of bridges. In a mucous membrane small leukocytic infiltration with impurity of eosinophils, a plethora of small vessels, staza are found. Fibrinous imposings contain a large number of leukocytes, colonies of microbes, a desquamated epithelium and slime (tsvetn. fig. 6).
At necrotic To. diphtheritic process with a necrosis of a mucous membrane and a dense spayaniye of fibrinous exudate with the subject damaged fabrics is more often observed. At dysentery, uraemia, septic states, poisoning with mercury salts and other heavy metals the mucous membrane nekrotizirutsya more often in the field of tops of folds where fibrinous imposings of dirty-green color are located (tsvetn. fig. 9). At severe forms the inflammation takes all mucosal surface of a cover; microscopically it is kept only in deep departments. The submucosa is thickened at the expense of hypostasis, a plethora and infiltration by neutrophils, lymphocytes and a nek-eye quantity of eosinophils. Small vessels are considerably expanded, places with the phenomena of a fibrinoid necrosis, existence of fresh blood clots and perivasculites (tsvetn. fig. 10). The disturbance of microcirculation leading to a hypoxia and a necrosis of a mucous membrane is characteristic of the majority of intoksikatsionny, shock and radiation injuries of a large intestine.
Inflammatory ulcer process in a large intestine is most often observed at tuberculosis, a typhoid, shigelloses, syphilis, and also at an amebiasis and a schistosomatosis (tsvetn. fig. 7 and 8). Diagnosis of these diseases in many respects depends on detection of the corresponding activators, a wedge, manifestations and characteristic morfol, changes.
At ischemic To. in a wall of a large intestine there are various changes that depends on rates of development of occlusion of arteries, a condition of collaterals, degree and duration of falling of the ABP and other factors. Most often the necrosis of the site of a large intestine owing to acute thrombosis or an embolism of a mesenteric artery develops. Much less often the strikturiruyushchy form hron, ischemic meets To., caused by gradual delay of a blood-groove, development of a necrosis of a mucous membrane, an inflammation and a sclerosis of all layers of an intestinal wall. Typicalness of localization of changes at ischemic To. in the left (splenic) bend of a colon is explained by the fact that in this zone connection of collaterals between systems top and bottom mesenteric arteries is carried out.
A clinical picture
Acute To. are characterized by sudden emergence ponos (see), abdominal pains, meteorism (see), tenezm (see), frequent vomiting, fever. Ponosa, as a rule, profuse, with slime, it is frequent with impurity of blood. Pains usually diffuse, skhvatkoobrazny. The palpation of a large intestine is painful: sites of the inflated gut alternate with spazmirovanny. At a heavy current acute To. there can be symptoms dehydration of an organism (see), hypopotassemias (see) and hypochloraemia (see).
Current hron. To. it is characterized by the periods of an aggravation and remission. The reasons of an aggravation — intestinal or systemic infections, intoxications, alimentary disturbances, allergic factors, psychological influences, funkts, shifts in the endocrine sphere. The monotonous constant current hron is less often observed. K. Leading symptoms hron. To. abdominal pains and disturbances of a chair are. Pains differ on intensity and localization. The aching pains in the lower and side parts of a stomach are most typical. Localization of pains is, as a rule, caused by the place of damage of a large intestine. So, pan-colitis can proceed with diffuse pains on all stomach, at right-hand, left-side and segmented To. pains correspond to localization of process. Pains are seldom intensive, amplify, as a rule, after meal. After a chair and a passage of flatus of pain decrease. At distribution patol, process on a serous cover of a gut (perikolit) or regional limf, nodes (see. Mesadenitis ) pains gain constant character, amplify at the movement (especially during the jolting), defecations, a cleansing enema; thermal procedures strengthen pains (dirt, a diathermy, paraffin, ozokerite, hot-water bottles). At the accompanying ganglionitis the persistent, aching, periodically amplifying pains in epigastriß area or on all stomach, not connected with character and a rhythm of food, bowel emptying, physical are typical. tension. If in patol, process joins a rectum (a proctosigmoiditis, a proctitis, a sphincteritis), the pain syndrome concentrates in the field of an anus and arises or amplifies at defecation.
A meteorism — a frequent symptom of a disease.
The dispepsichesky phenomena are constant and various. Patients are disturbed by off-flavor or bitterness, and also dryness in a mouth, an eructation, nausea, heartburn, a sensation of discomfort in a stomach.
At most of patients appetite is broken: more often he is is lowered.
Disturbances of a chair are various. The same patient can have both ponosa, and locks during the different periods of a disease, and also their combination (an unstable chair). Often the so-called syndrome of insufficient emptying of guts meets: allocation of small amounts kashitseobrazny or liquid a calla, sometimes with impurity of the issued pieces, is frequent with slime, several times a day. At the same time patients complain of feeling of incomplete bowel emptying after defecation. Desires arise preferential in the morning with short intervals or right after food (the raised gastrorektalny reflex). Profuse ponosa are observed at hron. To. quite seldom also hl are inherent. obr. invasive To. At defeat of distal department of intestines, especially with involvement in patol, process of an anal orifice sick the frequent, quite often following one after another desires to defecation which are followed by tenesmus, department of gases and a small amount liquid a calla with impurity of slime disturb. So-called false desires at which only a small amount of slime and gases sometimes departs take place.
Hron. To. can be followed locks (see). The long delay of fecal masses in lower parts of a large intestine (sigmoid colonic and a rectum) sometimes causes irritation of a mucous membrane of a gut that promotes strengthening of secretion and secondary fluidifying of a chair. In some cases the lock on 1 — 2 day is replaced by frequent defecations with department originally firm a calla (a fecal stopper), and then foamy, fermentative or putrefactive fetid fecal masses. For such states the term «locking ponosa» was approved.
The general condition of the patient suffers a little. The lose of weight, symptoms of a vitamin deficiency come only at long observance of the sparing defective diet, during the involvement in patol, process of a small bowel and a liver or at patients with an asthenoneurotic syndrome. At purpose of a full-fledged diet symptoms of insufficiency of food quickly disappear. Often hron. To. is followed by the cardiovascular phenomena (on terminology of some authors, intestinal and cardial and intestinal and vascular syndromes). Cardiovascular frustration arise reflex, a wedge, their manifestations are various. Some patients have a spastic reduction of intestines, frequent defecation result in sudden weakness, emergence of cold sweat, dizziness, falling of blood pressure, a subconscious or unconscious state. In other cases, hl. obr. corpulent and elderly subjects with high standing have diaphragms at a meteorism, at a lock or insufficiently full bowel emptying there are heartbeat, heartaches, disturbances of a cordial rhythm. Cardiovascular frustration meet at persons with excitable century of N of page, at a combination of damage of intestines to heart diseases or vessels (atherosclerosis, coronary insufficiency, an idiopathic hypertensia) more often.
For patients hron. To. very characteristic sign are disturbances vegetative and the central nervous system. Vascular dystonia, lability of cordial activity, bent to spasms of smooth muscles is typical for such patients. As a rule, along with an acrimony there is a bent to a depression. They have a suppressed mood, they are concentrated on the feelings; often there comes «leaving in a disease». The arisen psychasthenic reactions in some cases are estimated as a hypochiondrial syndrome.
Morbidity at a palpation of a large intestine, existence of spazmirovanny sites and their alternation with the expanded, humming departments — characteristic symptoms of a disease. At accompanying replace (most often a perityphlitis) and a mesadenitis body temperature can be subfebrile, morbidity during a palpation especially sharp and is not limited to area of a large intestine, observed also at percussion of a stomach; zones the raised horse-flesh of sensitivity come to light (see. Zakharyina — Geda of a zone ), corresponding localizations of process. At mesadenites sharp morbidity at a palpation is defined around a navel, in an upper left quadrant of a stomach, on the middle of the line connecting a navel to a point of intersection of the left sredneklyuchichny line and a costal arch in the field of a projection of an inner edge of a caecum and a root of a mesentery of a small bowel.
Sharp morbidity at a deep palpation in an anticardium is typical for the accompanying ganglionites and on the course of the white line of a stomach (localization of a celiac texture and vegetative nerve knots about a ventral aorta).
Left-side To. it is characterized by pains in the left half of a stomach, frustration of a chair. The chair is liquid, kashitseobrazny, several times a day, without feeling of full emptying. Locks or more often «locking ponosa», as a rule, can take place the act of defecation strengthens pains. Palpatorno is defined the painful, intense sigmoid colon condensed and quite often hilly at the expense of the accumulated fecal masses. In the presence of this sign differential and diagnostic actions are very important for an exception of a tumor of a large intestine.
In development right-hand To., more often designated as a typhlocolitis or an ileotyphlitis, the leading place is taken such inf. diseases at which the infection extends limfogenno or gematogenno (e.g., tuberculosis, hron, tonsillitis, cholecystitis). Pain is concentrated in the right half of a stomach. At this form K. locks, ponosa, change of locks and ponos, and also a chair, normal on a consistence, are observed. The caecum at a palpation is painful, condensed, at the accompanying perityphlitis restrictedly is mobile. Involvement in patol, process regional limf, nodes and development of a mesadenitis is typical. The perityphlitis causes irradiation of pains in a waist, the right inguinal area. Pains, as a rule, accrue at physical. tension, walking, jolting. In Calais inflammatory elements (leukocytes, slime) can be found.
Segmented To. meet less often. Supporting, and in some cases and the defining role in development sigmoiditis (see) and the proctosigmoiditis is played by diseases of an anus — hemorrhoids, cracks, a sphincteritis, a paraproctitis.
Transverzit meets extremely seldom. It is clinically shown by the pains, rumbling and feeling of a raspiraniye in a middle part of a stomach arising usually right after food. The chair is characterized by change of a lock and a diarrhea. The sudden desire to defecation can soon appear after food reflex, owing to pressure from the crowded stomach upon a cross colon. Transverzit is followed by nausea, an eructation, sometimes the dysphagy arising reflex.
An angular stomatitis — the isolated defeat of the left (splenic) bend of a large intestine — a rare form hron. K. The pains reaching big intensity, which are localized highly in left hypochondrium are typical for it. Pains often irradiate in a breast and in a back. Reflex there can be heartbeat, heartaches etc. Features of character of a pain syndrome force to carry out careful differential diagnosis of an angular stomatitis with coronary pathology and pancreatitis. Pains at an angular stomatitis are followed by pressure sense and a raspiraniye in the left upper part of a stomach. Chair irregular: the lock is replaced by a diarrhea; the liquid chair is often preceded by loud rumbling in the left bend of a colon.
Complications at To. are caused close anatomic and funkts, interrelation of bodies of a digestive tract; they can develop as a result of reflex influences, intoxication and other influences from the struck gut.
Half of patients hron. To. have the accompanying changes in a small bowel. More often it funkts, disturbances — disorders of motor, secretory, vsasyvatelny and tonic activity of a small bowel. Also typical displays of enteritis can develop; in such cases the disease is defined as hron, a coloenteritis (see. Enteritis, coloenteritis ). Patients To. often suffer from accompanying gastritis (see); at many hemorrhoids, damages of a gall bladder and biliary tract — dyskinesia are observed, cholecystitis (see), an angiocholitis (see. Cholangitis ). A complication To. can be appendicitis (see). Heavy complications are the perforation of an intestinal wall, peritonitis, profuse intestinal bleeding arising at ulcer To.; acute intestinal impassability can arise at the strictures accompanying ischemic To., commissures in an abdominal cavity at replace.
the Diagnosis is based on data of the anamnesis, a wedge, symptomatology, indicators koprologichesky and bacterial. researches calla, endoscopic and rentgenol, researches.
At a koprologichesky research reveal inflammatory elements in Calais — slime, leukocytes, erythrocytes are more rare. Find in a number of patients so-called tsekalny kcal, containing yodofilny flora, undigested cellulose, intracellular starch (see. Kal ).
Dysbacteriosis comes to light at bacterial. a research a calla and contents from upper parts of a small bowel method of serial delution with crops on elective environments for each group of bacteria.
At an endoscopic research (see. Kolonoskopiya , Rektoromanoskopiya ) the most typical is the picture of a catarral rektosigmoidit. The mucous membrane of distal department of a large intestine is hyperemic in various degree, is edematous. The hyperemia usually happens diffusion. Expanded blood vessels of a submucosa, lymphoid follicles sometimes increased are visible. The mucous membrane can be covered with either the continuous mucous mass, or separate lumps and films of slime. Disseminated dot hemorrhages, easy vulnerability of a mucous membrane can be observed. As a rule, catarral rektosigmoidit is followed by a catarral sphincteritis (see. Anus ), hemorrhoids (see).
Much more rare at hron. To. the atrophic form of a rektosigmoidit is observed. In these cases the mucous membrane is represented thinned, smooth, light pink color with well visible network of vessels of a submucosa.
Radiodiagnosis To. it is based on identification funkts, and morfol, changes in a large intestine. The survey X-ray analysis of an abdominal cavity in the conditions of natural contrast is applied at suspicion on toxic dilatation) a large intestine or perforation of colic ulcers.
One of the main methods of recognition To., specifications of degree of prevalence of process and disease severity is irrigoskopiya (see). At the same time special attention is paid to studying of a relief of a mucous membrane of a large intestine in the conditions of a medicamentous relaxation. Its changes at To. are characterized by considerable diversity; a basic element of changes of a relief is swelling, change of contours of folds of a mucous membrane: folds become expanded, subauriculate, their number considerably decreases, sometimes up to total disappearance of folds at sharp inflammatory hypostasis of a mucous membrane, a sclerosis, an atrophy. The general drawing of a relief becomes wrong, the direction of folds changes; it is quite often possible to find cross going edematous folds. After recovery of the patient there can be a return of a picture of a relief of a mucous membrane to a reference state. Apply a technique of a double contrast study to identification of pseudopolypuses.
Funkts, a condition of a large intestine study by reception of a baric suspension inside. At the same time watch a passage of contrast weight and its distribution on a gut, estimate a tone, a smeshchayemost, haustration of a gut.
At hron. To. in case of dominance in a wedge, a picture of the phenomena of diarrhea hyper mobility of a large intestine is noted: in 24 hours after reception of barium the large intestine is free from contrast weight. Hyper mobility can extend to all gut or be limited to its separate segments. In case of dominance in a wedge, a picture K. locks rentgenol. the research establishes the slowed-down advance of contrast weight on a large intestine, edges is late in it to 72 — 96 hours and more. In some cases motor function of a large intestine can be changed slightly.
During the research by means of an opaque enema it is possible to find the intensive reductions of a gut reaching a segmented spasm (fig). Haustration of a gut has the wrong asymmetric character, its distribution on a gut uneven, deep gaustralny segmentations are formed in places. On contours of a gut small stepped appearance can be found.
Commissural process as a result of the perikolit complicating hron. To., it is shown in the form of deformations of contours of a gut and disturbance of its smeshchayemost that especially well comes to light during the research in lateropositions.
At segmented (regional) To. rentgenol, changes in the basic correspond to those which are observed at diffusion forms. However they come to light on a limited extent or in several segments divided by sites of not changed gut.
The differential diagnosis is carried out most often with funkts, frustration, hron, dysentery and an amebiasis. At the same time are guided by features a wedge, manifestations of each of these diseases, and also by data a lab. and tool researches.
The differential diagnosis is carried out also with other diseases of intestines (hron, enteritis, nonspecific ulcer To., a disease Krone, new growths of a large intestine, hron, appendicitis, etc.), with diseases of a stomach, duodenum, liver and gall bladder, pancreas, and also with diseases of the bodies lying out of system of digestion which symptom complex joins disorders of intestinal function (with coronary heart disease and heart failure, a renal failure, an allergy, diseases of endocrine system, diseases of a nervous system, hron, infections — tuberculosis, a brucellosis, collagenoses, etc.).
It is recommended kolonoskopiya (see) with a biopsy of a mucous membrane of a large intestine.
It is extremely important to differentiate hron. To. and hron, dysentery (see). On a wedge, to a current to distinguish them can be difficult. Recognition is based on data bacterial, researches a calla and on a rektoskopiya.
Most often it is necessary to carry out differentiation To. with hron, enteritis (see. Enteritis, coloenteritis ). A characteristic symptom of enteritis is various expressiveness of disturbance of food, first of all a lose of weight. The sprue is typical for heavy enteritis. At an easy current hron, enteritis the wedge, a symptomatology not always guarantees a possibility of differentiation with To. For specification of diagnosis it is recommended to use tool methods — kolonoskopiya), a gastroduodenoskopiya, an irrigoskopiya. In a wedge, practice simultaneous damage of a small and large intestine — a coloenteritis meets more often; specification of extent of involvement in process of thin and thick departments of a gut defines a right choice of therapy.
At the expressed picture ulcer nonspecific colitis (see) differential diagnosis does not represent difficulties. Difficulties arise at a dizenteriyepodobny onset of the illness and those forms ulcer nonspecific To., who in a certain span on a current remind usual K. V this period a kolonoskopiya and an irrigoskopiya can give essential help in diagnosis. The progressing aggravation of symptoms of the patient, emergence of fever, release of blood and pus from a rectum, changes in blood test (a leukocytosis and acceleration of ROE etc.) specify the diagnosis of ulcer nonspecific colitis.
A disease Krone (see. Krone disease ) at localization of process in a large intestine it can clinically be shown first as To. The subsequent development typical for a disease the Krone of signs (release of blood with excrements, fever, anemia etc.) facilitates differential diagnosis. Finally the diagnosis is confirmed with the help rentgenol, and a kolonoskopichesky research. The disease Krone needs to be excluded at a persistent and heavy current To.
At all forms K. careful examination of the patient for an exception of tumors shall be conducted intestines (see), and first of all polypose and cancer; emergence of blood at defecation and especially out of the act of defecation, not connected with an exacerbation of hemorrhoids guards.
Funkts, frustration which are united in the concept «irritable colon» are difficult concerning their differentiation with K. Eto especially difficult that in a symptom complex To. disturbances are included funkts. Significantly help diagnosis given the anamnesis, especially establishment of an etiology of a disease. Existence in the anamnesis of the reasons promoting emergence To is less characteristic of a syndrome of «the angry large intestine». — dysentery, disturbance of food. Wedge. differentiation is based on the characteristic of a syndrome of «the angry large intestine» suddenly appearing attacks of abdominal pains, their various localization, intensity and duration. Painful and spazmirovanny departments of a large intestine are defined by Palpatorno. Mucous colic (see. Colic mucous ) often comes to an end with plentiful mucifying in the form of the films or tapes containing eosinophils. During the period out of attacks health of the patient satisfactory. However only the irrigoskopiya or endoscopy can help the correct diagnosis.
Hron, appendicitis often proceeds against the background of hron. K. Differential diagnosis is promoted by the local symptomatology typical for appendicitis. But in some cases, especially at right-hand To. (a typhlitis, an ileotyphlitis) and the accompanying mesadenitis, recognition hron. appendicitis it is represented difficult. Establishment of the diagnosis is helped rentgenol, by a research.
Differential diagnosis with other diseases of the digestive system is difficult at the emergence of frustration of a chair, abdominal pains which are followed by a meteorism. In most cases these signs testify to the accompanying K. Odnako quite often they are manifestation funkts, the disturbances caused by a basic disease and are a consequence of motor disturbances, enzymopathies (see), dysbacteriosis (see). More often the specified symptom complex develops at patients hron, gastritis with secretory insufficiency (see. Gastritis ), after a resection of a stomach, at patients hron, cholecystitis (see), at liver and pancreatic failure; less often it takes place at peptic ulcer (see), later cholecystectomias (see). Data of the anamnesis, wedge, inspection of the patient with attraction of an irrigoskopiya and kolonoskopiya (if necessary with a biopsy of a mucous membrane) allow to specify the diagnosis.
The disorders of intestinal function arising at the diseases lying out of the sphere of the alimentary system can testify about accompanying To. or to be manifestation funkts, disturbances — motor, secretory, and also excretory activity, dysbacteriosis. The differential diagnosis is carried out with attraction of all methods used for diagnosis of diseases of other bodies.
Patients with acute To. and the expressed aggravation hron. To. it is reasonable to hospitalize. Treatment is directed to elimination of losses of water, sodium, potassium, to fight against an intestinal dysbiosis, normalization secretory, motor evakuatornoy functions of intestines, decrease in sensitivity of the receptor device of intestines, reduction of inflammatory reaction of a mucous membrane of a large intestine. Treatment is carried out to the periods of remission on an outpatient basis and in specialized sanatoria. By the main method of pathogenetic therapy hron. To. is to lay down. food. By means of a dietotherapy provide satisfaction fiziol, the needs of an organism for feedstuffs, stimulation of regeneration of an intestinal epithelium and processes of natural immunity, normalization secretory and motor evakuatornoy functions of intestines, improvement funkts, conditions of other digestive organs involved in patol, process — a stomach, a pancreas, a liver and biliary tract. The diet appointed to term more than 4 — 5 days contains fiziol, norm of proteins, fats and carbohydrates. Content of sodium chloride shall be on the lower bound fiziol, norms (8 — 10 g in a daily diet); taking into account contents 3 — 5 and sodium chloride in a daily set of products 5 more g are in addition entered.
A set of products and the nature of their culinary processing shall be defined by a condition of motor and secretory function of intestines and other digestive organs, a stage of a disease (a recurrence, remission), existence or lack of a pain syndrome, meteorism.
Bilberry, a bird cherry, a quince rich with tannin, pears, strong tea, cocoa on water belong to the products detaining a peristaltics; to the products of a viscous consistence which are slowly moving ahead on intestines — mucous soups, the wiped porridges, kissels.
For the purpose of reduction of secretion of intestinal juice limit the products rich with cellulose and organic to-tami: crude vegetables and fruit, groat and flour products with the increased content of cellulose are excluded or limited, special methods of culinary processing of meat and fish products are used (steam boiling or in water, wiping, homogenization).
During the periods of sharp aggravations hron. To. it is appointed 2 — a 5-day diet which is characterized by most expressed mechanical and chemical shchazheniye of bodies went. - kish. path: patients receive the white crackers fat-free rather weak beef-infusion and fish broths with addition of mucous broths, meat or fish quenelles, frikadely, egg flakes, the boiled wiped meat. Steam dishes from low-fat grades of meat and fish in a chopped look, the wiped porridges on water or the fat-free beef-infusion broth, dietary soft-boiled eggs and in the form of steam omelets, sugar to tea no more than 40 g a day, kissels, broths and bilberry jelly, a bird cherry, pears, a quince, a dogrose, sweet grades of apples, freshly cooked fresh cottage cheese, tea, coffee and cocoa on water are resolved; milk is completely excluded.
At improvement of a state, and also at absence from the first day of a disease of profuse ponos the diet providing rather expressed mechanical and chemical shchazheniye of bodies is appointed went. - kish. a path, but, unlike described above, physiologically full. It includes: the dried white bread, a dry biscuit, biscuit, 1 — 2 time a week limited quantity of well baked lean bakeries of products, soups on the weak fat-free beef-infusion or fish broth with well razvarenny fillers (grain, vermicelli, frikadelyam, vegetables, etc.); the low-fat meat peeled of fastion and sinews, boiled in water or on couple, boiled and steam fish of low-fat grades; puree, a souffle and .vareny vegetables casseroles, various porridges, except millet and pearl-barley, on water with addition 1/3 of milk; soft-boiled eggs and in the form of steam omelets (to 2 pieces a day); fresh milk only as a part of groat and vegetable dishes in limited quantity, acid milk drinks (kefir, acidophilus milk, acidophilic milk, etc.), at good tolerance not strong cheese, not acid sour cream no more than 15 g on reception, fresh cottage cheese; kissels, jelly, mousses, the wiped compotes, steam souffles from sweet grades I am year and fruit (except melons, apricots and plums), baked apples, pears, a zephyr, a fruit candy, jam from sweet grades of berries and fruit. Butter is added to ready dishes in number of 5 — 10 g for the portion depending on portability.
During remission To. the diet, similar on chemical structure, a set of products and methods of their thermal treatment, but without mechanical shchazheniye is recommended. All dishes are given in not wiped look, the range them extends. The soaked herring, low-fat ham, boiled vegetables sour cream salads are in addition resolved. Crude vegetables and fruit (100 — 200 g a day), the juice (apple, orange, bilberry, cherry) diluted with hot water join in a small amount. During the periods of permanent remission in the absence of cholecystitis, hepatitis or gastritis at a number of patients food can be more various; meat and fish can be fried without breading or are baked.
At purpose of a diet for patients with locks it is necessary to consider the factors which caused a lock, and a condition of digestive organs, especially a degree of activity of inflammatory process in a stomach and intestines. These factors define set and the nature of culinary processing of products.
Use of antibacterial drugs is shown at an aggravation of inflammatory process, dysbacteriosis, ponosa, not stopped use of a diet and astringents, at aggravations accompanying hron, cholecystitis. Appoint streptomycin, sulfanamide drugs (Sulfapyridazinum, sulfadimethoxine, sulfaguanidine, Ftalazolum, Disulforminum, Salazopyridazinum); derivatives of nitrofuran (furasolidone, furadonin); derivatives 8 oxyquinolines (Intestopanum, etc.). Appoint antibiotics of a broad spectrum of activity. Treatment shall be carried out by courses lasting no more than 7 — 14 days. For the purpose of suppression of growth of microbes in a small bowel it is better to use the low-absorbed drugs allowing to receive at purpose of small doses rather big concentration of drugs in intestinal contents and to avoid side reactions.
At purpose of high doses of antibacterial drugs for an appreciable length of time, especially at use of antibiotics of tetracycline group, dysbacteriosis in a large intestine, as a rule, amplifies. For the purpose of normalization of microflora of a large intestine in a wedge, practice pure growths of normal intestinal microflora are used (kolibakterin, bifidumbacterium, bifikol); they are appointed courses. At the long use they can cause an aggravation of the dispepsichesky phenomena and ponos in certain patients.
In treatment hron. To. the means regulating secretory and motor function of intestines are used. As addition to the main drugs nitrate the main, Dermatolum, Tannalbinum, white clay, the calcium carbonate besieged starch are appointed bismuth.
The knitting and antiseptic action medicinal plants (a St. John's Wort, alder cones, a camomile, leaves of an eucalyptus, etc.) which are used in the form of water tinctures and broths possess.
At the pains caused by disturbance of motor function of intestines taking into account inherent to the patient To. also antispasmodics (atropine, drugs of a belladonna, Halidorum, Spasmolytinum, Platyphyllinum, Nospanum, a papaverine, Gangleronum) in combination with anti-adrenergic substances (dihydroergotamine or dihydroergotoxin) are shown to vegetative dystonia cholinolytic. Their action amplifies at addition of small doses of barbiturates, mestnoanesteziruyushchy (novocaine, anaesthesin) and analgesic derivatives of pyrazyl ketone (analginum, pyramidon, antipyrine).
At the accompanying cholecystitises and angiocholites which strengthen dyskinesia) intestines, purpose of cholagogue means taking into account dysfunctions of intestines is necessary course (up to two-three months) with change of drugs.
At defeat of area of an internal sphincter of a direct and sigmoid colon topical treatment in a look is shown to lay down. microclysters and candles. This method of treatment promotes clarification of a gut from slime; a number of drugs stimulates a reparation of a mucous membrane, possesses bactericidal and antiparasitic action. Being soaked up, drugs have the soothing, anti-spastic, desensibilizing effect. Microclysters and candles regulate motor function of intestines. It is better to apply microclysters without preliminary cleansing enemas not to strengthen irritation of intestines. They are entered after a chair in the evening and keep before emergence of desires on a chair. Medicines are administered in number of 30 — 50 ml at t ° 38 — 40 °C by the help of the syringe with a rubber tip or the rubber ureteric catheter connected to the syringe in genucubital position of the patient or in situation on the right side. At an aggravation To., followed by the ponosa expressed by an abdominal cavity pains microclysters with the knitting, adsorbing, anti-spastic drugs, water solutions of antiseptic, bactericidal and antiparasitic drugs are shown (the last two groups — according to indications). Various oil are shown to patients with insufficient bowel emptying and the patient with locks enemas (see). Candles are appointed at defeats of area of an internal sphincter, hemorrhoids and for simplification of the act of defecation by the patient with locks. As a form of use of various medicines it is possible to use ointments in these cases. In candles and ointments are applied the antiseptic, analgesic, stimulating epithelizations and anti-spastic drugs, and also various antibacterial drugs (Ichthyolum, Dermatolum, bismuth, antipyrine, novocaine, extracts of a belladonna, levomycetinum, furasolidone, etc.) in the quantity corresponding to a single dose of drug inside. Patients To. periodically shall receive polyvitaminic drugs.
Indications to operational treatment To. are very limited. As absolute indications to operation serve life-threatening complications various To.: perforation of a wall of a gut with development of peritonitis, the toxic dilatation of a large intestine which is not giving in to conservative therapy, profuse intestinal bleeding, acute impassability of intestines as a result of a stricture or commissural process. Relative indications to operational treatment arise at inefficiency of persistent conservative treatment of ulcer nonspecific colitis (see), complications in the form of strictures of a gut, the phenomena of partial intestinal obstruction.
Radical operations but an occasion To. and their complications, at relative indications are more often contraindicated to elderly people in the presence at them serious associated diseases.
The existing operational methods can be divided into ways of temporary unloading of the struck departments of a large intestine and the radical interventions directed to removal of the struck department. Imposing of different types ileo-and kolosty concerns to the first group of interventions (see. Enterostomy , Colostomy ). These operations are carried out generally in case of emergency at complications of a basic disease: at impassability of a gut (tseko-, transverzo-or sigmostoma). Radical operations — segmented resections of a large intestine — carry out at the cicatricial strictures of a gut caused ischemic To., divertuculosis, etc. In these cases make right-and left-side hemicolectomies (see), resections of a sigmoid or cross colon (see. Intestines ) and so forth.
Radical operations make after performing intensive conservative treatment, a cut shall have a specific focus (especially at invasive To.) and to provide decrease of the activity of local nonspecific inflammatory changes and correction of the general metabolic disturbances. Such treatment is necessary for prevention of postoperative complications among which are the most dangerous insufficiency of seams of an anastomosis, purulent peritonitis and commissural impassability of intestines.
Physiotherapeutic treatment is appointed for the purpose of elimination of spastic reactions and inflammatory changes in intestines, normalization funkts, by conditions of century of N of page and the receptor device of a gut. In the period of an aggravation hron. To. easy heat in the form of the warming compresses on a stomach (water, spirit, with a liquid paraffin, etc.), thermal hot-water bottles is recommended. Also the electrophoresis with Calcium chloratum, zinc sulfate, novocaine, Platyphyllinum is shown. Radiation of a stomach ultraviolet rays in gradually increasing dose (from 1 to 5 biodoses) has favorable effect. In the period of the fading aggravation in the absence of contraindications (e.g., bent to bleedings) UVCh, ultrasound are shown. Various methods of active thermal treatment (mud cure, paraffin, ozokerite, a diathermy) can be applied at hron. To. during the periods of remissions in small volume and only at good tolerance. Elimination of the spastic phenomena in intestines is promoted by thermal bathtubs (coniferous, radonic, etc.).
At hron. To. visas of a stage of an aggravation it can be recommended a dignity. - hens. treatment in local sanatoria for patients with diseases of the digestive system, and also in the l specialized balneo. sanatoria (Borjomi, Dzhermuk, Druskininkai, Yessentuki, Zheleznovodsk, Pyatigorsk, Riga beach, Truskavets, etc.). At hron. To. with ulcer or erosive process in a direct or sigmoid colon, the bleeding hemorrhoids sanatorium treatment is contraindicated.
Physiotherapy exercises at hron. To. out of the period of an aggravation as a fortifying method of treatment it is shown to all patients in the form of special complexes, and also in a look a gigabyte. gymnastics, walking, skating and skis, outdoor games in the fresh air. At the same time it is necessary to avoid overfatigue, sharp movements, exercises connected with a muscle tension of a prelum abdominale.
At timely begun treatment acute To., as a rule, there occurs recovery. At hron. To. performing treatment and observance of the recommended mode provides long remission. Out of the period of an aggravation efficiency of patients is completely kept.
Prevention — prevention of acute intestinal infection, elimination inf. the centers in an organism, a balanced diet, personal hygiene and hygiene of food.
Infectious and invasive colitis
Infectious and invasive colitis — syndromes which can develop at inf. and parasitic diseases, napr, dysentery, iyersinioza, adenoviral and enteroviral infections, salmonelloses, is more rare a typhoid and paratyphus.
Secondary damage of intestines with a syndrome inf. To. it can be observed at tuberculosis, syphilis, an actinomycosis. Protozoa (a pathogenic amoeba, balantidiya), the helminths parasitizing in a gleam of intestines (a threadworm, pinworms, ascarids, etc.) or in his veins (shistosoma) can be the reason of development of this syndrome, except causative agents of bacterial and viral infections. Other protozoa (lyambliya, trichomonads) extremely seldom cause the damage of a large intestine which is especially isolated. A current invasive To. usually chronic.
Reason of development inf. To. there can be also opportunistic microorganisms (staphylococcus, proteas, fungi from a sort Candida, etc.) or their associations that is more often observed at the weakened patients, at patients with new growths, a disease of blood, a radial illness, collagenoses.
As a result of long reception or repeated purpose of courses of the antibiotics of a broad spectrum of activity oppressing normal microflora of a large intestine can develop disbakteriozny To. The intestinal dysbiosis along with motor and secretory disturbances went. - kish. a path often is the reason of formation postinfectious To., in particular post-dysenteric, giving, as a rule, long hron, a current.
Regarding cases at inf. To. in fecal masses impurity of blood appears. Release of blood at To. it can be observed at dysentery, a schistosomatosis, disbakteriozny, tubercular and other damages of intestines.
Pathogeny inf. (invasive) To. it is connected with a variety etiol, factors and pathogenetic features of everyone inf. diseases, at a cut this syndrome develops (see. Amebiasis , Balanthidiasis , Helminthoses , Dysentery ). Refer disturbances of motor and secretory functions to number of the general pathogenetic factors went. - kish. path, changes of normal microflora of a large intestine, dystrophic and inflammatory changes of intestines, its nervous device, change immunol. reactivity of an organism.
Patol, anatomy reflects peculiar features inf. diseases, in the course a cut damage of a large intestine developed. The main forms of inflammatory defeat are catarral, fibrinous (croupous and diphtheritic), catarral and hemorrhagic (erosive and ulcer), phlegmonous, necrotic forms. Extent of defeat can be various (total To. with taking of all thick and a rectum or segmented To.), just as intensity and depth of defeat (mucous membrane, submucosa, muscular, serous layers). At hron, current inf. To. dystrophic and atrophic changes in tissues of a large intestine, it intra-and the extramural nervous device, boundary sympathetic gangliya, a celiac texture develop. These patol, changes at hron, forms inf. To. can prevail over inflammatory and cause funkts, disturbances.
Manifestations of a syndrome inf. (invasive) To., developing at various infectious diseases (bacterial, virus, protozoan, helminthoses), are very various and depend from a wedge, features of a course of a specific disease (dysentery, an adenoviral infection, a balanthidiasis etc.), and also on specific features of macroorganisms and secondary disturbances — the secretory, motor, connected with an intestinal dysbiosis, accompanying diseases, etc. The most frequent are frustration of a chair and an abdominal pain. Frustration of a chair is more often shown by ponosa. In cases hron, currents change of ponos and locks is characteristic. The liquid chair can be scanty (e.g., at dysentery) or plentiful (e.g., at a balanthidiasis), to contain patol, impurity (slime, blood, pus). Impurity of pus to excrements is, as a rule, observed in cases of activation of endogenous flora of intestines and superinfection at development of an intestinal dysbiosis. Frequency of a liquid chair can be various (from 2 to 20 times and more in days). More expressed and heavy symptoms develop at acute forms, especially in cases of total damage of intestines. However perhaps heavy current and at segmented defeats (acute forms of an amebiasis, dysentery, etc.). At hron. inf. To. perhaps secondary involvement in process of a small bowel, biliary tract, pancreas, liver, stomach. Some patients have symptoms of defeat of these bodies or them funkts, disturbances act into the forefront, according to complaints can be leaders.
Pains can be localized (according to the most struck part of a large intestine) or widespread (on the course of all large intestine), to have constant or skhvatkoobrazny character, to amplify before the act of defecation. Painful tenesmus, false, imperative desires are sometimes observed.
An important role in recognition inf. and invasive To. plays carefully collected anamnesis of a disease, existing epidemiol, a situation, complaints of the patient, character and localization of damage of intestines, a type of a chair. For establishment or an exception specific (bacterial, virus, protozoan, helminthic) the nature To. acute or hron, currents it is necessary careful bacterial., koprologichesky, and sometimes and virusol, research of excrements. Diagnostic help is given special serol. researches in pair serums, skin allergy tests, an endoscopic research.
Various forms inf. To. demand use of antibiotics, streptocides, nitrofurans and other chemotherapeutic means. At one forms prescription of antibiotics of a broad spectrum of activity, streptocides or their combinations is rational, at others — only the directed action depending on sensitivity of intestinal microflora (disbakteriozny To.). Injections of standard salt solutions, fiziol, solution, solution of glucose, Haemodesum, Polyglucinum, a blood plasma, diyeto-and vitamin therapy, the desensibilizing and fortifying means normalizing intestinal microflora (kolibakterin, bifidumbacterium, bifikol), Antianemic means are shown to patients with the expressed intoxication. Treatment of associated diseases is necessary. Duration of different types of treatment, including specific, decides specifically at each patient on a syndrome inf. To. depending on an etiology.
Features of colitis at children
the Special form — ulcer and necrotic To. newborns, is more often than premature children, in an etiopathogenesis to-rogo the leading value has a vascular and hemocoagulative component with the disseminated blood coagulation in vessels of an intestinal wall and the subsequent its necrosis, and then an ulceration. The child is younger, the isolated damage of a large intestine is observed less often; more often the small bowel (coloenteritis) is involved in process, and in certain cases all went. - kish. a path — gastroenterocolitis (see).
The reasons To. at children are similar described at adults. A current To. can be acute and chronic. In most cases acute To. at children of early age is inf. the disease caused by a dysenteric stick, enteropathogenic strains of colibacillus (EPP) of serotypes 0111, 055, 0124, etc., salmonellas, pathogenic stafilokokka, is more rare viruses, fungi.
A wedge, manifestations acute To. at children of the first months of life are characterized by bystry development of toxicosis with eksikozy (see. Toxic syndrome ). At the children weakened by the previous diseases (a hypotrophy, rickets, exudative diathesis), acute To. quite often is complicated by accession of septic complications (a toksiko-septic form). Children of advanced age have a dysenteric stick, proteas, a salmonella, an enteropathogenic stick the 0124th staphylococcus and fungi (the last most often as a result of the dysbacteriosis caused by an antibioticotherapia) can cause the isolated damage of a large intestine with development in hard cases of neurotoxicosis.
At patients with an easy form K. the general state suffers a little. Subfebrile temperature, colicy pains in a stomach after food and before defecation is sometimes noted. A chair, as a rule, kashitseobrazny, to 5 — 10 times a day, scanty, with trace amount of the fecal masses containing the isolated lumps of muddy slime, sometimes with streaks of blood. At a palpation of a stomach morbidity in the left ileal area where the painful, humming, spazmirovanny sigmoid colon is probed is defined. In hard cases the chair is observed to 15 — 30 times a day, loses fecal character, contains muddy lumps of slime, sometimes streaks of blood, pus; colicy pains in a stomach and tenesmus disturb, the gaping of an anus and loss of a mucous membrane of a rectum is less often noted, symptoms of the general intoxication quickly join. Features gain masklike character, temperature increases, there is vomiting, the child loses flesh, the diuresis decreases. Skin loses elasticity, fabrics become flabby. The child is sluggish or excited, later there are disorders of consciousness, symptoms of dehydration (see. Dehydration of an organism ). Frustration from cardiovascular system accrue.
Recovery at acute To. comes usually during 4 — 6 weeks.
At the children with a hypotrophy, rickets, anomalies of the constitution, malformations of intestines who are often ill forms long hron, the course of a disease what is promoted also later and insufficient treatment, accession of intercurrent, is more often respiratory and enteroviral, diseases, helminthoses, errors in a diet.
Hron. To. — a rare disease at children's age. The infection in these cases plays a role of a starting factor more often. It is clinically shown more often by diskinetichesky frustration. Aggravations of process can be caused by alimentary errors, a nerve strain, overfatigue and other factors. Change of intestinal microflora (dysbacteriosis) and the vitamin deficiency connected with it is of great importance. Aggravations hron. To. give the symptomatology reminding manifestations acute To., but the phenomena of the general intoxication are, as a rule, less expressed. Out of aggravations the adynamy, signs of polyvitaminic insufficiency, vascular and vegetative frustration, sometimes an iron deficiency anemia is noted nek-paradise. Diskinetichesky frustration are followed by alternation of ponos and locks, pristupoobrazny pains on the course of a large intestine, sometimes rectum pains, feeling of incomplete bowel emptying at defecation. At the child appetite is reduced; the bad dream, fatigue, decrease in memory is observed; children of younger age have a prolapse of the rectum and dystrophy.
At acute To. and at an aggravation hron. To. in a koprogramma find the slime containing the changed leukocytes — to 10 — 20 and more under review. At fresh process — it is neutrophils, at more long — lymphocytes. Erythrocytes are defined: 5 — 20 and more under review. At allergic To. in a koprogramma eosinophils are registered. If the small bowel is involved in process, in a koprogramma reveal the indicators characteristic of an enteritichesky syndrome: neutral fat, crystals fat to - t and soaps, the changed muscle fibers, cellulose, the starch found out of - it is intracellular; during the involvement in process of a stomach — not changed muscle fibers. There can be positive a test on the occult blood — Gregersen's reaction (see. the Benzidine test ).
Data X-ray contrast, rektoromanoskopichesky and other methods of a research correspond more often observed at adults.
Treatment To. at children it is carried out taking into account age, weight and an etiology of a disease. Patients are hospitalized. At acute To. and in the period of an aggravation hron. To. the bed rest is shown. Appoint an unloading diet with the subsequent transition on full, but mechanically and chemically sparing. At toxicosis and an eksikoza at children of early age and at neurocurrent sycosis at children of advanced age the water relationships, food is regulated, anti-toxic and infusional therapy is carried out. Antibacterial therapy is carried out under control of sensitivity of the activator to the used drugs: at To., caused by staphylococcus, appoint erythromycin, ampioks and other semi-synthetic Penicillin, antistaphylococcal gamma-globulin, plasma, a bacteriophage; during the seeding of enteropathogenic strains of colibacillus — streptocides, a protea — prick-proteyny a bacteriophage inside and in enemas; at salmonellezny and dysenteric To. treatment is carried out by the principles of therapy of these diseases.
7 — 10-day courses (3 — 4 courses) of antibacterial therapy alternate to breaks in 3 — 4 days under control a wedge, effect; at the same time appoint redoxons, And, the groups B desensibilizing and excitants (methyluracil, pentoxyl, an aloe etc.), anabolic hormones, physiotherapeutic procedures, sedatives, the knitting drugs to lay down. enemas from fish oil, a sage, a camomile, oil of a sea-buckthorn, carry out phytotherapy (a wormwood, infusion of a plantain, a celandine, etc.)*. In therapy ulcer and necrotic To. newborns according to indications are included by anticoagulants.
At dysbacteriosis with activation of fungi of the sort Candida and staphylococcus apply nystatin, levorinum, kolibakterin, bifidumbacterium, bifikol, laktobakterin, a staphylococcal bacteriophage.
The children who transferred To., are on dispensary observation. Treatment hron. To. it is possible to carry out in local specialized sanatoria.
Prevention To. at children it is carried out by the principles of prevention went. - kish. infections with the organization of healthy nutrition, timely diagnosis, hospitalization and treatment of patients and bacillicarriers.
Bibliography: Adam's N. T., Komlev E. S. and Babadzhanov A. K. Possibilities of complex radiodiagnosis of chronic colitis, Klin, medical, t. 51, No. 6, page 77, 1973; Atabekova K. S. Radiodiagnosis of chronic post-dysenteric ulcer colitis, Tashkent, 1975, bibliogr.; Beyul E. A. and E to and with e of N and N and N. I. Chronic enterita and colitis, M., 1975, bibliogr.; Bilibin A. F. Clinical chemotherapy and problem of endogenous infections, M., 1972; Of e with ate e in and the p E. C. Radiodiagnosis of diseases of a large intestine, M., 1968; Ghukasyan A. G. Diseases of intestines, page 117, M., 1964; Diagnosis of diseases of the digestive system, under the editorship of Ts. G. Mase-vich and P. N. Napalkov, page 46, M. — L., 1976; L about r and e I. T. Diseases of intestines, M., 1957, bibliogr.; Menshi-k about in F. K. Diseases of intestines, page 137, M., 1962; Novikova E. Ch. and Tagi * e in N. A. Sepsis at premature children, page 70, M., 1976; Nogaller A. M. Diagnosis and treatment of chronic diseases of the digestive system, page 115, M., 1966, bibliogr.; Tashevt., etc. Stomach diseases, intestines and a peritoneum, the lane with bolg., page 520, Sofia, 1964; F and-nardzhyan V. A. Radiodiagnosis of diseases of a digestive tract, t. 2, Yerevan, 1964; Frolkis A. B. Chronic coloenterites, L., 1975, bibliogr.; Alimentary tract roentgenology, ed. by A. R. Margulis a. H. J. Burhenne, v. 2, St Louis, 1967; B e r k R. N. a. L a s-8 e r E. C. Radiology of the ileocecal area, Philadelphia, 1975; Bosseckert H. Gastroenterologie — Ratgeber, S. 96 u. a., Jena, 1974; Bouchier J. A. Gastroenterology, L., 1973; CummackD. H. Gastro-intestinal X-ray diagnosis, Edinburgh — L., 1969; Frantz I. D. a.o. Necrotizing enterocolitis, J. Pediat., v. 86, p. 259, 1975; Gastroenterology, ed. by H. Bockus, v. 2, p. 634 a. o., Philadelphia, 1976; Handbuch der medizinischen Radiologie, hrsg. v. L. Diethelm, Bd 11, T. 1, B., 1969; MorsonB. C. a. Dawson I. M. P. Gastrointestinal pathology, p. 453 a.o., Oxford, 1974; S 1 e i s e n-g e r M. H. a. F o r d t r a n J. S. Gastrointestinal disease, Philadelphia, 1973; Spiro H. M. Clinical gastroenterology, N. Y., 1970; W e 1 i n S. W e 1 i n G. The double contrast examination of the colon, Stuttgart, 1976.
E. A. Beyul, H. I. Ekisenina; L. L. Ka-puller (stalemate. An.), A. N. Kishkovsky (rents.), A. V. Napayan, L. A. Tatosova (ped.), V. D. Fedorov (hir.), I. N. Shchetinina (epid.).