PROCTITIS

From Big Medical Encyclopedia

PROCTITIS (proctitis; grech, proktos an anus, a rectum + - itis) — the inflammatory process affecting preferential mucous membrane of a rectum.

Color illustrations. Fig. 1 — 6. An endoscopic picture of a mucous membrane of a rectum at some forms of a proctitis. Fig. 1. Catarral proctitis: the mucous membrane is moderately edematous, with the centers of a hyperemia, in certain sites is covered with transparent slime. Fig. 2. Purulent proctitis: the mucous membrane is edematous, sharply hyperemic, fibrinoznognoyny imposings are visible. Fig. 3. Ulcer proctitis: against the background of an edematous hyperemic mucous membrane the hemorrhages and superficial ulcers covered with fibrinous films are visible. Fig. 4. Ulcer and necrotic proctitis: the mucous membrane is edematous, the multiple ulcers covered with a necrotic plaque are visible. Fig. 5. Hypertrophic proctitis: the small centers of a hyperplasia in the form of follicles are visible. Fig. 6. Atrophic proctitis: the mucous membrane pale, is visible network of submucosal vessels.
Fig. Outward of a mucous membrane of an anus at a papillitis: the proctal nipples increased as a result of a chronic inflammation (are specified by shooters) in the basis of anal (proctal) columns.

The item proceeds sharply, subacutely and chronically (see. Inflammation ). At an acute current allocate catarral, purulent, ulcer, yazvennonekrotichesky forms (tsvetn. fig. 1 — 4), and also fibrinous and hemorrhagic. The contagium can get into a rectum in various ways: through a mouth (dysentery, cholera, etc.), gematogenno, through an anus (gonorrhea, a venereal ulcer, a pakhovy lymphogranulomatosis), at gunshot or other wounds, with foreign bodys. At such diseases of a rectum and the next bodies as hemorrhoids, a paraproctitis, polyps and cancer of a rectum, abscess of a duglasov of space, prostatitis, cystitis, a vaginitis the secondary proctitis can be observed. The item can be manifestation inf. damages of all large intestine (at dysentery, cholera, etc.); poisonings with poisons, mushrooms; mycotic defeat at prolonged treatment by antibiotics or manifestation of an inflammation of limited departments of a gut, napr, at hron, the colitis which is followed by locks (a congestive proctitis). Also the proctosigmoiditis, sphincteric P. (annite) is possible, e.g. at an anal fissure, the papillitis which is observed at an inflammation of proctal nipples (fig.), a cryptitis at an inflammation of morganiyevy crypts (see. Anus ). It is long the flowing, difficult giving in to treatment beam P. quite often it is observed after radiation therapy of malignant tumors of bodies of a basin (see. Beam damages ).

Acute P. is shown by constant rectum pains, the involuntary expiration from it serous, purulent, mucous, hemorrhagic allocation, fervescence. Function of a gut is broken: the outside sphincter of an anus is weakened, quite often the anus gapes. Gradually under the influence of treatment acute P.'s symptoms abate, there can occur recovery or P. passes in subacute or hron, a stage. Impurity of slime in fecal masses or its detection at a rektoromanoskopiya demonstrates unfinished inflammatory process. In the outcome of an acute proctitis, especially gonorrheal, and also ulcer, cicatricial narrowings of a rectum are possible. P.'s diagnosis is based on data of survey of area of an anus, rectal research (see), rektoromanoskopiya (see). At a research the hyperemia, puffiness of a mucous membrane of a gut is found. Imposings of slime, fibrin, hemorrhage, bleeding, ulcerations are characteristic. Has an important role in diagnosis of inflammatory diseases of direct and sigmoid guts tsitol. research of intestinal contents.

Acute and subacute P.'s treatment should be begun with elimination of the reasons which caused it. Recommend a bed rest, restriction of the use of the foodstuff containing a lot of cellulose, exclude fried, hot dishes, prohibit reception of alcoholic drinks. Food shall be mechanically sparing. Appoint antibiotics, streptocides, warm enemas 2 — 3 times a day with solution of potassium permanganate, Rivanolum, 2% solution of colloid silver or protargol, with infusion of a camomile or with fish oil. Good results are yielded by introduction to a rectum of foamy antiseptic agents. Sedentary bathtubs and perineal warm souls with antiseptic solutions are useful. The forecast is more often favorable. However in some cases at out of time begun treatment transition in hron, a form is possible.

Chronic P. has three main forms — hypertrophic, normotrofichesky and atrophic. At a hypertrophic form endoscopic are noted reinforced, edematous, it is sometimes excessive the expanded friable folds of a mucous membrane with a little increased easily distinguishable limf, follicles (tsvetn. fig. 5). At a normotrofichesky form of a fold of a mucous membrane have a normal appearance. At an atrophic form (tsvetn. the mucous membrane of a rectum is thinned by fig. 6), dry with smoothed folds and the translucent vessels, is easily vulnerable. At all forms of chronic P. quite often subjective feelings are absent, in fecal masses small impurity of slime is found. At an asymptomatic hron. Items patients seldom see a doctor. However P. which is followed by locks, pains in the left ileal area (proctosigmoiditis) or in an anus (sphincteric P. — annite, a cryptitis, a papillitis), can cause the periodic or systematic frustration forcing patients to see a doctor. In the medical purposes periodic reception of antibiotics, streptocides are recommended, to lay down. enemas (see). According to A.S. Shklyar (1974), the positive effect can be gained from glucocorticoid therapy. The resort therapy is recommended. Subaqual bathtubs or rectal irrigations by warm alkaline water of the type Borjomi, Yessentuki are effective, Truskavets which promote rejection of slime and stimulate a peristaltics (see. Intestinal washings ). For fight with locks (see) recommend preferential vegetable diet.

At under acute or the chronic local inflammatory processes in a rectum (a cryptitis, a papillitis) which are followed by the expressed pain, success brings operational treatment — removal of the struck crypt or the inflamed proctal nipples.

Forecast at the correct and timely treatment most often favorable.

Prevention The item comes down to timely treatment of the diseases promoting its emergence.

See also Rectum .

Bibliography: Aminev A. M. Guide to a proctology, t. 3, Kuibyshev, 1973; Shklyar A. S. Local glucocorticoid therapy of proctites and proctosigmoiditis, in book: Aktualn. vopr. gastro-Enterolum., under the editorship of A.S. Loginov, t. 7, page 348, M., L974; Connell A. M and. lake of Comparison of acetarsol and prednisolone-21-phosphate suppositories in the treatment of idiopatic proctitis, Lancet, v. 1, p. 238, 1965; Girard M. et ChabanonR. Action de la betamethasone en lavements dans la recto-colite hémorragique et certaines rectites, J. Méd. Lyon, t. 40, p. 571, 1965; Saegesser F. a. Wari-d e 1 D. Rectocolites ulcéro-hémorragiques chroniques et cancers du gros intestin, in book: Oncologie chirurgicale, publ. par F. Saegesser et J. Pettavel, p. 688, P., 1971.

A. M. Aminev; Century of A. Novels (tsvetn. fig.).

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