ULCER NONSPECIFIC COLITIS (Latin colon a colon + - itis; synonym: colitis gravis, colitis ulcerosa, ulcer and hemorrhagic chronic colitis, idiopathic ulcer colitis, a hemorrhagic purulent rectocolitis, a mucous and hemorrhagic rectocolitis, ulcer colitis, an ulcer proctocolitis, «eczema of a rectum», a vasculitis of an intestinal wall, a peptic ulcer of a large intestine) — the recurrent disease of not clear etiology which is characterized by a gemorra-gicheski-purulent inflammation of a large intestine with development of local and system complications.
First description morfol. pictures Ya. N to. belongs to K. Rokitan-sky (1842). Its detailed description is made in 1875 by Wilks and Mokson (S. Wilks, W. Mokhop). In an independent nosological form Ya. N to. it is allocated in 1888 by White. The term «nonspecific ulcer colitis» is entered in 1913. A.S. Kazachenko.
The disease affects equally persons of both sexes, is more often aged from 20 up to 40 years; however there are cases of children and persons 50 years are more senior. I. N to. meets everywhere, is more often in the countries with a temperate climate, incidence in the cities is higher, than in rural areas. In the countries of Europe 5,8 — 14,0 of 10 000 hospitalized patients suffer from it. Dependence of frequency and severity of a disease on geographical conditions is noted. So, in Japan I. N to. meets seldom and proceeds easily, in the USA — often and differs in a heavy current.
Etiology and pathogeny. Origins of a disease are up to the end not studied. The various, quite often contradictory points of view concerning an etiology and a pathogeny I expressed. N to.; the set of theories of developing of a disease was put forward (infectious, enzymatic, alimentary, allergic, vascular, neurogenic, etc.) * Attempts to reveal the specific activator and to prove inf. the nature of a disease were sterile. Data immunol. researches, the nature of the changes developing in a large intestine, positive effect at use of steroid hormones and immunodepressants, an originality a wedge, manifestations and a current demonstrate
participation in development of a disease of immune mechanisms. Crucial importance in its emergence is attached to disturbances of pituitary and adrenal system and change of reactivity of an organism. The heavy current is observed at persons with imperfect mechanisms immunol. protection (perhaps, genetically caused), when in reply even on usual and furthermore the organism answers strong irritants with the perverted reaction — a giperergichesky inflammation. Carry stressful situations, defeat of century of N of page, disturbance of a biocenosis and enzymatic shifts in intestines to the contributing factors, change of reactivity of a mucous membrane of a large intestine, to-rye can provoke developing of a disease or promote emergence of a recurrence.
Pathological anatomy. An inflammation at I. N to. usually begins in a rectum (proctitis). In rare instances it is limited to this department of a large intestine, but, as a rule, process extends in the proximal direction, occupying adjacent departments (left-side colitis) or all colon (total colitis); sometimes the distal department of an ileal gut also is involved in inflammatory process. Other departments went. - kish. a path are not surprised. At I. N to. inflammatory process is localized preferential in a mucous membrane of a large intestine. Folds of the last are considerably thickened or almost completely maleficiated owing to the expressed hypostasis and a plethora, their surface is covered with translucent slime, putreform imposings or a thin coat of fibrin. In a mucous membrane a large number of small ulcers to dia is found. 1 — 3 mm, and also large ulcers of irregular shape with the subdug edges. Almost final fracture of a mucous membrane therefore all inner surface of a large intestine represents an extensive ulcer is in some cases noted. Ulcers of a mucous membrane are usually limited to limits of a submucosa (layer), but sometimes at extensive defeats the bottom them reaches a muscular coat. At the acute course of a disease in zones of defeat perhaps considerable expansion of a gleam of a large intestine (toxic dilatation). Against the background of large ulcers the islands of the remained mucous membrane having an appearance of polyps (inflammatory polyps) of a finger-shaped form length several centimeters, and also polipovidny growths of granulyatsionny fabric often are found. Inflammatory polyps meet at hron more often. current I. N to. and unlike adenomatous (ferruterous) polyps malignancies seldom are exposed.
At microscopic examination of a wall of a large intestine in initial stages I. N to. define the inflammatory infiltrate consisting preferential of lymphocytes with impurity of polymorphonuclear leukocytes, which is usually localized in own plate of a mucous membrane and seldom spreading to a submucosa. In places of formation of ulcers it gets (most often on perivascular spaces) into deep layers of a wall of a gut. Plasmocytes at an early stage of a disease meet seldom, lymphoid follicles in basal departments of a mucous membrane — the usual size or a gi-perplazirovana. Considerable expansion of blood vessels, hl is noted. obr. venous departments of capillaries of small veins, and swelling of their endothelium. Surrounding fabrics are edematous. Disturbance of microcirculation can be followed by development of the hypoxia leading to damage of an epithelium. At an elektronnomikroskopichesky research at an early stage I. N to. the damage of microvillis of epithelial cells with a border leading to disturbance of a cellular barrier is observed. The developed picture of a disease is followed by emergence of leukocytes between cells of a surface layer of an epithelium, development of the cryptitis which is characterized by accumulation of neutrophils in cavities of liber-kyunovy glands (fig. 1). The obliteration of distal departments of these glands leads to formation of crypts abscesses (fig. 2). At an ulceration of the epithelium covering crypts abscesses the last are opened with formation of small ulcers. Opening of several merged crypts abscesses leads to formation of more serious ulcer defects. Development of extensive ulcerations is caused by distribution of inflammatory process on a submucosa what deep niches at the edges of ulcers, otslaivayushchy a mucous membrane sometimes throughout several centimeters testify to. In the field of ulcers arrozirovanny small arteries and veins are visible, in a gleam to-rykh fresh or organized blood clots often are found. The bottom of ulcers is covered by granulyatsionny fabric,
Fig. 1. Microdrug of a mucous membrane of a large intestine: dense kruglokletochny infiltration (i), in a gleam of separate crypts of accumulation of neutrophils (2); coloring hematoxylin-eosine; x 70.
Fig. 2. Microdrug of a mucous membrane of a large intestine: crypts abscesses (i)
with break in submucosa (2) \coloring hematoxylin-eosine; x 70.
densely infiltrirovanny lymphocytes and plasmocytes with impurity of the eosinophils forming here a peculiar protective barrier to microbes what absence at patients I testifies to. N to. phlegmons of an intestinal wall or lymphadenitis. At a long current I. N to. in inflammatory infiltrate the quantity of plasmocytes increases and segmentoyaderny leukocytes almost completely disappear. The quantity of eosinophils fluctuates over a wide range. However not always on cellular composition of inflammatory infiltrate it is possible to judge a stage patol. process since the cellular structure depends also on degree of allergization of intensity of medicinal therapy and other reasons. It is expressed - the cash limfoplazmotsitarny infiltration of a mucous membrane remains even during long-term remission.
At microscopic examination of inflammatory polyps minor inflammatory changes of a mucous membrane, in some cases its hyperplasia are noted.
Regeneration of an epithelium in places of injury of a mucous membrane happens incomplete because the epithelial layer does not create full-fledged crypts and almost does not contain scyphoid cells. Along with it in an atrophied mucous membrane without the expressed signs of an inflammation it is occasionally possible to observe considerable dysplastic changes of an epithelium.
Patients have Me. N to. changes in a thymus are revealed: along with signs of involution of body (physiological and aktsidentalny) increase in little bodies of Gassa-lya is noted (see the Thymus).
Clinical picture. The first symptom of a disease usually are the rectal bleedings reminding hemorrhoidal; the loss of blood at defecation makes usually from several drops to 20 ml. The chair issued or kashitseobrazny. Quite often the disease begins with emergence of slizistognoyny allocations from a rectum, abdominal pains, locks, arthralgias, subfebrile temperature can be Early symptoms of a disease. Occasionally the disease begins temperature increase and a bloody diarrhea, reminding dysentery. All symptomatology in this case is developed quickly, within several weeks.
In the period of a heat of a disease the wedge, manifestations are various. The most frequent of them are rectal bleedings, plentiful mucous is purulent - bloody allocations from a rectum, frustration of a chair, the progressing lose of weight, fever, anemia, arthralgias.
Depending on expressiveness the wedge, pictures mark out three severity of a disease: easy, moderately severe and heavy. Considering features of a course of process, nek-ry clinical physicians distinguish acute, recurrent and chronic continuous forms Ya. N to.; a number of domestic and foreign researchers allocate four main forms, or option, a disease: quickly progressing, slowly progressing, chronic recurrent and soft.
I. N to. quickly progressing current meets in 5 — 10% of cases. In literature this form of a disease is called also acute, inflammatory, fulminant (fulminantny), fulminating, toxic. It is characterized by a heavy current, diffusion damage of all large intestine and involvement in process of a small ileal bowel. Frequent plentiful bloody purulent discharges from a rectum, tenesmus, colicy pains in a stomach, repeated intestinal bleedings are followed by anorexia, frequent vomiting, fever of gektichesky or intermittent type, the progressing exhaustion, dehydration, tachycardia, hepatitis (see), anemia, acceleration of ROE (40 mm an hour are higher), a leukocytosis, a hypoproteinemia, etc. The prematurity of complications is characteristic of this form of a disease.
I. N to. slowly progressing, or continuous, currents meets approximately in 10% of cases. This form of a disease also proceeds hard, is characterized by gradual involvement in process of different departments of a large intestine and continuous increase of the symptoms described above.
Hron. the recurrent current meets most often (60 — 70% of cases) and is observed at medium-weight forms of a disease. More often the departments of a large intestine located at the left are surprised. The disease begins, as a rule, gradually, sometimes at children's age; aggravations are replaced by remissions of various duration (weeks, months and even years). Quite often this form is combined with a pseudorheumatism, a peptic ulcer, allergic diseases. In 40% of cases seasonality of a recurrence is noted.
I. N to. soft, or a lung, a current meets in 10 — 15% of cases. Limited defeat of distal department of a large intestine without distribution of process on other departments of intestines, absence heavy a wedge, symptoms, dominance of a neurotic component is characteristic of this form. Assume that such course of a disease is a consequence of disturbance of nervous control at rather high mobilization immunol. mechanisms of protection, than resistant limitation patol speaks. process of a large intestine by distal (most reactive) department.
I. N to. differs in a torpid current, however even at the progressing forms with total damage of a large intestine there can occur long-term remission. Nevertheless any patient at achievement even full a wedge, recovery is not guaranteed against a recurrence.
Elderly people have Me. N to. it is characterized by a long monotonous current, rather rare emergence of complications in the form of defeat of various bodies and systems, but the bigger frequency and weight of local complications.
At pregnant women the course of a disease depends on time of its emergence. So, I. N to., developed in time of pregnancy, proceeds more softly; at its emergence at the end of pregnancy or the adverse course of process is after the delivery noted. Performing adequate therapy of a disease at pregnant women is complicated in connection with the big frequency of allergic reactions, intolerance of medicines, and also impossibility to apply topical treatment.
I. the N to, is followed by various complications as local (intestinal), and the general. The most dangerous local complications are toxic dilatation of a gut, massive bleeding (see. Gastrointestinal bleeding), perforation of a wall of a gut (see the Perforation) with peritonitis (see), a colon cancer (see Intestines). At I. N to. hemorrhoids (see) also anal fissures (see), strictures of a large intestine, pseudo-polyposes and polyposes of intestines are observed (see Intestines). Arthropathies (see), damages of skin in the form of a pyoderma (see), a knotty erythema (see the Erythema knotty), etc., hepatitis (see), acute stomach ulcer (see Ulcers symptomatic), pancreatitis (see), pneumonia (see) and pleurisy (see), pyelonephritis (see), a nephrolithiasis (see), a stomacace (see), dystrophy, a thrombembolia (see), damage of eyes in the form of conjunctivitis (see), a keratitis (see), an amyloidosis of internals (see the Amyloidosis), mental disorders belong to the general changes which are characterized by defeat of many bodies and systems.
The diagnosis is made on the basis of anamnestic yielded and results complex clinical laboratory, tool and rentgenol. researches. An important role in diagnosis is played by the rector an omanoskopiya (see) and a kolonoskopiya (see), the characteristic changes allowing to reveal — hypostasis, a hyperemia, contact bleeding, ulcerations, mucous it is purulent - hemorrhagic exudate, pseudo-polyposes, narrowing of a gleam of a gut.
Rentgenol. the research is applied to confirmation of the diagnosis of a disease, definition of localization and extent patol, process, a form and a stage of a disease, identification of complications, and also for the purpose of dynamic overseeing by results of conservative or operational treatment. Rentgenol. the research includes a survey X-ray analysis of an abdominal cavity (without
Fig. 3. Survey roentgenograms of a large intestine at hard filling with its baric suspension: and — is normal; — at quickly progressing form of ulcer nonspecific colitis (a gleam of a large intestine uniform, contours uneven, gaustra of a colon are absent).
pre-treatment of intestines), an irrigoskopiya (see), a pariyeto-grafiya (see), an angiography (see).
At suspicion on quickly progressing form Ya. N to. rentgenol. the research is begun with a survey picture of an abdominal cavity. At this form of a disease the large intestine is unevenly filled with gas on a considerable extent; a gleam of a gut more often uniform, its wall is, as a rule, thickened, especially on the party of an attachment of a mesentery, a pulled inner surface. At retrograde introduction of a baric suspension the large intestine is rather quickly filled; contrast weight freely gets through an ileocecal opening into a terminal part of an ileal gut. Quickly progressing form of a disease is characterized by total damage of a large intestine. A gleam it on vsvkhm an extent almost uniform, gaustra of a colon, as a rule, are absent or are poorly expressed (in the right departments); contours of a large intestine uneven, indistinct (fig. 3, b), are defined by places spikulopodob-ny (in the form of needles) and divertikulopodobny protrusions. At semi-hard filling of a large intestine and a research with beams of high rigidity the multiple central defects of filling, various in a form and extent, alternating with resistant baric spots (a picture of a «scrappy» or «landkartoobrazny» relief) are defined. It is caused by the multiple ulcers of a mucous membrane alternating with the inflammatory changed sites in a look psev-
dopolip and growths of granulyatsionny fabric. A large intestine of a gipermobiln (hypermotility) in this connection contrast weight quickly is thrown out distal departments. The relief of a mucous membrane of a large intestine is maleficiated by places, in places has honeycombed structure or the rough chaotic drawing.
At slowly progressing and chronic recuring фор^ a move I. N to. in an early stage of a disease, despite the expressed symptomatology, rentgenol. the picture is not specific. In this case the large intestine is unevenly filled with contrast weight, the segmented spasms which more often are localized in the area fiziol are noted. sphincters, irregularity and strengthening of haustration, small, scarcely noticeable uniform crenation and illegibility of contours. Walls of a large intestine polymorphic, are available the central defects of filling, emptying of a gut unevenly, its relief is maleficiated, the mucous membrane is thinned, folds are faltering and deformed, dot contrast spots and slime, a smoothness of a pneumorelief, rigidity of walls of affected areas of a gut come to light. About existence I. N to. existence not less than three specified rentgenol testifies. signs. In the heat of a disease at these forms Ya. N to. on the survey roentgenogram of an abdominal cavity filling with gas of a large intestine on a considerable extent is observed that testifies to rigidity of its walls. The wall of a large intestine is thickened, deprived gaustr; its internal contour glad-
cue and uneven. On preferential localization of defeat on the basis rentgenol. pictures allocate a proctosigmoiditis, left-side, total and regional colitis. Filling of a large intestine is made the small volume of a baric suspension. At the same time its bystry distribution and free penetration into a small bowel, uneven narrowing of a gleam and shortening of a large intestine is noted. The specified changes are combined with straightening hepatic (right) and splenic (left) bends, absence gaustr a colon, roughness or a small crenation and an illegibility of contours (fig. 4). Besides, nishepodobny and spikulopodobny protrusions and rigidity of walls, the symptom of «a double contour» caused by penetration of a contrast agent into the ulcers located vnutristenochno come to light. The structure of an intra intestinal baric column is heterogeneous hl. obr. at the expense of pseudopolypuses. The relief of a mucous membrane can be smoothed, close-meshed, cellular (fig. 5), however thin longitudinal folds are defined more often, to-rye in places are interrupted. In case of defeat of a small bowel in it similar changes are defined. At a pariyetografiya the thickening or thinning of walls of a straight line and colon is noted.
At the soft course of a disease rentgenol. features are not noted.
Fig. 4. The survey roentgenogram of a large intestine and terminal department of a small bowel at a chronic recurrent form of ulcer nonspecific colitis at hard filling with a baric suspension: the gleam of a large intestine is unevenly narrowed, the gut is shortened; the hepatic (right) bend of a colon is straightened, the splenic (left) bend is more developed, than normal (it is specified by shooters).
Fig. 5. The survey roentgenogram of distal department of a large intestine at slowly progressing form of ulcer nonspecific colitis: the close-meshed structure of a relief of a mucous membrane is defined.
An angiographic picture at Y. N to. it is characterized by uniform expansion of blood vessels direct and sigmoid colonic guts, sharp break of vessels of a rectum, a thickening of walls of capillaries, earlier filling, expansion and the chaotic direction of veins. Pseudopolypuses often represent avascular zones.
Leaders rentgenol. signs of toxic dilatation of a large intestine are expansion of all its departments (especially cross colon), sometimes inflation of a small bowel, existence in it of horizontal fluid levels. At perforation of a wall of a gut in an abdominal cavity free gas is defined, at cicatricial strictures permanent uniform narrowing of a large intestine on a limited extent is observed.
Differentsia ln y diagnosis. Diagnosis I. N to., as a rule, does not present special difficulties, however at the beginning of a disease there is a need to differentiate it with dysentery (see), an amebiasis (see), a disease Krone (see Krone a disease).
More bystry development patol is characteristic of dysentery. process in intestines, positive takes bacterial. researches, epidemio l. anamnesis.
Existence of an amebiasis is confirmed by detection of fabric forms E. histolytica in excrements, a positive take of reaction of an immunofluorescence with amoebic antigen and therapeutic effect of metronidazole, emetine and other antiamoebic means.
The disease Krone differs from I. N to. an ochagovost of process, in half of cases lack of damage of a rectum, localization of process is more often in the right departments of a large intestine, availability of inflammatory infiltrate in an abdominal cavity, a tendency to formation of strictures and fistulas, and also data gistol. researches of a wall of a large intestine.
Elderly people have Me. N to. it is necessary to differentiate also with ischemic colitis (see Intestines), for to-rogo lack of changes in a rectum and localization of process in a splenic (left) bend of a colon are characteristic.
Differential diagnosis I. N to., besides, carry out with a balanthidiasis (see), a schistosomatosis (see), a strongyloidosis (see), a spra (see), a pellagra (see), Whipple's disease (see. Intestinal lipodystrophy), such diseases of intestines (see), as a divertuculosis, tuberculosis of intestines, inborn family polyposes and a colon cancer, cancer of a rectum (see the Rectum), and also a pseudomembranous coloenteritis (see Enteritis), colitis (see) etc. Differential diagnosis in these cases is carried out taking into account the anamnesis, a wedge, pictures, data of a microscopic, bacteriological examination a calla, results of a X-ray, tool and histologic inspection.
Treatment of patients I. N to., first of all, consists in impact on local and general reactivity; it is directed to decrease in allergic and inflammatory reaction, reduction of permeability of capillaries of intestines, stimulation of pituitary and adrenal system or compensation of its insufficiency, improvement of processes of a hemopoiesis and trophicity of fabrics. At severe forms and an exacerbation of a disease of patients hospitalize. Treatment demands strictly individual approach to patients, however in all cases the lechebnookhranitelny mode and purpose of a diet with the increased content of proteins and vitamins, an exception of rough and spicy food, milk is necessary.
Medicinal therapy is defined by a form of a disease. At the progressing (heavy) forms Ya. N to. the main medicine are corticosteroids (a hydrocortisone, etc.), to-rye enter parenterally. Nek-ry clinical physicians in some cases apply immunodepressants (Azathioprinum, etc.). In a complex to lay down. actions include hemotransfusions; the patient enter blood substitutes and Phillips's solution, and also appoint vitamins (And, Yo, K, groups B, ascorbic to - that), anti-spastic means (a papaverine, Nospanum, etc.) and fermental drugs (abomin, festal, etc.), antibiotics of a broad spectrum of activity.
At hron. recurrent, and in some cases and the soft course of a disease apply corticosteroids (Prednisolonum) inside. Are effective, especially at the soft course of a disease, salazosulfa-Nile amides (Sulfasalazinum on 3 — 8 g a day, Salazopyridazinum on
1,5 — 2 g a day), to-rye appoint by courses up to 3 months and more. Also the sedatives desensibilizing means (Pipolphenum, Suprastinum, etc.), the drugs of calcium, vitamins, fermental drugs derivative of oxyquinoline are shown (Intestopanum, enterosepto l). Locally apply enemas with a hydrocortisone on 60 — 120 mg on 50 — 100 ml of isotonic solution of sodium chloride, from 5% suspension of a salozopi-ridazin, shipovnikovy or sea-buckthorn oil. Antibiotics are appointed only in case of accession of consecutive infection (after definition of sensitivity of the sowed flora). The patient with signs of reduced immunity (a furunculosis, stomatitis, etc.) levamisole is shown.
To the prevention or elimination of dysbacteriosis apply to-libakterin, bifikol, bifidumbacterium. For the purpose of stimulation of processes of regeneration enter biogenic stimulators (an aloe, etc.), methyluracil, pentoxyl.
At hron. recuring I. N to. (in the spring and in the fall, after intercurrent infections) hold an antirecurrence-noye to the threatened period treatment by Sulfasalazinum in a dose on 0,5 g 4 times a day.
Operational treatment I. N to. apply only according to strict indications at emergence of such life-threatening complications as perforation, toxic dilatation, cancer of intestines, massive repeated bleeding, and also at inefficiency of intensive conservative care. Distinguish planned, urgent and immediate surgeries.
Planned operations make the patient with the heavy continuous or recurrent course of a disease at inefficiency of massive complex conservative therapy, disability and increase of metabolic frustration up to dystrophy; at development of permanent narrowing of a large intestine with the phenomena of the increasing impassability. Refer operations for the colon cancer which developed against the background of I to planned. N to.; reconstructive (reconstruction of the vicious, incorrectly functioning ileostoma) and recovery (imposing of an ileorektalny anastomosis after the subtotal resection of a colon made in the past) operations, and also the operations directed to removal of earlier left sites of a large intestine (the direct, blind and ascending colonic guts) in to-rykh ulcer process continues.
Urgent operations carry out the patient with quickly progressing form Ya. I. to. or a recurrence of a disease at inefficiency within 10 — 14 days of conservative therapy; at the profuse or recurrent intestinal bleedings leading within several days to the expressed anemia in case of inefficiency of hemotransfusions and other conservative actions; at acute toxic dilatation of a large intestine in case of inefficiency of complex conservative treatment of this complication (massive transfusion therapy, use of corticosteroids, unloading of a stomach and intestines by means of probes) during 6 — 12 hours; at suspicion on perforation of a gut.
The only indication for an immediate surgery is the diagnosed perforation of a gut.
Special preoperative preparation at I. N to. it is not required since the carried-out treatment of a disease is sufficient for an operative measure. Special preparation of intestines usually it is not carried out (enemas and purgatives are contraindicated at acute forms of a disease), on the eve of operation limit the products rich with cellulose. Before immediate surgeries concerning perforation of a gut make intravenous drop injection of liquids and hold a complex of antishock events.
Radical operations carry out under an endotracheal anesthesia ((see) using muscle relaxants (see) that promotes reduction of time of operation, provides its smallest injury and reduces number of intraoperative ?oslozhneniye. Under local anesthesia make only palliative operations (ileostomy) or simple reconstruction ileosty.
Most of surgeons apply radical operation — a subto-talny resection of a large intestine «with imposing of a trailer ileostoma and sigmostoma (see Intestines, operations). Advantage of this operation are smaller injury and an opportunity in the subsequent to make recovery ileoproctostomy operations (see) and ileo-sigmoidostomies (see).
At dysfunction of a sphincter of an anus, at a sharp sfiktura and fibrosis of a rectum, at a malignancy of process in a lower part of a rectum .sverkhradikalny operation — a kolo-proctectomy is shown, at a cut delete all colonic and a rectum and impose a constant ileosto-ma. A number of surgeons considers a koloprokt-ektomiya a main type of intervention at I. N to. Operation is made in one, by two or three stages depending on disease severity. Apply two-stage operation more often. The first stage — a total colectomy with removal of an ileostoma by formation of a proboscis (see Enterostomy), advantage a cut is that intestinal contents do not get on skin, and shutdown of a rectum. The second stage — the proctectomy — is made in 3 weeks.
At critical condition of patients for the purpose of temporary relief of their state and preparation for radical operation sometimes previously carry out a double-barreled separate ileostoma, at a cut all large intestine affected with ulcer process remains, but passing on it food masses is excluded. Due to the neradi-kalnost of such intervention and short duration of effect in 10 — 14 days against the background of intensive treatment carry out radical operation.
Features of postoperative maintaining patients are defined by weight of the previous operation, extent of disturbances of a homeostasis (first of all changes of electrolytic balance, protein metabolism, anemia). As a rule (in connection with weight of a state), the operated patients need holding resuscitation actions (massive infusional, replacement therapy, etc.). In the postoperative period development of peritonitis, commissural intestinal impassability dynamic (less often), suppuration of wounds, hypostasis and dysfunction of an ileostoma, etc. is possible. The lethality after planned operations reaches 10 — 12%, after urgent and emergency interventions — 20 — 45%.
The forecast is serious, especially at quickly progressing course of a disease, at Krom the lethality reaches 50%. In many respects the forecast depends on timeliness and correctness of treatment. Perforation of a gut and peritonitis, plentiful repeated bleedings, consecutive infection, thromboembolisms, a malignancy, disturbances of electrolytic balance, endogenous dystrophy and postoperative complications at the operated patients are the main reasons for lethal outcomes. Is of great importance timely (at the corresponding indications) an operative measure. After radical operations the forecast for life more often favorable, however most of patients are disabled in connection with considerable disturbance of exchange processes.
Prevention of a disease is not developed. The existing preventive actions are directed to the prevention of a recurrence and lengthening of remissions (healthy nutrition, the sparing mode, an exception of stressful situations, antirecurrent medicamentous therapy, etc.).
Features of ulcer nonspecific colitis at children. Children have Me. N to. meets considerably less than at adults. The disease can develop at any age, even in the first weeks of life. More often the children transferred from the first weeks of life on artificial feeding get sick. Mental stresses, bruises of a stomach can be provocative factors.
At children morfol. changes in a large intestine differ from those at adults a little. Only more considerable reactive hyperplasia in lymphoid follicles of a mucous membrane of a large intestine and regional limf, nodes, followed by increase in their sizes is noted. Current I. N to. at children can be easy, moderately severe and heavy. The heavy and moderately severe course of a disease is observed approximately in 50% of cases, the easy current — with an identical frequency at children of both sexes is more often at boys.
The beginning of a disease at most of children gradual or subacute. The acute (dizenteriyepodobny) beginning is noted only at 3% of the diseased. Further I. N to. gets hron. continuous or recurrent current. The fulminant current meets quickly coming lethal outcome seldom (slightly more often at chest age). The first symptoms of a disease are impurity of blood to Calais, sometimes an abdominal pain and increase of a chair. Full development a wedge, pictures is observed most often in 1 — 2 month after emergence of the first symptoms.
Treatment includes a dietotherapy (an exception of cow's milk, smoked products, restriction of carbohydrates), psychotherapy and phytotherapy. Doses salazosulfanilamid depend on age of children. In 7 — 10 days at an urezheniya of a chair, disappearance of blood from a calla the dose is reduced by one third; during the obtaining lasting effect further reduction of a dose is made by each 2 — 3 weeks. The course of treatment at the easy course of a disease and moderately severe makes not less than 2 — 3 months, at heavy — not less than 6 months. At insufficient effect of salazosulfanilamid in addition appoint derivatives of oxyquinoline (Intestopanum), apply the immunodepres-websites (Azathioprinum) less often. Unlike adults steroid hormones to children are appointed extremely seldom, only in the absence of effect of other drugs (it is necessary to refrain also from their appointment during the preoperative period). Biol. the drugs contributing to normalization of intestinal microflora (kolibakterin, bifikol, etc.), are shown only to patients with easy forms of a disease. Apply also vitamins, intramusculary administer iron preparations. Hemotransfusion and introduction of blood substitutes to children make only at very severe disease or in the period of a preparation for surgery.
Indications to a planned operative measure are a heavy current I. N to., followed by sharp lag in growth, dystrophy, heavy anemia, and lack of effect of conservative therapy. Extension of indications to operational treatment of children is connected with danger of a malignancy of process in 15 — 20 years from the beginning of a disease. Operational treatment I. N to. at children it is carried out by the same principles, as at adults. At children unlike adults the rectum is surprised to a lesser extent, than other departments of a large intestine that it allows to leave it at a colectomy and to impose an ileorektalny anastomosis. Children easier than adults undergo this operation, and at most of them practical recovery is observed.
The forecast at the easy course of a disease and at most of children at I. N to. rather favorable, moderately severe in case of full treatment. Approach of long long-term remissions is possible. At heavy I. N to., and a part of patients at a moderately severe disease even in case of prolonged treatment always has a danger of an aggravation.
Prevention of aggravations consists in an exception of allergenic factors, including inoculations, in strict observance of a diet, the sparing mode with reduction of exercise stresses.
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