Nonspecific ulcerative colitis: symptoms and treatment
Nonspecific ulcerative colitis (abbr. NUK) is a chronic inflammatory disease that affects the intestine. Nonspecific ulcerative colitis, the symptoms of which lead to the development of characteristic ulcers on the surface of the mucous organ, can lead to the development of serious complications, ranging from intestinal bleeding and ending with narrowing of the lumen by the intestinal wall with subsequent development in the late period of the progression of a disease such as colorectal cancer.
The main peak of the incidence of NNA is in patients aged 20 to 40 years, the second «wave» at the peak incidence falls at the age of 60-70 years.
There are some peculiarities in terms of gender and belonging to a specific locality. For example, it is known that nonspecific ulcerative colitis in men is diagnosed a little more often than ulcerative colitis in women, approximately a ratio of 1.4: 1 is estimated.
It is also known that residents of rural areas are less likely to face this disease than residents of cities and megacities.
Pausing directly on the pathological process, we note that, as a rule, the NNC originates from the rectum, and afterwards, due to the gradual spread, it affects the entire intestinal mucosa. Based on some available data, it can be noted that on average about 30% of cases, the actual inflammatory process only covers the rectum and sigmoid colon (ie, the process is limited to only these areas). At the same time, up to 50% of cases of the pathological process are accompanied by coverage of the rectum and sigmoid colon as well as the transverse colon and descending colon. In addition, for the remaining 20-30% of cases, it can be indicated that the pathological process affects the entire intestine.
The actual changes affecting the intestinal mucosa are determined on the basis of a specific phase of the inflammatory process. Thus, in the acute phase, the changes consist of the following lesions: swelling of the mucosa and its redness, development of spontaneous bleeding or bleeding due to a specific contact (eg, mucosa and feces), external pitting of ulcers, appearance of pseudopolyposal formations (resembling polyps of formation that form in the background Inflammatory process).
They also distinguish the phase of remission, it is characterized by atrophy, accompanied by thinning of the mucous membrane with a simultaneous violation of its inherent functions. In addition, within this phase, the vascular pattern of the mucosa disappears, and lymphatic infiltrates are formed in it.
To understand the processes occurring in this disease, you can consider the anatomical features of the large intestine and its physiology.
Large intestine: anatomy, features of physiology
The intestine is divided into a thick and small intestine. The large intestine originates from the end portion of the small intestine, and its completion is the anus. The large intestine is about a meter and a half in length, its wide beginning, here it reaches 7-15 cm in diameter, it gradually narrows, thereby reaching a diameter of 4 cm in the region of the final part of the intestine.
In addition to these features, the colon is also characterized by the fact that it has six parts (divisions):
- The cecum. This area of the intestine is located under the upper edge of the ileum. Indications of the length of the caecum can on average be determined in 75 cm.
- Colon ascending colon. It is located on the side of the abdomen, on the right. The colon functions as a continuation of the cecum. Anatomically in its location, it reaches the region of the right hypochondrium, in which its transition to the right bend occurs. The length of this gut is about 24 cm.
- The transverse colon. This gut originates from the right bend, in the further there is its transition to the umbilical region, after it goes to the right hypochondrium. From the left hypochondrium this gut forms a left bend, on top it is located near the liver, the spleen and the large curvature of the organ of the stomach, while under it are the loops of the small intestine. The length of this department is on average 56 cm.
- Colon descending colon. The intestine is about 22 cm long, located in the abdomen on the left, side.
- Sigmoid colon. On average, this gut is 47 cm long, it is a continuation of the previous department, and is also a region of passage into the rectum. For the most part, the empty sigmoid colon is in the pelvic area.
- Rectum. Actually this part is the final department in the large intestine, on average, its length is about 15 cm, it ends with an anus.
Each of these departments has muscular and submucosal layers, as well as the mucous membrane, the latter at the same time has a surface in the form of epithelial cells, and also has crypts — specific micelles.
There are in the colon and some peculiar features of it. So, the fibers in the base of her muscle layer on the outside contain muscle bands, there are three of them. Such tapes originate from the appendix, and their completion falls on the lower part of the area of the sigmoid colon. Muscle fibers in the ribbons have a greater tonus compared to the muscle fibers in the base of the muscle layer. Given this, in those areas where the tonus is the smallest in the muscular wall of the intestine, a specific type of protrusion is formed — the hauters. In the rectum there are no hausters.
Now let us dwell on the main features, or rather the functions that characterize the physiology of the large intestine.
- The suction function. About 95% of the fluid during the day is absorbed precisely in the medium of the large intestine along with electrolytes, this index is equivalent to an average of 1.5-2 liters.
- Evacuation function. Accumulation of feces occurs in the large intestine, in the future, as is clear, this is accompanied by its removal from the body.
What is noteworthy, in the normal state of the area of the intestinal lumen an average of about four hundred different bacteria live, with about 70% of the total number of bacteria accounted for by bacteroides and bifidobacteria.
These varieties are directly involved in the processes of digestion of dietary fibers, as well as in the processes of the breakdown of fats and proteins. In addition, the bacteria produce the necessary nutrients necessary for the body. Due to the activity of bifidobacteria, the production and supply of the body with vitamins of group B (B1, B2 and B12), folic acid and nicotinic acid is ensured. In addition, there is an assumption that the risk of developing colon cancer is reduced due to the activity of bifidobacteria.
We also note that thanks to the representatives of the microflora in the medium of the large intestine, development of various types of substances possessing antibacterial activity is provided, and this, in turn, allows to properly react to the appearance of pathogenic microorganisms.
Nonspecific ulcerative colitis: causes
There are no specific reasons provoking the disease, but there are certain assumptions regarding the factors predisposing to its development. In particular, such factors are assumed to have a negative impact on the immune response, which is why the NJC is developing.
Among this type of factors, for example, the genetic predisposition is distinguished (the presence of this disease in the nearest relatives), as well as some gene mutations.
In addition to this, the effects of a certain infectious component are singled out, on this account there are two main theories concerning the participation of microorganisms in the development of the disease. On the basis of the first of them, the infection, more precisely by itself, its entry into the intestinal environment is a predisposing factor to the development of inflammation of its mucosa. Speech in this case is about pathogenic bacteria (certain of their varieties), that is, about bacteria that can provoke the appearance of an infectious disease. On the basis of the second theory, in the development of inflammation, they repel from the excessive reaction of the organism to the part of the immune response to antigens from the side of non-pathogenic bacteria, that is, those bacteria that do not cause disease.
It is also assumed that among the predisposing factors to the development of NNA can be indicated the long-term use of anti-inflammatory non-steroid drugs. Stresses, food allergies — these factors also belong to the group of predisposing people.
Nonspecific ulcerative colitis: symptoms
Before proceeding directly to the symptomatology, we will denote that ulcerative colitis differs depending on the specific area of localization of the pathological process and on the degree of its prevalence. For example, left-sided colitis accompanied by a lesion area of the colon descending colon and sigmoid colon, with the development of inflammation in the rectum suggests proctitis, and if the defeat undergone completely all the colon, it is — a total colitis
In the general plan of examination, the NNC is characterized by a wave-like course, remissions alternate with periods of exacerbations. Exacerbations are accompanied by various manifestations of symptoms, which, again, is determined by the specific area of localization of the pathological process, and also by the degree of its intensity.
Ulcerative proctitis, for example, is accompanied by painful false urge to defecate, hemorrhages from the anus, pain in the lower abdomen.
In some cases, manifestations of bleeding proctitis from the anus are the only symptom that indicates the presence of this disease. It also happens that blood is also found in impurities of pus.
If it is a question of left-sided colitis, then the course of the disease is accompanied by diarrhea, in the fecal masses, it is also possible to detect an admixture of blood. This symptom, like abdominal pain, in this case is characterized by a fairly pronounced degree of manifestation, the pain is mostly cramping and in most cases centers on the left. Among the accompanying signs of the disease, you can identify bloating, decreased appetite. Also, against a background of prolonged diarrhea and digestive disorders, in frequent cases, the total weight loss of patients is noted. In addition to diarrhea, in some cases, constipation may occur (with a limited form of rectal involvement), although diarrhea is a satellite of the disease in 95% of cases on average.
In total colitis, which, as noted, accompanied by the defeat of the entire colon, stomach pain is manifested intense diarrhea constant and plentiful, bleeding from the anus also sufficiently expressed. It is necessary to separately indicate that a total colitis in itself is a condition dangerous to the life of the patient, because his companion become dehydrated, the development of collapse by a significant decrease in blood pressure and orthostatic and hemorrhagic shock.
In particular, a dangerous condition is fulminant (or lightning) form of manifestation of ulcerative colitis, because it can cause the development of an extremely serious nature of the manifestations of complications, which can reach even rupture of the intestinal wall. As one of the most common variants of complications in this form of the disease, a toxic increase in the size of the colon is designated, which is defined as a megacolon. It is believed that this condition is due to the actual blockade, which is received in the intestine of smooth muscle receptors against the background of the effects of excessive production of nitric oxide. Such a course of the pathological process leads to the development of total relaxation from the muscular layer.
What is noteworthy, on average, up to 20% of cases of manifestations of the disease are not limited to intestinal manifestations. So, when NUC satellites actual inflammatory process may be a different form of dermatological pathologies (erythema nodosum, pyoderma gangrenosum, etc.), Inflammation of the eyes (episcleritis, uveitis, iritis, etc.), Stomatitis, bone softening (osteomalacia), diseases of joints ( spondylitis, arthritis and so forth.), diseases of the biliary system, osteoporosis, glomerulonephritis, myositis, vasculitis and so forth. There may be a temperature in the range up to 38 degrees, pain in muscles and joints, etc.
Nonspecific ulcerative colitis: complications
The pathological process, which is topical for the disease, can later become the cause of the development of a number of complications, we will distinguish some of them:
- Toxic gut expansion. In short, in the general review, we have already identified this pathological change, we will highlight the additional aspects that concern it. So, it is important to take into account that this pathology is quite dangerous, in addition to muscle expansion, there is also swelling due to gases, and because of the expansion of the wall the intestines are subject to thinning, which, in turn, promises its subsequent rupture and development of peritonitis. Li >
- Secondary forms of intestinal infections. Because of the existing inflammation, the intestinal mucosa is an ideal medium for intestinal infection. This kind of complication greatly aggravates the general picture of the NNC current. Here there is dehydration, diarrhea (up to 14 times a day), fever.
- Fertilization of the process. In this case, it is about the formation of an inflammatory process of malignant tumor formation.
- Purulent complications. As one of the options, we can designate a paraproctitis, in which acute inflammation of the cellulose in the environment of the rectum develops. Treatment of such inflammation is performed only surgically.
As the main method of diagnosing ulcerative colitis, the colonoscopy method is used, due to which it is possible to study the lesion in detail, that is, the internal walls of the intestine and its lumen.
Such diagnostic methods as X-ray examination using barium and irrigoscopy determine the possibility of detecting existing defects in the walls of the intestine, and also determine how much its size has changed against the background of actual pathological processes. In addition, here you can identify violations of peristalsis and the altered state of the lumen (more precisely — its narrowing).
CT (computed tomography) is also quite effective in the part of results by the method of diagnosis, it can be used to visualize the pattern of pathological changes in the intestinal environment.
Additionally, in the diagnosis of the disease, the coprogram method is used, a test is performed for the presence of hidden blood, bacteriological culture is performed.
Due to the analysis of blood in NUK, a picture of the nonspecific form of the inflammatory process can also be obtained. On the basis of biochemical indicators of blood, one can judge the presence of other pathologies in the main pathological process with this disease, as well as the presence of functional disorders in various systems and organs, including the presence of concomitant disorders of the digestive system.
During a colonoscopy, as a rule, a biopsy (removal of the material) of a portion of the intestinal wall that has undergone changes is used, which is used for subsequent histological examination.
Treatment of ulcerative colitis due to a vague idea of the causes that provoke it is reduced to providing measures to reduce the intensity of the inflammatory process, as well as measures aimed at eliminating or reducing symptoms, while preventing the development of complications and exacerbations of the disease. In each case, such treatment is individual, in it, as in any treatment, it is important to follow the recommendations given by the doctor. A special role in the treatment is the observance of a diet with the exclusion of a number of products, aggravating the general state of the intestine and the pathological process in it.
If signs appear that indicate the possible presence of such a disease as ulcerative colitis, you need to consult a proctologist.