What Is Fulminant Colitis?

Broadly speaking, any chronic inflammation that causes the colon can be called chronic colitis. It is a chronic, repetitive, multiple, inflammatory edema, ulcer, bleeding caused by various intestinal causes Lesions. In a narrow sense, it refers to ulcerative colitis. The cause is not very clear, the lesions are limited to the mucosa and submucosa, and the common parts are the sigmoid colon, rectum, and even the entire colon. The disease is characterized by a long course and chronic recurrent episodes. It is mainly characterized by abdominal pain and diarrhea. Mucus, constipation, or diarrhea occur alternately. More common in young adults.

Basic Information

English name: chronic colitis
Visiting department: Gastroenterology
Multiple groups: 20 to 30 years old

Common causes: Related to infection, immunity, genetics, food allergies, mental factors, etc.
Common symptoms: Mainly abdominal pain, diarrhea, mucus, constipation or diarrhea
Contagious: no

Causes of chronic colitis

The etiology of chronic colitis is complex. The most common etiology is non-specific colitis, such as irritable bowel syndrome, inflammatory bowel disease, intestinal flora imbalance, and small intestinal malabsorption. Generally believed to be related to infection, immune inheritance, environment, food allergies, defense dysfunction and mental factors.

Allergic factors

Allergic lesions are affected by individual differences. Mainly intestinal allergies, occasionally involving the skin. Some people are allergic to high-protein foods such as fish, shrimp, crab, and cow's milk. These foreign proteins enter the body to produce a large amount of histamine, which triggers an allergic reaction. An allergic reaction is a reaction caused by sensitizing substances and autoimmunity, which stimulates a large number of immune cells to condense and all gather on the surface of the mucosa of the digestive tract, causing inflammation of the mucosal surface such as edema, hyperemia and exudate.

2. Infectious factors

It is generally considered to be related to infection. Whenever the disease occurs, the use of antibiotics can control the disease and the effect of treatment to varying degrees, indicating that the disease has the role of pathogenic bacteria.

3. Abuse of antibiotics

Abuse of antibiotics can cause intestinal flora imbalance or enteritis caused by antibiotic-resistant strains.

Clinical manifestations of chronic colitis

Chronic diarrhea

The severity of diarrhea varies, and those with mild bowel movements may have bowel movements 3 to 4 times a day, or diarrhea and constipation may alternate; severe cases may occur once every 1 to 2 hours. Some patients may have nocturnal diarrhea and / or postprandial diarrhea. When the rectum is severely affected, a sudden sensation may occur. The stool is mostly mushy, mixed with a lot of mucus, and even with pus and blood.

2. Repeated abdominal pain

Abdominal pain is mostly chronic, sometimes mild and severe. Sometimes abdominal pain precedes diarrhea, sometimes accompanied by symptoms such as fever, nausea, bloating, and loss of appetite. The abdominal pain can be around the umbilicus or the left lower abdomen.

3. Other performance

Occasional manifestations of arthritis, iridocyclitis, liver dysfunction, and skin lesions. Due to prolonged attacks, patients often show weight loss and pale, and often experience tenderness in the colon during abdominal examinations during active disease. There may be signs of acute abdomen with fever and reduced bowel sounds, especially in acute or fulminant cases.

Chronic colitis examination

Fiber colonoscopy

Diagnosis is mainly based on colonoscopy, because 90% to 95% of patients are affected by the rectum and sigmoid colon. Early lesions in the microscopy showed multiple intestinal mucosal erosions or superficial ulcers, and congested and edema mucosa was seen, which was brittle and prone to bleeding. Ulcers can be seen in progressive cases, surrounded by raised granulation tissue and edema of the mucosa, which look like polyps, or can be called pseudopolyps formation. Rectal and sigmoid colonic cavities can be significantly reduced in chronic progressive cases. To clarify the scope of the disease, colonoscopy is currently used for whole colon examination, and multiple biopsies are performed at the same time to identify Crohn's disease colitis, and pathological diagnosis of tissue biopsy Is the "gold standard" for chronic colitis.

2. Double contrast angiography of barium enema

In the barium perfusion imaging, the colonic bag disappeared, the bowel wall was irregular, pseudopolyps formed, and the bowel cavity became thin and rigid. Barium enema examination is not recommended for patients with abdominal signs, but plain X-ray examination of the abdomen should be performed to observe the signs of toxic megacolon, colonic dilatation, and free gas under the diaphragm.

3. stool test

Stools routinely see red, white blood cells and a small amount of pus cells, detect faecal toxins, and culture aerobic and anaerobic bacteria, and then culture dysentery bacillus and amoeba. If pathogenic bacteria can be found, it is a chronic colitis diagnosis One of the important foundations.

4. Blood biochemical examination

It can be seen that electrolyte disorders, often low potassium, low sodium and hypoproteinemia, serum protein can be less than 30g / L, white blood cell count can be as high as more than 20,000, and mainly neutral cells.

Chronic colitis treatment

(A) treatment principles

Actively find the cause of the disease, protect the gastric mucosa, fight against pathogens, eliminate enterotoxin, improve symptoms, symptomatic treatment, and prevent recurrence. In the chronic phase, conservative treatment is the main treatment. Surgical treatment can be used for cases with explosive or ineffective medical treatment.

(B) TCM Syndrome Differentiation and Treatment

1. Poisonous heat is hot and clear

Damp heat is heavy, inappropriate treatment, damp heat is poisonous, block middle coke, turbidity, diarrhea, toxic heat into camp blood, evidence of high fever, thirst, short urine, red pouring, or egg pattern thin Stool, red tongue, pulse string or fine count. Expelling dampness and clearing heat, lifting clearing and stopping dysentery. The side with Pueraria lianlian soup plus or minus.

2. Heat and Yin are not consumed

Due to yin deficiency in the body of the patient, or both postpartum and postoperative injuries of qi and blood, dampness, heat, poison, and evil for a long time, and yin and blood consumption. Because of the multiple yin deaths after the diarrhea, the yin-depleted body is declining and the poisonous heat is like the sun. Hot flashes in the afternoon, dry mouth or drink, no redness, five upset fever, short urine, red tongue, red pulse, pulse count. Expelling nourishing yin through heat. Fang used artemisia scutellariae soup to add or subtract.

3. Spleen deficiency and dampness, clear and turbid

The corpus spleen is deficient, wet and air-blocked, and the spleen is weak and wet, and the turbidity is indistinguishable. God is lazy, eats less, appetites, thirst and does not want to drink, diarrhea, frequent loose stools, white tongue coating, thin pulse. Expelling Qi, strengthening the spleen, soaking wet and preventing diarrhea. Fang used Shenling Baizhu pills to add or subtract.

4. Deficiency of Spleen and Kidney, Deficiency of Yang Deficiency

Due to excessive pouring, yin will fall to the yin, and yin will have no yang attachment, resulting in yin to yang. The cold limbs are cold, the limbs are thin, the limbs are cold, the chills, the abdomen are bloated, and the pulse is slightly waning. Expelling the cold in the middle, returning to the sun to save. Fang uses Sini Tang and Sishen Tang.

(3) Western medicine treatment

Medical treatment

(1) Bed rest and whole body support treatment Including fluid and electrolyte balance, especially potassium supplementation, hypokalemia should be corrected. At the same time, we must pay attention to the supplementation of protein, compound amino acids and water-soluble vitamins to improve the nutritional status of the whole body. If necessary, we should provide total parenteral nutritional support. Those with anemia can be transfused. Milk and dairy products should be avoided when ingesting the gastrointestinal tract. .

(2) Etiology treatment Anti-infective drugs: According to bacterial culture and bacterial drug sensitivity tests, anti-infective drugs against pathogenic bacteria, such as droperimic acid capsules, ciprofloxacin, metronidazole, and sulfasalazine salicylic acid, are selected. Acid preparations (Edita, mesalazine), etc., or antibiotic retention enemas, such as compound norfloxacin enemas. Corticosteroids: Prednisone or dexamethasone are commonly used drugs, but long-term hormone maintenance is not currently believed to prevent relapse.

(3) symptomatic treatment gastrointestinal antispasmodics, such as atropine, probencin, nifedipine; antidiarrheal drugs, such as compound camphor tincture, smecta, loperamide, etc .; regulation of intestinal flora Medicines, such as bifidobacteria live bacteria preparations, bifidus triple viable preparations, lactobacillus, etc .; increase gastrointestinal peristaltic drugs, such as morpholine, cisapride, etc .; relieve constipation drugs, such as oral fruit guide tablets, topical Paraffin oil, Kaisailu and so on.

2. Surgical treatment

20% to 30% of patients with severe chronic colitis eventually need surgery

(1) Indications for surgery The indications for immediate surgery are: a large amount of uncontrollable bleeding; toxic megacolon with an adjacent or clear perforation, or ineffective treatment of toxic megacolon for several hours; fulminant Patients with acute chronic colitis who have undergone steroid hormone therapy for 4 to 5 hours and whose symptoms have not improved; Patients with obstruction due to stenosis; Patients with suspected or confirmed colon cancer; Relapsed refractory chronic colitis that worsens and chronic symptoms persist , Malnourished, weak, unable to work, unable to participate in normal social activities and sexual life; when the steroid hormone dose is reduced, the disease immediately worsens, so that months or even years can not stop hormone therapy; children suffering from chronic colitis and When it affects its growth and development; severe extracolonic manifestations, such as arthritis, gangrenous pyoderma, or bile liver disease, etc., surgery may have an effect on it.

(2) Surgery options There are currently four types of surgery for chronic colitis. Total colorectal resection and ileostomy; Total colon resection and ileal anastomosis; Controlled ileostomy; Total colorectal resection and ileal pouch-anal anastomosis.

Prognosis of chronic colitis

1. The disease is prolonged for a long time, and it is not easy to cure. Usually medication can relieve symptoms. Usually pay attention to prohibit spicy, alcohol, cold and greasy food.

2. Medication is difficult to control, or there are many complications, surgery should be considered.

3. Be sure to continue treatment until the colonoscopy report is normal, otherwise it is easy to relapse.

Chronic colitis prevention

1. Pay attention to the combination of work and rest, do not be too tired, and maintain good sleep; patients with fulminant, acute, and severe chronic types should stay in bed.

2. Pay attention to clothing and keep warm and cold; exercise appropriately to enhance physical fitness.

3. Generally, you should eat foods that are relatively light, soft, digestible, nutritious, and sufficient in calories. Small meals and multiple vitamins should be added. Do not eat raw, cold, high-fat oily and fiber-rich foods.

4. Pay attention to food hygiene, and avoid intestinal infections to induce or exacerbate the disease. Avoid tobacco and alcohol, spicy food, milk and dairy products.

5. In general, keep your mood comfortable, avoid mental stimulation, and relieve all kinds of mental stress.