What Is Pseudomembranous Colitis?

Pseudomembranous enteritis is an acute fibrous exudative inflammation that mainly occurs in the colon and small intestine. Most of them cause imbalance of the normal intestinal flora after the application of antibiotics. It is difficult to distinguish Clostridium spp. . Because it is closely related to the application of antibiotics, it is also known as "antibiotic-associated enteritis". The disease occurs in the elderly, critically ill patients, immunocompromised patients, and patients after major surgical operations. The clinical manifestations are different, but only Mild diarrhea can also cause high fever, severe diarrhea, water and electrolyte disorders, toxic megacolon, and even life-threatening. The disease is severe and has a high mortality rate if not treated in time. Due to the widespread use of broad-spectrum antibiotics and immunosuppressants, the incidence of the disease is on the rise.

Basic Information

nickname

Antibiotic-associated enteritis

English name

pseudomembranous enterocolitis

Visiting department

Internal medicine

Multiple groups

Elderly, critically ill, immunocompromised, and patients after major surgery

Common locations

Intestine

Common causes

Clostridium difficile multiplies rapidly and produces toxins

Common symptoms

Diarrhea and severe cases have a lot of watery diarrhea, which can discharge plaque-like pseudo-membrane. Often accompanied by lower abdominal pain, dull, bloating, or spastic pain

Causes of pseudomembranous enteritis

The disease can occur after surgery, or under antibiotic treatment due to the condition, the internal environment of the body changes, and the intestinal flora is imbalanced, causing Clostridium difficile to multiply rapidly and produce toxins.

Clinical manifestations of pseudomembranous enteritis

Diarrhea is the main symptom, and the degree and frequency of diarrhea varies. Lighter stools can be healed 2 to 3 times a day, and heal itself after stopping antibiotics. In severe cases, a large amount of watery diarrhea can be seen 30 times a day. Some patients can discharge plaque-like pseudomembrane. Often accompanied by abdominal pain, mostly in the lower abdomen, with dull, bloating or spasmodic pain, but also accompanied by abdominal distension, nausea, vomiting, fever, etc., severe and violent patients may appear water and electrolyte disorders, hypoproteinemia, moderate Toxicity and hypovolemic shock.

Pseudomembranous enteritis

Laboratory inspection

Peripheral blood white blood cell count increased, mainly neutrophils. There is no specific change in routine examination, only white blood cells are rare in naked eyes. Have hypoalbuminemia, electrolyte imbalance, or acid-base imbalance. Fecal bacteria are cultured under special conditions. In most cases, clostridium difficile is found to grow. Clostridium sludge antitoxin neutralization tests are often positive.

2. Endoscopy

When the disease is highly suspected, endoscopy should be performed in time. The disease often affects the left hemicolon, and the rectum may be disease-free. Endoscopic macroscopic observation: only mild mucosal congestion and edema, unclear blood vessel texture, and non-specific enteritis; milder cases can be seen with superficial erosion, pseudomembranous distribution and peripheral hyperemia; in severe cases, pseudomembranous patches Or map-like, the pseudomembrane is not easy to fall off, and ulcers can be seen in some of the falloff areas. Pseudomembrane is characteristic and has great significance for clinical diagnosis.

3.X-ray inspection

A plain film of the abdomen can show intestinal paralysis or mild to moderate intestinal dilatation. Barium enema examination showed thickening of the intestinal wall, significant edema, and disappearance of the colonic bag. In some cases, gas can be seen between the intestinal walls. This symptom is caused by intestinal wall necrosis and colonic bacteria invasion; or the appearance of ulcers or polypoid lesions. The above-mentioned X-ray manifestations lack specificity, and therefore have little diagnostic value. Air barium contrast enema examination can improve the diagnostic value, but there is a risk of intestinal perforation and should be used with caution.

Diagnosis of pseudomembranous enteritis

Medical history

Occurs more than 50 years of age, more women than men. Most patients have a history of gastrointestinal surgery or other serious illnesses, and have recently used antibiotics, especially broad-spectrum antibiotics. Symptoms are more common within 4 to 10 days of antibiotic treatment or 1 to 2 weeks after antibiotic withdrawal. There are diarrhea, abdominal pain, some patients can discharge plaque-like pseudo-membrane, but also accompanied by abdominal distension, nausea, vomiting, fever and other symptoms.

2. Signs

Shock manifestations such as increased pulse, decreased blood pressure, and shortness of breath, signs of dehydration; changes in poisoning such as insanity; signs of abdominal tenderness, abdominal muscle tension, flatulence, and weakened bowel sounds.

3. Laboratory inspection

Stool smear examination, whether the proportion of cocci was increased. If necessary, the fecal double-enzyme clostridium antitoxin neutralization method can be used to determine the presence of clostridium toxin.

4. Auxiliary inspection

(1) X-ray examination shows intestinal flatulence and fluid level.

(2) Fiber colonoscopy showed redness and edema of mucosa, plaque on the surface, or a pseudo-membrane that had been fused.

Differential diagnosis of pseudomembranous enteritis

This disease should be distinguished from ulcerative colitis, colon Crohn's disease, ischemic enteritis, and AIDS colitis.

Treatment of pseudomembranous enteritis

1. Immediately stop using the original antibiotic

Antibiotics should be tested and discontinued in time for suspected patients. For the primary disease, users must use narrow-spectrum antibiotics with specific targets. Avoid antispasmodics and antidiarrheals to prevent toxins from staying in the intestine.

2. For critically ill patients

Supportive therapy should be strengthened to correct water and electrolyte disorders, supplement blood volume, supplement plasma and albumin to enhance patient resistance, enable patients to pass the dangerous period, and gain time for the treatment of the cause.

3. Etiology treatment

Should choose effective drugs for the cause such as metronidazole, vancomycin and so on.

4. Restore normal flora

Oral use of drugs containing Lactobacillus acidophilus, Bifidobacterium, etc., or enema can be used to restore the normal flora of the patient's intestine.

5. On medication

Repeated severe cases with poor response can be considered surgical treatment if necessary.

Prevention of pseudomembranous enteritis

First of all, we should pay attention to the use of antibiotics to avoid the abuse of antibiotics and reduce the incidence of pseudomembranous enteritis. In particular, the use of broad-spectrum antibiotics must have a clear purpose, and the drug should be discontinued in time after achieving the expected effect. For frail elderly patients, especially after major abdominal and pelvic surgery, and cancer patients with low immune function, the use of antibiotics that can easily induce Clostridium difficile should be avoided as much as possible. Patients who must use antibiotics should be more vigilant, be detected early and treated promptly to reduce the occurrence of severe pseudomembranous enteritis.

Prognosis of pseudomembranous enteritis

If the disease can be diagnosed early and treated in time, most patients can recover, clinical symptoms and signs are improved and disappeared, and pathogenic bacteria in the stool turn negative and toxins disappear. If the diagnosis is delayed and the etiology is not well controlled, the comorbidities during the treatment process will have serious consequences.