What Is Pseudomembranous Enterocolitis?

Pseudomembranous colitis (PMC) is also called clostridium difficile anaerobic enteritis, postoperative enteritis, antibiotic enteritis, antibiotic-induced clostridium difficile anaerobic enteritis, and so on. PMC often occurs after major surgery and in patients who cause critical and chronic wasting diseases. The use of broad-spectrum antibiotics, especially after oral jiemycin, promotes imbalance in the intestinal flora and makes it difficult to distinguish the abnormal reproduction of Clostridium anaerobic. The production of mycin causes acute shock inflammation of the intestinal mucosa, forming a false membrane on the necrotic mucosa.

Pseudomembranous colitis

Pseudomembranous colitis (PMC) is also called clostridium difficile anaerobic enteritis, postoperative enteritis, antibiotic enteritis, antibiotic-induced clostridium difficile anaerobic enteritis, and so on. PMC often occurs in large

Colon analysis map

intestinal obstruction

Neutrophil

The onset of the disease is rapid, and it usually occurs in patients after major abdominal surgery and antibiotics. It can appear as early as several hours to two days after starting the medication. No later than after discontinuation

1. Mild and hot type: due to heavy damp and heat, inappropriate regulation, damp and hot contamination, so that damp and mild heat and evil intertwined, stagnation in the middle coke, turbidity, no degree of diarrhea, mildew into the blood. Symptoms include high fever, irritability, bleeding, short urine, red pouring, diarrhea, or loose eggs. Even the heat is closed inside, the sperm burns, the limbs are cold, the mind is faint, the tongue is red, the number of pulse strings or counts. 2. Heat Sheng Yin consumption type: due to the patient's corpus yin deficiency, or postpartum and postoperative qi and blood injuries, damp mold heat and evil for a long time, Yin blood consumption. Because of the diarrhea after the diarrhea, the body of yin deficiency is dying, and the sun of poisonous heat is dying. Symptoms include high fever, poor sundial, hot flashes, dry mouth or drink, dry red, five upset fever, short urine, frequent diarrhea, red tongue, pulse count. 3. Spleen Deficiency and Wetness Type: Factors of deficiency of body and spleen, dampness and spleen, spleen due to transport, dereliction of duty, water tends to large intestine, and water can't be separated into valleys, respectively. Moisturizing and soaking, the inappropriate treatment, not only consumes the stomach yin, but also damages the spleen and yang, so that the spleen is weak, wet, and turbid. Symptoms pale, tired and lazy, eat less and appetite, thirst and do not want to drink, or see chills and cold, puffiness, diarrhea, frequent loose stools, white tongue coating, thin pulse. 4. Deficiency of spleen and kidney, yang deficiency and desire to lose type: due to excessive pouring, it will die more than yin, and yin exhaustion will have no dependence on yang, which will cause yin and yang to fall off. Symptoms include weight loss, coldness in the limbs, coldness, fatigue, abdominal distension, abdominal pain, diarrhea straight down, anus eversion, even tongue fatigue and cystic contraction, and the pulse is weak.

Cells and organelles

1. Early diagnosis and timely treatment are extremely important to improve the cure rate and reduce mortality. Once the diagnosis is confirmed, the original antibiotic should be stopped immediately.

2. Supportive therapy: Pay attention to rest. Infusion corrects water and electrolyte disorders. Correct hypoproteinemia. In recent years, it has been found that the watery diarrhea caused by ectomycin can be supplemented with sodium chloride by oral glucose saline, and correct acidosis.

3. Cultivate the normal intestinal flora to inhibit the growth of Clostridium difficile (usually 5-10 g of normal human feces, mix with 200 ml of physiological saline, and retain the enema after filtering, 1 to 2 times a day for 3 to 5 consecutive times) day. You can also use lactobacillus-containing milk enemas or oral vitamin C and vitamin B family, folic acid, lactase, glutamic acid and so on.

4. Drug treatment: Vancomycin and non-absorbable sulfa drugs can effectively treat and prevent experimental vole pseudomembranous enteritis and artificial pseudomembranous enteritis, and make it difficult to distinguish (bred) clostridium and its mold in feces. Su disappeared quickly. Therefore, vancomycin is listed as the preferred antibacterial agent. Oral 250 ~ 500mg each time, 4 times a day. Sulfonamides such as SG and PST are taken orally, 1 g each time, 4 sticks daily. . Metronidazole can also effectively treat pseudomembranous enteritis. The adult dose is 1.5g per day, and the treatment period is 10 to 15 days. Although metronidazole is quickly absorbed in the upper digestive tract, it can still effectively combat Clostridium difficile (fertility) after oral administration, and has clinical value.
Some scholars have used Clostridium gangrenosus polyvalent antimycin to treat difficult-to-identify (bred) Clostridium infection, and achieved good results. Method: 50,000U was added to 500ml of 5% dextrose saline, and then dripped twice a day. In addition, there is the use of hyperbaric oxygen to treat the disease.
5. Other treatments: Try antispasmodics. Individual reports have tried hormones in critically ill patients, and adrenocortical hormones can be used if necessary. Some advocate the use of cholestyramine. It exerts ion exchange in the intestine and combines with Clostridium bacillus to excrete, and can promote the absorption of bile salts in the terminal ileum to improve diarrhea. Take 4g orally every 6 hours for 5 days. If refractory diarrhea is accompanied by hypoproteinemia and electrolyte disturbances or toxic colonic dilatation, surgical decompression is performed if necessary, and a transverse colostomy is performed. Avoid antidiarrheals, so as not to induce toxic colonic dilatation. Patients with severe postoperative malnutrition can be treated with intravenous high nutrition infusion.

Chinese Medicine

1. Strictly grasp the indications for the use of antibiotics to prevent abuse. The preventive application of antibiotics should be strictly controlled.
2. Clindamycin is a drug resistant to Staphylococcus aureus and Anaerobic fragile Bacterium, but when infected with the above bacteria, unless other drugs are ineffective or unconditional application, clindamycin and Linco Mycin. Ampicillin is also prone to pseudomembranous colitis. Attention should be paid in clinical use.
3. Clinicians should seriously observe the complications of using antibiotics and identify and confirm the diagnosis early to avoid delay in treatment. Patients with diarrhea should promptly discontinue medication for stool tests and repeat sigmoidoscopy if necessary, especially for patients with clinically suspected pseudomembranous colitis or patients with unexplained fever after major bowel surgery.
4. Bartlet believes that patients who plan to be treated with clindamycin or lincomycin can take oral fangcomycin to prevent pseudomembrane colitis.
Most patients can be cured after treatment. Mild patients, some can heal themselves. Very few patients have improved after treatment, but diarrhea can occur again. Severe cases, especially elderly patients after bowel surgery, the mortality rate can reach 50% to 70%. In recent years, due to timely diagnosis and treatment, the mortality rate has fallen below 30%. ^[1]

I. Rest: Rest has great benefits for the disease, especially for patients during the active period, we should emphasize adequate rest to reduce mental and physical burdens. You can gradually increase your activity as your condition improves, but you should generally avoid heavy physical activity.
2. Diet and nutrition: During the diarrhea period, pay attention to supplementing nutrition, and appropriately reduce the cellulose content in the diet, such as leek, celery, garlic cloves, etc., and use a less residue diet to reduce the high fiber content that may bring to the colon mucosa. Mechanical damage. With regard to drinking milk for patients with colitis, it depends on whether diarrhea worsens after drinking milk, because patients with ulcerative colitis may be allergic to cow's milk protein. On the other hand, some patients may take milk diarrhea due to intestinal lactase deficiency. In China, there are more people with lactase deficiency than in the West. Therefore, patients with inflammatory bowel disease during diarrhea should carefully ask if they have a history of allergy to cow's milk. Limiting the intake of dairy products may sometimes stop. Diarrhea effect.
Due to diarrhea, blood in the stool, chronic inadequate food intake, and poor nutritional absorption, patients may have iron deficiency, folic acid deficiency, or anemia, and appropriate supplementation should be given. Generally it can be supplemented by oral or injection. The use of traditional Chinese medicine for invigorating spleen, nourishing blood and nourishing kidney can also achieve the purpose of increasing physical fitness and nutritional supplementation. Long-term diarrhea should be supplemented with calcium and trace elements such as magnesium and zinc.

Intestinal perforation: It is a complication of toxic intestinal dilatation, but it can also occur in severe forms. It usually occurs in the left colon. Corticosteroid application is considered a risk factor for intestinal perforation.
Intestinal stenosis: It usually occurs in cases with extensive lesions and a duration of more than 5-25 years. Its location is more common in the left semicolon, sigmoid colon or rectum. It is generally asymptomatic in clinical cases, and can cause intestinal obstruction in severe cases. When intestinal stenosis, we should be alert to tumors and identify benign and malignant.
Toxic intestinal dilatation: This is a serious complication of this disease. It occurs mostly in patients with pancreatitis, with a mortality rate of up to 44%. The clinical manifestations are rapid deterioration of the condition, obvious symptoms of poisoning, accompanied by diarrhea, abdominal tenderness and reversal. Pain, bowel sounds weakened or disappeared, white blood cell count increased, and bowel perforation easily occurred.
Large amount of blood in the stool: Blood in the stool is one of the main clinical manifestations of the disease, and the amount of blood in the stool is also an indicator of the severity of the disease. The large amount of blood in the stool refers to a large amount of intestinal bleeding in a short period of time, accompanied by a rapid pulse, decreased blood pressure and decreased hemoglobin, and requires blood transfusion treatment.