LECTURE No. 10. Chronic diseases of the colon in children. Clinic, diagnosis, treatment

Chronic nonspecific diseases of the colon.

1. Functional disorders:

1) chronic constipation;

2) irritable bowel syndrome;

3) diverticular disease.

2. Organic disorders:

1) chronic colitis;

2) nonspecific ulcerative colitis;

3) Crohn's disease;

4) intestinal amyloidosis.

Classification of functional bowel disorders.

1. Intestinal upset:

1) irritable bowel syndrome;

2) functional bloating;

3) functional constipation;

4) functional diarrhea;

5) unidentified functional disorders.

2. Functional abdominal pain:

1) functional abdominal pain syndrome;

2) functional pain of an unknown nature.

3. Functional disorders of the gastrointestinal tract in children:

1) functional dyspepsia;

2) irritable bowel syndrome;

3) functional abdominal pain;

4) abdominal migraine;

5) aerophagy.

1. Chronic constipation

Etiology. Reasons for development: improper diet, suppression of the urge to defecate, medications, local organic causes.

Clinic. The frequency of stool becomes less than 3 times a week, the consistency of stool becomes denser (“sheep feces”), and difficulties appear associated with bowel movements. Chronic constipation is divided into:

1) functional, which are divided into nutritional, dyskinetic, psychoneurogenic, endocrine, inflammatory;

2) organic.

Functional chronic constipation includes cases of rare bowel movements when it is not possible to identify any organic cause for this condition.

Diagnostics. Diagnosis of chronic constipation is as follows.

1. High proctolonoscopy.

2. Proctosigmoidoscopy in combination with irrigoscopy.

3. Fractional X-ray injection of barium through the small intestine.

Treatment. Diet therapy for chronic constipation.

1. Black and white bread with bran, legumes; cereals: oatmeal, buckwheat and barley.

2. Meat with a lot of connective tissue.

3. Raw vegetables and fruits, dried fruits.

4. Pickles, sweet kissels and compotes.

5. Fermented milk products. Water, fruit juices, mineral waters (Essentuki No. 4 and 17).

Diet therapy for constipation in infancy.

1. Fruit juices, vegetable purees.

2. Cabbage and beetroot juices, prune puree.

3. A mixture of "Fris" (for regurgitation, constipation, intestinal colic).

4. Mixture "Semperbifidus" (lactolac-tulose), etc. Diet therapy for constipation in other age groups.

1. Wheat bran.

2. Seaweed (kelp).

3. Thermal contrast liquids for drinking.

4. Biologically active additives (with dietary fiber).

Principles of treatment.

1. Laxative anthraglycosides (senna leaves, rhubarb; yew-sem, senadexin); synthetic (phenolphthalein, bisacodyl); lactulose (normase, portalac), hilak-forte.

2. Motility regulators (raglan, cerucal, motilium, coordi-nax).

3. For pain, a group of reserpine, antispasmodics. Anti-inflammatory in microenemas.

4. Phytotherapy.

5. Physiotherapy.

6. Therapeutic exercise.

7. Psychotherapy.

2. Irritable Bowel Syndrome

Irritable bowel syndrome is pain associated with the small intestine and disturbances in its function in the absence of morphological changes.

Clinic. Characteristic complaints associated with violation of the regularity of bowel movements, which exist for more than 3 months (or recur); changes in stool, flatulence and flatulence, occupying over 25% of the day.

Clinical symptoms: violation of the regularity of bowel movements (mainly in the form of constipation, diarrhea). Abdominal bloating, feeling of fullness, flatulence. Difficult to localize abdominal pain, varying in intensity. Feeling of incomplete bowel movement after bowel movement.

Diagnostics. Ultrasound of the abdominal organs, endoscopic examination, combined endoscopic and x-ray examination of the colon.

Treatment. Treatment for irritable bowel syndrome is as follows.

1. Motility regulators: antispasmodics - pinaverium bromide (dicetel); forlax.

2. Enveloping and adsorbing: smectite.

3. Normalization of microflora: probiotics and prebiotics; intestinal antiseptics (intetrix, metronidazole).

4. Psychotherapy: psychotropic drugs, autogenic training, exercise therapy with the participation of a psychotherapist.

3. Diverticular disease

Diverticular disease is based on visible pathological changes in the colon.

Diverticula are formed as a result of weakening of the intestinal wall where blood vessels pass through.

Clinic. With uncomplicated diverticulitis - symptoms of IBS.

In acute diverticulitis, symptoms of peritoneal irritation; fever, leukocytosis; acute cramping, often left-sided, abdominal pain; sometimes there is blood in the stool.

Diagnostics. X-ray contrast examination (irrigoscopy), endoscopy with biopsy, ultrasound of the abdominal organs, computed tomography.

Treatment. Treatment of diverticular disease is as follows.

Stage I - diet with ballast substances, swelling agents, treatment of constipation.

Stage II - restriction of food intake, parenteral nutrition, antispasmodics and antibiotics; then - a diet rich in ballast substances, swelling agents.

Stage II diverticulitis is recurrent and resistant to therapy, as well as stage III and IV diverticulitis with local complications - surgery.

4. Organic disorders of the colon

Chronic colitis. Classification of chronic colitis.

1. By process localization:

1) right-handed;

2) left-sided;

3) transverse;

4) total.

2. Process phase:

1) exacerbation;

2) remission.

3. Type of intestinal dyskinesia:

1) hypomotor;

2) hypermotor;

3) mixed.

Diagnosis of chronic colitis.

1. Sigmoidoscopy (catarrhal or catarrhal-follicular proctosigmoiditis).

2. Irrigography, irrigoscopy (thickening and expansion of folds and their intermittency; smoothness of the haustra; narrowing of the intestine),

3. Colonofibroscopy (hyperemia, edema and hypertrophy of the folds of the mucous membrane, expanded vascular pattern; the mucous membrane, as a rule, lacks shine, may be whitish).

4. Morphology (dystrophic changes, vascular congestion and hemorrhages, edema, etc.).

Treatment of chronic colitis.

1. Diet number 4 (for 3-5 days), then diet number 4b.

2. Anti-inflammatory: sulfonamides; azo compounds (sulfasalazine), salofalk and salosinal; intetrix; 5-NOK (nitroxoline), nicodine.

3. Correction of intestinal dysbiosis.

4. Antispasmodic and myotropic (atropine, no-shpa, papaverine, etc.).

5. Vitamin therapy.

6. Phytotherapy.

7. Physiotherapy.

8. Local treatment.

9. Therapeutic exercise.

10. Mineral waters.

Nonspecific ulcerative colitis. Nonspecific ulcerative colitis is an autoimmune inflammatory-dystrophic lesion of the colon mucosa with the development of hemorrhages and erosions, the formation of extraintestinal manifestations of the disease and complications of a local and systemic nature.

The main reasons for the development of NUC:

1) viral or bacterial;

2) milk intolerance;

3) emotional stress reactions;

4) violation of the biocenosis of the intestine and the environment;

5) hereditary predisposition;

6) immunological changes and allergic reactions to foods (most often to cow's milk). Diagnosis of nonspecific ulcerative colitis. Blood tests (anemia, accelerated ESR, leukocytosis, hypoproteinemia, dysproteinemia).

Coprogram (mucus, leukocytes, red blood cells, sometimes stool looks like “raspberry jelly”).

Bacteriological examination of feces (manifestations of intestinal dysbacteriosis).

Sigmoidoscopy (hyperemia, edema, bleeding, erosion, ulcers, mucus, fibrin, pus).

Irrigoscopy, irrigography (diffuse granularity of the mucosa, absence of haustra; jagged contours of the colon, filling defects).

Endoscopy for UC: active stage - redness, loss of vascular pattern; granularity of the mucous membrane; vulnerability to contact, petechiae, bleeding; mucus, pus; ulcerations of the mucous membrane, flat, draining, superficial; pseudopolyps (inflammatory, not tumoral in nature); continuous extension from the rectum in a proximal direction; "recurrent ileitis". Inactive stage - pale, atrophic mucous membrane.

Morphological picture of UC: continuous infiltration of polymorphonuclear leukocytes, limited to the mucous membrane. Crypt abscesses. Decreased number of goblet cells.

X-ray picture of UC: the mucous membrane is covered with granulations, “needle-like” (spicules). Ulcerations, "button ulcers". Pseudopolyps. Loss of haustration, “the garden “hose” phenomenon". Small erosions against the background of a rearranged relief of the mucosa in ulcerative proctosigmoiditis. Jagged contours of the colon, caused by many edges forming ulcers, in ulcerative colitis. In the transverse colon there are a large number of ulcers on the relief. Fringe contours of the colon in ulcerative colitis. Cobblestone symptom. In the left half of the intestine - pseudopolyposis. Pseudo-polyposis in total ulcerative colitis.

Treatment. Crohn's disease is a granulomatous inflammation of any part of the digestive tract with the development of ulcerations of the mucous membrane, narrowing of the lumen, fistulas and extraintestinal manifestations of the disease.

Treatment of UC and Crohn's disease.

1. Rational diet: frequent, fractional meals.

2. Basic drug therapy: azo compounds (sul-phasalazine, salazopyrine, salazopyridazine; salofalk, salosinal); angioprotectors (trental, parmidine); multivitamins. For Crohn's disease (azathioprine, cyclosporine, methotrexate).

3. Corticosteroids (prednisolone). For Crohn's disease (bu-desonide).

4. Eubiotics (intetrix, trichopolum, ercefuril, enterol, etc.).

5. Treatment of intestinal dysbacteriosis.

6. Infusion therapy. Hemosorption and plasmapheresis.

7. Anabolic hormones (nerabol, retabolil, etc.) - according to strict indications.

8. Treatment of anemia: iron preparations (ferrumlek, ectofer, etc.) parenterally.

9. Antihistamines (diazolin, suprastin, tavegil, etc.).

10. Normalization of intestinal function, antispasmodics and analgesics (papaverine, no-spa, halidor); enzymes (pancreatin, panzinorm, digestal, mezim-forte); imodium; fight against constipation (bran, petroleum jelly).

11. Sedatives (relanium, valerian root decoction, motherwort tincture, seduxen).

12. Dimephosphone (membrane stabilizing, immunomodulatory, bactericidal effect).

13. Sandostatin is an analogue of somatostatin.

14. Herbal medicine (chamomile, calendula, St. John's wort, gray alder, motherwort, mint, plantain).

15. Physiotherapy.

16. Local treatment.

17. Surgical treatment (subtotal one- or two-stage colectomy).

Amyloidosis of the colon. Amyloidosis of the colon is a partial or complete paralytic intestinal obstruction.

Gastrointestinal bleeding. Ulcers of the intestinal mucosa. Malabsorption syndrome.

Treatment for amyloidosis of the colon.

1. Derivatives of 4-aminoquinoline (chloroquine, delagil, plac-venil); corticosteroids (prednisolone); immunocorrectors (T- and B-activin, levamisole).

2. Means for stimulating amyloid resorption: ascorbic acid, anabolic hormones.

3. Colchicine, dimethyl sulfoxide, prednisolone.

In case of secondary amyloidosis, the underlying disease should be treated first.

Author: Pavlova N.V.

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