Hospital therapy. Diagnosis of nonspecific ulcerative colitis (most important)

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Hospital therapy. Diagnosis of nonspecific ulcerative colitis (most important)

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52. Diagnosis of nonspecific ulcerative colitis

Diagnosis and differential diagnosis. In clinical blood tests with a mild form of the disease, slight neutrophilic leukocytosis, an increase in ESR, and red blood counts are not changed. As the severity of the course increases and the duration of the exacerbation increases, anemia of mixed genesis occurs (B12-deficient and iron-deficient), and the ESR increases.

In the biochemical analysis of blood in moderate and severe forms, dysproteinemia, hypoalbuminemia, hypergammaglobulinemia, electrolyte imbalance, and acid-base state are noted. In the general analysis of urine, changes appear only when complications arise in the form of nephrotic syndrome against the background of amyloidosis, when characteristic changes in urine tests are noted - proteinuria, "dead" urinary sediment, there is also an increase in the blood and the level of creatinine, urea.

The main role in the diagnosis is acquired by endoscopic examination with targeted biopsy, since in nonspecific ulcerative colitis, the colon mucosa is primarily affected. The rectum is always involved in the pathological process, i.e., erosive and ulcerative changes are detected during endoscopy immediately behind the anal sphincter during sigmoidoscopy. In ulcerative colitis, the rectosigmoid bend is not always possible to overcome due to severe spasm. An attempt to hold the tube of the proctoscope is accompanied by severe pain. In this situation, the proctoscope should be inserted to a depth of no more than 12-15 cm.

The endoscopic picture depends on the form of the disease. With a mild form, edematous dull mucous membrane, thick whitish overlays of mucus on the walls of the intestine, and slight contact bleeding are visible. The vascular pattern of the submucosal layer is not visually determined. In the moderate course of the disease, hyperemia and edema of the mucous membrane, severe contact bleeding, hemorrhages, erosions and irregularly shaped ulcers, thick overlays of mucus on the walls of the intestine are revealed. In a severe course of the disease, the mucous membrane of the colon is destroyed over a considerable extent. A granular, bleeding inner surface, extensive areas of ulceration with fibrinous deposits, pseudopolyps of various sizes and shapes, pus and blood in the intestinal lumen are found. Contraindications for colonoscopy and sigmoidoscopy are severe forms of ulcerative colitis in the acute stage of the disease.

In the presence of an epidemic of intestinal infections, the diagnosis is easily established. But even in the case of sporadic morbidity in acute intestinal infections, the colitis syndrome flows without relapses, while ulcerative colitis has a relapsing course. The most accurate methods for identifying acute intestinal infection include bacteriological and serological.

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