Lecture on colon diseases and treatment of chronic colitis

2021-08-10 01:06 PM

Polyps are benign, but ductal polyps and villi can be chemotactic. Polyps can be solitary, or there are multiple polyps throughout the colon (polyposis: polypome).

Colon diseases include

Colonic pathology with physical damage

Group of inflammatory bowel disease: caused by many causes.

Tumor group: polyp, cancer

Functional bowel disease.

General features

All colonic diseases have similar clinical symptoms:

Colonic abdominal pain.

Diarrhea disorder.

Abnormal stool properties.

Therefore, it is easy to misdiagnose in clinical practice.

Colon disease in Vietnam is different from Western countries

The pathology of the colon is more functional than the water.

Colonic pathology with organic damage:

Inflammation of the colon due to infection is common.

Proctitis - hemorrhagic colon accounts for a small percentage.

Tumor pathology; rare diverticulum.

Colon polyps:

Polyps are benign, but ductal polyps and villi can be chemotactic. Polyps can be solitary, or there are multiple polyps throughout the colon (polyposis: polypome).

Usually asymptomatic, discovered incidentally only through colonoscopy or colonoscopy.

Symptoms:

Hemorrhagic (60%), usually insidious, rarely massive.

Cancer: The risk of chemotaxis is usually after 10 years and depends on the type of polyp (tubular gland, villi) and size (d > 1 - 1.5 cm readily calcified).

Treatment:

Endoscopic polypectomy (if solitary polyp).

Colon resection (polyposis).

Treatment of chronic colitis

The principles of treatment

Dietary restrictions:

Reduce fat, reduce raw vegetables, and green vegetables.

Correction of bowel disorders:

Depending on patient diarrhea or constipation.

Constipation: Use laxatives, preferably osmotic laxatives (Macrogol), plant fiber group,...

Diarrhea: It is most appropriate to use a bandage for the colonic mucosa (Smecta, Actapulgite,...).

Symptomatic treatment:

Pain relief.

Regulate bowel motility:

Trimebutin group (Debridat, Tritin,...):

The mechanism of action is similar to that of enkephalin.

The drug can regulate intestinal motility disorders. (increase or decrease in peristalsis) to a normal rhythm.

Dosage: 1-2 tablets x 3 times/day.

Group Mebeverine Hydrochloride (Duspatalin):

The drug has an antispasmodic effect through the mechanism of blocking sodium and calcium channels in the membrane of smooth muscle cells of the intestine.

Dosage: 1-2 tablets x 3 times/day.

Psychotherapy, patient reassurance.

Treat the cause.

Treatment specific to the cause

Treatment of chronic tuberculosis caused by colitis:

Anti-tuberculosis drugs - formulations:

3SHZ + 6 - 9SH (HZ).         

3REH (RZH) + 6 - 9 REH (RZH).

2 RES + 4 - 6 RES H.

In fact, the duration of treatment is longer than that of pulmonary tuberculosis.

Corticoid:

Treatment of adhesions, atrophy, and narrowing of the colon due to tuberculosis.

Usually used for the first 8 weeks in parallel with anti-tuberculosis therapy.

Dosage: 1mg/kg/day.

Attention: Contraindications of corticosteroids.       

Surgery:

When there are complications: cecal perforation, peritonitis.

Or TB lesions cause semi-obstruction, intestinal obstruction.

Treatment of chronic amoebic colitis:

Use of amoeba-killing antibiotics, amoebic antibiotics include:

Imidazole group:

Metronidazole: 30mg/kg/day x 7-10 days.

Tinidazole (Fasigyne).

Ornidazole (Tiberal) 1.5 - 2g/day x 3 -5 days.

Secnidazole (Flagentyl).

 Emetine: Very toxic, rarely used.

Dose: 1mg/kg/day x 10 days subcutaneously or intramuscularly.

Dehydroemetine : Less toxic.

Dose: 1.2mg/kg/day x 10 days.

Or: 1.5mg/kg/day x 5-7 days.

Quinoline: Kills intestinal amoeba only.

Iodées (Direxiode): 3-9 tablets / day x 7 - 20 days.

Methylées (Intetrix): 4-6 tablets/day x 10 days.

Other groups of amoebicides:

Arsenic, Diloxamide, Paranomycine, ... are now rarely used.

Treatment of ulcerative colitis (hemorrhagic proctitis):

The principles of treatment:

Mainly medical treatment.

The main aim of treatment is to control the inflammatory process.

Before treatment must assess the extent of colitis.

Antidiarrheal drugs (diphenoxylate, loperamide,...) must be used with extreme caution because they can cause colonic complications due to toxicity.

Classification of colitis:

 

Minor illness

Sevever Illness

Diarrhea

< 4 times/day, only a small amount of blood in the stool

³6 times / day

Temperature ( °C)

Normal

> 37,8

Pulse (beat/minute)

< 90

> 90

Hemoglobin ( g/dl )

Normal

< 10,5

VS ( mm/ first hour )

< 30

³ 30

General measures:

Nutrition:

Complete fasting: no oral feeding

Parenteral nutrition with temporary nutritional replacement therapy

Nervous stability - patient psychology.

Correction of electrolyte disturbances.

Blood transfusion in the presence of anemia.

Use medicine:

Anti-inflammatory group 5-ASA: is a specific treatment drug.

Group 5ASA : (5 Amino Salicylic acid): Including drugs.

Sulfasalazine (5ASA và Sulfapyridin).

Mesalazine (Mesacol, Tidocol).

Attack: 2-4g/day x 4-6 weeks.

Maintenance: 1-1.5g/day x 1-2 years.

Corticosteroid anti-inflammatory: As a combination therapy.

Specify when:

Not responding to group 5ASA.

Proctitis - severe hemorrhagic colon.

Medicine:

Prednisolone 1mg/kg/day (u)

Corticosteroids can be given intravenously if the disease is severe. After the disease is stable, switch to the oral route, or combine with an enema if the damage to the lower part is obvious.

Treatment time:

Attack :4 => 8 => 12 weeks then reduce the dose.

Maintenance: 1-2 years.

Outpatient treatment:

Emergency:

Colon perforation.

Failure of internal therapy (after 7 - 10 days of internal therapy).

Long-term: colectomy at relapse prevents locking complications.       

Treatment of Crohn's disease: (Similar to the treatment of proctitis - hemorrhagic colitis):

General measures

Corticoid.

5ASA.

Neuro-psychology.

Surgery.

Azathioprine (Immurel): 1mg/kg/day.

Metronidazole: 20mg/kg/day.

Pseudomembranous colitis:

Stop the stimulant.

Vancomycin 500mg x 4 /day.

Or Metronidazole 30mg/kg/day.

Supportive treatment:

Cholestyramine 4g x 3/day.

Treatment of diverticulitis:

Before treatment, an unprepared abdomen should be taken to rule out perforation.

Treatment includes:

Rested.

Eat thin.

Infusion.

Antibiotic:  

Metronidazole.

b - Lactam.

Aminoglycosides.

Pain relief, spasm relief:

Buscopan, Spasmaverin, ....

Indications for surgery:

Hatching peritonitis.