Large intestine- the final section of the digestive tract, responsible for the adsorption of liquid, glucose, electrolytes, vitamins and amino acids from processed food. Here, a fecal lump is formed from the digested mass and transported out through the rectum. The large intestine is the section of the gastrointestinal tract that is most susceptible to numerous diseases: inflammation, tumor formations, and absorption nutrients.

Diseases in the colon often mature unnoticed by a person. When the first symptoms appear, expressed in discomfort in the abdomen, they are not particularly paid attention to, mistaking them for a common disorder:

• problems with stool (diarrhea, constipation, their alternation);
• flatulence, rumbling, feeling of fullness in the stomach, more often occurring in the evening;
• pain in the area anus, on the sides of the abdomen, subsiding after defecation, release of gas.

Over time, signs of problems progress. Intestinal discomfort is accompanied by mucous, purulent, bloody discharge from the anus, sensations of constant pressure in the anus, unproductive urge to go to the toilet, “embarrassment” with involuntary discharge of gases and feces. As a rule, such phenomena are observed when the disease has already reached a mature stage.

A number of diseases cause poor absorption nutrients in the large intestine, as a result of which the patient begins to lose weight, experience weakness, vitamin deficiency, and development and growth in children are impaired. Diseases such as tumors are often discovered when a patient enters surgery with intestinal obstruction. Let's consider individual diseases colon in more detail.

Ulcerative colitis: symptoms and treatment

At severe symptoms inflammation, drugs are prescribed to destroy clostridia - Vancomycin or Metronidazole. In severe cases of the disease, the patient is hospitalized, since the most possible severe consequences: toxic dilation of the intestine, peritonitis, heart attack, up to fatal outcome. In any form of clostridial dysbiosis, it is prohibited to stop diarrhea with antidiarrheal drugs.

Neoplasms are the most dangerous diseases of the large intestine

Intestinal tumors – one of the most common neoplasms in human body. takes an “honorable” first place among oncological diseases. Malignant neoplasms with localization in the colon and rectum significantly predominate over benign tumors.

According to statistics, people over 40 years of age are most susceptible to intestinal oncology, and the risks increase with age. The main factor behind the rapid spread cancer diseases intestines - Not proper nutrition. This is a diet poor in insoluble fiber and vitamins, consisting mainly of refined foods, containing large number animal and trans fats, artificial additives.

Doctors also warn about increased risk those who have a hereditary predisposition to the growth of polyps, have cases of intestinal cancer in the family, have been diagnosed with chronic inflammation of the mucous membrane, especially ulcerative colitis.

The insidiousness of polyps and tumors growing into the intestinal lumen is that they are practically asymptomatic for a long time. On early stages It is very difficult to suspect cancer. As a rule, tumors are found by chance during endoscopic examinations or x-rays. And if this does not happen, the patient begins to feel signs of the disease when it has already gone far.

Common symptoms of a neoplasm in the colon are constipation, soreness, and bloody elements in the stool. The severity of the symptoms largely depends on the location of the cancer. In 75% of cases, the tumor grows on the left side of the colon, and in this case, complaints arise quickly and rapidly intensify: painful “toilet” problems, attacks of pain, indicating the development of intestinal obstruction. Location of education in right half It is 5 times less common, and it ensures a long latent period of oncology. The patient begins to worry when, in addition to frequent diarrhea notices weakness, fever and weight loss.

Since all intestinal problems are similar in their symptoms, one can never rule out tumor process. If you have complaints about bowel function, it is better to consult a doctor and undergo an examination: donate stool for occult blood, do a colonoscopy or sigmoidoscopy, if there are polyps, check them for oncogenicity through a biopsy.

Treatment for colon cancer is radical. The operation is combined with chemotherapy and radiation. At favorable outcome to avoid relapse, regular monitoring of the intestines for neoplasms of any nature and lifelong healthy diet, physical activity, giving up bad habits.

This disease goes by several names: dyskinesia, mucous colitis, spastic colon. represents intestinal disorders associated with impaired colon motility. This pathology may be due to concomitant diseases Gastrointestinal tract, that is, of a secondary nature. Irritable bowel disease, caused directly by motor dysfunction, is a disease in its own right.

On motor activity intestines can be influenced by various factors:

• acute intestinal infection in the anamnesis;
• lack of fiber in the diet;
• enzymatic deficiency, as a result - intolerance to certain foods;
• food allergies;
• dysbacteriosis;
• chronic colitis;
• suffered severe stress;
• general emotional instability, tendency to psychosomatic conditions.

The mechanism of peristalsis failure in IBS has not been fully studied, but it has been established that it is caused by impaired nervous regulation and hormonal production of the intestine itself.

Irritable bowel disease differs from other diseases in the vagueness of its symptoms. Discomfort in the abdomen is almost always present, but it is not possible to unambiguously determine the location of the pain, its nature, or the supposed provoking factor. The patient’s stomach hurts and growls, he is tormented by diarrhea, constipation, which replace each other, and all this regardless of changes in diet, that is, no diet helps in this case. IBS can cause discomfort in the back, joints, and radiate to the heart, although no signs of pathology are found in these organs.

When diagnosing spastic bowel, the doctor must first rule out oncology and other dangerous intestinal diseases. And only after comprehensive examination Gastrointestinal tract and removing suspicion of other diseases, the patient can receive a diagnosis of IBS. It is often based on the patient’s subjective complaints and a careful history taking, which allows us to determine the cause of this condition. This is very important because effective treatment IBS is impossible without determining the cause that provoked dyskinesia.

During treatment, emphasis should be placed on measures aimed at eliminating unfavorable factors: with psychosomatics - on sedative therapy, in case of allergies - to desensitize the body, etc. The general principles of treating irritable bowel are as follows:

Colon diverticula

A diverticulum is a stretching of the intestinal wall with the formation of a “pocket” that bulges into abdominal cavity. The main risk factors for this pathology are and weak tone intestinal walls. The favorite localization of diverticula is the sigmoid and descending colon.

Uncomplicated diverticula may not cause any discomfort the patient, in addition to the usual constipation and heaviness in the abdomen. But against the background of dysbacteriosis and stagnation of contents in the diverticulum cavity, inflammation can occur - diverticulitis.

Diverticulitis manifests itself acutely: abdominal pain, diarrhea with mucus and blood, high temperature. With multiple diverticula and the inability to restore tone intestinal wall Diverticulitis can become chronic. The diagnosis is made after endoscopic examination colon and x-ray.

Diverticulitis is treated antibacterial drugs, and after removing the acute form, introduce beneficial microflora. Patients with uncomplicated diverticula are given proper nutrition to establish normal bowel movements and prevent constipation.

If persistent multiple diverticula have formed, it is recommended to prevent their inflammation. long-term therapy sulfasalisin and enzymatic agents. If complications occur with signs of an “acute” abdomen, surgical intervention is performed.

Congenital and acquired anomalies of the structure of the large intestine

Anomalies of the structure of the large intestine include:

• dolichosigma - elongation of the sigmoid colon;
• megacolon - hypertrophy of the colon along the entire length or in individual segments.

An elongated sigmoid colon may be asymptomatic, but is more common chronic constipation and flatulence. Due to the large length of the intestine, passage is difficult feces, stagnation and accumulation of gases form. Recognize this state only possible on x-ray, demonstrating a sigma anomaly.

Treatment for dolichosigma involves normalizing stool. A laxative diet, bran, and laxatives are recommended. If these measures do not bring results, a quick solution to the problem is possible. Surgical intervention is indicated if the elongation of the intestine is significant, with the formation of an additional loop that prevents the normal evacuation of food masses.

Persistent constipation, accompanied by severe pain and bloating, allows one to suspect megacolon. There may be no stool long time- from 3 days to several weeks, since feces are retained in the dilated intestine and do not move further. Externally, megacolon can manifest itself as an increase in the volume of the abdomen, stretching of the anterior abdominal wall, signs of fecal intoxication of the body, bilious vomiting.

The cause of megacolon is congenital or acquired innervation of the colon due to embryonic disorders, toxic effects, trauma, tumors, and certain diseases. If a narrowed section of the intestine occurs due to a mechanical obstacle or obstruction, an expanded section is formed above it. In the innervated walls, muscle tissue is replaced by connective tissue, as a result of which peristalsis completely stops.

Most often, the megacolon is located in the sigmoid region (megasigma). Enlargement of the colon can be detected using x-rays. This diagnosis must be differentiated from true intestinal obstruction, which requires immediate surgical intervention. – eliminated radically in childhood.

In case of mild pathology, conservative treatment is carried out:

• diet with high content fiber;
• elimination of dysbacteriosis;
• taking enzymes;
• mechanical and drug stimulation motor skills;
• physiotherapy and therapeutic exercises.

Megacolon, complicated by poisoning of the body with fecal toxins, acute intestinal obstruction, fecal peritonitis, tumor and others dangerous conditions, requires excision of the affected part of the intestine.

Most diseases of the large intestine have a similar clinical picture, therefore, timely consultation with a doctor greatly facilitates diagnosis and avoids irreparable consequences for the life and health of the patient. Be sure to visit a specialist if you have the following complaints:

• the appearance of blood in the stool;
• abdominal pain that does not go away for more than 6 hours;
• prolonged absence of stool;
• frequent constipation or diarrhea.

In acute forms of ulcerative colitis and fulminant relapses of the chronic form of the disease, such serious complications as perforation and toxic dilatation of the colon often develop. Walker, Curtis (1965) and others in the development of perforations great value give abscess formation in the intestinal wall, which they observed in all its membranes.

According to our data, abscess formation in the intestinal wall (excluding crypt abscesses) is a rare phenomenon, so it is difficult for us to associate the occurrence of perforations with purulent melting of the intestinal wall. Perforations can occur, on the one hand, when the destructive-ulcerative process spreads into the depths of the wall, and on the other hand, in the mechanics of the development of perforations, focal destructive-necrotic processes in the submucous and muscular membranes and intramural hemorrhages, which we had to observe outside, are undoubtedly important. zones of ulceration in the acute course of the disease.

Toxic dilatation of the colon is morphologically characterized by a sharp expansion of its lumen. The intestinal wall is thinned. Deep ulcers, merging, form extensive fields of ulceration, the bottom of which is muscle or serosa. Damage to the intestinal wall is reduced mainly to a destructive-necrotic process - fibrinoid necrosis of collagen fibers, myomalacia of the muscularis propria, necrosis of intramural ganglion cells nerve ganglia. Hemodynamic disorders, primarily in the form of vascular paresis, apparently associated with impaired innervation, aggravate the severity of destructive processes in the wall of the colon.

The literature discusses the nature of changes in the intramural vessels of the intestinal wall and their pathogenetic significance. Rachet (1950), Gallart-Mones (1956), Gallart-Esquerdo (1950), Dalarue (1956) vascular changes in the form of capillary angioectasia and diapedesis are classified as early manifestations having direct relation to the process of ulceration. Hemodynamic disorders are further aggravated by proliferation and desquamation of the endothelium, thrombosis (Warren, Sommers, 1949, 1954; Bargen, 1962). According to Bargen (1962), vascular changes are the cause of “red infarcts of the mucous membrane” with subsequent ulceration. Goldgraber (1960) believes that in the initial stages of the disease, blood stagnation in the capillaries of the intestine predominates, then arteriolitis and capillary thrombosis develop, which leads to the formation of a scab, the rejection of which is the initial stage of ulceration. Hintz (1970) points out that in the initial phases of the disease there is hyperemia and a tendency to bleeding, followed by collapse of the capillaries. Degenerative changes basement membranes and reticular stroma with the subsequent formation of crypt abscesses, he considers a consequence of hemodynamic disturbances. However, not all researchers agree with this statement. Thus, Goldgraber (1960) points out the rarity of vascular damage in nonspecific ulcerative colitis.

Colon perforation is one of the most common and most dangerous complications. Most often it is observed with total damage to the colon and during the first attack of the disease.

Acute toxic dilatation of the colon. The syndrome of acute toxic dilatation of the colon in ulcerative colitis was first described by Madison and Bargen in 1951. Since then, the question of its pathogenesis and treatment has been discussed in all monographs devoted to nonspecific ulcerative colitis. According to most authors, the leading role in the pathogenesis of its development belongs to severe intoxication with damage to the neuromuscular apparatus of the intestine, hypokalemia and accompanying intestinal strictures. Clinical signs this complication appears sharp deterioration condition, abdominal pain, flatulence, lack of peristalsis, as well as progressively increasing intoxication. The diagnosis is confirmed by X-ray examination, which reveals a sharply distended colon (the width of the intestinal lumen is more than 7 cm), thinning of the walls and disappearance of haustration. Information on the incidence of this dangerous complication is also heterogeneous. The prognosis of this complication is unfavorable, only 25% of patients respond to treatment, and mortality, according to various sources, reaches 22-33.2%. Since the entire thickness of the intestinal wall is involved in the acute inflammatory process, perforation occurs in almost one third of patients.

Massive intestinal bleeding ranks third in frequency of occurrence after perforation and acute toxic dilatation of the colon. Data on the incidence of acute intestinal bleeding are very contradictory, which is associated with different approach to establish a diagnosis of this complication. It is significant that those dealing, as a rule, with more severely ill patients, lead low frequency massive bleeding, but, on the contrary, high. Mostly massive bleeding occurred when acute form and severe exacerbations of the total process.

The article was prepared and edited by: surgeon The etiology of ulcerative colitis, like Crohn's disease, is not clear. In the pathogenesis of the disease, immune disorders are of primary importance. Infection plays a role, as well as psychological factors, stress. Unlike Crohn's disease, the pathological process in ulcerative colitis begins with inflammation of the colon mucosa. Initially, neutrophilic and lymphocytic infiltration and swelling of the mucous membrane are observed, later it ulcerates, microabscesses form, and wall perforation is possible. At chronic course diseases develop fibrosis, hyperplasia of the mucous and submucosal membranes, sometimes strictures and pseudopolyps.

Clinic of nonspecific ulcerative colitis

In severe cases, the patient experiences frequent (up to 20-40 times a day) loose stool mixed with blood and mucus, sometimes pus. Tenesmus and severe pain in the left iliac region, which can spread throughout the entire abdomen. Various nonspecific manifestations are often encountered: fever, erythema nodosum; arthritis affecting predominantly large joints, less commonly sclerosing cholangitis, iritis, episcleritis, recurrent thrombophlebitis, skin necrosis. Neutrophilia and an increase in ESR are detected in the blood. As the disease progresses, function is usually impaired. small intestine and so-called total intestinal failure occurs.
Severe disease is observed in only 10% of cases; milder variants are more common. As a result of treatment, the patients’ well-being periodically improves, but subsequently under the influence various factors an exacerbation develops. In mild cases, intestinal damage is more limited in extent and often affects only the sigmoid and rectum. Stools are usually infrequent (4-6 times a day) and contain a small amount of mucus. Blood in the stool appears only periodically. Nonspecific ulcerative colitis is often combined with other diseases of immune origin (Hashimoto's goiter, autoimmune hemolytic anemia etc.).
With a mild course of the disease, sometimes patients first consult a doctor only when complications develop.

Toxic dilatation of the colon

Expansion and swelling of any part of the large intestine occurs, most often the transverse colon. The severity of diarrhea decreases because the movement of feces through the affected section of the intestine is disrupted. The stool may consist only of mucus, pus and blood secreted by the distal intestine. Toxic dilatation of the large intestine occurs spontaneously due to the intake of certain medicines, X-ray examination of the intestine, against the background of hypokalemia. The severity of the patients’ condition is due to severe intoxication. There is a fever, arterial hypotension, tachycardia, leukocytosis, often hypokalemia and hypoalbuminemia. Irrigoscopy reveals an increase in the diameter of the colon to 6-10 cm.
Treatment begins with the abolition of anticholinergics or opium drugs, if they were used, and a starvation diet. A sufficient amount of liquid rich in potassium salts (to eliminate hypokalemia) and protein preparations are administered parenterally. Sometimes antibiotics are prescribed. The use of enemas should be considered contraindicated; you can try to carefully insert a probe through the rectum to remove gas from the swollen intestine. If the measures taken are ineffective, then the question arises about the need for colectomy, which in severe cases with increasing intoxication should be carried out within 4-6 hours.

Colon perforation

Recognizing this complication is difficult, since it usually develops in patients with severe ulcerative colitis, who already had severe abdominal pain and general intoxication. If the condition worsens with ulcerative colitis, accompanied by a decrease in blood pressure and an increase in tachycardia, it is necessary to conduct a survey X-ray examination of the abdominal cavity, which in such cases reveals free gas and some other signs of perforation. In the presence of this complication, a colectomy is usually performed; attempts to suturing the ulcers are usually unsuccessful.

Colon cancer

Colon cancer against the background of ulcerative colitis occurs quite often, especially when it lasts for a long time. If the disease lasts 15 years, then cancer occurs in 12% of cases, and if more than 20 years, then its frequency reaches 25%. Due to the risk of developing colon cancer in the chronic course of ulcerative colitis, it is recommended that after 8-10 years from the onset of the disease, an annual colonoscopy with a biopsy of the mucous membrane is recommended. If this study reveals severe dysplasia of the mucous membrane, then colonoscopy must be performed at least once every six months.

Diagnosis and differential diagnosis of ulcerative colitis

Nonspecific ulcerative colitis in the initial stage must first of all be differentiated from acute dysentery. Similar clinical manifestations in some cases observed in colon cancer, ischemic colitis, diverticulitis of the colon, Crohn's disease with damage to the colon.
Irrigoscopy in patients with nonspecific ulcerative colitis reveals the disappearance of haustration, intestinal rigidity, shortening and narrowing of the lumen. In severe cases, the contours of the mucous membrane are almost not defined, the intestine takes on the shape of a “water pipe”. Areas of impaired patency, ulcers, and pseudopolyps are also found. In mild cases, there may be no radiological changes. X-ray examination reveals some complications of this disease (toxic dilatation of the intestine, perforation of its wall).
The results are of great importance to confirm the diagnosis endoscopic examination. In most cases, you can limit yourself to performing sigmoidoscopy. In mild cases of the disease, the mucous membrane is swollen, hyperemic, bleeds easily, and there are single or no erosions. In more severe cases, endoscopy reveals erosions and ulcers covered with mucopurulent plaque. In the chronic course, strictures and pseudopolyps are formed. If the X-ray data are not convincing, then a colonoscopy is performed to clarify the extent of the disease. To exclude Crohn's disease affecting the large intestine, a biopsy of the colon mucosa is performed.

Complications of UC are divided into local and general (systemic). Local ones include perforation, toxic dilatation (toxic megacolon), intestinal bleeding, rectal or colon strictures, fistulas, perianal skin irritation and colon cancer.

Systemic complications are associated with extraintestinal manifestations of ulcerative colitis.

You can read about the causes, diagnosis and types of ulcerative colitis in the article.
Read about treatment methods for UC.

Perforation of the intestinal wall occurs when it expands and thins. The opening is usually located in the sigmoid colon or in the area of ​​the splenic flexure.

More often, perforations are multiple and penetrate into the abdominal cavity, less often they are single and covered. In new-onset ulcerative colitis, the incidence of perforation does not exceed 4%. Severe, long-term UC is complicated by perforation in approximately 10% of cases.

Diagnosis of this complication is quite difficult, since it causes serious condition patient, and it is not always possible to obtain information from him about the symptoms that bother him. The results of a physical examination are also insufficiently informative (perforation is characterized by symptoms of peritoneal irritation).

An X-ray examination helps to establish the diagnosis of intestinal perforation, in which free gas is detected in the abdominal area.

Toxic dilatation (toxic megacolon) of the colon

This severe complication UC, which develops in 5-10% of cases.

Lead to the development of toxic dilatation

• damage to the neurointestinal apparatus of the intestine,
• inflammatory damage to the smooth muscles of the intestinal wall,
• hypokalemia with impaired muscle tone,
• (, shigellosis, etc.),
• ulceration,
• toxemia,
• diagnostic procedures (x-ray examination, colonoscopy),
• irrational drug therapy(prescription of opioid drugs, anticholinergic drugs).

Some researchers note the influence of steroid therapy and cholinergic drugs on the development of this syndrome.

Toxic megacolon is a paralysis of the smooth muscle muscles of the intestines that develops due to severe inflammatory process. It is often the result of the thoughtless prescription of drugs that reduce intestinal motility (codeine, loperamide, anticholinergics and other drugs) for the treatment of diarrhea in acute ulcerative colitis, which can provoke toxic distension of the colon.

Just like the use of laxatives in the presence of constipation in patients with ulcerative colitis, especially against the background of hypokalemia, may cause the appearance of signs of toxic megacolon.

Toxic megacolon of the colon appears

• a sharp deterioration in the patient's condition,
• increasing intoxication,
• inhibition of reactions,
• an increase in body temperature of more than 38.8⁰С,
• decreased stool frequency,
• enlargement of the abdomen,
• weakening of peristaltic bowel sounds,
• flatulence,
• slight tension in the muscles of the anterior abdominal wall,
• tachycardia more than 120 beats/min.,
• leukocytosis over 10.6x10⁹/l,
• anemia.

Most important method in the diagnosis of this complication - a survey x-ray examination of the abdominal wall. It is performed with the patient lying on his back. Characteristic radiological sign this complication is a significant expansion colon from 5 to 16 cm, on average 9 cm.

As a rule, the transverse colon is subject to the greatest expansion. And in approximately 50% of cases it is eliminated surgical intervention. The rectum does not undergo expansion.

The prognosis for this complication is very serious, especially when toxic dilatation and perforation of the colon occur simultaneously.

Conservative therapy for toxic megacolon is usually carried out within 24 hours.

Everything is canceled medicines administered orally (by mouth).

Task conservative therapy- correction of water and electrolyte balance, protein deficiency and anemia. Antibiotics and glucocorticoids must be prescribed loading doses. It is necessary to constantly monitor the patient's condition. Monitoring diuresis is mandatory. It is important to carry out ultrasound and x-ray monitoring of the condition of the dilated colon.

If a patient with severe ulcerative colitis fails to achieve positive dynamics within 2-3 days, then he is indicated for urgent surgery.

Intestinal bleeding

Bleeding as a complication of UC must be distinguished from the discharge of scarlet blood in the feces during the normal course of ulcerative colitis.

With this complication, blood from the anus is released in clots. Massive bleeding in ulcerative colitis develops in no more than 1% of patients. The causes of intestinal bleeding may be growths granulation tissue at the bottom of the ulcer, vasculitis of the bottom and edges of the ulcers.

These changes are accompanied by necrosis of the vascular wall, phlebitis, leading to sharp narrowing veins of the mucous, submucosal and muscular membranes of the intestine, expansion of their lumen with the formation of vessels resembling wide lacunae or cavernous-type vessels, which undergo rupture and cause massive bleeding.

Surgical treatment is necessary for a patient with intestinal bleeding in the event that stabilization of the patient's condition requires the introduction of blood in a volume exceeding 3000 ml within 24 hours.

Strictures of the rectum or colon

Found in approximately 10% of patients with ulcerative colitis. In a third of patients, the obstruction is localized in the rectum. In the presence of colonic strictures, there is always a need for differential diagnosis with colon cancer or.

Inflammatory polyps of the colon

Polyps are diagnosed when and x-ray examination. A characteristic sign of this complication, detected during irrigoscopy, is the presence of multiple filling defects along the intestinal wall. The diagnosis of pseudopolyposis is confirmed histologically.

Systemic complications

Systemic complications are those that affect various systems and human organs. They occur in a significant proportion of patients with severe UC. Most complications are of an autoimmune nature and are an indicator of activity pathological process. These complications of ulcerative colitis are divided into two groups: colitis-related and colitis-independent.

Extraintestinal complications of UC

In ulcerative colitis, both intestinal and extraintestinal diseases can occur. Need to know about possible symptoms, which at first glance are not associated with the intestines. This will allow you to be alert, undergo examination and diagnose serious inflammation intestines as early as possible.

Such manifestations of the disease occur in 30% of patients suffering from UC. Observed certain dependence between extraintestinal manifestations, extent of colonic involvement, and disease severity.

Lesions of the organ of vision

Eye diseases occur in 13-30% of cases.

Possible diseases:

• episcleritis;
• uveitis;
• retrobulbar neuritis;
• iridocyclitis;
• keratitis;
• retinal arteritis obliterans.

Of these diseases, uveitis is the most common. And often eye symptoms are determined many years before manifestation intestinal symptoms nonspecific ulcerative colitis.

Exacerbation of eye diseases develops against the background of severe exacerbations of ulcerative colitis and can even lead to blindness. Moreover, eye pathology can persist during periods of remission of the underlying disease.

Symptoms of eye damage:

• prolonged redness of the eye;
• pupil deformation;
• the appearance of “flies” before the eyes,
• deterioration of visual acuity,
• the appearance of flashes and flickering before the eyes,
• the shape of objects is distorted,
• vision becomes blurred
• difficulty reading,
• deterioration twilight vision, color vision disturbance.

Skin manifestations and lesions of the oral mucosa

These complications occur in 15% of people with ulcerative colitis and their course is directly related to exacerbations of this disease.

This type of complications is manifested by the following diseases:

• necrotizing pyoderma;
• aphthous stomatitis;
• gingivitis;
• ulcerations lower limbs(erythema multiforme);
• psoriasis.

Stomatitis

Damage to the oral mucosa is more common in patients

• with anemia,
• with underweight,
• with vitamin deficiency.

This disease is relatively common in UC. Progression of the disease can lead to the development of gangrenous stomatitis.

Erythema nodosum

This complication is often combined with arthritis ( chronic inflammation joints) and quite often is the first manifestation of ulcerative colitis.

Erythema nodosum manifests itself with symptoms such as:

• the appearance of dense nodes of different diameters from 5 mm to 5 cm,
• over the nodes the skin is red and smooth,
• the nodes rise slightly above the general skin, but there are no clear boundaries,
• the tissues around the nodes swell,
• the nodes grow very quickly, but, having increased to a certain size, they stop growing,
• pain on palpation,
• after 3-5 days the nodes change color, the skin becomes brownish, then turns blue and gradually turns yellow,
• nodes often appear on the front surface of the legs,
• Most often the disease begins acutely, with fever.

Pyoderma gangrenosum

The skin is affected against the background severe course diseases, most often on the legs and in the sternum area. The appearance of this complication allows us to draw conclusions about the development of sepsis (blood poisoning).

Other skin complications

IN lately complications of UC are described, such as

• focal dermatitis,
• boils,
• superficial skin abscesses,
• skin ulcerations,
• skin rashes (macular, papular, pustular, urticarial).

Lesions of the joints and spine

These complications occur in 20-60% of patients with ulcerative colitis. They appear more often when chronic form diseases.

Diagnoses that may be a consequence of ulcerative colitis:

• osteopathy;
• peripheral arthritis;
• ankylosing spondylitis;
• arthralgia;
• sacroiliitis.

Joint pain

Arthritis (joint disease) occurs equally often in both adults and children, in both men and women. Ulcerative colitis most often affects the joints upper limbs and small joints, in Crohn's disease - knee and ankle joints.

This complication occurs, as a rule, with significant damage to the colon. Exacerbations of the disease in 60-70% of cases are associated with exacerbations of UC.

The main symptoms are:

• swelling of the joints;
• soreness;
• redness of the skin over the joints;
• effusion into the synovial cavity.

With each exacerbation, as a rule, no more than three joints are affected. Moreover, different joints may suffer from attack to attack.

Back pain

Ankylosing spondylitis is often combined with peripheral arthritis, uveitis and psoriasis.

The main symptoms of spondylitis are:

• back pain;
• immobility of the spine;
• improvement in movement and exercise.

The disease can progress even during remission of ulcerative colitis and often leads to disability.

Liver lesions

Ulcerative colitis is often accompanied by diseases such as:

• fatty liver hepatosis;
• liver abscess;
• gallstones;
• sclerosing cholangitis.

Fatty liver hepatosis

In terms of frequency, fatty liver hepatosis ranks first. The process does not progress and there is no tendency to transform it into cirrhosis of the liver. Strict compliance diet, normalization of body weight, normal content of protein, vitamins and microelements in the blood significantly improves the patient’s condition and has a positive effect on the course of the disease.

With this complication, you should be especially careful about the administration and duration parenteral nutrition, since the soluble amino acids introduced in this case can have toxic effect to the liver.

Sclerosing cholangitis

One of the most dangerous complications of UC. Hereditary and immunological factors are of great importance in its development.

It is characterized by inflammatory fibrosis, extrahepatic and intrahepatic strictures. bile ducts may be accompanied by pancreatitis. This pathology occurs more often in young men and is manifested by the following symptoms:

• skin itching;
• fever;
• pain in the right hypochondrium.

Gallstones

Gallstone disease develops with ulcerative colitis as a consequence of malabsorption bile acids in the jejunum due to chronic diarrhea.

Urolithiasis

The severity of the disease is directly related to the extent of damage to the jejunum. With diarrhea, bile acids and calcium bind, and dietary oxalates remain in the intestinal lumen and are intensively absorbed with increased permeability of the intestinal mucosa.

Changes in the blood

As a rule, with ulcerative colitis, iron deficiency anemia, B₁₂-deficiency anemia, and autoimmune hemolytic anemia develop.

With UC, the risk of developing phlebothrombosis increases. The reason for this is high level fibrinogen in the acute phase of the disease and low concentration of antithrombin.

TO external factors factors that provoke this complication include hydration, bed rest, parenteral nutrition.

Hepatic vein thrombosis, embolism may occur pulmonary artery, which can cause death in inflammatory bowel diseases.

Rare extraintestinal complications in ulcerative colitis

IN medical practice marked relatively rare cases diseases, the development of which is also directly related to ulcerative colitis:

• bronchopulmonary diseases (pulmonary fibrosis, bronchitis, bronchiectasis),
• heart diseases (myocarditis, pericarditis, septic endocarditis).

If these diseases develop and their treatment is ineffective, an examination should be carried out gastrointestinal tract, since if they are complications of its inflammation, then without complex therapy it is impossible to achieve a good result.