Chronic enteritis and colitis are inflammatory diseases of the small and large intestines respectively. Chronic enteritis is characterized by inflammation and damage to the small intestine mucosa, impairing digestion and absorption. It has many potential causes and can lead to diarrhea, abdominal pain, weight loss and malnutrition. Ulcerative colitis specifically affects the colon, and is thought to involve immune system dysfunction. It causes bloody diarrhea and general symptoms like fatigue. Treatment focuses on suppressing inflammation, improving intestinal function, and managing complications.

1. .
Name:- Mohit Rulaniya
Topic:- Chronic enteritis and colitis

2. Chronic enteritis and colitis
• Chronic enteritis – poly – etiological disease of small intestine characterized by the:
- development of inflammatory-degenerative processes;
- atrophy of small intestine mucosa;
- violation of functions of the small intestine, primarily absorptive and digestive.
- Etiology
-
infection ( salmonellosis, dysentery etc.)
- nutritional factors (long use of poor quality food, spicy food, abuse of alcohol);
- food allergy;
- toxic effects: chronic intoxication with medicinal and chemical substances;
- abuse of certain drugs;
- exposure to penetrating radiation;
- hereditary-constitutional factor: congenital deficiency of enzymes, in particular, involved
in the cleavage of various carbohydrates;
- diseases of the digestive tract - "secondary" enteritis.

3. Pathogenesis
• In the small intestine inflammation of the mucous membrane develops disorders of motility
and a decrease in its barrier function violation of the integrity of the epithelium this
leads to a violation of digestion (maldigestion syndrome) and absorption (malabsorption
syndrome) exudation of the liquid part of the blood and electrolytes in the cavity of
the small intestine (exudative enteropathy syndrome).

4. Classification of Chronic Enteritis
• Flow:
- easy flow;
- moderate;
- heavy;
• On the nature of functional disorders:
- syndrome of insufficiency of digestion;
- syndrome of insufficiency of absorption;
- syndrome of exudative enteropathy;
• Clinical phase:
- phase of exacerbation;
- the phase of remission.

5. Clinical manifestation
Local symptoms:
- diarrhea -4-6 and more times a day;
- poly feces;
- fatty stool “toilet feces smears”;
- dull, spastic pain (at the navel);
- gastrointestinal bleeding (melena);
• Common symptoms:
- loss of weight;
- skin lesion (dry skin, hair loss, brittle nails);
- еdema (due to hypoproteinemia);
- severe weakness, muscle tremor, hunger and sweating
- anemia (V12 and iron deficiency).

6. Clinical examination
• Diagnosis of chronic enteritis still begins with the study of anamnesis, complaints and the
results of physical examination (palpation, percussion and auscultation).
• At palpation: it is possible to reveal local resistance and hyperesthesia on the left and
above a navel;
is often determined soreness in the mesogastric region;
• Loud rumbling at palpation of the cecum;
• During percussion, tympanic sound and splash sound are detected;
• At auscultation there is a loud rumbling and gurgling.

7. Additional examination
• Microscopy of feces on eggs of worms, lamblia and other parasites;
• Sowing feces for salmonella, shigella, campylobacteria, iersenia;
• A blood test:
- a general blood test;
- determination of the level of microelements of blood (potassium, sodium);
- albumin, gamma globulin levels;
- thyroid hormones level;
- amylase of blood and urine.
• Sigmoidoscopy;
• Duodenoscopy;
• Colonoscopy;
• Irrigoscopy - is performed on special indications for differential diagnosis.

8. Treatment Drug-therapy
• Basic principles of treatment:
- improvement of cavitary digestion (enzyme preparations);
- correction of disorders of the microflora of the small intestine (antibacterial
preparations, probiotics and prebiotics);
- increased contact time of the food lump with the mucous membrane (loperamide,
diphenoxylad, codeine, sandostatin);
- reduction of intestinal secretion and stimulation of absorption (sandostatin,
corticosteroids);
- correction of metabolic disorders. To combat violations of water-electrolyte metabolism,
rehydration therapy is used (trisol, quartesol, acesol intravenously, orally-rehydron,
citroglucosalan).

9. The main syndromes and symptoms in the
pathology of the large intestine
• In diseases of the colon, the main syndromes are:
- Abdominal pain;
- Flatulence;
- Constipation;
- Intestinal obstruction;
- Intestinal bleeding.

10. Examination in the pathology of large intestine
• Сoprological research. In patients with pathology of the colon, the daily amount of excreted
feces is determined, its consistence and shape, color, odor,a presence of impurities (mucus,
blood, pus and parasite).
• Finger examination of the rectum - an obligatory method of primary medical examination of a
patient with diseases of the colon. Any instrumental research should be carried out only after
a finger examination of the rectum.
• Rektoromonoskopiya (sigmoskopiya) allows you to assess the color and blood supply of the
mucous membrane, to establish a source of bleeding or suppuration, to reveal signs of rigidity
of the intestinal wall. Immediately before the study, the patient is treated with an enema.
Radiologic examination of the large intestine involves the performance of an overview
radiography of the abdominal cavity (with suspicion of pneumoperitoneum, intestinal
obstruction);
- simple irrigoscopy (shown to weakened patients);
- irrigoscopy with double contrast allows to study in detail the state of the mucous membrane of
the large intestine.
Colonoscopy is the main method of diagnosing tumors, Crohn's disease, ulcerative colitis and
intestinal tuberculosis.

11. Examination in the pathology of large intestine (cont.)
• Computed tomography - this method allows to detect such changes in
the intestinal wall as: inflammation of diverticula, abscesses, fistulous
passages, identify enlarged lymph nodes.
• Ultrasound examination makes it possible to assess the condition of the
entire intestinal wall, to reveal changes in the external contours.
• Endoscopic ultrasound of the colon is based on the study of the thickness
of the intestinal wall, its structure and contours, allows to determine T
and N stage of tumors of the large intestine.
• A radioisotope study is used only in certain clinical situations.

12. Non – specific ulcerative colitis
• Ulcerative colitis - nonspecific diffuse, inflammatory-ulcerative lesion of the
mucosa of the rectum and colon, often having a chronic recurrent course,
clinically manifested by bloody diarrhea, the development of intestinal and
extraintestinal manifestations.
• Epidemiology - the prevalence of ulcerative colitis varies from 28 to 117
patients per 100 000 of the population. In the southern countries of Europe,
in Asia and Africa, the frequency of morbidity is low. The frequency of
ulcerative colitis in large cities is about 1.5-4 times higher than in rural areas.
In general, people of both sexes get the same frequency, but ulcerative colitis
is more common in men.

13. Etiology and pathogenesis
• Etiology is unknown.
• Pathogenesis - in the development of ulcerative colitis, an
important role is played by immune disorders. Such factors as
viruses, bacteria and bacterial products (endotoxin, cell wall
peptidoglycan), food (proteins, milk) in combination with
neuropsychological, information and physical overloads, often
on the background of adverse environmental effects are
considered as potential participants in the pathogenesis of
ulcerative colitis.

14. Classification of ulcerative colitis
symptom easy moderate severe
stool frequency Less than 4 times a day 5-6 times per day More than 6 times per day
rectal bleeding slight expressed abundant
temperature normal subfebrile febrile
number of leukocytes normal moderate increase leukocytosis
Anemia Hemoglobin normal HB- 90-100 g/l Less than 90 g/l
erythrocyte sedimentation
rate
normal 20-35 mm/h More than 35 mm/h

15. Classification of ulcerative colitis (cont.)
Phase:
- acute;
- with a gradual onset and a mild clinical symptomatology;
- relapsing form is characterized by a change in exacerbations and
remissions;
- сontinuous form is characterized by a lack of remission for 6-8
months, despite adequate therapy.
By the extent of the defeat of the large intestine:
- distal colitis (proctitis, proctosigmoiditis);
- left-sided colitis with affection of the descending colon to the splenic
angle or to the middle of the transverse colon;
- total colitis

16. Clinical manifestation
• The clinical symptoms are conventionally divided into 4 groups:
- Intestinal symptoms - diarrhea of varying intensity with impurities of blood,
pus in feces;
- Symptoms of endotoxemia - symptoms of general intoxication, fever, anemia,
leukocytosis, increase in blood level of acute phase proteins (C reactive
protein, seromucoid);
• Metabolic disorders are due to impaired absorption, diarrhea, toxemia. They
are manifested by loss of body weight sometimes till to cachexia, dehydration,
electrolyte disorders (especially hypokalemia), edema;
• Еxtraintestinal systemic manifestations occur in 50-60% of patients with
ulcerative colitis. These include arthritis, erythema nodosum, iritis, uveitis,
sacroileitis, ankylosing spondylitis, primary sclerosing cholangitis, chronic
active hepatitis, pancreatitis, hepatobiliary system damage in the form of liver
steatosis with an increase in alkaline phosphatase, gamma-glutamyl
peptidase.

17. intestinal complications of inflammatory diseases of
the large intestine
Intestinal bleeding. Intestinal bleeding is diagnosed if clots appear in the stool.
Perforation. The frequency of perforations in patients with ulcerative colitis varies 2.8 to
3.2% of cases. Most often, perforation is localized in the transverse colon, rarely in the
sigmoid colon.
Toxic megacolon (toxic dilatation of large intestine). The frequency of this complication is
2-3% and increases with the severity of ulcerative colitis.
Strictures with ulcerative colitis are rare and localized in the distal parts of the large
intestine.
Fistulas of the anus and rectal-vaginal fistulas are found in 3-4% of patients with ulcerative
colitis.
Cancer. The risk of colorectal cancer in patients with a duration of ulcerative colitis for
more than 30 years is 10-12%.

18. Treatment of ulcerative colitis
The purpose of treatment is to suppress the activity of inflammation, to
model the proper immune response of the body.
• Basic drugs: stereoid hormones and salicylates;
• Additional drugs: immunomodulators, antispasmodics, antidiarrheal
drugs, antibiotics, preparations for normalization of water-salt
metabolism

19. 5 amynosalicylic acid drugs and their mechanism of action
• The mechanism of action of 5 aminosalicylic acid (salicylate):- anti-inflammatory action,
immunocorrective action.
• Aminosalicylates mainly act locally, suppressing many of the effector mechanisms
involved in inflammation.
• Sulfasalazine: tablets - 0.5 g, daily dose - 3.0-5.0 grams, depends on the severity of the
disease.
• Salofalk: tablets - 0.5 g., Daily dose of 2.0-4.0 grams, depends on the severity of the
disease.
microclysters - 2.0 grams; 4.0 grams, daily dose of 1.0-2.0 grams
candles 0.5 grams, 0.25 grams; daily dose of 1.0 grams (500 mg 2 times)
• Pentasa: 0.5 g tablets, daily dose 4.0 grams
candles 1.0 g.; enema 1.0g.

20. Other groups of drugs
• Immunosuppressants - second-line drugs in the treatment of ulcerative colitis and are
prescribed in its severe forms, when the use of glucocorticoids and aminosalicylates is
not effective. Azatioprin, 6-mercaptopurin – first week 50 mg per day, than
increase the dose to: azatioprin - 2,5-3,0 mg/kg per day, 6-
mercaptopurin – 1-1,5 mg/kg per day. Duration 12 weeks and more.
• Antibiotics are prescribed:
- for the treatment of secondary infections against aminosalicylates and glucocorticoids;
- with the development of purulent complications.
Apply semisynthetic penicillins (methicillin, ampicillin, pentriksil) in doses of 0.5-1.0 g
intravenously or intramuscularly every 4-6 hours. Duration 10-14 days.