What is ischemic colitis: signs and complications, diagnosis, treatment and diet, prevention. Colitis Ischemic segmental colitis

Colitis- is a lesion of the large intestine of an inflammatory or inflammatory-dystrophic nature. Based on the location of the lesion, pancolitis and segmental colitis are distinguished: typhlitis (right-sided colitis with damage to the upper parts of the colon), sigmoiditis, proctosigmoiditis (colitis lower sections intestines). Colitis can be acute and chronic, in elderly and old age They also distinguish ischemic colitis.

Reasons:

The main cause of the occurrence and development of ischemic damage to the wall of the colon is a violation of intestinal circulation, most often associated with atherosclerosis of the branches abdominal aorta. An atherosclerotic plaque clogs the lumen of the inferior mesenteric artery partially or completely, which leads to dystrophic and, in the latter case, to necrotic changes in the wall of the colon. Less commonly, the cause of intestinal circulatory disorders can be hemorrhagic vasculitis, periarteritis nodosa, systemic lupus erythematosus, etc. The predominant localization of the lesion is the area of ​​the splenic angle.

Causes of acute colitis:

The vast majority of cases of acute colitis are associated with infectious factor. The causative agents of acute colitis can be Salmonella, Shigella, Escherichia, Yersinia, etc., and less commonly, some viruses and other pathogenic flora. Sometimes the cause may be allergic reactions, non-bacterial poisoning, or gross errors in diet. Depending on the type of inflammation, acute colitis is divided into catarrhal, erosive, ulcerative colitis, fibrinous. Acute inflammation intestinal wall leads to disruption of all functions of the colon varying degrees expressiveness.

Drug-induced colitis is associated with prolonged and uncontrolled use of antibiotics and laxatives; concomitant colitis develops against the background secretory insufficiency glands of the stomach, pancreas and arise due to constant irritation mucous membrane of the colon by products of incomplete digestion of food in the overlying parts of the gastrointestinal tract.

Cases of chronic colitis of an allergic nature have been described. In the mechanism of development of chronic colitis, the leading role is played by inflammatory, dystrophic and atrophic changes in the colon mucosa, accompanied by disturbances in its motor and secretory functions. Certain importance is attached to disorders of the immune status.

Symptoms:

Ischemic colitis can occur in benign (reversible), stenotic (caused by gradual cessation of blood flow) and fulminant (necrotizing) forms. The type of flow depends on the caliber of the affected vessel, the severity of the blood flow disturbance and the development of collateral blood supply.

The fulminant form, associated with irreversible necrosis of the intestinal wall, is manifested by severe pain in the left half of the abdomen, signs of intestinal obstruction, rectal bleeding, the outcome of which is peritonitis.

In the case of the development of benign and stenosing forms of the disease, the clinical picture is not so acute. As a rule, patients note intense pain in the upper or left half of the abdomen, usually immediately after eating, vomiting, flatulence and other digestive disorders. Body temperature often rises. In half of the cases, diarrhea is observed, often mixed with blood, but constipation may also occur, as well as their alternation with diarrhea. When palpating, there is pronounced pain along the descending colon, sometimes a protective muscle tension in the left half of the abdomen.

Symptoms of acute colitis:

Acute colitis usually occurs in combination with acute enteritis or gastroenteritis and accompanies many intestinal infections. Patients complain of acute nagging or cramping pain in the abdomen, rumbling, loss of appetite, loose stool mixed with mucus and blood - in severe cases. Its frequency ranges from 4-5 to 15-20 times a day. Tenesmus may occur, and with the rapid development of the disease, the stool takes on the character of “rectal spitting.” Body temperature can reach high numbers. In especially severe cases, symptoms of general intoxication come to the fore. When palpating the abdomen, rumbling and pain along the colon are noted.

Symptoms of chronic colitis:

Chronic colitis is one of the most common diseases of the gastrointestinal tract. Often combined with chronic gastritis and gastroenteritis. The course of the disease in some cases is long-term and asymptomatic, in others it is chronically recurrent.

Usually there is pancolitis, in which patients complain of abnormal stool - diarrhea, sometimes alternating diarrhea and constipation (unstable stool), with pronounced changes in the stool there may be streaks of blood, large number mucus. The abdomen is distended and there is flatulence. A characteristic symptom is a feeling of incomplete bowel movement after defecation. In spastic colitis, feces have a fragmented appearance (“sheep feces”).

Dumb aching pain are noted in different parts of the abdomen, mainly on the left and below, but can also be diffuse without clear localization. Characterized by intensification after eating and before defecation. Pain in the anus may occur due to inflammation of the mucous membrane of the rectum and sigmoid colon. When inflammation passes to the serous (outer) lining of the intestine (pericolitis), the pain may increase with walking and shaking and decrease in a horizontal position. A warm heating pad, antispasmodics, and anticholinergics relieve pain.

When palpating the abdomen, pain is detected along the length of the large intestine, alternating spasmodic and dilated areas filled with liquid and solid contents, strong rumbling and even splashing in one of the sections of the intestine. The presence of chronic perivisceritis leads to stability of the muscles of the anterior abdominal wall over the affected areas.

The most commonly affected parts of the large intestine are the rectum and sigmoid colon. Often proctosigmoiditis occurs after acute dysentery, with chronic infectious process. Clinical symptoms characterized by a tendency to constipation. The stool may also be of the “sheep feces” type with a lot of mucus, sometimes streaked with blood. Pain is most often in the left iliac region, anal passage, persist for some time after defecation or a cleansing enema. When palpated, the pain of the spasmodic sigmoid is determined.

Colitis in children:

Acute colitis in children occurs in the same way as in adults. Chronic colitis in children in most cases is the result of acute intestinal infections, most often dysentery. In some cases, the cause may be helminthic infections. When the disease lasts up to 2-3 years, segmental colitis usually occurs with predominant damage to the lower parts of the colon. In some cases, predisposing factors may be congenital anomalies intestinal development, such as megacolon, dolichosigma. With a duration of more than 3 years, the disease takes on the character of pancolitis.

The clinical picture varies depending on the phase of the disease and the predominant localization of the pathological process. During the period of exacerbation, the presence of pain in the abdomen is characteristic, more often in the umbilical region or along the colon in the right (with typhlitis) or left (with sigmoiditis) iliac regions. Increased pain is facilitated by: physical activity, consumption of large amounts of plant fiber, milk, as well as flatulence and increased motility before defecation. In young children pain syndrome corresponds to the “slipping” syndrome, when there is a loosening of the stool after eating.

At older ages, unstable stools or a tendency to constipation are common. As in adults, rumbling in the stomach and flatulence are noted. When the overlying parts of the gastrointestinal tract are involved in the process, nausea, belching, and, less often, heartburn and vomiting may occur. When palpated, the large intestine is spasmodic and painful in places. In the phase of incomplete clinical remission, children have no complaints, but stool disorders will persist, as well as some pain upon palpation. In the stage of complete clinical remission instrumental methods studies can reveal changes in the colon.

A special form of colitis is severe damage to the large intestine - pseudomembranous colitis, which is not associated with the development of dysbacteriosis. The causative agent of pseudomembranous colitis is clostridium, the toxin of which causes destructive processes in the mucous membrane of the colon. The disease can develop after taking the first dose of an antibiotic, but it can also occur in long term. Diarrheal syndrome with pseudomembranous colitis it is severe with pronounced colitis stool (mucus, blood and leukocytes), combined with fever and cramping abdominal pain without clear localization.

Diagnostics:

In the diagnosis of colitis, an important role belongs to both the anamnesis and physical examination, as well as laboratory and instrumental data. To identify (exclude) the infectious nature of acute and chronic colitis, a thorough interview of the patient is required. In all cases, coproscopy and bacteriological examination stool, for diagnosis and differential diagnosis endoscopic research methods are used.

Diagnosis of ischemic colitis:

To confirm the diagnosis, patients with partial blockage of the inferior mesenteric artery undergo irrigo-, knee-, or sigmoidoscopy. Irrigoscopy detects a filling defect in the form of a “thumb print” at the site of the lesion, with endoscopic examination swelling of the mucosal area, submucosal hemorrhages, ulceration and narrowing during long term diseases. The diagnosis can be definitively confirmed using selective angiography inferior mesenteric artery.

Diagnosis of chronic colitis:

In diagnosis, both survey and objective examination data, as well as the results, are of great importance instrumental studies. Irrigoscopy specific disorders does not reveal. Typically, acceleration or deceleration of peristalsis, spastic contractions or atony of the intestinal wall are detected. Colonoscopy and sigmoidoscopy reveal catarrh mucous membrane of the colon, in severe cases there may be purulent or necrotic lesions. If necessary, a biopsy of the mucous membrane is taken during a colonoscopy.

It is necessary to differentiate chronic colitis with enteritis, diverticulosis, ulcerative nonspecific colitis, tumor processes intestines. A difficult question is the distinction between colitis and functional bowel disease - dyskinesia or irritable bowel syndrome. Usually the phenomena of dyskinesia are combined with the presence of neurotic symptoms, but the former predominate. Unlike colitis, during sigmoidoscopy and colonoscopy, the colon mucosa is not changed; spasm of certain sections of the intestinal wall is noted. Irrigoscopy reveals multiple contractions of the circular muscles, advancement contrast agent through the intestines is accelerated, disordered. Emptying of the sigmoid colon is incomplete.

To confirm the diagnosis of pseudomembranous colitis, in addition to a clear connection between the disease and antibiotic use wide range action requires an endoscopic examination of the sigmoid colon.

Treatment:

In the fulminant form of ischemic colitis with the development of an acute abdomen, the patient is indicated for emergency surgery - removal of the affected area of ​​the colon. In the treatment of the stenotic form, antispasmodics, anticholinergics, antisclerotic drugs, and angioprotectors are used. When an infection occurs, antibacterial agents are used. Effective method treatment is removal of the affected inner shell arteries, vascular plastic surgery. When strictures develop, the affected area of ​​the intestine is also removed. The use of cardiac glycosides, which cause narrowing of the mesenteric arteries, is contraindicated.

Treatment of acute colitis:

Treatment of acute colitis is carried out in outpatient or inpatient conditions depending on the severity of the patient's condition. A mechanically and chemically gentle diet is prescribed (table No. 4 according to Pevzner) until you feel better, followed by its gradual expansion. To replenish lost fluid and salts are used saline solutions(“Regidron”, “Oralit”, trysel, quartasol, etc.). The method of restoring the water-salt balance is selected based on the patient’s condition.

As a pathogenetic and symptomatic therapy are used enzyme preparations, enveloping agents and adsorbents ( activated carbon, white clay, etc.) and cardiovascular drugs according to indications. If the infectious nature of colitis is established, etiotropic therapy consists of prescribing antibacterial agents taking into account the sensitivity of the isolated pathogen to them. In mild cases, it is preferable not to use antibiotics, especially broad-spectrum antibiotics, limiting the use of diet and symptomatic remedies.

Treatment of chronic colitis:

Treatment of chronic colitis, depending on the phase of the disease and the patient’s condition, can be carried out both in hospital and in outpatient setting, and must be continuous. Diet therapy for chronic colitis must be strictly specific. During an exacerbation, split meals are prescribed 6-7 times a day; one of diets No. 4a, 4b, 4c is recommended. In case of severe exacerbation, the first one to two days in the hospital can be spent therapeutic fasting. At home therapeutic nutrition includes slimy soups, weak meat broths, pureed porridges in water, boiled meat in the form of steam cutlets and meatballs, soft-boiled eggs, boiled river fish, jelly, sweet tea. During the period of remission, the diet can be expanded to include first boiled, pureed, and then fresh vegetables and fruits.

Antibacterial therapy is prescribed in courses of 4-5 days, for mild and moderate severity - sulfonamides, if they have no effect - antibiotics strictly taking into account the sensitivity of the sown flora. For severe pain - antispasmodics (papaverine, no-spa), platifillin. For general strengthening purposes, B vitamins and ascorbic acid are used (preferably by injection). The means of symptomatic therapy are enzyme preparations, for diarrhea - astringents and adsorbents, heated mineral waters without gas - Essentuki No. 4 and 20, Berezovskaya, as well as infusions and decoctions medicinal herbs with an astringent and anti-inflammatory effect (blueberry fruits, oak bark, sage leaves, alder fruits, etc.); for constipation, herbal laxatives are used - senna leaf, buckthorn bark, joster fruits, etc., and from mineral waters - Essentuki No. 17, Smirnovskaya, Slavyanovskaya, Batalinskaya.

In case of severe flatulence, it is advisable to add cumin seeds, dill, chamomile flowers, and centaury stems to the collections of medicinal herbs. For persistent constipation, it is recommended to take bran, which is brewed with boiling water before use and infused, and after cooling, used in its pure form or added to various dishes, starting with a teaspoon and increasing the dose to 1-2 tbsp. l. 3 times a day.

If the rectum is predominantly affected, therapeutic microenemas are prescribed: oil enemas (sea buckthorn oil, rosehip oil), warm chamomile decoction. To the complex therapeutic measures include (if necessary) sedatives, psychotherapy, acupuncture, as well as physiotherapeutic procedures (warming compresses on the stomach, electrophoresis of papaverine, novocaine, mud therapy). During the period of remission, to normalize intestinal motility, patients are prescribed a deep abdominal massage (colon massage). Spa treatment carried out in local sanatoriums and balneological resorts (Druskininkai, Truskavets, Caucasian Mineralnye Vody, Feodosia).

The prognosis for chronic colitis is generally favorable, but in terms of complete recovery it is doubtful. In mild cases of pseudomembranous colitis, discontinuation of the antibiotic leads to full recovery patient, while in severe cases the prescription of trichopolum or vancomycin is required.

– is it acute or chronic? inflammatory disease of the large intestine, which occurs due to disruption of the blood supply to its walls. It manifests itself as abdominal pain of varying intensity, unstable stools, bleeding, flatulence, nausea, vomiting, weight loss (in chronic cases). In severe cases, body temperature rises and symptoms of general intoxication appear. For diagnostic purposes, sigmoidoscopy, irrigoscopy, colonoscopy, and angiography of the inferior mesenteric artery are performed. Treatment for initial stages conservative, if ineffective - surgical.

Ischemic colitis is a segmental circulatory disorder in the walls of the large intestine due to occlusion or narrowing blood vessels, which leads to inflammation, stricture and necrosis of the intestinal area. The term “ischemic colitis” was first introduced in 1966. The disease is registered mainly in older people. Patients over 50 years of age account for 80% of cases of ischemic colitis. It occurs with equal frequency in men and women, and is distributed evenly in all countries and on all continents. According to various sources, about a third of all diseases of the large intestine in patients of the older age group are caused by poor circulation in its walls. Treatment and diagnosis are carried out by proctologists, although initially patients with symptoms of ischemic colitis may be hospitalized in the department of gastroenterology or general surgery.

Causes of ischemic colitis

There are many causes of ischemic colitis; they are associated with spasm of the vessels supplying blood. large intestine, their occlusion, a decrease in total blood pressure. Vascular occlusion can occur due to atherosclerosis, embolism or thromboembolism of mesenteric vessels, allergic reactions, injuries, postoperative complications, systemic vasculitis, DIC syndrome. Ischemic colitis, as a consequence of low blood pressure, causes states of shock, acute allergic reactions, dissection of aortic aneurysm, severe anemia, significant dehydration (blood loss, intestinal infection with profuse diarrhea).

With vascular occlusion, necrosis or gangrene of the intestinal wall most often develops. The area of ​​the lesion depends on the diameter of the vessel, complete or incomplete overlap of its lumen, duration of occlusion, and the possibility of development collateral blood flow. If the lumen of the vessel is blocked gradually, for example, with atherosclerosis, ischemic colitis can acquire chronic course with the formation of strictures.

The large intestine is one of the most poorly supplied organs with blood, especially in those areas where there are vascular anastomoses. Its functional activity is accompanied by an even greater decrease in blood flow. Therefore, shock conditions, heart failure (acute or chronic), blood loss during injuries, operations or fluid loss during intestinal infections very quickly lead to the development of ischemia and, as a consequence, ischemic colitis.

Most often, ischemic colitis develops in the sigmoid and transverse colon, especially in cases where its cause is atherosclerosis. But this does not exclude the possibility that other departments may be involved. The mucous membrane is primarily affected, but over time the submucosa may become involved and muscle layer. If occlusion of large arteries occurs, the process develops rapidly with the participation of all layers of the intestinal wall. Ischemic changes can be reversible and irreversible. If necrosis has not occurred and there is no gangrene, the mucous membrane quickly returns to normal after blood flow is resumed. In chronic ischemic colitis, changes increase gradually, this can lead to inflammation, ulcers and ultimately to the development of strictures.

Ischemic colitis can be acute or chronic. Acute colitis develops with infarction of the mucous membrane, submucosal layer and the entire intestinal wall. Chronic colitis may be complicated over time by colonic strictures. There are also transient forms of ischemic colitis (with reverse development of symptoms and morphological changes), stenotic (with the formation of strictures), gangrenous (with the formation of ulcers, necrosis of all layers of the intestinal wall, frequent complications and progressive morphological changes without reverse development).

Symptoms of ischemic colitis

Ischemic colitis develops acutely or subacutely. Specific symptoms This disease does not have, so diagnosing it can be quite difficult. Mostly, patients complain of abdominal pain, periodically recurring intestinal bleeding, unstable chair. Diarrhea alternates with constipation; there is a predominant tendency to frequent loose stools with a large amount of mucus and blood impurities. Palpation of the abdomen reveals pain in the left iliac region, near the navel. Digital rectal examination can reveal blood, mucous and purulent discharge in the rectum. The intensity of one or another symptom depends on the form of ischemic colitis and the size of the affected area.

A reversible form of ischemic colitis develops when the period of circulatory disturbance was short or collaterals began to develop quickly. Characterized by periodic pain in the abdomen on the left or near the navel. Sometimes their intensity and duration are so small that patients do not pay attention to them. The pain appears half an hour after eating or after physical activity and can disappear on its own within several hours. The nature of the sensations is similar to the pain of angina pectoris or intermittent claudication. After some time, tenesmus may occur, and the patient develops loose stools with blood and mucus. Blood in the stool is sometimes detected several days or weeks after the onset of the disease.

With the further development of the pathological condition, the symptoms may go away on their own or increase if ischemic colitis becomes irreversible. In the latter case, the patient's pain intensifies, the stool becomes profuse, liquid, with discharge of blood, mucus, putrid smell. The general condition worsens, hyperthermia, nausea, vomiting, and symptoms of general intoxication may appear. Profuse bleeding, even with severe course ischemic colitis occurs extremely rarely. Massive necrosis of the intestinal walls can lead to perforation of the colon and peritonitis. Chronic ischemic colitis often leads to the formation of strictures, intestinal obstruction, and the formation of cancerous tumors at the site of narrowing of the colon.

Diagnosis of ischemic colitis

The most informative methods for diagnosing ischemic colitis are instrumental research methods. Sigmoidoscopy helps to suggest a diagnosis, but does not provide a complete picture. In the reversible form of ischemic colitis, direct and sigmoid colon small hemorrhages in the mucous membrane are visible. At necrotic form You can see ulcers with clear edges and fibrin films against the background of pale mucosa. More diagnostic information can be obtained by performing a biopsy.

Irrigoscopy is one of the most informative diagnostic studies with ischemic colitis. With reversible changes in the areas of ischemia, defects in the form of finger indentations can be seen. Through short time they may disappear, so the study should be carried out immediately at the first suspicion of ischemic colitis. Necrotic changes are visible as persistent ulcerative defects. When performing irrigoscopy, strictures can also be diagnosed. Colonoscopy allows you to see more clearly morphological changes in the walls of the entire large intestine, take a biopsy from areas with ischemia or strictures of the colon, especially if there is a suspicion of their malignant degeneration.

To determine the cause and level of vascular obstruction, angiography of the inferior mesenteric artery is performed. For complications of ischemic colitis, general and biochemical tests blood. To correct antibiotic therapy, stool and blood cultures are performed to determine drug sensitivity.

Differential diagnosis for ischemic colitis is carried out with infectious diseases (dysentery, amoebiasis, helminthiasis), nonspecific ulcerative colitis, Crohn's disease, malignant neoplasms. In infectious diseases, symptoms of general intoxication come to the fore; there is a corresponding epidemiological history. Ulcerative colitis develops gradually, over at a young age. The development of colon cancer occurs over a long period of time, often over several years.

Treatment of ischemic colitis

At the first stage of the disease, conservative therapy. A gentle diet, mild laxatives, and drugs that improve blood flow (vasodilators) and blood rheology (antiplatelet agents) are prescribed. The results of complex treatment of ischemic colitis are improved by drugs such as dipyridamole, pentoxifylline, and vitamin complexes. If the patient’s condition is serious, detoxification therapy is carried out, the water-electrolyte balance is corrected, and sometimes a blood transfusion is performed. Of great importance for unloading the intestines is parenteral nutrition. For bacterial complications of ischemic colitis, antibiotics and sulfonamide drugs are prescribed.

Surgical treatment of ischemic colitis is indicated for extensive necrosis, gangrene of the large intestine, perforation and peritonitis. The affected area of ​​the intestine is removed within healthy tissue, then an inspection is carried out and postoperative drainage is left. Since patients with ischemic colitis are mostly elderly, complications after such operations are quite common. For strictures that block or narrow the intestinal lumen, elective surgeries are performed.

Forecast and prevention of ischemic colitis

The prognosis of ischemic colitis depends on the form of the disease, course and presence of complications. If blood flow has resumed and necrosis has not developed, the prognosis is quite favorable. With necrosis, everything depends on the extent of the process, timely diagnosis and correct surgical intervention. Also, the course of the pathology depends on the age, general condition of the patient and concomitant diseases.

Since ischemic colitis occurs in most cases as a complication of atherosclerosis, heart failure, and the postoperative period during interventions on the intestines, stomach, and pelvic organs, the basis of prevention is adequate treatment primary diseases. Regular preventive medical examinations are also of great importance.

And we also have

Ischemic colitis is a disease characterized by ischemia (blood circulation disorders) of the vessels of the large intestine. As a result of the development of pathology, the affected segment of the intestine does not receive the required amount of blood, so its functions are gradually impaired.

Ischemic colitis predominantly affects older people. In more in rare cases pathology affects people of working age.

Reasons

Ischemic colitis is a complex pathology, the progression of which can be triggered by many unfavorable factors. The most common causes of the disease are the following: states:

• hypoperfusion. As this pathology progresses, the blood supply to the intestine is significantly reduced, which in the future leads to ischemia of certain areas;
• atherosclerotic vascular lesions. – this is a pathology in which a certain amount of lipids (fats) accumulates on the walls of blood vessels, which interferes with normal blood flow;
• . In some forms of these ailments, the vessels located in the intestines may become inflamed;
• . A blood clot can completely or partially block the lumen of an artery or vein, resulting in ischemia;
• DIC syndrome;
• intestinal neoplasms;
• aortic dissection;
• liver transplant;
• idiopathic colitis (the main cause of the disease is not known);
• the use of certain groups of synthetic drugs. For example, hormonal.

Forms

Ischemic colitis, according to the nature of the pathological process, is:

• sharp;
• chronic.

In turn, acute ischemic colitis occurs:

• with progression of intestinal mucosal infarction. Necrosis (necrosis) of this organ occurs due to a disruption in its blood supply;
• with progression of intramural infarction. The zone of necrosis is localized inside the wall of the large intestine;
• with progression of transmural infarction. As a result of the development of this process, absolutely all intestinal walls are affected.

Chronic ischemic colitis usually occurs with abdominal pain, nausea and bowel dysfunction. In heavy clinical cases Intestinal strictures develop - pathological narrowing of a certain area of ​​the intestine.

Clinicians also distinguish three forms of this disease:

• transient. Blood circulation in the vessels is not often disrupted, but against the background of this process inflammation develops, which passes over time;
• stenosing, also called pseudotumorous. Circulatory disorders are permanent. The inflammatory process progresses, resulting in scarring of the intestinal wall;
• gangrenous colitis. This form of the disease is the most severe and dangerous for both the health and life of the patient. All layers of the walls are affected. Against this background, complications progress.

Symptoms

The clinical picture primarily depends on the degree of circulatory disturbance in the large intestine. The larger the area affected by ischemia, the more pronounced the symptoms of the disease will be.

As the disease progresses, several characteristic symptoms are observed:

• severe abdominal pain. Its location may vary depending on the location where the affected area itself is located. The pain can be observed on the right or left, or be girdling. The pain symptom radiates to the neck, back of the head, subscapular and interscapular areas. It is observed constantly or occurs periodically and paroxysmally (periods of exacerbation alternate with periods of calm). The nature of the pain is pressing and dull. But if you don’t pay attention to this symptom in time and don’t visit medical institution for diagnosis and treatment, then gradually pain symptom intensifies and becomes intense, cutting, sharp.

The pain may intensify after exercise, eating, or due to constipation (a characteristic symptom).

• increased sweating;
• flatulence and bloating are observed;
• sleep disturbance;
• nausea and vomiting;
• belching with an unpleasant odor;
• intestinal bleeding;
• constant disturbance of stool. This is manifested by the patient having diarrhea alternating with constipation. In this case, this is a characteristic symptom;
• weakness and fatigue;
• weight loss;
• headache;
• an increase in body temperature is accompanied by chills.

If you have one or more of the above symptoms, it is recommended to immediately contact a qualified specialist for diagnosis, confirmation or refutation of the diagnosis. Self-medication in this case is unacceptable, since you can only aggravate your condition and provoke the development of complications.

Diagnostics

First, the doctor analyzes the patient’s complaints. The symptoms, their nature and intensity are clarified. Next, an anamnesis of the patient’s life and the disease itself is collected. To diagnose the disease, laboratory and instrumental techniques are used to accurately diagnose and identify the cause of the pathology.

Laboratory methods:

• stool analysis;
• coagulogram;
• lipid spectrum blood serum;

Instrumental techniques:

• bicycle ergometer test;
• Doppler study;
• angiographic examination;
• X-ray of the intestines;
• laparoscopy.

Treatment

The course of treatment can only be prescribed qualified specialist after diagnostics and evaluation of the results obtained. In many ways, therapy depends on the degree of damage to the intestinal vessels. A standard treatment plan includes:

• purpose of diet No. 5. The patient is advised to reduce the consumption of spicy, fried and fatty foods;
• normalization of hyper- and dyslipidemia. In this case, it is necessary to stop the progression of atherosclerosis;
• drugs are prescribed whose main effect is aimed at reducing blood viscosity;
• vasodilators;
• hypoglycemic drugs;
• nitrates. These substances help relieve pain;
• symptomatic therapy. In this case, all measures are aimed at reducing the symptoms of the disease;
• essential phospholipids;
• enzymatic preparations;
• if the patient has overweight, then it is necessary to normalize it;
• Surgical treatment is indicated in the most difficult clinical situations, and it consists of removing the affected part of the large intestine.

Diet

Diet plays one of the most important roles in the treatment of ischemic colitis. It can only be prescribed by a doctor. He can also create a proposed menu.

Products allowed for consumption:

• jelly, compote, weak tea;
• eggs in the amount of one piece per day;
• wheat or rye bread;
• vegetable oil;
• low-fat cottage cheese;
• low-fat cheese;
• porridge;
• greens and vegetables;
• soups prepared with vegetable broth;
• You can eat lean meat.

• pickled vegetables;
• products made from butter dough;
• soups with meat or mushroom broths;
• fats and lard;
• fried eggs;
• radish, green onions and spinach;
• spicy seasonings;
• chocolate;
• alcohol;
• cocoa and black coffee.

Complications

If you don't pay attention in time alarming symptoms and do not treat the disease, the following complications may develop:

• perforation;
• intestinal obstruction;
• profuse intestinal bleeding.

Preventive measures

In order to avoid treating ischemic colitis in the future, it is necessary to carry out its prevention in a timely manner. Basic preventive measures are aimed at eliminating the causes that provoke the progression of the pathology:

• stick to correct mode nutrition (you can, as during treatment, adhere to diet No. 5);
• moderate physical activity;
• passing preventive examinations for timely detection and treatment of ailments;
• increasing immunity.

Is everything correct in the article? medical point vision?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Jaundice – pathological process, the formation of which is influenced by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Call this pathological condition Any disease can, and they are all completely different.

The clinical picture of the disease depends, first of all, on the degree of circulatory disturbance in the intestine (the larger the area affected, the more pronounced clinical picture diseases). Most often there are several symptoms.

• Abdominal pain. Its localization (location) depends on the location of the lesion in the colon. It can appear in the right, left half of the abdomen or be encircling. Pain can radiate (spread) to the subscapular, interscapular region, neck, back of the head, and lower back. The pain can be constant or paroxysmal (intensify and subside). In nature it can be dull, pulling, pressing, and as the disease progresses - cutting, sharp, very intense. It can be triggered by the following factors:
  • physical activity. The appearance or intensification of pain after brisk walking, long-term physical work(especially in a bent state), lifting weights;
  • eating - pain often appears immediately after eating and decreases after 1.5-2 hours. Some foods cause increased pain, for example, milk and dairy products, sweets, too spicy, hot or cold foods;
  • constipation

It is also possible that the pain may intensify at night when lying down.

• Flatulence (increased gas production), bloating.
• Nausea, vomiting, belching.
• Abnormal stool (alternating constipation and diarrhea).
• Intestinal bleeding.
• Loss of body weight. Weight loss may be associated with disruption of the digestive processes in the intestines, which develop against the background of ischemic colitis, as well as with the fear of eating, which entails increased pain (sitophobia).
• Decreased performance, weakness, fatigue.
• Sleep disturbance – drowsiness during the day and insomnia at night.
• Headaches and dizziness.
• Increased sweating.
• Chilliness, chills, increased body temperature.

Forms

By flow ischemic colitis may be sharp And chronic.

• Spicy :
  • with the development of a heart attack (necrosis (death) of the organ due to acute lack of blood supply) intestinal mucosa, in this case, only the mucous membrane of the colon is affected;
  • with the development of intramural infarction, in this case, the focus of necrosis is located inside the intestinal wall;
  • with the development of transmural infarction guts (all layers of the intestinal wall are affected).

• Chronic :
  • chronic ischemic colitis - bother constant pain in the abdomen, stool disturbances, nausea, vomiting and other symptoms;
  • intestinal strictures - narrowing of part of the intestine.

Also distinguished 3 forms ischemic colitis.

• Transitional form: circulatory disorders in the vessels of the intestine occur periodically, against the background of which inflammation develops, which resolves over time.
• Stenosing form (pseudotumorous): due to constantly occurring circulatory disorders and inflammation, scarring develops (scar formation - rough connective tissue) intestinal wall and narrowing of the intestine.
• Gangrenous colitis: the most severe form of the disease, characterized by damage to all layers of the intestinal wall and frequent development of complications.

Reasons

• Atherosclerotic vascular disease (a disease associated with the deposition of lipids (fats) in the vascular wall of blood vessels).
• Hypoperfusion (decreased blood supply to the intestines).
• Thrombosis (formation of blood clots in blood vessels - thrombi).
• Vasculitis (inflammation of intestinal vessels).
• DIC syndrome (disseminated intravascular coagulation syndrome): a systemic (occurs in all vessels) process of massive blood coagulation in vessels of various sizes.
• Aortic dissection (the most large vessel which exits the left ventricle of the heart).
• Sickle cell anemia (hereditary (passed from parents to children) disease in which the structure of the hemoglobin protein is disrupted, as a result of which it acquires characteristic shape sickle; In this disease, the function of hemoglobin (oxygen transport) is impaired).
• Liver transplantation.
• Tumors (neoplasms) of the intestine.
• Using certain medications (such as contraceptives ( contraceptive drugs)) - for women.
• Idiopathic colitis (the cause of the disease is difficult to identify).

Diagnostics

• Analysis of complaints (complaints of abdominal pain, the appearance of blood in the stool, abnormal stool, etc.) and medical history (when (how long ago) did the symptoms of the disease appear, are they related to food intake and physical activity).
• Analysis of the life history (did the patient have any organ diseases abdominal cavity, tumors, operations, whether he is constantly taking any medications, etc.).
• Measuring body temperature and blood pressure to assess the severity of the patient's condition.
• General inspection. Identification of signs of lipid (fat) metabolism disorders in the body - obesity, especially of the abdominal type (accumulation of fat in the abdominal area), xanthelasmas (small yellow or brownish formations located symmetrically on the eyelids) and xanthoma (small yellow or brownish formations located most often on the chest, back and elbows). Pallor of the skin is also possible (associated with blood loss or existing anemia).
• Laboratory research methods.
  • Complete blood count (to detect possible anemia (anemia, low levels of red blood cells) and hemoglobin (oxygen carrier protein)), signs are usually present inflammatory process(increased ESR, leukocytes (white blood cells)).
  • Study of the blood coagulation system (involved in blood clotting).
  • Lipid spectrum of blood serum (cholesterol (fat-like substance) and its fractions (subtypes), atherogenic index (lipid ratio), triglycerides (lipid subtype)).
  • General urine test for suspected accession renal failure(impaired kidney function, especially excretory function) and infections.
  • Stool analysis. Impurities of blood, mucus, and undigested fiber may be detected, which indicates indigestion.

• Instrumental research methods.
  • Electrocardiography (ECG) is a method of recording electrical fields that are formed during the work of the heart.
  • Ultrasound of the abdominal aorta and its branches to detect vascular damage (a disease associated with the deposition of lipids (fats) in the vascular wall of blood vessels).
  • Doppler examination of the celiac trunk, splenic artery, common hepatic artery, superior and inferior mesenteric arteries to identify damage to the arteries (vessels).
  • Functional (stress) tests: bicycle ergometer test (exercise bike), treadmill ( treadmill) etc. These tests reveal how well the patient tolerates physical activity and how he reacts to it.
  • Angiographic examination abdominal region aorta and its branches.
  • X-ray examination of the intestine (irrigoscopy) allows you to identify changes in the intestine and assess their degree.
  • Colonoscopy ( diagnostic procedure, during which the doctor examines and evaluates the condition inner surface colon using a specially optical instrument (endoscope)). A biopsy (taking a piece of intestine for analysis) is performed during a colonoscopy.
  • Laparoscopy – endoscopic examination and surgical intervention on the abdominal organs. The procedure is carried out through small holes in the anterior abdominal wall, through which a device - an endoscope - is inserted to examine the abdominal organs and an instrument with which the operation is performed, if necessary.

Treatment of ischemic colitis

• Diet (table No. 5) and nutrition correction: reducing the amount of fatty, fried, spicy foods, reducing the consumption of animal fats, replacing them with vegetable ones.
  • Allowed:
    • porridge;
    • vegetables, greens;
    • eggs (no more than 1 per day);
    • sugar, jam, honey.
  • Prohibited:
    • ​products made from butter dough (pancakes, pancakes, cakes, fried pies, etc.);
    • cooking fats, lard;
    • mustard, pepper, horseradish;
    • alcoholic drinks.

• Correction of hyper- (increased lipids in the body) and dyslipidemia (impaired lipid (fat) metabolism in the body) to reduce the progression of atherosclerosis (a disease associated with the deposition of lipids (fats) in the vascular wall of blood vessels).
• Antiplatelet therapy (drugs that reduce blood viscosity).
• Vasodilators.
• Hypoglycemic agents (lowering glucose (sugar) levels) if available diabetes mellitus(a disease that occurs due to a deficiency of the hormone insulin (a pancreatic hormone, the main effect of which is to reduce the level of glucose (sugar) in the blood)).
• Symptomatic (elimination of disease symptoms) therapy aimed at reducing structural changes and improving the functional state of the digestive organs.
• Nitrates (to relieve pain).
• Essential phospholipids (drugs for restoring liver function).
• Enzyme preparations to improve digestion.
• Weight loss with concomitant obesity.
• Surgical treatment (removal of the affected part of the intestine).

Complications and consequences

• Intestinal obstruction(partial or complete difficulty in passing intestinal contents through the intestines).
• Perforation (perforation, rupture of the wall) of the intestine.
• Toxic megacolon (dilation of the large intestine).
• Massive intestinal bleeding.

Prevention of ischemic colitis

Prevention of ischemic colitis is aimed at eliminating the causes that caused it.

A diet (table No. 5) and nutritional correction are indicated: limiting the amount of fatty, fried, spicy foods, reducing the consumption of animal fats, replacing them with vegetable ones.

Allowed:

• non-acidic fruit and berry juices, compotes, jelly, weak tea and coffee with milk;
• wheat, rye bread, shortbread cookies;
• low-fat cottage cheese, sour cream in small quantity, low-fat cheeses;
• various soups based on vegetable broth with the addition of vegetables, cereals, pasta;
• butter, vegetable oil up to 50 g per day;
• meat products from lean beef, chicken and other lean poultry, boiled or baked after boiling, cooked in pieces or chopped;
• porridge;
• vegetables, greens;
• eggs (no more than 1 per day);
• fruits and berries (except very sour ones), compotes, jelly;
• sugar, jam, honey.

Prohibited:

• products made from butter dough (pancakes, pancakes, cakes, fried pies, etc.);
• cooking fats, lard;
• soups with meat, fish, and mushroom broths;
• sorrel, spinach, radish, green onion, radish;
• fatty meat (beef, lamb, pork, goose, duck, chicken);
• fatty fish (sturgeon, stellate sturgeon, beluga, catfish);
• fried and hard-boiled eggs;
• pickled vegetables, canned food, smoked meats, caviar;
• mustard, pepper, horseradish;
• cranberry, sour fruits and berries;
• ice cream, cream products, chocolate;
• black coffee, cocoa, cold drinks;
• alcoholic drinks.

Ischemic colitis– chronic disease of the large intestine. It occurs due to disturbances in blood flow in its walls. In severe cases, intoxication occurs. Treatment depends on the form of the disease; surgery may be used.

The disease occurs in old age, usually in women. Ischemic colitis occurs severe inflammation large intestine. The blood supply is responsible for the arteries at the top and bottom. Superior artery responsible for blood supply to the blind and small intestine, the lower one is responsible for blood flow in the left side of the large intestine.

The disease leads to the development of dysbiosis and decreased immunity in the intestines. In this case, the splenic flexure is affected, symptoms appear in varying degrees of complexity.

Causes of the disease

Define the real reason ischemic colitis is very difficult. There are a large number of factors that cause this disease. The main ones include:

• vascular spasms;
• occlusion;
• decrease in blood pressure.

Occlusion occurs against the background of atherosclerosis, herbs, complications after surgery, and allergic reactions. If blood pressure drops sharply with this disease, this may cause acute allergies, severe anemia, dehydration.

In severe cases, necrosis and gangrene develop against the background of occlusion, which depends on the area of ​​intestinal damage. In the large intestine poor blood supply because of the anatomy. Heart failure, trauma, and shock further aggravate this process.

Forms of ischemic colitis

There are two forms of ischemic colitis: acute and chronic. Acute can cause infarction of the intestinal mucosa. Necrosis of the tissues of this organ occurs. Distributes inside the walls.

The chronic form is accompanied severe pain in the abdomen, stool disorders, nausea, vomiting, disrupted intestinal structure and pathological changes.

There are three clinical forms diseases:

• Transitional. In this case, blood circulation is rarely disrupted, but an inflammatory process develops.
• Stenosing (pseudotumorous). Blood supply disruption occurs regularly. The inflammation worsens, scarring appears on the walls of the large intestine.
• Gangrenous. The most severe and life-threatening form of ischemic colitis. All layers of the intestinal walls are affected. This causes severe complications that develop rapidly.

Before starting treatment, it is important to determine the form of ischemic colitis. To do this, the patient needs to undergo diagnostics.

Clinical picture

The manifestation of symptoms depends on the disruption of blood flow in the large intestine. If a large area is affected, the signs will appear brightly and frequently. The following symptoms indicate the development of the disease:

Severe abdominal pain localized in the affected area. It can occur on the right or left side. Pain is felt in the neck, back and even in the back of the head. The pain can be periodic and occur in attacks. Characterized by a dull pain, which can intensify with strong physical stress and constipation.

• Increased sweating.
• Flatulence, bloating.
• Insomnia.
• Vomit.
• Persistent nausea.
• Belching with a rotten smell.
• Bleeding in the intestines.

The affected person suffers from constipation and diarrhea. Stool disorders cause the following symptoms:

• severe weakness;
• weight loss;
• frequent headache;
• chills, body aches;
• temperature rise.

If pain in the abdominal cavity occurs, a visit to a gastroenterologist is recommended. The patient passes comprehensive examination. You cannot endure the pain in this case and put off visiting a doctor. The chronic stage is difficult to treat.

Diagnostics

If ischemic colitis is suspected, a person consults a surgeon or gastroenterologist. The doctor takes into account the patient’s complaints, collects anamnesis, and tries to diagnose the disease based on characteristic features. Instrumental and laboratory tests will help confirm the diagnosis:

• General analysis of blood, urine, feces.
• coagulogram;

• histology;
• blood serum analysis;
• enzyme-linked immunosorbent test;

• radiography;
• colonoscopy;
• endoscopy;

• angiographic studies.

The results of these studies help diagnose ischemic colitis and determine the stage of its development. During the examination, the patient may be diagnosed with the following diseases: helminthiasis, dysentery, ulcerative colitis, tumors. They also cause signs of intoxication.

Treatment methods

Treatment is prescribed in combination with diet and bed rest. Especially if ischemic colitis manifests itself in acute form. It is important to start drug therapy at the first manifestations of the disease, this will help prevent the development of chronic disease.

Drug therapy consists of antispasmodics and drugs to improve blood circulation in the large intestine. During an exacerbation, the doctor may prescribe a short course of antibiotic treatment. It usually lasts 5-7 days, after which the patient long time must accept bacteria.

If you have hypertension, you cannot sharply reduce your blood pressure. This can have a negative impact on the development of ischemic colitis and accelerate its development. Medicines are prescribed on an individual basis, taking into account the characteristics of each patient’s body.

If conservative treatment methods fail desired result, surgery is required. Especially in the development of the gangrenous form. The patient is hospitalized and surgery is performed. Rehabilitation period lasts a long time, the patient constantly takes medications.

The intestines are responsible for the state of the immune system, so after drug therapy a person is prescribed complex vitamins and drugs to stimulate the immune system.

Diet

For the use of medications to produce results, the patient must follow a diet. Products that are allowed:

• natural juices;
• crackers, bread;
• low-fat fermented milk products;

• vegetable broth soups;
• butter, olive, sunflower;
• lean meats;

• eggs;
• boiled or steamed vegetables;
• honey, jam.

List of foods that are prohibited:

• fresh baked goods;
• fatty soups;
• canned food;

• manufactured products, semi-finished products;
• sour fruits, berries;
• sweets, chocolate, cocoa;
• alcohol.

In ischemic colitis, nutritional adjustments are mandatory. The healing process depends on this. During the period of remission, you also need to follow a diet and eat only high-quality foods.

Drug therapy

In this case, a person may be prescribed the following medications:

• vasodilators;
• hypoglycemic agents (to reduce glucose levels in diabetes mellitus);
• medications to improve liver function;
• enzymes.

The doctor determines the treatment regimen individually. Dietary restrictions apply to every patient. You cannot self-medicate or take it without the advice of a specialist.

It is worth noting that the disease can cause complications. These include:

• intestinal obstruction (in severe cases requires surgery);
• perforation of the intestinal walls;
• wall expansion and necrosis;
• bleeding.

If such signs develop, you should consult a doctor. In some cases it is enough drug therapy, and in more complex cases surgery may be necessary.

In addition to diet, the doctor prescribes recommendations for each patient for ischemic colitis for a quick recovery:

• Physical activity is prohibited.
• You should not lean forward too often or sharply.
• Walking on fresh air(20-30 minutes).
• Get adequate sleep, it is useful to sleep at lunchtime (1 hour).
• Warm shower.
• Comfortable clothes without tight belts.
• Treatment in sanatoriums 2 times a year.

It is important to consider that lifestyle, nutrition and emotional state affects the function of the digestive system.

Folk remedies

Cure ischemic colitis traditional medicines impossible. Despite this, some of them are suitable as adjuvant therapy.

• Hawthorn. The pharmacy sells ready-made tea with this plant. It is recommended to drink it 2 times a day with the addition of honey. The course of treatment can last up to 3 months.
• Melissa. Tea made from this herb has a sedative effect, relieves spasms and helps reduce inflammation. You can drink it 2 times a day, especially useful before bed.

• Rose hips. A decoction is prepared from dried fruits. Take throughout the day before meals.

Traditional medicine should not be the main method of treating ischemic colitis. This serious illness requires drug therapy. IN postoperative period The patient has been on bed rest for a long time, so folk remedies will be useful as an addition to the main treatment.

How to predict the development of the disease

Ischemic colitis occurs after approximately 60 years of age. Women are at risk due to their anatomy. At this age they develop various pathologies and diseases that cause the development of new diseases. Elderly people should carefully monitor their diet, medications, and lifestyle.

Very rarely, ischemic colitis occurs in young people, so it is very difficult to predict the development of this disease. With timely diagnosis and dietary nutrition, treatment will be quick and limited to medication.

A disease cannot fail to send signals to a person for a long time. In this case, everything depends on the attitude towards own health. Initial stage easily turns into acute and chronic. However, treatment requires more complex therapy, surgical intervention. Rehabilitation will be long. After this, digestive problems can often occur.