Nonspecific ulcerative colitis code microbial 10. Ulcerative colitis. Treatment of spastic colitis of the intestine

One of the most common pathologies of the distal intestine is chronic colitis. For statistical research and accounting of morbidity, chronic colitis according to the ICD has the code K52.

Gastroenterologists and proctologists often use the code for this disease when preparing various medical records. Chronic colitis is characterized by an inflammatory lesion of the colon, which in some cases is ulcerative in nature and is accompanied by destruction of the mucous membrane. To make a correct diagnosis, it is necessary to know the classification and the main etiological factors that cause this pathological condition.

Chronic colitis in ICD 10

In the international classification of diseases of the 10th revision, nosological units are sorted depending on clinical manifestations, pathogenesis and etiology. The colitis code in ICD 10 is K52, however, depending on the form of the disease, the code varies from K52.0 to K52.9. Non-specific ulcerative colitis and Crohn's disease are distinguished as separate diseases, since they are of an autoimmune nature. The main causes provoking the development of inflammatory lesions of the large intestine are:

Chronic inflammation of the colon, depending on the factor that causes it, can be infectious or non-infectious. Also, the disease is often combined with gastroenteritis and other pathologies of the digestive system.

Features of the course of the disease

In patients, complaints of pain in the abdomen and stool disorders prevail.

Depending on the form of the pathological process, blood and mucus in different proportions can be found in the feces.

Often patients suffer from constipation or vice versa - diarrhea. In ICD 10, chronic colitis belongs to the section of diseases of the digestive tract, so a gastroenterologist or proctologist should be involved in the diagnosis of pathology. Early diagnosis can significantly increase the chances of a successful cure, provided that the patient adheres to a special diet and follows the doctor's recommendations. If you do not contact a specialist in time, serious complications can occur in the form of bleeding, intoxication, or the development of a malignant tumor.

An intestinal disease such as ulcerative colitis, according to the international classification of diseases (ICD 10), has 51 codes. It combines 8 varieties of this serious illness. All of them were combined by the following factors:

• These diseases begin with the rectum of the colon, and then spread in the proximal direction;
• In 25% of cases there is a total lesion of the colon;
• In the most severe cases, defective lesions extend to the serous, submucosal, and muscular membranes located in the intestinal wall;
• They are characterized by both bleeding ulcers in the colon and inflammatory pseudopolyposis.

Collected under ICD 10 code 51, varieties of non-specific colitis often cause electrolyte imbalance, hypoproteinemia, and anemia. Less commonly, they can lead to such terrible consequences as colon cancer or perforation of the intestinal wall.

All varieties of ulcerative colitis available in the ICD are divided according to the following factors:

1. With the flow. It can be chronic with periodic relapses or having a continuous course, as well as acute, sometimes even fulminant;
2. According to the prevalence of inflammation in the intestines in the varieties of ulcerative colitis, collected in ICD 10, they can be total or left-sided. Also presented here are proctitis and proctosigmoiditis;
3. The intestinal pathologies collected under this code also have a general division according to severity. In the most severe cases, they are accompanied by frequent and severe diarrhea, which happens more than 6 times a day, and macroscopic blood inclusions are visible in the masses released from the intestines. The general condition of the patient in this case can be called quite bad: weakness, severe anemia, tachycardia and fever;
4. According to the stages of the disease, the varieties of nonspecific ulcerative colitis, combined into one group according to the ICD, are divided into active (the disease proceeds in an acute form) and passive, which is a state of remission, at any time capable of giving a relapse of the disease;
5. They also have a subdivision according to the presence of extraintestinal manifestations. In the classification of diseases according to the ICD, ulcerative colitis can be with or without them;
6. It is noted in this pathology of the intestine and the presence or absence of complications.

All varieties of intestinal pathology, united in one group of the international classification of diseases, require immediate contact with a specialist and the start of adequate treatment. In case of delay, the situation may be fraught with surgical intervention with complete removal of the intestine.

How to relieve stomach cramps and the causes of their appearance

The main causes of spasms of the stomach and intestines in children:

• pyloric stenosis;
• lactase deficiency;
• dysbacteriosis.

If colic in the stomach in adults is accompanied by diarrhea, these are signs of the following diseases:

1. irritable bowel syndrome;

2. intestinal infection;

3. pancreatitis, pancreatic colic (pain is given to the back, collarbone and shoulder blades, most often felt on the left, fever and nausea are possible).

Pain in the lower abdomen, especially on the right, accompany an attack of appendicitis. But at first, painful jerks can be felt in the epigastric zone. Cramps in the stomach are also symptoms of intestinal and biliary colic.

Signs of other disorders:

• acute gastritis;
• ulcerative colitis;
• stomach ulcer;
• oncological diseases.

Also, spasms often occur due to a nervous breakdown. For impressionable people, enough stress is enough for them to have an attack. It can pass quickly, but sometimes lasts up to several hours. Stomach cramps mainly occur during hunger, while the person usually looks at food with dislike or indifference.

When to see a doctor?

With frequent spasmodic pain in the stomach, you should consult a specialist - a gastroenterologist or a neurologist. You need to be especially concerned if the attacks are accompanied by diarrhea, fever, general weakness, dizziness, vomiting, increased heart rate and yellowing of the skin or whites of the eyes. Women should immediately call an ambulance for bleeding from the vagina. This applies to everyone if the convulsions began shortly after the injury or cause unbearable pain.

Postpone going to the doctor and special treatment is allowed only when the pain in the stomach subsides quickly. In stressful situations, it is not necessary to immediately run for an examination, it is better to try to calm down; Breathing practices help fight colic: you need to breathe quickly, but at the same time, the breaths should not be deep. With the urge to vomit, it is not recommended to eat for 6 hours. You can eat soft pureed foods, unleavened crackers, and spicy, dairy, fatty and sour foods should be excluded.

Medicines and folk remedies

If you don't know what to do for cramps, don't self-medicate. You can alleviate your condition by taking painkillers: No-shpy, Spazmalgon or Almagel.

Spasms are treated with folk remedies. Making these tinctures is quite simple.

1. Peppermint tea helps a lot. It is necessary for half an hour to insist in two hundred milliliters of boiling water 2-3 teaspoons of dry mint leaves. Use the infusion as a tea leaves, diluting in equal proportions with warm water.

2. Take a tablespoon of chamomile flowers and the same amount of yarrow for a glass of infusion, pour boiling water over them and wait half an hour. Warm herbal tea should be drunk by the sip during painful conditions.

3. With severe stomach pains, fresh motherwort juice helps. One teaspoon of juice is mixed with fifty milliliters of warm water and drunk immediately.

4. Spasms of the stomach and intestines also pass when taking tincture from celandine. Green grass is poured with vodka in equal proportions, then tightly corked and allowed to brew for 9 days. Drink 1 teaspoon of the remedy.

Clinical picture of ulcerative colitis

Ulcerative colitis is a chronic inflammatory pathology of the large intestine, characterized by the development of ulcers and hemorrhages in the mucous membrane.
The disease affects people between the ages of twenty and forty. Women are more likely to suffer from ulcerative colitis.

Causes of the disease

The etiological factor of the disease has not yet been established.

There are a number of hypotheses about the occurrence of ulcerative colitis of the intestine:

• ulcerative colitis is an infectious pathology of unknown etiology,
• ulcerative colitis is an autoimmune disease based on the production of its own antibodies against the epithelial cells of the large intestine by the immune system,
• ulcerative colitis is hereditary.

The provoking factors of the disease are:

• high carbohydrate diet low in dietary fiber
• intestinal dysbiosis,
• mental trauma, stress, emotional overstrain,
• sedentary lifestyle.

Pathomorphology

The pathological anatomy of nonspecific ulcerative colitis is represented by diffuse superficial lesions of the walls of the large intestine. Usually the pathological process is localized in the rectum and sigmoid colon. Total damage to the entire intestine is very rare.

Morphological signs of ulcerative colitis are small ulcers on the mucous membrane of the large intestine. At the same time, it is full-blooded, the unaffected epithelium is hypertrophied and protrudes significantly above the mucosal surface. Ulcers, as a rule, are not deep, the walls of the intestine are compacted.

Perhaps the accession of infection and the development of secondary purulent inflammation. All this leads to hypersensitivity of the mucous membrane, which begins to bleed even with a slight impact.

Classification

Classification depending on the location of the pathology

1. Regional colitis is a local lesion of the colon with a small area of ​​inflammation that can grow and then become more severe.
2. Total colitis is manifested by inflammation, covering the entire epithelium of the large intestine and affecting deep tissues.
3. Left-sided ulcerative colitis.
4. Ulcerative proctitis is a regional inflammation of the end section of the colon.

Classification depending on the course of the disease

• Acute colitis is characterized by sudden onset of obvious attacks under the influence of environmental factors,
• Chronic colitis is a sluggish hereditary disease,
• Recurrent colitis is a type of chronic form of the disease, turning into acute under the influence of provoking factors, and after their disappearance, returning back to chronic.

The last two types are relatively difficult to treat, since the affected area is quite large.

Symptoms of ulcerative colitis

According to the severity of the manifestation of clinical symptoms, the disease is divided into degrees: mild, moderate and severe.

Mild and moderate severity are characterized by the presence of general symptoms of ulcerative colitis of the intestine in the patient: malaise, weakness, fever up to 38 ° C, and local signs: frequent stools up to five times per knock, the appearance of blood in the feces and cramping abdominal pain.

The severe course of the disease is manifested:

• fever over 38°C,
• tachycardia,
• pulse over 90 beats per minute
• pallor of the skin due to developed anemia,
• dizziness
• weakness
• weight loss
• frequent stools more than six times a day,
• the presence of a large amount of blood in the stool, sometimes blood is excreted in clots,
• intense cramping pain in the abdomen preceding the act of defecation.

Nonspecific ulcerative colitis may present with constipation and pain in the left iliac region. At the same time, the body temperature rises slightly, and patients do not pay special attention to these signs. But soon there is rectal bleeding mixed with pus. The amount of blood released ranges from a few drops to twenty milliliters.

Clinical symptoms of nonspecific ulcerative colitis are divided into intestinal and extraintestinal.

Intestinal symptoms of ulcerative colitis: diarrhea or constipation, blood and mucus in the stool, cutting or aching pain in the left side of the abdomen, anorexia and weight loss, fever, water and electrolyte imbalance with kidney damage.

Extraintestinal symptoms: conjunctivitis with further deterioration of vision, stomatitis, gingivitis, arthritis, skin diseases, thrombophlebitis, thromboembolism.

If the pain in the abdomen does not stop for six hours and there is a discharge of blood from the rectum, then urgent medical care is needed, hospitalization of the patient and a thorough examination in order to exclude acute surgical pathology.

The course of the disease in children and the elderly has its own characteristics.

Nonspecific ulcerative colitis develops in children of all ages, but most often in adolescents. The disease is manifested by symptoms that are very scarce and slightly expressed. Symptoms of ulcerative colitis in children are growth retardation and paroxysmal diarrhea. The periods of remission at the same time last quite a long time - several years.

In older people, the disease develops sluggishly, which is associated with an age-related decrease in the immune function of the body. In the elderly, complications develop much less frequently than in children and young people.

It is necessary to differentiate ulcerative colitis with dysentery, salmonellosis, Crohn's disease, pseudomembranous colitis, celiac disease, diverticulum, hemorrhoidal bleeding. Of the entire list of diseases, Crohn's disease is considered the most similar in clinical manifestations to ulcerative colitis. The main difference is that Crohn's disease is characterized by lesions of the entire thickness of the intestinal wall, and ulcerative colitis - only the mucous membrane.

Diagnostics

Diagnosis of nonspecific ulcerative colitis always begins with an analysis of the patient's complaints and anamnestic data. Then the patient is examined, in which signs of anemia are revealed, and palpation of the abdomen determines pain on the left or throughout the abdomen.

Additional research methods are laboratory, endoscopic and radiological.

Laboratory research methods:

• general blood analysis,
• blood for clotting
• standard studies taken during hospitalization of a patient in a hospital.

The main instrumental research method is fibrocolonoscopy. It is carried out as follows: a flexible probe is inserted into the rectum through the anus, having a micro-camera at the end, with which you can examine and assess the condition of the colon mucosa. Any endoscopic examination is prohibited in full during the period of exacerbation of the disease, as this can worsen the patient's condition and even lead to perforation of the intestinal wall. Colonoscopy is a universal diagnostic method that allows you to understand what ulcerative colitis is.

Irrigoscopy is a safer and less informative research method, which consists in introducing a barium suspension into the rectum using an enema, followed by an X-ray examination. With the help of barium on the x-ray, you can get a cast of the intestinal mucosa and use it to judge the presence and severity of ulcerative defects.

X-ray diagnostics allows you to determine the localization of the pathological process, its prevalence, the presence of complications and monitoring the development of the disease.

Microbiological examination of nonspecific colitis is carried out in order to exclude the viral etiology of the disease. To do this, bacteriological seeding of the material under study is carried out and a conclusion is made on the basis of the results obtained. Ulcerative colitis is characterized by the release of pathogenic microorganisms from the feces, an increase in the number of staphylococci, Proteus, a decrease in lactobacilli, as well as the release of specific microflora, which is uncharacteristic for the intestines of a healthy person.

It is possible to identify complications of ulcerative colitis - perforation of the colon - using a plain radiography of the abdominal organs without the use of contrast agents.

Complications of ulcerative colitis

Complications of ulcerative colitis occur when the treatment of pathology is not started in a timely manner or is not effective.

1. Bleeding life threatening.
2. Toxic dilatation of the colon, resulting from the stoppage of peristaltic contractions and the presence of pronounced inflammatory changes in the intestinal mucosa.
3. Perforation of the colon, which is a violation of the integrity of the intestinal wall with the outflow of intestinal contents into the free abdominal cavity.
   

   This leads to the development of other complications - peritonitis and sepsis.

4. Polyps and colon cancer.
5. Stenosis and development of intestinal obstruction.
6. Hemorrhoids and anal fissures.
7. Extraintestinal complications: arthropathy, hepatitis, cholecystitis, pyoderma, mental disorders.

But perhaps it is more correct to treat not the consequence, but the cause?

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Ulcerative colitis, unspecified

Definition and background[edit]

Ulcerative colitis- a chronic disease of the colon, characterized by immune inflammation of its mucous membrane. Ulcerative colitis affects only the large intestine and never spreads to the small intestine, the rectum is necessarily involved in the process, inflammation is most often limited to the mucous membrane (with the exception of fulminant colitis) and is diffuse. The exception is the condition referred to as "retrograde ileitis", but this inflammation is temporary and is not a true manifestation of ulcerative colitis.

The prevalence of ulcerative colitis ranges from 21 to 268 cases per 100,000 population. The annual increase in the incidence is 5-20 cases per 100 thousand of the population, and this figure continues to increase (approximately 6 times over the past 40 years).

The social significance of ulcerative colitis is determined by the predominance of the disease among people of young working age - the peak incidence of ulcerative colitis is plaque, as well as the deterioration in the quality of life due to the chronicity of the process, and, consequently, frequent inpatient treatment.

An exacerbation (relapse, attack) of ulcerative colitis is understood as the appearance of typical symptoms of the disease in patients with ulcerative colitis in the stage of clinical remission, spontaneous or drug-supported. An early relapse is defined as a relapse occurring less than 3 months after medically achieved remission. In practice, signs of clinical exacerbation are an increase in the frequency of defecation with blood and / or characteristic changes found during endoscopic examination of the colon.

Remission of ulcerative colitis consider the disappearance of the main clinical symptoms of the disease and the healing of the colon mucosa. Allocate:

Clinical remission - the absence of blood in the stool, the absence of imperative / false urges with a frequency of bowel movements no more than 3 times a day;

Endoscopic remission - the absence of visible macroscopic signs of inflammation during endoscopic examination of the colon;

Histological remission - the absence of microscopic signs of inflammation.

To describe the extent of the lesion, the Montreal classification is used, which assesses the extent of macroscopic changes during endoscopic examination of the colon.

According to the nature of the flow, there are:

a) acute (less than 6 months from the onset of the disease):

With a fulminant onset;

With a gradual onset;

b) chronic continuous (lack of more than 6-month periods of remission against the background of adequate therapy);

c) chronic relapsing (the presence of more than 6-month periods of remission):

Rarely recurrent (1 time per year or less);

Often recurrent (2 times or more per year).

The severity of the disease is generally determined by the severity of the current attack, the presence of extraintestinal manifestations and complications, refractoriness to treatment, in particular the development of hormonal dependence and resistance.

The classification of ulcerative colitis depending on the response to hormonal therapy facilitates the choice of rational treatment tactics, since the goal of conservative treatment is to achieve stable remission with the cessation of glucocorticosteroid (GCS) therapy. For these purposes, the following are distinguished:

1. Hormonal resistance

In the case of a severe attack, persistence of disease activity despite the intravenous administration of corticosteroids at a dose equivalent to 2 mg/kg per day of prednisolone for more than 7 days

In the case of a moderate attack, the preservation of disease activity with oral administration of corticosteroids at a dose equivalent to 1 mg / kg per day of prednisolone for 4 weeks.

2. Hormonal addiction

An increase in disease activity with a decrease in the dose of corticosteroids below a dose equivalent to mg prednisolone per day for 3 months from the start of treatment

The occurrence of a relapse of the disease within 3 months after the end of treatment with corticosteroids.

Etiology and pathogenesis[edit]

There are three main concepts of the emergence of UC.

1. Direct exposure to unidentified exogenous environmental factors; infection is considered as the main cause.

2. An autoimmune mechanism (against the background of a genetic predisposition), in which exposure to one or more "triggering" factors leads to a cascade of reactions directed against one's own antigens. A similar pattern is characteristic of other autoimmune diseases.

3. An imbalance in the immune system of the gastrointestinal tract, against which the impact of various adverse factors leads to an excessive inflammatory response, which occurs due to hereditary or acquired disorders in the mechanisms of regulation of the immune system.

Numerous mechanisms of tissue and cellular damage are involved in the development of inflammation in UC. Bacterial and tissue antigens cause stimulation of T- and B-lymphocytes. With an exacerbation of UC, a deficiency of immunoglobulins is detected, which contributes to the penetration of microbes, compensatory stimulation of B cells with the formation of IgM and IgG. Deficiency of T-suppressors leads to increased autoimmune response. Among the inflammatory mediators, first of all, we should mention the cytokines IL-lp, IF-y, IL-2, IL-4, IL-15, which affect the growth, movement, differentiation, and effector functions of numerous cell types involved in the pathological process in UC.

An important role in the pathogenesis of UC is assigned to a violation of the barrier function of the intestinal mucosa and its ability to recover. It is believed that a variety of food and bacterial agents can penetrate into the deeper tissues of the intestine through defects in the mucous membrane, which then trigger a cascade of inflammatory and immune reactions.

Clinical manifestations[edit]

The main clinical symptoms of ulcerative colitis include diarrhea and/or false urges with blood, tenesmus and urge to defecate, and nocturnal defecation. With a severe attack of ulcerative colitis, general symptoms may appear, such as weight loss, general weakness, anorexia, and fever.

Ulcerative colitis, unspecified: Diagnosis[edit]

There are no clear diagnostic criteria for ulcerative colitis. Diagnosis is based on a combination of history, clinical presentation, and typical endoscopic and histological findings.

Endoscopic examination of the colon is the main method for diagnosing ulcerative colitis, but there are no specific endoscopic signs. The most characteristic are continuous inflammation, limited to the mucous membrane, starting in the rectum and spreading proximal, with a clear border of inflammation. The endoscopic activity of ulcerative colitis is best reflected by contact fragility (bleeding on contact with the endoscope), the absence of a vascular pattern, and the presence or absence of erosions and ulcerations.

Microscopic signs of ulcerative colitis include deformity of the crypts (branching, multidirectionality, the appearance of crypts of different diameters, a decrease in the density of crypts, “shortening of the crypts”, the crypts do not reach the underlying layer of the muscularis mucosa), an “uneven” surface in the biopsy of the mucosa, a decrease in the number of goblet cells, basal plasmacytosis, infiltration of the lamina propria, the presence of crypt abscesses and basal lymphoid accumulations. The degree of inflammatory infiltration usually decreases with distance from the rectum.

Differential diagnosis[edit]

If ulcerative colitis is suspected, differential diagnosis begins with the exclusion of inflammatory diseases of the colon that do not belong to the group of IBD (inflammatory bowel diseases). These are infectious, vascular, drug, toxic and radiation lesions.

Ulcerative colitis, unspecified: Treatment[edit]

Treatment options for ulcerative colitis include medication, surgery, psychosocial support, and dietary advice.

The choice of the type of conservative or surgical treatment is determined by the severity of the attack, the extent of the colon lesion, the presence of extraintestinal manifestations, the duration of the anamnesis, the efficacy and safety of previous therapy, as well as the risk of complications of ulcerative colitis.

Purpose of therapy- achievement and maintenance of steroid-free remission (cessation of glucocorticosteroids (GCS) within 12 weeks after the start of therapy), prevention of complications of ulcerative colitis, prevention of surgery, and with the progression of the process, as well as the development of life-threatening complications - timely appointment of surgical treatment. Since the complete cure of patients with ulcerative colitis is achieved only by removing the substrate of the disease (coloproctectomy), when remission is achieved, the non-operated patient must remain on constant maintenance (anti-relapse) therapy.

It should be especially noted that glucocorticosteroids cannot be used as maintenance therapy.

Indications for surgical treatment

Indications for surgical treatment of ulcerative colitis are the ineffectiveness of conservative therapy (hormonal resistance, ineffectiveness of biological therapy) or the impossibility of its continuation (hormonal dependence), intestinal complications of ulcerative colitis (toxic dilatation, intestinal perforation, intestinal bleeding), as well as colon cancer or high risk its occurrence.

Failure or inability to continue conservative therapy

The ineffectiveness of conservative therapy is evidenced by:

Hormonal dependence can be effectively overcome with the help of biological drugs and/or immunosuppressants (azathioprine, 6-MP) in 40-55% of cases, and in case of hormonal resistance, the appointment of cyclosporine A or biological therapy can induce remission in 43-80% of cases. However, in some patients with a high risk of complications and ineffectiveness of conservative therapy with the development of hormonal resistance or dependence, it is possible to perform surgical treatment without attempting the use of biological agents or immunosuppressants.

Prevention[edit]

Other [edit]

Predicting the effectiveness of conservative therapy in a severe attack of ulcerative colitis

The joint observation of the patient by an experienced gastroenterologist and coloproctologist remains key to the safe management of a severe attack of ulcerative colitis. Although drug therapy is effective in many cases, there is evidence that delaying the necessary surgical treatment is detrimental to the patient's outcome, in particular by increasing the risk of surgical complications. Most studies of predictors of colectomy were conducted before the widespread use of biological therapy and cyclosporine and predict the ineffectiveness of corticosteroids, rather than infliximab and immunosuppressants.

ICD-10 code

Related diseases

Symptoms

* "False urge" to defecate, "mandatory" or obligatory urge to defecate.

* Abdominal pain (often in the left half).

* fever (temperature from 37 to 39 degrees, depending on the severity of the disease).

* weight loss (with prolonged and severe course).

* water and electrolyte disturbances of varying degrees.

* Pain in the joints.

It should be noted that some of these symptoms may be absent or minimally expressed.

The reasons

If both parents suffer from ulcerative colitis, then the risk of developing it in a child by the age of 20 increases to 52%.

Smoking is a risk factor for the development of nonspecific ulcerative colitis. Smokers have a lower risk of developing the disease than non-smokers or people who have stopped smoking. A convincing explanation for the protective effect of smoking in ulcerative colitis has not yet been given. It is assumed that smoking reduces the blood flow in the rectal mucosa, resulting in a decrease in the production of inflammatory agents.

Treatment

Medical treatment. The main drugs for the treatment of ulcerative colitis are 5-aminosalicylic acid preparations. These include sulfasalazine and mesalazine. These drugs have an anti-inflammatory effect and have a healing effect on the inflamed colon mucosa. It is important to remember that sulfasalazine may cause more side effects than mesalazine and is often less effective in treatment. In addition, drugs containing mesalazine as an active ingredient (salofalk, mesacol, samezil, pentasa) have an effect in different parts of the colon. So, pentas begins to act in the duodenum, mesacol - starting from the colon.

Hormones - prednisolone, dexamethasone - are prescribed with insufficient effectiveness of 5-ASA drugs or with a severe attack of ulcerative colitis. They are usually combined with sulfasalazine or mesalazine. In cases of moderate and / or severe disease, prednisone or its analogues are administered intravenously at doses of 180 to 240 mg per day or more, depending on the activity of the disease. Every other day, if there is a therapeutic effect, hormones are administered orally in tablet form. Usually, the starting dosage is mg per day, depending on the activity of the disease and the body weight of the patient. Subsequently, the dose of prednisolone is reduced by 5 mg per week. Hormonal drugs do not heal the colonic mucosa, they only reduce the activity of exacerbation. Remission (inactive disease) is not maintained when hormones are prescribed for a long time.

Biological preparations - remicade, humira - are prescribed for hormone-resistant forms of the disease.

Medical reference books

Information

directory

Family doctor. Therapist (vol. 2)

Rational diagnostics and pharmacotherapy of diseases of internal organs

Nonspecific ulcerative colitis

Definition

Nonspecific ulcerative colitis (NUC) is a chronic inflammatory disease of the colon of unknown etiology, clinically manifested by a recurrent course with periods of bloody diarrhea, and pathomorphologically - diffuse superficial inflammation of the colon mucosa, which has a proximal extent from the rectum and is limited to the rectal and colonic mucosa.

NUC is more common among Caucasians and residents of North America, Northern Europe, and Australia. In Western European countries, the frequency of NUC is 6-15 new cases per 100 thousand population per year, and the prevalence is people. per 100 thousand population. The greatest incidence is registered at the age of years.

Until now, it has not been fully elucidated. A certain influence of possible risk factors is assumed: ethnicity, genetic predisposition, immune disorders, oral contraceptives, infectious agents, psychological factors (stress), high socioeconomic status, food allergies (intolerance to refined sugar, food additives, hydrated fats, foreign proteins ), early artificial feeding.

NUC is considered as a systemic autoimmune process - a violation of the immune response with selective activation of T-lymphocytes, a change in the function of macrophages, the formation of immune complexes leads to the release of inflammatory mediators and tissue destruction. Migration from the vascular bed to the site of damage of mononuclear cells and neutrophils enhances inflammation of the mucous membrane, leading to the release of new portions of inflammatory mediators. The persistence of old antigens and the emergence of new ones (due to the destruction of the epithelium) closes a vicious circle.

Classification

K 51 - Ulcerative colitis.

51.0 - Ulcerative enterocolitis.

51.1 - Ulcerative ileocolitis.

51.2 - Ulcerative proctitis.

51.3 - Ulcerative rectosigmoid.

51.4 - Pseudopolyposis of the intestine.

51.5 - Mucous proctocolitis.

51.8 - Other forms.

Acute (including fulminant);

Chronic continuous current;

Chronic relapsing course.

According to the prevalence of the process:

By severity (Truelove, Witts):

Severe (diarrhea more than 6 times a day with macroscopically visible blood, an increase in body temperature above 37.5 ° C, a heart rate of 90 beats per minute or more, anemia (a decrease in hemoglobin less than 75% of the norm), an ESR acceleration above 50 mm / h) ;

Moderate (intermediate form between severe and mild form);

Mild (diarrhea less than 4 times a day, normal body temperature, no tachycardia, mild anemia (hemoglobin not less than 100 g/l), ESR less than 30 mm/hour).

According to the stages of the disease:

According to the presence of extraintestinal manifestations:

With extraintestinal manifestations;

No extraintestinal manifestations.

According to the presence of complications:

Diagnostics

Diarrhea mixed with blood and mucus;

Subfebrile body temperature;

Constipation (due to spasm of the rectum).

Damage to the skin and mucous membranes (erythema nodosum, pyoderma gangrenosum, aphthous stomatitis);

Eye damage (episcleritis, uveitis, conjunctivitis, keratitis, iridocyclitis, retrobulbar neuritis);

Joint damage (arthritis, ankylosing spondylitis);

Damage to the liver and bile ducts (reactive hepatitis, primary sclerosing cholangitis, cholangiocarcinoma);

Damage to the respiratory system;

Vasculitis, glomerulonephritis, myositis (occur rarely);

General: general weakness, weight loss, electrolyte deficiency, hypoalbuminemia, amyloidosis.

When collecting anamnesis, special attention should be paid to identifying the presence of NUC in close relatives, a history of intestinal infections, taking antibiotics, NSAIDs, laxatives, etc. (if taken, then for how long and in connection with what).

Physical examination, most often, is uninformative - in mild cases, no pathology is determined, in moderate cases, pain in the colon (departments) can be detected on palpation, pallor of the skin with the development of anemia, as well as extraintestinal manifestations.

The appearance of a high fever of a septic type, a decrease in blood pressure, soreness and tension in the muscles of the anterior abdominal wall indicate a severe course of UC and the possible development of complications:

Toxic dilatation of the intestine (development can be facilitated by taking antidiarrheal or laxatives, barium enemas) - fever, tachycardia, abdominal pain and severe pain on palpation are very pronounced. An x-ray examination reveals an increase in the diameter of the colon of more than 6 cm and the presence of air in its wall;

Perforation (clinically manifested by signs of peritonitis);

Colon cancer.

Mandatory laboratory tests

Clinical blood test (decrease in the level of erythrocytes, hemoglobin, leukocytosis, acceleration of ESR, thrombocytopenia) - repeatedly in severe cases;

Clinical analysis of urine (usually without pathological changes);

Total protein and protein fractions (dysproteinemia with an increase in α 2 - and γ-globulins);

Plasma sugar (usually within normal limits);

Liver tests (AST, ALT, alkaline phosphatase, gamma-GTT, bilirubin and its fractions, thymol test) (in severe cases or the presence of extraintestinal manifestations, the level of transaminases may increase) - in severe cases repeatedly;

CRP (quantitative determination) - an increase in the level, in severe cases, repeatedly;

Serum iron level;

Blood type and Rh factor;

Mandatory instrumental studies

Endoscopic examination with morphological examination of biopsy specimens - the "gold standard" of diagnosis - is performed in all cases to verify the diagnosis. In a mild form, diffuse hyperemia, the absence of a vascular pattern, erosion, single superficial ulcerative areas are detected, inflammation is limited to the rectum. With moderate severity, the mucosa is "granular", petechiae, contact bleeding, non-confluent superficial ulcerative areas of irregular shape, covered with mucus, fibrin, and pus are visible. Predominantly left-sided lesion of the colon. In severe form (as a rule, total damage to the colon) - intense necrotizing inflammation, purulent exudate, spontaneous hemorrhages, microabscesses, pseudopolyps.

Morphological examination of biopsy specimens reveals inflammatory infiltration predominantly of the mucosa (sometimes of the submucosa), mucosal edema and hemorrhages in its stroma, crypt abscesses, superficial ulcers, disappearance of goblet cells. If toxic dilatation of the intestine is suspected, endoscopy should not be performed.

X-ray examination is quite informative, but has some limitations - it is not recommended to be performed at the height of exacerbation, except in cases where the diagnosis remains unclear.

In the acute form (taking into account the severity), it can be determined from a normal picture to a "granular" mucosa, single or multiple ulcerative defects, patchy relief of the mucosa, etc. Toxic dilatation (diameter - more than 6-7) can be detected.

In the chronic form, an increase in the retrorectal space, "granular" mucosa, loss of haustration (colon in the form of a water pipe), pseudopolyps are determined.

X-ray examination of the chest organs - once.

Ultrasound examination of the abdominal organs - once.

Additional laboratory and instrumental studies

If indicated - coagulogram, serum immunoglobulins, reticulocytes, HIV testing, hepatitis B and C, blood electrolytes (K, Na, Ca).

If necessary, clarify the diagnosis - abdominal radiography, computed tomography, magnetic resonance imaging, laparoscopy (especially for differential diagnosis with tuberculous bowel disease).

With Crohn's disease, with intestinal tuberculosis, with other colitis (radiation, drug, infectious, ischemic, pseudomembranous, etc.), with IBS, with diffuse familial polyposis.

If there are indications:

Oncologist (in the presence of dysplasia in biopsy specimens of the intestinal mucosa);

Surgeon (with the development of complications);

Optometrist (in the presence of extraintestinal manifestations of UC);

Gynecologist (for women).

Treatment

Achievement of clinical and endoscopic remission with relief or reduction of symptoms of the disease. Full recovery is possible only with radical surgical treatment - colectomy.

With a pronounced exacerbation or the presence of complications, they are subject to hospitalization in a hospital. The average duration of inpatient treatment is 3-6 weeks. In severe form - up to 2 months. Subsequently, they are subject to constant dispensary observation once every 6 months.

Patients are recommended psycho-emotional rest. The effectiveness of any diet in UC has not been established. If you are lactose intolerant, avoid taking products containing it. A high protein diet may be recommended. Completely prohibit the intake of alcohol.

5-aminosalicylates: sulfasalazine - 2-4 g / day, mesalazine - 2-4 g / day (per os / per rectum - suppositories, enemas)

Topical steroids: budesonide 9-18 mg/day for 2 months.

Systemic steroids: prednisolone - up to 400 mg / day, hydrocortisone - up to

400 mg/day, methylprednisolone - 60 mg/day, for 2 months.

Immunosuppressors: azathioprine - 2-2.5 mg / kg / day;

Antibacterial drugs: metronidazole - 500 mg 2 times a day, ciprofloxacin 500 mg 2-3 times a day;

Anticytokine drugs - infliximab (according to the scheme).

Symptomatic treatment - the use of antidiarrheal agents as needed (do not use in severe cases and the threat of toxic dilatation of the intestine), antispasmodics, antibiotics, sorbents, enzyme preparations, iron preparations (for anemia), electrolyte solutions and complete parenteral nutrition (for severe cases).

5-aminosalicylates (the duration of maintenance therapy is not limited), and in the hormone-dependent form - prednisolone.

Surgical treatment is used in complicated forms of UC, or when conservative therapy is ineffective (the effectiveness of aminosalicylates is assessed on the first day of therapy, corticosteroids - on the 7-21st day, immunosuppressants - after 2-3 months).

Absolute indications for surgical treatment are perforation, intestinal obstruction, toxic dilatation of the intestine, abscess, bleeding, severe colon dysplasia, colon cancer.

Relative indications are the ineffectiveness of conservative therapy, the presence of fistulas, mild epithelial dysplasia.

In general, the prognosis for a sufficient response to aminosalicylates and steroids is favorable. Patients with mild forms are able-bodied, those with moderate forms are limitedly able-bodied, those with severe forms and those operated on are disabled of the 2nd group.

Prevention

No generally accepted primary prevention has been developed. Smoking and appendectomy before the age of 20 years are considered to be protective factors for UC.

Secondary prevention is aimed at preventing factors provoking exacerbation (infections of the intestines, upper respiratory tract, etc., taking NSAIDs, stress).

Nonspecific ulcerative colitis. Crohn's disease

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan (Order No. 764)

general information

Short description

Classification

Factors and risk groups

Diagnostics

1. Diagnostic measures for CD

Complaints and anamnesis: diarrhea, pain in the right iliac region, weight loss.

Laboratory studies: accelerated ESR, leukocytosis, thrombocytosis, anemia, hypoproteinemia, hypoalbuminemia, CRP, an increase in alpha 2-globulins.

Complaints and anamnesis: bleeding from the rectum, frequent bowel movements, frequent (constant) urge to defecate, stools mainly at night.

Physical examination: abdominal pain predominantly in the left iliac region, tenesmus.

Laboratory studies: accelerated ESR, leukocytosis, posthemorrhagic anemia, reticulocytosis.

Consultations of experts - according to indications.

List of additional diagnostic measures

Codes of forms of colitis according to microbial 10

Colitis is an inflammatory disease of the large intestine that can occur for a variety of reasons. The disease can be caused by poisoning, a violation of the microflora, the abuse of drugs, any infectious disease, and so on.

Disease classification

The International Classification of Diseases of the Tenth Revision (ICD-10) assigns different numbers depending on which type was diagnosed in the patient. The disease can be both acute and chronic. There are several main types of the disease:

1. Ulcerative. There are many reasons for this type of disease. However, all forms of ulcerative colitis have the ICD-10 code K51. The ICD code of the ulcerative form can also indicate which type of ulcerative colitis is present in this patient.
2. Infectious. The cause of this disease are pathogenic microorganisms. The code for this type of disease is designated as K52.2. Allergic and alimentary colitis can also be included here.
3. Ischemic. It occurs as a result of a violation of blood circulation in the vascular system of the large intestine. Refers to number K52.8.
4. Toxic. Appears due to intoxication of the body and is recorded under the number K52.1.
5. Radiation. This type of disease develops only as a result of radiation sickness and carries the code K52.0.

Spastic colitis has an ICD-10 code depending on the cause of its occurrence. It can also be said that the ICD-10 code for chronic colitis is determined in the same way. In addition, the disease may be complicated by gastroenteritis and therefore have a different classification code.

The classification of colitis allows you to determine the cause of its occurrence, as well as outline further plans for its therapeutic cure. A therapeutic course should be developed by the attending physician, who will select the most effective methods of treatment for each specific situation.

Treatment

Treatment should be developed by a gastroenterologist or coloproctologist. First of all, colitis is treatable through dietary adjustments. The disease is characterized by irritation of the colon mucosa, so the main point of the diet is to create more comfortable conditions for the digestive apparatus.

To this end, foods high in fiber should be temporarily discontinued, and replaced with soft boiled or stewed foods with a minimum of spices, and preferably their complete absence.

It is necessary to eat 4-6 times a day, which will allow the gastrointestinal tract not to resort to heavy loads. In addition, you should drink plenty of fluids to avoid dehydration of the intestinal mucosa.

In addition to the diet, methods of classical drug therapy can also be used. Various antibiotic drugs are used (Cifran, Enterofuril, Normix), analgesics and antispasmodics (Papaverine, No-shpa). The issue of normalization of stool and intestinal microflora is also being addressed.

Conclusion

When the first signs of colitis appear, you should consult a doctor as soon as possible. If you do not start treatment of the disease on time, then it can turn into a chronic form, after which it will become much more difficult to cure it.

For the purpose of prevention, it is necessary to monitor the quality of your diet, exclude fatty, fried, too sour and spicy foods from the diet, and periodically visit a proctologist and gastroenterologist. Chronic colitis is best treated through long-term therapy in spa conditions.

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Ulcerative colitis, or (NJC)- a chronic inflammatory disease of the colon mucosa, resulting from the interaction between genetic factors and environmental factors, characterized by exacerbations. It is found in 35 - 100 people for every 100,000 inhabitants, that is, it affects less than 0.1% of the population. Currently, in the English-language literature, "ulcerative colitis" is considered a more accurate term.

Etiology

The etiology of NUC is not exactly known. The following reasons are currently being considered:

1) Genetic predisposition (the presence of relatives of Crohn's disease or ulcerative colitis increases the risk of developing ulcerative colitis in a patient). A large number of genes are being studied for which a relationship with the development of the disease is revealed. However, at present, the role of only genetic factors has not been proven, that is, the presence of mutations in a particular gene will not necessarily cause the development of ulcerative colitis;

protective factors.

1) It is believed that active smoking reduces the risk of developing ulcerative colitis and the severity of its course. It has been proven that people who quit smoking have a 70% increased risk of developing ulcerative colitis. In these patients, the severity and prevalence of the disease is greater than in smokers. However, when relapsed into smoking in those with advanced disease, the benefit of smoking is questionable.

2) Appendectomy at a young age for "true" appendicitis is considered a protective factor that reduces the risk of developing ulcerative colitis.

3)Scientists have proven that a high intake of oleic acid in food reduces the risk of developing the disease by 90%. According to gastroenterologists, oleic acid prevents the development of ulcerative colitis by blocking chemicals in the gut that exacerbate inflammation in the disease. Doctors have suggested that if patients received large doses of oleic acid, about half of the cases of ulcerative colitis could be prevented. Two to three tablespoons of olive oil per day is enough to show the protective effect of its composition, clinicians say.

pathological anatomy

In the acute stage of ulcerative colitis, exudative edema and plethora of the mucous membrane are noted with thickening and smoothing of the folds. As the process develops or becomes chronic, destruction of the mucous membrane increases and ulcerations are formed that penetrate only to the submucosal or, less often, to the muscular layer. Chronic ulcerative colitis is characterized by the presence of pseudopolyps (inflammatory polyps). They are islands of the mucous membrane, preserved during its destruction, or a conglomerate formed as a result of excessive regeneration of the glandular epithelium. In severe chronic disease, the intestine is shortened, its lumen is narrowed, there are no haustras. The muscular layer is usually not involved in the inflammatory process. Strictures are uncommon in ulcerative colitis. In ulcerative colitis, any part of the colon can be affected, but the rectum is always involved in the pathological process, which has a diffuse continuous character. The intensity of inflammation in different segments may be different; changes gradually pass into the normal mucosa, without a clear boundary. Histological examination in the phase of exacerbation of ulcerative colitis in the mucous membrane shows expansion of capillaries and hemorrhages, the formation of ulcers as a result of epithelial necrosis and the formation of crypt abscesses. There is a decrease in the number of goblet cells, infiltration of lamina propria with lymphocytes, plasma cells, neutrophils and eosinophils. In the submucosal layer, the changes are insignificant, except for cases of ulcer penetration into the submucosa.

Symptoms

• Frequent diarrhea or mushy stools mixed with blood, pus and mucus.
• "False urge" to defecate, "mandatory" or obligatory urge to defecate.
• pain in the abdomen (more often in the left half).
• fever (temperature from 37 to 39 degrees, depending on the severity of the disease).
• decreased appetite.
• weight loss (with prolonged and severe course).
• water and electrolyte disturbances of varying degrees.
• general weakness
• joint pain

It should be noted that some of these symptoms may be absent or minimally expressed.

Diagnostics

Diagnosis of ulcerative colitis in most cases is not difficult. Clinically, it is manifested by the presence of blood and mucus in the stool, frequent stools, and abdominal pain. Objective confirmation of the diagnosis occurs after fibroileocolonoscopy with examination of the ileum and histological examination of biopsy specimens, until this moment the diagnosis is preliminary.

• In a clinical blood test, there are signs of inflammation (an increase in the total number of leukocytes, stab leukocytes, platelets, an increase in ESR) and anemia (a decrease in the level of red blood cells and hemoglobin).
• In a biochemical blood test - signs of an inflammatory process (increased levels of C-reactive protein, gamma globulins), anemia (decrease in serum iron), immune inflammation (increased circulating immune complexes, class G immunoglobulins).

One of the modern markers for the diagnosis of inflammatory bowel diseases (including ulcerative colitis) is fecal calprotectin. With an exacerbation, its level rises (above 100-150).

In some cases, the diagnosis of ulcerative colitis can be misdiagnosed. Other pathologies imitate this disease, in particular, acute intestinal infections (dysentery), protozoal invasions (amebiasis), Crohn's disease, helminthic invasions, colon cancer.

To exclude infections, it is necessary to obtain a negative stool culture tank, the absence of antibodies to pathogens in the blood. A number of intestinal infections are determined or excluded by determining the pathogen by PCR in feces. The same method determines the presence of helminths in the feces (it is also desirable to carry out the determination of antibodies to helminths in the patient's blood). It must be remembered that the detection of helminths does not exclude the diagnosis of ulcerative colitis.

It is difficult to differentiate between ulcerative colitis and Crohn's disease. Ulcerative colitis affects only the colon (in rare cases, with a total lesion of the colon, retrograde ileitis is observed, when non-specific inflammation of the ileum mucosa is detected during ileocolonoscopy). Ulcerative colitis is characterized by continuous involvement of the colonic mucosa, while in Crohn's disease it is most often segmental (eg, sigmoiditis and ileitis). It is also important to conduct a histological examination taken from different parts of the colon and ileum. Determination of specific antibodies often helps to distinguish ulcerative colitis from Crohn's disease. So, for example, antibodies to the cytoplasm of neutrophils with a perinuclear type of luminescence (p-ANCA) are more characteristic of ulcerative colitis (detected in 35-85% of patients), and in Crohn's disease they are found only in 0-20% of cases.

Treatment

In the period of mild or moderate exacerbation, outpatient treatment is indicated. Diet for ulcerative colitis. From the moment of exacerbation, diet No. 4a is prescribed. With the subsidence of inflammatory processes - diet 4b. During remission - diet 4b, then a regular diet with the exception of foods that are poorly tolerated by the patient. In case of severe exacerbation of ulcerative colitis - the appointment of parenteral (through a vein) and / or enteral nutrition.

Medical treatment. The main drugs for the treatment of ulcerative colitis are 5-aminosalicylic acid preparations. These include sulfasalazine and mesalazine. These drugs have an anti-inflammatory effect and have a healing effect on the inflamed colon mucosa. It is important to remember that sulfasalazine may cause more side effects than mesalazine and is often less effective in treatment. In addition, drugs containing mesalazine as an active ingredient (salofalk, mesacol, samezil, pentasa) have an effect in different parts of the colon. So, pentas begins to act in the duodenum, mesacol - starting from the colon.

Notes

Sources

• Nonspecific ulcerative colitis - Ulcerative colitis: features of therapy at the State Scientific Center of Coloproctology
• Nonspecific ulcerative colitis
• Ulcerative Colitis and Pregnancy Consilium medicum
• Modern aspects of the treatment of non-specific ulcerative colitis: results of evidence-based medicine Consilium medicum
• Clinical-endoscopic-morphological dissociations in children with inflammatory bowel diseases Consilium medicum

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See what "Ulcerative Colitis" is in other dictionaries:

Ulcerative colitis is a chronic recurrent disease of the colon of unknown etiology, characterized by hemorrhagically purulent inflammation of the colon with the development of local and systemic complications. Causes Accurate data on the prevalence of ulcerative colitis ... ... Disease Handbook

Nonspecific chronic relapsing disease characterized by severe inflammatory lesions of the colon with abdominal pain, diarrhea (abundant bloody purulent discharge), painful urge to defecate ... Big Encyclopedic Dictionary

Nonspecific, chronic relapsing disease characterized by severe inflammatory lesions of the colon with abdominal pain, diarrhea (profuse bloody purulent discharge), painful urge to defecate. * * * ULCER… … encyclopedic Dictionary

Colitis, symptoms of the disease, its prevalence are considered in detail. A detailed description of the types of colitis activity, its differentiated diagnosis and popular treatment methods is presented.

Colitis, symptoms of the disease, its prevalence are considered in detail.

A detailed description of the types of colitis activity, its differentiated diagnosis and popular treatment methods is presented.

↯ More articles in the journal

From the article you will learn

Prevalence of colitis

Ulcerative colitis, the symptoms of which will be discussed next, is an inflammatory bowel disease of undetermined etiology. The disease has a chronic relapsing form.

Help to detect ulcerative colitis symptoms that are combined with extraintestinal manifestations. We will talk about them further.

Treatment of colitis is a complex of well-coordinated actions of the attending physician and the patient himself. In a special memo, you can get acquainted with basic information about the manifestations and treatment of the disease.

Ulcerative colitis, the symptoms and treatment of which are discussed here, is common in representatives of the Caucasian population of the world, as well as in the inhabitants of the east. It occurs with approximately the same frequency in men and women.

This inflammatory bowel disease occurs with a frequency of about 6-8 cases per 100,000 population. The most susceptible to the disease are patients aged 15-35 years.

Family cases of the disease are often recorded (according to various sources, from 2-20% of cases).

The disease can be both acquired and due to the genetic characteristics of the patient.

For specialists, this means that ulcerative colitis, the symptoms of which are described here, can be caused by both external factors and internal, genetic ones.

Classification: severity, lesion, symptoms of colitis

Chronic colitis code for ICD 10 has the designation K51.

In order to provide a particular patient with quality care for his illness, the doctor must evaluate:

1. The extent and localization of inflammation in the intestine.
2. The severity of the disease during its exacerbation.
3. The nature of the course of the disease.

When making a diagnosis of ulcerative colitis, the treatment of which will be described below, is primarily directed to the rectum, since it is from this that the disease most often begins.

In this case, one usually speaks of distal colitis.

With the spread of the disease, other parts of the colon are involved in the inflammatory process, in ascending order.

In 80% of cases, left-sided colitis is chronic KSD, when inflammation affects the colon only up to the splenic flexure.

Depending on other variants of the course of the disease, the doctor may diagnose total or subtotal colitis.

Consider several classifications depending on how colitis develops the symptoms of these types of disease.

According to the prevalence of damage

As noted above, the attending physician must determine the area that was primarily affected by the disease.

On the basis of distribution, they distinguish:

1. Total colitis.

2. Subtotal colitis.

3. Left-sided colitis (extends to the splenic flexure).

4. Classical distal colitis, which manifests itself in two variants:

• proctosigmoiditis;
• proctitis.

Classification according to severity of symptoms

Chronic colitis ICD 10 is also defined according to the Truelove classification and, which is based on a sign of exacerbation according to the severity of symptoms. This approach is the most convenient and simple for any clinician, since it allows you to determine the severity of the attack of the disease.

The classification is divided into mild, moderate and severe colitis.

The table presents colitis symptoms that allow you to determine the severity of the disease.

We see that this classification takes into account both the external manifestations of the disease, as well as laboratory data and other symptoms.

At the same time, there is a certain relationship between the severity of the exacerbation of the disease and the localization of the inflammatory process.

By the nature of the flow

Nonspecific ulcerative colitis ICD 10 is also divided into three forms depending on the nature of the course:

Recurrent form

With relapses of the disease, the patient experiences attacks of the disease of different duration, which alternate with periods of remission of different duration.

If repeated relapses occur more than 2 times a year, the disease is characterized as frequently relapsing.

Continuously flowing colitis, the symptoms of which are supplemented by relapses at least 2 times a year

This form of the disease occurs in 10% of patients. Treatment of UC in a continuously flowing form is characterized by the fact that for a long time doctors cannot achieve endoscopic and clinical remission of the patient

Fulminant form

The most severe and complicated form of the disease, its clinical manifestation.

Clinical signs and symptoms of colitis

If colitis is suspected, the symptoms are studied by specialists comprehensively.

The most typical are the following:

1. Hematochezia. This is the first symptom that should alert the patient himself, it is characterized by the presence of blood in the stool. Depending on the nature of hematochezia, the doctor can determine the location of the inflammatory process in colitis.
2. Stool predominantly at night.
3. Liquid stool.
4. Burning, drawing and cutting pains in the rectum (tenesmus).
5. Weight loss.
6. Stomach ache.
7. Constipation.

Diarrhea in colitis is hemorrhagic in nature, while the symptoms may periodically disappear and not alert the patient.

In ulcerative colitis, attacks begin unexpectedly and manifest as follows:

• there is mucus and blood in the stool;
• sharp urge to defecate;
• cramping pains in the lower abdomen.

If the rectosigmoid colon is affected, the patient's stool may be dry and hard, but between episodes of defecation, he may have mucus with blood.

With the development of the inflammatory process, the frequency of defecation acts can increase to 10 per day or more, even at night.

At the same time, the urges themselves are accompanied by pulling and cramping pains. With the development of the disease, feces may contain, in addition to mucus, a large amount of pus and blood.

Nonspecific ulcerative colitis, the treatment of which is not observed or ignored, can take a fulminant (toxic) form. The patient has signs of peritonitis and abdominal pain, body temperature rises to 40°C with other signs of intoxication.

Against this background, the symptoms of colitis are supplemented by general weakness, weight loss, anemia and fever.

Extraintestinal manifestations

Treatment of ulcerative colitis is also prescribed in the presence of three types of extraintestinal manifestations:

1. Violations that develop in parallel with the main exacerbation.

These include:

• gangrenous pyoderma;
• erythema nodosum;
• aphthous stomatitis;
• episcleritis;
• peripheral arthritis.

One of these signs always occurs in 30% of patients diagnosed with colitis.

2. Disorders caused by nonspecific ulcerative colitis, but manifesting independently of its other symptoms:

• uveitis;
• sacroiliitis;
• ankylosing spondylitis;
• sclerosing cholangitis.

3. Disorders that develop against the background of problems with the intestines. This group of disorders is observed mainly after the development of Crohn's disease of the small intestine and manifests itself as:

• malabsorption (accompanied by a deficiency of minerals and some fat-soluble vitamins). It manifests itself in the form of clotting disorders, anemia, lack of magnesium and calcium;
• the formation of gallstones;
• hydronephrosis and hydroureter;
• amyloidosis.

Separately characterizing the symptoms of colitis, a group of thromboembolic complications is singled out, which are not assigned to any of these groups, since they simultaneously belong to all three due to multiple factors.

Diagnosis of ulcerative colitis

Many patients delay the visit to the doctor, so it often takes a long period of time from the appearance of the first symptoms to the establishment of the correct diagnosis.

This situation occurs for various reasons:

1. Subjective (many specialists do not know the clinical picture of the disease well enough);
2. Objective (a complex complex diagnosis is required, and the symptoms of the disease are diverse).

In order to determine the symptoms of colitis, a comprehensive diagnosis is used, including physical, laboratory and instrumental studies).

Speech modules for communication with the patient

Speech modules are a special technology that allows the doctor to competently build, clearly and convincingly articulate the benefits of a particular type of treatment, and easily and painlessly work with their complaints.

There are very few ready-made speech modules for medical workers. One of them is available for download in the Chief Physician System. The sample can be downloaded by the customers of the System and

Physical examination

In order to determine the symptoms and prescribe treatment for ulcerative colitis, it is not enough to assess the condition of the abdominal organs and intestines. A specialist should be systematically and in a complex study of all systems and organs of the body.

The survey includes:

• palpation and visual examination of the mucous membranes, skin, and subcutaneous fat;
• assessment of the morphological and functional features of the patient's articular apparatus;
• when analyzing the state of the cardiovascular and respiratory systems, the specialist should be aware of the complex of extraintestinal lesions. If patients of the older age group are examined, it is important to remember about possible concomitant diseases (CHD, obstructive pulmonary disease, etc.);
• digital examination of the colon, as the patient may develop colorectal carcinoma.

Laboratory research

Before prescribing treatment for colitis, a specialist must conduct laboratory tests. They are aimed at identifying extraintestinal manifestations of colitis, assessing disease activity and determining complications.

In the future, during the treatment, repeated laboratory studies are carried out to assess the dynamics of the patient's condition, assess the effectiveness of treatment, as well as conduct drug monitoring.

Laboratory pathognomonic tests for the primary unambiguous diagnosis of colitis do not currently exist.

Instrumental Research

A complex of instrumental diagnostic methods also helps to determine colitis, the symptoms that were mentioned above. Consider the most popular of them.

• X-ray method.
• Ultrasound method. Ultrasound helps to determine the severity of inflammation in different parts of the colon, to monitor the effectiveness of treatment. The adequacy and effectiveness of the prescribed therapy is evidenced by a decrease in the thickness of the inflamed intestine. The diameter of the intestinal lumen also increases.
• Morphological research methods. Each individual sign of ulcerative colitis is nonspecific for this disease, however, a comprehensive histological examination is important for making a diagnosis, determining the activity of inflammation and determining the complications of the disease.
• Ileocolonoscopy. One of the most informative methods for diagnosing colitis. However, in the later stages of the disease, this method can be dangerous, due to the high risk of intestinal perforation and the development of toxic dilatation.
• Densitometry. The method is indicated for patients who take glucocorticoids for a long time, as it is able to determine bone density disorders.

Diagnosis example - ulcerative colitis

Here are the two most common formulations of the disease, in which the Truelove and Witts classification considered above is applied.

• nonspecific ulcerative colitis, Truelove 1 activity, distal form, relapsing course;
• nonspecific ulcerative colitis, Truelove 3 activity, total form, often relapsing course. Extraintestinal manifestations of the disease: pyoderma gangrenosum

ICD-10 codes

Nonspecific ulcerative colitis ICD 10 has a common coding - K51. Depending on the form and type of colitis, an additional coding is applied:

Colitis treatment

The disease colitis, the symptoms of which were discussed above, is subject to complex therapy.

Treatment of colitis has three main objectives:

1. Stop the next exacerbation of the disease.
2. Support disease remission.
3. Prevent the development of the disease and its complications, including such a serious complication as colorectal cancer.

Indicators that the course of the disease is under effective control with prescribed therapy are:

• lack of surgical interventions;
• lack of repeated hospitalizations of the patient in the hospital;
• administration of glucocorticoids to the patient.

For adequacy and effective treatment, the patient must take into account a number of factors:

1. Gender and age of the patient.
2. He has other illnesses.
3. The presence of drug intolerance.
4. Localization of the inflammatory process.
5. The presence of extraintestinal manifestations.
6. Disease activity.

Treatment of colitis is most often medical, with complications and adverse development of the disease - surgical

Medical treatment for colitis

Treatment of UC depends on the form of the disease, it determines the complex of drugs that will relieve the symptoms of the disease and affect the activity of the disease.

1. Treatment of colitis in the stage of severe exacerbation:

• The most effective and widely used agent is glucocorticoids. The ineffectiveness of this group of drugs for maintaining long-term remission has been proven;
• with disease activity corresponding to the Truelove 3 form, treatment of the disease begins with the introduction of parenteral prednisolone at a dosage of about 240-300 mg per duck;
• in the absence of the effect of the appointment of prednisolone during the week, it is necessary to consider the appointment of cyclosporine (intravenous or parenteral), which allows to achieve relief of exacerbation.

Among glucocorticoid drugs, drugs with a reduced systemic effect are distinguished. For example, budesonide has proven to be effective when administered to patients whose colitis symptoms are in the stage of low exacerbation activity.

2. Treatment of colitis in patients with moderate activity of exacerbations:

• in the treatment of UC of mild and moderate forms, 5-ASA preparations, which include sulfasalazine and mesalazine, have shown their effectiveness. Dosage of drugs - 2.5-3 mg per day, in the presence of clinical remission is reduced.

3. Treatment of UC during exacerbations of distal forms:

• suppositories and enemas are used as monotherapy if the form of the disease is mild or moderate;
• in the presence of proctosigmoiditis, topical preparations or foam-based solutions are prescribed in the form of enemas;
• in many clinical cases, specialists combine oral and topical forms of drugs;
• in left-sided colitis, drugs of the ASK-5 group are prescribed twice a day. If there is no clinical response to this therapy, the use of foam or glucocorticoid-based enemas is considered.

4. Anti-relapse therapy and treatment of UC. For the prevention of relapses, all the same drugs of the 5-ASA group are effective, but their dose is significantly reduced compared to the situation in the treatment of the active phase of the disease.

5. The use of mercaptopurine and azathioprine in the treatment of UC. Previously, the use of these drugs was controversial - many researchers said that patients in this case increase the risk of developing colorectal cancer due to their immunosuppressive action.

However, recent studies have shown that these suspicions are unfounded.

Today, immunosuppressants are used when 5-ASA preparations have proven ineffective in preventing relapses. When prescribing them, timely drug monitoring is important, which includes weekly and monthly control tests, including colitis symptoms.

Also, as a maintenance therapy, patients can be prescribed methotrexate, which is less effective than azathioprine, but often shows positive results of therapy. When it is prescribed, drug monitoring is also carried out.

6. Treatment of colitis with infliximab. This drug is prescribed if other considered regimens for the treatment of colitis as maintenance therapy have shown their ineffectiveness. The drug is prescribed as a dropper intravenously, the course is repeated every 8 weeks.

At the same time, the cellular composition of the blood, liver markers are monitored in parallel, and the general condition of the patient is analyzed.

7. Antibiotics for colitis. In the diagnosis of ulcerative colitis, antibiotics are usually not prescribed, but in the presence of severe inflammation and the threat of developing toxic dilatation, it is advisable to use broad-spectrum antibacterial drugs (ciprofloxacin, metronidazole).

8. Additional complex methods of treatment:

• saline solutions;
• protein preparations;
• opioids;
• anticholinergics;
• loperamide;
• probiotics.
• transfusion of red blood cells;
• plasmapheresis.

The success of treatment often depends on how successfully substitution and basic therapy will be selected by specialists, which should effectively act in combination.

Three quality standards of medical care to improve the work of the clinic

The Irkutsk Diagnostic Center has integrated the principles of lean manufacturing and international JCI standards into the ISO-based quality management system.

Taking into account the requirements of the standards, the Center identified several groups of potential risks: those related to infrastructure, patients and personnel.

Determined temporary losses, unnecessary movement of personnel, defects and risks of medical errors.

Based on the analysis carried out, the specialists of the Center developed a new scheme of the emergency care process and introduced new SOPs. Read about the successful experience of colleagues in the journal "Zdravookhraneniye"

Surgery

One common treatment for ulcerative colitis is a colectomy.

Absolute indications for surgery include:

1. colorectal cancer.
2. Heavy bleeding.
3. Intestinal perforation.
4. The ineffectiveness of drug treatment of patients with toxic dilatation of the large intestine for 2-3 days.

When prescribing this type of surgical intervention, the specialist must evaluate all its possible consequences, as well as a possible deterioration in the patient's quality of life in the postoperative period and long-term rehabilitation.