The large intestine is supplied with blood from the mesenteric arteries, the upper one of which feeds the thin, ascending, blind and partially transverse colon of the intestine, and the lower part - the left colonic part. When ischemia of colonic structures occurs, most of the microorganisms that colonize them provoke the development of the inflammatory process in the intestinal wall, up to the bacterial transient invasion.
Against the background of ischemia caused by inflammation, connective tissue and even fibrous structures are formed. Pathology is most typical for elderly patients. According to statistics, in patients with colitis after 50 years of age in more than 75% of cases is diagnosed ischemic form of pathology.
Definition of
Ischemic colitis is the acute or chronic form of inflammation of the colonic tissue that occurs when blood supply to the intestinal wall is impaired. Similar disorders occur due to narrowing or occlusion of vascular courses, resulting in an inflammatory process, stricture, and then necrosis of the intestine.
Causes of pathology
Intestinal inflammation of the ischemic form refers to quite complex pathological conditions and is provoked by a number of factors.
The most common cause of ischemic colitis are:
- Vasculitis, which inflames vascular tissue located in the intestinal structures;
- Hypoperfusion - with the progression of this pathology, the intestinal blood supply decreases, which subsequently leads to ischemic lesions of individual sites;
- DIC-Syndrome;
- Aortic delamination;
- Anemia;
- Intestinal obstruction;
- Vascular atherosclerosis, in which fat deposits accumulate on the walls;
- Thrombosis, in which blood clots block the vascular lumen, which leads to ischemia;
- Intestinal malignancy;
- Liver transplant;
- Colitis of idiopathic form;
- Some types of drug therapy, for example, hormone therapy.
The causes of ischemic inflammation of the intestine are many, but they all have a connection with vascular spasms. The large intestine is poorly supplied with blood, and against the background of shock conditions, large blood loss, myocardial insufficiency or dehydration against intestinal infections leads to a rapid development of ischemia.
Forms
Like many other pathologies, ischemic colitis can occur in a chronic or acute form. In addition, colitis acute forms can occur:
- With the progression of an intramural infarction type, when the necrotic focus has intra-wall localization;
- With the prevalence of infarction of the intestinal mucosa, at which necrosis occurs against the background of blood supply disorders;
- With progressive transmural type myocardial infarction, as a result of which intestinal lesions are of a large scale.
Depending on the clinical form of the pathology, ischemic colitis can be:
- Stenosing or pseudotumorous, in which the blood flow disorders are constant, with inflammation rapidly progressing, provoking scarring of intestinal walls;
- Transient, in which vascular blood flow may not be disturbed, but pathological processes still lead to the development of inflammation, which eventually passes;
- Gangrenous is the most dangerous and severe form of colitis, in which the lesion affects all the intestinal layers. This form often leads to the development of serious complications.
Symptoms of ischemic colitis
Characteristic manifestations of intestinal colitis are attacks of vomiting and diarrhea, swelling and frequent cramping-like pain in the abdomen.
Patients are worried about headaches or bleeding, dizziness and hyperdensity, insomnia. Patients with a background of ischemic inflammation of the intestine have a noticeable weight loss due to digestive disorders.
The most characteristic sign of such a colitis is a pronounced soreness in the abdomen, which can bother for two to three hours. Usually soreness is localized in the left side, although the specific location of pain depends on the lesion focus.
In particularly difficult cases, the mesenteric artery occludes, which leads to the development of gangrene.
This complication is indicated by the appearance of an acute pain in the abdomen on the left, intestinal obstruction, peritonitis and bleeding.
With palpation of the peritoneum, muscle tension and severe soreness are felt. If a patient has cardiovascular pathologies, a gangrenous complication can trigger the patient's death. Therefore, timely diagnosis is important, which will help prevent gangrenous complications.
Diagnosis
To accurately determine the diagnosis and to assign effective treatment to the patient, a thorough diagnosis is necessary.
A complete analysis of the patient's complaints is carried out, and a picture of the pathology is drawn up on the symptoms. The doctor evaluates the general condition of the patient, measures the temperature, pressure readings.
Assign laboratory blood tests, determine the degree of its coagulability, identify the lipid component, etc. A stool test is also performed to identify bloody impurities indicative of serious damage to the digestive system.
Endoscopic and radiographic studies are also conducted. It is important to conduct the patient electrocardiography to assess the performance of cardiac structures. Colonoscopy is also performed, and a biopsy helps to identify the exact nature of the pathology and to prescribe the right therapy.
Treatment of
Against the background of ischemic inflammation of the intestine, patients usually develop myocardial insufficiency, which occurs due to spasmodic contractions and violations of the permeability of the intestinal walls. Therapy is complex:
- The drugs from the group of vasodilators are prescribed;
- Administration of sulfonamides is indicated;
- With the purpose of enriching the blood with oxygen supply, oxygen intake is indicated;
- For the elimination of the inflammatory process, NSAIDs are indicated;
- Copious blood loss requires a blood transfusion;
- To restore the water-electrolyte balance in the intestinal tissues, detoxification treatment is indicated.
The intestine, affected by inflammatory processes, needs rest, so patients take food through the parenteral route. If the bacterial infection is attached to the inflammatory process, then mandatory antibiotic therapy with penicillin drugs is indicated.
With the development of gangrene or necrosis, peritonitis or perforation, urgent surgical intervention is indicated.
Additional vitamin therapy( vitamin B and C), intake of iron-containing drugs, and pain relief analgesics are necessary.
The diet of the patient requires special attention. At the initial stages of the pathological process, it is recommended to eat foods that contain fiber.
Ischemic inflammation of the intestine requires the conduct of etiotropic therapy. If pathology is accompanied by infectious lesions, then it is necessary to prevent the development of dehydration, so patients need to take Oralit, Regidron and adsorbents such as white clay or activated carbon.
If necessary, the reception of cardiovascular drugs is indicated. Signs of hyperthermia require antibiotics. With the rapid development of the clinical picture of colitis, drug therapy may be useless. In such a case, surgical removal of the affected areas of the intestine is prescribed.
Complications of
If a patient does not seek help from a specialist and starts a pathological process, complications can not be avoided.
Most often, they are associated with rectal bleeding or intestinal obstruction, peritonitis, or perforation of the intestinal walls.
The pathology forecast is completely dependent on the degree of development of complications and the stage of development of the inflammatory process in the intestine.
In the absence of necrosis and complete restoration of blood flow, the prognostic picture is favorable and pathology can be cured.
But if ischemic colitis is accompanied by extensive necrotic lesions, and the pathology has developed to a neglected stage or is complicated by atherosclerosis or myocardial insufficiency, then surgical treatment is necessary, which is difficult to predict the outcome. In such a situation, the rehabilitation of the patient will be crucial.
Prophylaxis of
If a patient is at risk for developing ischemic inflammatory bowel disease, then all factors that trigger the development of pathology must be eliminated.
An integral part of the prophylaxis is a therapeutic diet, which involves limiting fried and sharp, fatty foods. Instead of animal fats, it is better to use vegetable oils. Under the prohibition of alcohol, coffee, ice cream and mustard, a variety of pickled billets, fatty meat, buns and eggs.