COLON DISEASE
POLYPOSIS Polyps are non malignant tumors on legs that grow from mucosa. Classification By etiology: Innate Acquired By process’ spreading: Single Multiple Total (injury of all intestines).
POLIPOSIS
POLIPOSIS
DIVERTICULOSIS Diverticula are saclike protrusions of the colonic wall, varying in size from a few millimeters to several centimeters.
DIVERTICULOSIS
DIVERTICULOSIS
DIVERTICULOSIS
DIVERTICULOSIS
CROHN’S DISEASE CROHN’S DISEASE - is an unspecific inflammatory process of submucosal membrane of gastrointestinal tract with propensity to the segmental lesions and recurrent passing. The local signs of disease exist in different areas of digestive tract organs. Most frequent and most intensive they are in the distal segment of small intestine.
CLASSIFICATION I. According to frequency of localization: 1. Segmental ileitis. 2. Segmental colitis. 3. Segmental enteritis. 4. Segmental enterocolitis. II. According to clinical passing: 1. Acute enterocolitis. 2. Chronic enterocolitis. 3. Uncomplicated enterocolitis. 4. Complicated enterocolitis (acute and chronic intestinal obstruction, internal and external fistula).
CLINICAL MANAGEMENT General weakness Increase of temperature of body Intermittent pain, that arises after the reception of meal Diarrhea without some visible features or with the blood
DIAGNOSTIC PROGRAM 1. Anamnesis and physical examination. 2. Finger examination of rectum. 3. Examination of rectum by a rectal mirror. 4. Proctosigmoidoscopy. 5. Fiberoptic colonoscopy. 6. Fiberoptic gastroscopy. 7. Survey sciagraphy of organs of abdominal cavity. 8. Roentgenologic examination of organs of abdominal cavity with the peroral contrasting. 9. Irrigoscopy and irrigography. 10. General analysis of blood and urine. 11. Biochemical blood test. 12. Coagulograma. 13. Sonography. 14. Histological examination of granuloma.
EQUIPMENT FOR COLONOSCOPY
COLONOSCOPY
ENDOSCOPY EXAMINATION Hyperemia Deep cracks of mucus membrane Ulcers Symptom of “roadway” Stenosis
CROHN’S DISEASE, SYMPTOM OF “ROADWAY”. ENDOSCOPY EXAMINATION
COMPLICATIONS OF THE CROHN’S DISEASE LOCAL formations of fistula (ileoileal fistula, entero-entero, enterovesical fistula) acute or chronic intestinal obstruction perforation of the changed wall of bowel intestinal bleeding malignization GENERAL ulcers of tongue node erythema arthritises chronic lesionss of liver
CROHN’S DISEASE. MULTIPLE FISTULAS.
CROHN’S DISEASE. HYPEREMIA AND DEEP CRACKS OF MUCUS MEMBRANE OF COLON, ULCERS, SYMPTOM OF “ROADWAY”
CROHN’S DISEASE. HYPEREMIA AND DEEP CRACKS OF MUCUS MEMBRANE OF COLON, ULCERS, SYMPTOM OF “ROADWAY”
STRICTURE ASCENDING PART OF THE COLON. CROHN’S DISEASE. IRRIGOGRAM.
CONSERVATIVE TREATMENT The medicine of the first row is 5-АSК (aminosalicylic acid, sulfasalazone and glucocorticoid). The medicines of the second row are: 6- mercaptopurine, azatiopurine and metronidazole. At diarrhea loperamide — 2 mg peroral 3–4 times per days, smecta — 1 pack 3 times per days. At relapse of disease after operation prednisolone is applied — for 40–60 mg peroral every day during 1–2 weeks. For patients which are irresponsive to steroid, asatioprine is appointed (2 mg/kg) peroral. Metronidazole in a dose of 400 mg twice a days is used in the case of granulomatous disease of perineum.
UNSPECIFIC ULCERATIVE COLITIS UNSPECIFIC ULCERATIVE COLITIS is a diffuse inflammatory process that is accompanied by the ulcerous-necrosis changes in the mucus membrane of colon and rectums. The rectum is involved in more than 95% of cases.
UNSPECIFIC ULCERATIVE COLITIS Frequency: In the US: The annual incidence of ulcerative colitis is 10.4-12 cases per 100,000 people. The prevalence rate is 35-100 cases per 100,000 people. Race: Ulcerative colitis occurs more frequently in white people. Sex: Ulcerative colitis affects 30% more females than males. Age: The incidence of ulcerative colitis peaks in people aged 15-25 years and in people aged 55-65 years, although it can occur in people of any age.
PATHOLOGY Ulcerative colitis is a disease confined to the mucosal and submucosal layers of the colonic wall, progressing from mucosal edema and lipemia to vascular congestion, superficial ulcers, Increased cellular infiltration of the lamina propria, cyst abscesses beginning in the rectum and advancing proximally to involve the entire colon.
THE HISTOLOGIC FEATURES OF A TYPICAL ULCER PATHOLOGY THE HISTOLOGIC FEATURES OF A TYPICAL ULCER
As shown in this photograph, the mucosal lining of the colon in ulcerative colitis is remarkably disturbed. Islands of edematous mucosa are isolated by ulcerations.
X-Ray examination, is typical for ulcerative colitis in its chronic phase.
UNSPECIFIC ULCERATIVE COLITIS. “WATER PIPE” SYMPTOM.
UNSPECIFIC ULCERATIVE COLITIS. “WATER PIPE” SYMPTOM.
UNSPECIFIC ULCERATIVE COLITIS. “WATER PIPE” SYMPTOM.
CLASSIFICATION I. According to clinical passing: a) acute unspecific ulcerous colitis; fulminant form of colitis; b) chronic unspecific ulcerous colitis; forms of chronic recurrent and chronic continuous colitis. II. According to distribution of pathological process: a) ulcerous proctitis, proctosigmoiditis; b) left-side ulcerous colitis; c) total ulcerous colitis. III. According to weight of disease: a) easy degree; b) middle degree; c) heavy degree.
CLINICAL MANAGEMENT Pain in the abdomen Diarrhea Tachycardia Decline of arterial pressure Avitaminosis Edemata.
DIAGNOSTIC PROGRAM 1. Anamnesis and physical is given. 2. Finger examination of rectum. 3. Examination of rectum by a rectal mirror. 4. Proctosigmoidoscopy. 5. Fiberoptic colonoscopy. 6. Survey sciagraphy of organs of abdominal cavity. 7. Irrigoscopy and irrigography. 8. General analysis of blood and urine. 9. Biochemical blood test. 10. Coagulograma.
EQUIPMENT FOR COLONOSCOPY
COLONOSCOPY
ENDOSCOPY EXAMINATION Hyperemia of mucus membrane Swollen Contact bleeding Plural erosions Ulcers Festering and necrosis stratifications
UNSPECIFIC ULCERATIVE COLITIS
UNSPECIFIC ULCERATIVE COLITIS
UNSPECIFIC ULCERATIVE COLITIS. BLEEDING.
UNSPECIFIC ULCERATIVE COLITIS. BLEEDING.
UNSPECIFIC ULCERATIVE COLITIS. MALIGNIZATION.
UNSPECIFIC ULCERATIVE COLITIS. PSEUOPOLIPOSIS.
The contracted X-Ray of colon with barium The contracted X-Ray of colon with barium. Typical ulcerative colitis in its chronic phase.
LAB STUDIES Anemia (ie, hemoglobin <140 g/L in males and <120 g/L in females) Thrombocytosis Elevated sedimentation rate and elevated C-reactive protein. Both of these findings correlate with disease activity. Hypoalbuminemia (ie, albumin <35 g/L) Hypokalemia (ie, potassium <3.5 mEq/L) Hypomagnesemia (ie, magnesium <15 mg/L) Elevated alkaline phosphatase.
CONSERVATIVE TREATMENT Intensity and methods of conservative therapy always must depend on the phase of disease: a) moderately expressed passing of disease or proctitis — corticosteroid enema and sulfasalazone peroral; b) at heavy passing is parenteral introduction of liquids, nutritives, blood transfusion, system use of corticosteroids, surgical treatment; c) at chronic passing is corticosteroids peroral, asatioprine, surgical treatment; d) at remission is preparations of 5-aminosalicylic acid peroral, examination for the exception of cancer of colon.
CONSERVATIVE TREATMENT Basic antiinflammatory facilities : sulfasalazopreparations (sulfasalazone, salazopirine) salicylazosulfanilamide (salazosulfapyridine, salazodimetoxine) and corticosteroids.
ABSOLUTE INDICATION FOR SURGICAL TREATMENT Perforation of wall of bowel Acute toxic dilatation Stenosis Profuse bleeding Malignization
The most important modification of the operation was the creation of an ileal pouch or reservoir proximal to the ileoanal anastomosis.
The most important modification of the operation was the creation of an ileal pouch or reservoir proximal to the ileoanal anastomosis.
FORMATION OF THE ILEAL RESERVOIR AFTER COLPROCTECTOMY.
X-RAY OF THE OF THE ILEAL RESERVOIR (by М.П. Захараш)
TRANSFORMATION OF THE ILEAL RESERVOIR INTO THE ILEORECTAL ANASTOMOSIS (by М.П. Захараш).
STAGES OF THE TRANSFORMATION OF THE ILEAL RESERVOIR INTO THE ILEORECTAL ANASTOMOSIS (by М.П.Захараш).
FORMED ILEAL RESERVOIR