Ulcerative colitis
History taking】
The content of medical history mainly includes: diarrhea and abdominal pain, mucus and pus and blood stool, urgency and heaviness, fever, emaciation, anemia and other related symptoms, as well as description of the onset, recurrence and aggravation triggers, and the previous treatment process. Meng Yong, Department of Anorectology, Jinan Hospital of Traditional Chinese Medicine
Physical examination]
Pay attention to the signs of peritoneal irritation and extra-intestinal manifestations such as joints, eyes, mouth, liver and spleen.
Auxiliary examination
1. Routine examination of blood, urine, feces and ultrasound of liver, gallbladder and spleen.
2. Stool culture for three consecutive times, looking for amoeba in the stool.
3. Colonoscopy and intestinal mucosal biopsy.
4. Barium enema examination.
Diagnostic points
1. Clinical manifestations: persistent or recurrent mucus and blood stools, abdominal pain with varying degrees of systemic symptoms. The past history and physical examination should pay attention to the joints, eyes, mouth, liver and gallbladder and other extra-intestinal manifestations.
2. Colonoscopic findings.
(1) Mucosa with congestion, edema, multiple superficial ulcers. Most of the lesions start in the rectum and are diffusely distributed.
(2) The mucosa is rough and granular, brittle, bleeding easily, or with purulent secretions.
(3) Pseudo-polyps can be seen, and the annular folds become blunt or disappear.
(3) Mucosal biopsy: Inflammatory reaction, often with erosion, crypt abscess, abnormal glandular arrangement and epithelial changes.
4. Barium enema
(1) Coarse disorganization of the mucosa and/or fine granular changes.
(2) Multiple ulcers or pseudo-polyps.
(3) Stenosis, shortening of the intestinal canal, disappearance of the colonic pouch may appear tubular.
5. On the basis of exclusion of bacillary dysentery, amebic enteritis, chronic schistosomiasis, intestinal tuberculosis, Crohn’s disease, and radiation enteritis, the diagnosis may be made on the basis of the following conditions.
(1) The disease can be diagnosed on the basis of clinical and one of the three items seen by colonoscopy and/or mucosal biopsy.
(2) The disease can be diagnosed on the basis of one of the three clinical and barium enema findings.
(3) The diagnosis of the disease can be made by the presence of typical colonoscopic findings or barium enema in cases with atypical clinical symptoms.
(4) A complete diagnosis should include clinical manifestations, severity, extent of the lesion and stage of the lesion.
Differential diagnosis
1) Chronic bacillary dysentery, chronic amoebic dysentery, chronic schistosomiasis, intestinal tuberculosis, fungal enteritis.
2. colon cancer, clonorchiasis, allergic enteritis, ischemic enteritis, radiation enteritis, etc.
Treatment principles
1. Different programs are used according to the severity and stage of the disease.
2. Internal medicine treatment.
(1) General treatment: Patients with fulminant and acute attacks should rest in bed, can be appropriately sedated and fasted for several days, other types of patients can be given easily digestible, less fiber nutrient-rich food, avoid dairy products. Pay attention to control the use of antispasmodic drugs.
(2) Anti-inflammatory drugs: salbutamol and 5-aminosalicylic acid.
(3) Adrenocorticotropic hormone and adrenocorticotropic hormone: mainly used in the acute phase of ulcerative colitis and severe cases.
(4) Immunosuppressants: In patients where anti-inflammatory drugs or hormones are ineffective, other immunosuppressants such as azathioprine may be used instead or in addition.
3. Surgical treatment.
Surgical indications.
(1) Intestinal perforation or imminent perforation.
(2) Massive or recurrent bleeding.
(3) Intestinal stenosis complicated by intestinal obstruction.
(4) Cancer or multiple polyps.
(5) Toxic megacolon that has failed medical treatment.
(6) Peri-colonic abscess or fistula formation.
(7) Long-term medical treatment is ineffective and affects the development of children.
Efficacy criteria
1) Cure: disappearance of symptoms and signs, disappearance of lesions seen by barium enema and colonoscopy or only scarring without active ulcers.
2. Remission: clinical symptoms and signs disappear, but congestion and other mild inflammatory active lesions are still seen in the intestinal mucosa by colonoscopy and barium enema.
3. Invalid: clinical symptoms and signs do not improve or even aggravate after treatment, and the barium enema and colonoscopy see no improvement or even aggravation from before treatment.
Discharge criteria]
Those who achieve cure or remission can be discharged.
Clonorchiasis
History taking]
History mainly includes diarrhea, abdominal pain, blood in the stool, fever, emaciation, anemia and other related symptoms, and should also describe the occurrence, development and treatment process of the disease.
Physical examination]
Pay attention to abdominal signs and extra-intestinal manifestations.
Auxiliary examination
1. In addition to the routine examination, the main examination is fecal examination, such as fecal culture, etc.
2. Colonoscopy and intestinal mucosal biopsy.
3. Barium enema.
Diagnostic points
To confirm the diagnosis of the disease.
1. One of the following (1), (2), (3) + (4) or (5) or (6).
2. Two of the following (4) + (1), (2) and (3).
(1) Discontinuous or regional intestinal lesions.
(2) Pavement-like manifestation of the intestine or longitudinal ulcers.
(3) Intestinal masses or strictures.
(4) Non-caseating granuloma.
(5) Fissure or fistula.
(6) Perianal lesions.
3. All other intestinal diseases must be excluded.
Differential diagnosis
1. Small bowel clonorchiasis should be differentiated from acute appendicitis, small bowel lymphoma, intestinal tuberculosis, posterior duodenal bulb ulcer, etc.
2. Colon clonorchiasis should be differentiated from ulcerative colitis, amoebic disease, ischemic enteritis, colon cancer, etc.
Treatment principles
1. General treatment: Rest, bed rest for more serious cases. Less residue, easy to digest, nutritious diet, avoid strong tea, wine, coffee, etc., pay attention to the water-electrolyte balance.
2. Internal medicine treatment.
(1) Antimicrobial drugs: salbutamol and 5-aminosalicylic acid.
(2) Adrenocorticotropic hormone and adrenocorticotropic hormone.
(3) Immunosuppressants: If antibacterial drugs and adrenocorticosteroids are ineffective, immunosuppressants such as azathioprine can be tried.
3. Surgical treatment.
Indications for surgery.
(1) Drug therapy is ineffective.
(2) intestinal obstruction.
(3) Affecting growth and development.
(4) intestinal fistula.
(5) Recurrent bleeding.
(6) Toxic megacolon.
(7) cancerous lesions
(8) intestinal perforation
(9) anal fistula and perianal abscess.
(10) Serious systemic complications.
Efficacy criteria
1) Cure: disappearance of symptoms and signs, and disappearance of intestinal scar formation or lesions as shown by colonoscopy and barium enema.
2. Remission: symptoms and signs disappear, but the intestinal lesion is still not completely healed.
【Discharge criteria】
Those who reach the standard of cure or remission can be discharged from the hospital.
Intestinal nodule
History taking】
The history should mainly describe abdominal pain, change in stool habit, abdominal mass and systemic toxic symptoms, especially the history of extra-intestinal tuberculosis.
Physical examination
Mainly pay attention to abdominal signs, superficial lymph nodes and other signs.
Auxiliary examinations
1. Blood sedimentation, chest X-ray, stool routine and culture, looking for antacid bacilli, etc.
2. Tuberculin test.
3. Colonoscopy and intestinal mucosal biopsy.
4. Barium enema or barium meal.
Diagnostic points]
1. History of parenteral tuberculosis.
2. Abdominal pain, diarrhea, constipation, fever, night sweats, etc.
3. abdominal signs such as right lower abdominal pressure, mass or intestinal obstruction.
4. Typical x-ray signs.
5. Colonoscopic signs.
6. Other intestinal diseases must be excluded.
Differential diagnosis
It is mainly distinguished from clonorchiasis, ulcerative colitis, colon cancer, amoebic enteropathy, chronic schistosomiasis, chronic appendicitis, lymphoma, etc.
Treatment principles
1. rest and nutrition.
2.Anti-tuberculosis treatment; (refer to the chapter of “Tuberculosis” for details)
3. symptomatic treatment: such as water, electrolyte balance, etc.
4. surgical treatment.
Applicable to
(1) intestinal obstruction
(2) intestinal perforation.
(3) haemorrhage.
Efficacy criteria
1) Cure: symptoms and signs disappear, and colonoscopy shows that the original lesion has been scarified.
(2) Remission: symptoms and signs mostly disappear or completely disappear, and colonoscopy shows that the lesion ulcer has a tendency to heal.
Discharge criteria
Those who achieve cure or remission can be discharged from the hospital.