pseudomembranous colitis
Introduction
Introduction to pseudomembranous colitis Pseudomenbraneous colitis is an acute mucosal necrotizing inflammation that mainly occurs in the colon and is covered with a pseudomembrane. This disease is common after the application of antibiotics, so it is an iatrogenic complication that has been confirmed to be caused by the toxin of Clostridiumdifficile. Those who are seriously ill can die. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: hypovolemic shock hypotension fainting coma
Cause
Cause of pseudomembranous colitis
The disease resistance and immune function are low, and the flora is an important cause.
After the application of broad-spectrum antibiotics, especially lincomycin, clindamycin, ampicillin, amoxicillin, etc., inhibiting the normal flora in the intestine, allowing the rapid propagation of Clostridium difficile and Toxins cause disease, this disease can also occur after surgery, especially after gastrointestinal cancer surgery, and other serious diseases such as intestinal obstruction, malignant tumor, uremia, diabetes, heart failure, sepsis, etc. Cases generally have low disease resistance and immunity, or are treated with antibiotics due to the needs of the disease. The internal environment of the body changes, and the intestinal flora is dysfunctional, which is conducive to the reproduction of Clostridium difficile and cause disease.
Clostridium difficile and its toxins are the causative factors of the disease, but the potency of the toxin in the feces is not parallel with the severity of the disease, indicating that the toxin is not the only factor affecting the severity of the disease.
Prevention
Pseudomembranous colitis prevention
Rational use of antibiotics to prevent abuse. Antibacterial drugs, also known as "antibacterial agents", are a class of drugs used to inhibit bacterial growth or kill bacteria. Antibacterial drugs may also be referred to simply as "antibacterial agents" without causing ambiguity. Antibacterial agents are not the same concept as antibiotics. Antibiotics are actually only one type of antibacterial agents. Antibacterial drugs include antibiotics, sulfonamides, quinolones and other drugs in addition to antibiotics such as penicillins and tetracyclines.
Complication
Pseudomembranous colitis complications Complications hypovolemic shock hypotension fainting coma
Severe cases can lead to hypovolemic shock, which is a large loss of body fluids in the body or blood vessels, causing blood pressure reduction and microcirculation disturbance caused by a sharp decrease in effective blood volume. The performance is dizziness, pale, cold sweat, cold and cold limbs; irritability or indifference, severe fainting, and even coma; rapid pulse, blood pressure, shortness of breath, cyanosis; less urine, even no urine. In severe cases, death can result.
Symptom
Pseudomembranous inflammatory symptoms Common symptoms Abdominal pain Abdominal tension Abdominal abdominal tenderness Diarrhea Gut breathing Shortness of breath Intestine flatulence Nausea dehydration
Clinical manifestations of pseudomembranous colitis: fever, abdominal pain, nausea, bloating, large amount of diarrhea, diarrhea is green sea-like or yellow egg-like loose stool, detached pseudomembrane; diarrhea after diarrhea is relieved, pulse increases, blood pressure drops, shortness of breath Dehydration signs, insanity, abdominal tenderness, abdominal muscle tension, flatulence and bowel sounds are weakened.
The age of onset of this disease is mostly in the group of 50 to 59 years old. The number of women is slightly more than that of men. Most of the onset is rapid. The mild condition is mild diarrhea, and the severe one can be violent, and the disease progresses rapidly.
(1) Diarrhea is the most important symptom, mostly within 4 to 10 days after the application of antibiotics, or within 1 to 2 weeks after withdrawal, or 5 to 20 days after surgery, the degree and frequency of diarrhea are different, light Cases, stool 2 to 3 times a day, can be self-healing after stopping antibiotics, severe cases have a large number of diarrhea, stool can be more than 30 times a day, sometimes diarrhea can last 4 to 5 weeks, a few cases can discharge plaque Pseudo-membrane, blood feces are rare.
(B) abdominal pain is a more common symptom, sometimes very intense, may be associated with abdominal distension, nausea, vomiting, so that it can be misdiagnosed as acute abdomen, surgical anastomotic leakage.
(3) Toxic manifestations include tachycardia, fever, spasm, and disorientation. In severe cases, hypotension, shock, severe dehydration, electrolyte imbalance, metabolic acidosis, oliguria, and even acute renal function often occur. Not complete.
Examine
Examination of pseudomembranous colitis
Shortly after the use of antibiotics or after the discontinuation of antibiotics, especially after the application of lincomycin or clindamycin, sudden appearance of mucinous diarrhea without red blood cells; or worsening of the condition after abdominal surgery, and diarrhea should occur Think of this disease, through the sigmoidoscopy, see the positive detection of cytotoxicity in the pseudomembrane and feces can quickly obtain a diagnosis.
(1) Laboratory examination: the peripheral white blood cells increase, mostly above 10,000~20,000/mm3, even up to 40,000/mm3 or higher, mainly due to neutrophil enlargement. Sexual changes, only white blood cells, rare blood in the eyes, hypoalbuminemia, electrolyte imbalance or acid-base balance disorders, cultured under special conditions of fecal bacteria, in most cases can be found in the growth of Clostridium difficile, fecal cells Toxin detection has the value of diagnosis. The filtrate of the patient's feces is diluted by different multiples. The tissue culture solution is placed in the culture medium to observe the cytotoxic effect. The 1:100 or more has diagnostic significance, and the anti-toxin neutralization test of Clostridium sphaeroides is often positive.
(2) Endoscopy: When the disease is highly suspected, endoscopy should be performed in time. This disease often involves the left colon, while the rectum can be free of lesions. Sigmoidoscopy is one of the important diagnostic methods, such as lesions on the right. For the semi-colon, a colonoscopy is required. If no typical lesions are found in the initial stage, repeating is required. Endoscopic observation: in the early stage or in the treatment, the endoscopy may have no typical performance, the intestinal mucosa may be normal, or only There is mild congestion, edema, severe mucosal fragility and obvious ulcer formation, and the mucosal surface is covered with yellow-white or yellow-green pseudomembrane.
(3) X-ray examination: abdominal plain film can show intestinal paralysis or mild, moderate intestinal dilatation, barium enema examination can be seen thickening of the intestinal wall, significant edema, colonic bag disappears, in some cases, there is gas between the intestinal wall This sign is caused by partial necrosis of the intestinal wall and bacterial invasion of the colon; or the appearance of ulcer or polypoid lesions, the above-mentioned X-ray findings lack specificity, so the diagnostic value is not large, and the comparison of air sputum contrast enema can improve the diagnostic value. However, there is a risk of intestinal perforation and should be used with caution.
Diagnosis
Diagnosis and identification of pseudomembranous colitis
It can be diagnosed based on medical history, clinical symptoms and laboratory tests.
The disease should be differentiated from ulcerative colitis, colonic Crohn's disease, ischemic enteritis, and AIDS colitis.
