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Обратная связь
Hemorrhoids are one of the most
common diseases. Word «hemorrhoid»
translated from Greek language means
«bleeding», which directly connected
with the most prevalent symptom of this
disease – there is blood outflow from
anus. Hemorrhoids are equally common
among male and female. Frequently
females mark acute haemorrhoidal
thrombosis; usually it happens during
third trimester of pregnancy    
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Anorectal abscess signifies
inflammation of the fat in one of the
spaces surrounding the anorectum.
Infection from rectum by anal glands,
which are situated in anal crypts of the
anal canal penetrate perianal tissue.
Crypt abscess always is at the level of
the dentate line. The reasons of crypt
abscess are different: constipation,
hemorrhoids, anal fissure ecc. Anal
gland infection is also the principal
cause of anal fistulas.  
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Anal fissure is a spontaneously
appeared linear tear (ulcer) in the anal
mucosa. Anal fissure is quite common.
Among proctology disease this is one
of three the most frequent (11%-15%
or 20-23 cases amongst 1000 people).
Anal fissures are more prevalent
among young and middle- age females.    
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 Constipation.   Now constipation is
one of the most common conditions that
bring a patient to see a physician in al
the world.  For example, 2.5 million
people with constipation (1.2% in the
general population) visit each year
doctors and even more numbers try
to solve this problem by themselves
using laxatives. What is constipation?
Constipation is not separate disease.
There is symptom of many illness.  
Read_______
.
Ulcerative colitis is chronic recurrent
bowel disease, which is based on
manifest diffuse non-specific
inflammation of the mucosa of the
rectum and colon.
Read_______

Cron`s colitis is chronic, recurrent,
inflammatory disease of unknown
etiology that affects the gastrointestinal
tract This disease is characterized by
skip lesion and transmural inflammation,
and it can be affect any segment of the
gastrointestinal tract. This illness also
has tendency to early, local and system
complications.   
Read_______

Polyps and polyposis syndromes.
The definition of polyp is not clear at all.
Presently, only epithelial glands
excrescence, which rises above mucosa,
is called true polyp.   
 Read_______

 
Rectal cancer. These days rectal
cancer without exaggeration is the
problem of global degree.   
Read_______

Colon cancer.  Measurement of (CEA)
carcinoembryonic antigen, which was
found in embryonic cellules of
gastrointestinal tract, is another
direction in the early detection of colon
and rectal cancer.
Read_______
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Home >>Diseases >> Ulcerative colitis

Ulcerative colitis

Ulcerative colitis is chronic recurrent bowel disease, which is based on manifest diffuse non-specific inflammation of the
mucosa of the rectum and colon.
 
Epidemiology and morbidity
Last years the quantity of inflammatory bowel disease cases increased in North Europe
Country  
The quantity of cases per 100 000 of in-patients
Switzerland   
5,8
Finland
7,0
Denmark
7,8
Belgium
10,8
England
14,8
In Western Europe and USA circa 3,5-6,5 to 60 of new cases of ulcerative colitis per 100 000 people are detected annually.
More than 50% of initially diagnosed patient are 20-40 years old (par 29 years old).      


Etiology
Presently, the unified opinion about the reasons and pathogeneses of ulcerative colitis doesn’t exist.
Scientists emphasize principal etiological factors
1. Genetical factor (genetical markers of ulcerative colitis were found in human’s HLA system).
2. Microbe factor (patients with ulcerative colitis has big amount of antibodies against 0-antigen Escherichia Coli 014,  
effectiveness of probiotics, which consist Escherichia Coli strain – Nissle 1917 in ulcerative colitis treatment)  
3. Dysfunction of intestinal barrier
4. Influence of external factors (Nicotine decreases the risk of Ulcerative colitis, but increase in several times the risk to
get Conh’s disease. Some drags, for example, nonsteroidal anti-inflammatory drugs (NSAIDs), and fast food aggravate
outcome of inflammatory bowel diseases).
5. Dysfunction of immune system (dysfunction of local immunity regulation is the base of intestinal inflammation)
So, genetical predisposition, dysfunction of local immunity regulation, influence of external factors determine inflammation
of intestinal mucosa of patients with ulcerative colitis (UC).



Pathogenesis

Big variety of cellular and tissue lesion mechanisms are included in process of inflammation. Bacterial and tissue antigens
stimulate T- and B- lymphocytes. Flare of ulcerative colitis is characterized by Immunoglobulin deficit, which facilitate penetration
of microbes. Penetration of microbes stimulate B- lymphocytes, which synthesizes Immunoglobulin M and G. Excess synthesis of
Immunoglobulin M and G determines creation of immune complexes with cytotoxic effect, which determine destruction of
colocyts. Bacterium and leftover food pass through mucosal defects and enhance inflammation.      


Pathomorphology

Usually, inflammation begins in rectum (near dentate line) and continues proximally. Primarily, process appears as a vascular
reaction and only later as a destruction of epithelium (erosions and ulcers). Ulcers are always superficial (never deeper than
submucosa), they can be different dimension. Sometimes, all surface of intestine, instead of mucosa, is presented by big ulcer
covered by fibrin. But usually there are a lot of small ulcers, erosions and also pseudo-polyps (hyper regeneration of epithelium
after ulcers). Morphological disorders are always more evident proximally (descending and sigmoid colon and rectum). Terminal
part of ileum is involved in 18-30% of cases. Lymphocytes prevalent in inflammatory infiltrate, when disease begins and in flare
period. These cellules are found in ulcer bottom and in granulation tissue, which is covered by fibrin.
Inflammation involves all layers of intestine

Classification of ulcerative colitis.
Ulcerative colitis is classified by clinical characteristic, activity and severity.  

Mild form is characterized by less than 4 bowel movements per day, small amount of blood in feces. Patient doesn’t have fever
or frequent pulse and doesn’t lose wait. General condition is good.
Moderate form is characterized by 5-8 bowel movements per day, bigger amount of blood and mucus in feces, moderate fiver,
anemia and a bit frequent pulse. General condition is still good.
 
Severe form is characterized by more than 8 daily bowel movements, large amount of blood, mucus and pus in feces, fiver
(more than 38C), frequent pulse (more than 90 per minute), anemia (hemoglobin less than 90g/l). General condition is bad of
very bad.   
    
                   Normal mucosa of large intestine
First stage of activity
Second stage of activity
Third stage of activity
Fourth stage of activity
Clinical features
Ulcerative colitis usually begins as a distraction of mucosa in rectum and sigmoid colon (90-95% of cases). Other organs (skin,
joints, vertebra…) also can be involved. The most frequent features are diarrhea and hematochezia (blood in feces). Blood in
stool is not always presented. Sometimes disease can begin as a constipation and stomachache.


Complications of ulcerative colitis can be local and systemic

Local complications
- Toxic dilatation develops in 3-5% of patients. Mortality in this case is 28-32%.
- Large bowel perforation develops in 3-5% of patients. Mortality in this case is 72-100%
- Intestinal obstruction caused by strictures
- Intestinal bleeding (1-6% of cases)
- Perianal complications: anorectal abscess, anal fistula, anal fissure occur in 4-30% of cases
- Rectal and colon cancer. The risk of cancer increase is significantly elevated after 8-10 years of disease.
Systemic complications
- Amiloidosis  
- Hyper-coagulation, anemia, hypoproteinemia
- Vasculit,
- Ulcers of shin and foot
- Poly-arthritis

The most important examinations for patients with ulcerative colitis
-   Digital examination
-   Rigid proctosigmoigoscopy
-   Colonoscopy
-   Barium enema examination
-   Laboratory tests
Barium enema examination

Severe activity, toxic dilatation, suspect perforation and peritonitis are the contraindications for rigid proctosigmoigoscopy
and colonoscopy.

Differential diagnosis should include Crohn`s colitis, antibiotic-associated colitis, infectious colitis, ischemic bowel
disease and diverticulitis.  



Antibiotic-associated colitis
Infectious colitis                                                   Ishemic bowel disease
Ulcer of rectum
Crohn`s colitis
Read also
Treatment of ulcerative colitis
Ulcerative colitis
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