What are the causes of ulcerative enteritis?

Ulcerative enteritis is a disease of the large intestine, which is usually caused by the presence of bacteria or bacterial growth in the intestines. It can cause blood in the stool or abdominal pain, and can also easily lead to symptoms such as mucus in the stool or abdominal cramps. It can easily lead to weight loss, emaciation, severe anemia, etc. It should be treated in time. Maintain dietary hygiene, do not eat too much cold or raw food, keep the bowel movements smooth, drink more warm water, and avoid irritating foods and carbonated drinks. Carbonated drinks will irritate the intestines and aggravate ulcerative enteritis, so try not to drink them.

Causes

The cause of ulcerative colitis remains unknown. Genetic factors may play a role. Psychological factors play an important role in the progression of the disease, and pre-existing morbid mental conditions such as depression or social distance can be significantly improved after colectomy. Some people believe that ulcerative colitis is an autoimmune disease.

It is currently believed that the onset of inflammatory bowel disease is the result of the interaction between exogenous substances causing host response, genes and immune influences. According to this view, ulcerative colitis and Crohn's disease are different manifestations of the same disease process.

Clinical manifestations

The initial presentation of ulcerative colitis can take many forms. Bloody diarrhea is the most common early symptom. Other symptoms include abdominal pain, bloody stools, weight loss, tenesmus, vomiting, etc. Occasionally, the main manifestations are arthritis, iridocyclitis, liver dysfunction, and skin lesions. Fever is a relatively uncommon sign. In most patients, the disease presents as a chronic, low-grade disease, while in a minority of patients (about 15%) it presents as an acute, catastrophic outbreak. These patients present with frequent bloody stools, up to 30 times a day, as well as high fever and abdominal pain.

Signs are directly related to the stage of the disease and clinical manifestations. Patients often have weight loss and pale complexion. During the active stage of the disease, the colon is often tender during abdominal examination. There may be signs of an acute abdomen with fever and decreased bowel sounds, particularly in acute or fulminant cases. Toxic megacolon may present with abdominal distension, fever, and signs of acute abdomen. Due to frequent diarrhea, the skin around the anus may be abraded and peeled. Perianal inflammation such as anal fissures or anal fistulas may also occur, although the latter is more common in Crohn's disease. Rectal examination is painful. Examination of the skin, mucous membranes, tongue, joints, and eyes is extremely important.

diagnosis

The following clinical manifestations and auxiliary examinations can help diagnose this disease.

1. Clinical manifestations

Except for a few patients with acute onset, the onset is generally slow and the severity of the disease varies. The main symptom is diarrhea, with stool containing blood, pus and mucus, often accompanied by paroxysmal colonic spasmodic pain and tenesmus, which can be relieved after defecation.

Mild patients have mild symptoms, with less than 5 episodes of diarrhea a day.

Severe diarrhea occurs more than 5 times a day, and the diarrhea is watery or bloody. There is severe abdominal pain and fever symptoms. The body temperature may exceed 38.5℃ and the pulse rate is greater than 90 beats/minute.

The fulminant form is less common. The onset is acute, the disease progresses rapidly, the diarrhea is large, and there is often blood in the stool. Body temperature can rise to 40°C, and in severe cases, symptoms of systemic poisoning may appear. If the disease is not cured over time, weight loss, anemia, nutritional disorders, weakness, etc. may occur. Some patients have extraintestinal manifestations, such as erythema nodosum, iritis, chronic active hepatitis and pericholedochal inflammation.

2. Auxiliary examination

The diagnosis mainly relies on fiber colonoscopy, because 90% to 95% of patients have rectum and sigmoid colon affected, so in fact fiber sigmoidoscopy can make a clear diagnosis. Microscopic examination revealed congested, edematous mucosa that was brittle and prone to bleeding. In advanced cases, ulcers may be seen, surrounded by raised granulation tissue and edematous mucosa, resembling polyps or pseudopolyps. In chronic progressive cases, the rectum and sigmoid colon lumens may be significantly reduced. In order to clarify the extent of the lesion, a fiber colonoscopy should be used to perform a full colon examination and multiple biopsies should be performed at the same time to differentiate it from clonal colitis.

Double contrast barium enema is also an aid in diagnosis, especially in determining the extent and severity of the disease. Barium perfusion can reveal the disappearance of the colon bag shape, irregular intestinal wall, formation of pseudopolyps, and narrowing and rigidity of the intestinal cavity. Although barium enema examination is valuable, it should be done with caution and bowel preparation should be avoided because it can worsen colitis. For patients without diarrhea, liquid diet for 3 days is sufficient before examination. Barium enema examination should not be performed in cases with abdominal signs. Instead, abdominal X-rays should be performed to observe for signs of toxic megacolon, colon dilatation, and free gas under the diaphragm.

complication

1. Toxic colon dilatation

It occurs during the acute active phase, with an incidence of approximately 2%. It is caused by inflammation affecting the colon muscle layer and intermuscular nerve plexus, resulting in low intestinal wall tension and staged paralysis. A large amount of intestinal contents and gas accumulate, causing acute colon dilatation and thinning of the intestinal wall. The lesions are more common in the sigmoid colon or transverse colon. Causes include hypokalemia, barium enema, use of anticholine drugs or opioids, etc. The clinical manifestations are rapid deterioration of the disease and obvious symptoms of poisoning, accompanied by abdominal distension, tenderness, rebound pain, weakened or disappeared bowel sounds, and increased white blood cell count. Abdominal X-rays may show widening of the intestinal cavity and disappearance of the colon pouch. Prone to intestinal perforation. The mortality rate is high.

2. Intestinal perforation

The incidence rate is about 1.8%. It often occurs on the basis of toxic colon dilatation, causing diffuse peritonitis and the appearance of free gas under the diaphragm.

3. Heavy bleeding

It refers to patients who have heavy bleeding and need blood transfusion treatment, with an incidence rate of 1.1% to 4.0%. In addition to bleeding due to ulcer-involved blood vessels, hypoprothrombinemia is also an important cause.

4. Polyps

The polyp complication rate of this disease is 9.7% to 39%, and this type of polyp is often called a pseudopolyp. It can be divided into mucosal ptosis type, inflammatory polyp type, and adenomatous polyp type. The most common site of polyps is the rectum, and some people believe that they are most common in the descending colon and sigmoid colon, and decrease upwards. Its outcome may be to disappear with the recovery of inflammation, to be destroyed with the formation of ulcers, to persist for a long time or to turn into cancer. Canceration mainly comes from adenomatous polyp type.