Colitis at children - the polietiologichesky disease of a thick gut which is followed by its inflammatory and dystrophic changes. Colitis at children proceeds with belly-aches, nausea, change of frequency and character of a chair, an indisposition. Diagnosis of colitis at children includes a koprologichesky and bacteriological research a calla, carrying out an irrigografiya, rektosigmoskopiya and kolonoskopiya, endoscopic biopsy of a mucous gut. Treatment of colitis at children in many respects depends on its pathogenetic form and includes a dietotherapy, antibacterial and symptomatic therapy, phytotherapy, restoration of normal intestinal microflora.
Colitis at children
Colitis at children - the inflammation of a large intestine which is characterized by pains and functional violations from a thick gut. Not less than 10% of all cases of chronic colitis begin at children's age therefore diseases of a thick gut, their diagnostics and treatment make one of complex problems of children's gastroenterology. Owing to anatomo-physiological features of a gastrointestinal tract of children of early age, inflammatory process, as a rule, proceeds with simultaneous involvement of a small and thick intestine (enterokolit). The isolated defeat of various departments of intestines – enteritis and colitis usually occurs at children of school age.
The colitis reasons at children
Sharp colitis at children, as a rule, develops against the background of intestinal infection (salmonellosis, a shigellez, an esherikhioz, an iyersinioz, a food toksikoinfektion, a rotavirusny infection, etc.) and is in most cases combined with sharp gastritis, sharp enteritis or a gastroenteritis. Sometimes as the reason of sharp colitis at children the individual intolerance of some components of food, gross violations of a diet, radiative effects act.
Chronic colitis can be an outcome of sharp colitis (for example, at dysentery at children), and also to develop owing to helminthic and parasitic diseases (an askaridoz, a lyamblioz), systematic violation of the food mode, influence of household poisonous agents, irrational use of medicines (NPVS, antibiotics, laxative, etc.), sekretorny insufficiency of digestive glands (the congenital and acquired enzimopatiya - a tseliakiya and disakharidazny insufficiency), dysbacteriosis and so forth.
Realization of an inflammation mucous intestines is promoted by psychogenic factors, vegeto-vascular dystonia at children, the burdened heredity, congenital features of development of intestines (a dolikhosigma, megacolon), an inactive way of life, addictions at teenage age.
Classification of colitis at children
Inflammatory changes in a thick gut can be widespread or limited one or several segments. According to it allocate the isolated inflammation of a blind gut (tiflit); the inflammation of the blind and ascending gut (tiflokolit); the inflammation cross (transverzit) guts; the inflammation of transition cross (angulit) guts in descending; the inflammation of a sigmovidny gut (sigmoidit); the inflammation of a direct and sigmovidny gut (proktosigmoidit); the inflammation of a rectum (proktit); generalized inflammation (pan-colitis).
Taking into account an etiologichesky factor colitis at children happens infectious, alimentary, parasitic, toxic, medicamentous, beam, neurotic, secondary, the obscure etiology.
On the basis of an endoscopic picture and morphological features allocate catarrhal, atrophic and erosive and ulcer colitis at children. Colitis at children is divided by character of a clinical current on sharp and chronic; as a current — on monotonous, recidivous, progressing, latent; on weight of a current — on lungs, average weight, heavy.
Depending on a condition of motility of a thick gut and the prevailing functional violations of intestines distinguish colitis at children with prevalence of locks or ponos, change of locks and ponos. In the clinical course of colitis at the child allocate a phase of an aggravation, clinical remission, kliniko-endoscopic (histologic) remission.
The main clinical forms of colitis which are found at children are presented by sharp colitis, chronic colitis, nonspecific ulcer colitis, spastic colitis.
Colitis symptoms at children
Sharp infectious colitis at children proceeds against the background of the expressed toxicosis and an eksikoz: the increased temperature, anorexia, weakness, vomiting. As a result of a spasm of intestines of the child pains in podvzdoshny area, tenezma disturb. The chair becomes frequent from 4-5 to 15 times a day; excrements have watery, foamy, character; greenish color, impurity of slime and streak of blood. During defecation loss of a rectum can be noted. At survey of the child with sharp infectious colitis symptoms of dehydration pay attention: decrease in turgor of fabrics, dryness mucous, point of features, oliguriya.
Chronic colitis at children has a wavy current with alternation of aggravations and remissions. As the main clinical displays of colitis at children serve the pain syndrome and violation of a chair. Pains are localized areas of a navel, the right or left podvzdoshny area; have the aching character; arise after meal, amplify during movements or before defecation.
Frustration of a chair at chronic colitis at children can be expressed by diarrhea, locks or their alternation. Increase of desires on defecation (to 5-7 times a day) with allocation a calla of various character and a consistence is sometimes noted (liquid, with slime or undigested food, "sheep" or tape-like a calla etc.). The lock at children with the subsequent otkhozhdeniye of firm kalovy masses can lead to formation of cracks of back pass and emergence of a small amount of scarlet blood in a chair.
Children with chronic colitis complain of swelling and a raspiraniye of a stomach, rumbling in intestines, the strengthened otkhozhdeniye of gases. Sometimes in clinic of colitis at children psychovegetative frustration dominate: weakness, fatigue, irritability, sleep disorder, headache. The long course of colitis at children can lead to a delay of an increase of body weight and growth, anemia, hypovitaminosis.
Diagnosis of colitis at children
Diagnosis is based on data of the anamnesis, a clinical picture, fizikalny, laboratory, tool (radiological, endoscopic) inspections.
At blood test anemia, a gipoalbuminemiya, decrease in level of electrolytes in blood serum is found in the children having colitis. The Koprologichesky research reveals existence in Calais of leukocytes, slime, a steatorea, amilorea, kreatorea. Bacteriological a research the calla allows to exclude the infectious nature of sharp and chronic colitis at children. The analysis the calla on dysbacteriosis, as a rule, shows change of a microbic landscape of intestines due to increase of opportunistic agents – stafilokokk, a protea, Candide.
At an endoscopic research of intestines (a kolonoskopiya, a rektoskopiya) at children the picture of catarrhal colitis comes to light more often: the mucous membrane of a thick gut is hyperemic, edematous; lymphoid follicles are increased; a large amount of slime, dot hemorrhages, vulnerability mucous is found at contact. The endoscopic biopsy of a mucous gut and a morphological research of a bioptat promote differential diagnostics of various forms of colitis at children.
For the purpose of specification of degree and weight of an inflammation at colitis at children the irrigografiya is carried out. For studying of a functional condition of a thick gut the barium passage X-ray analysis is carried out.
Treatment of colitis at children
Treatment of colitis at children is directed to elimination of the activator, restoration of function of intestines, the prevention of a recurrence or an aggravation. In all cases of colitis at children also chemically sparing diet is appointed mechanically: rather weak broths, mucous broths, steam dishes, omelets, porridges, kissels.
Therapy of sharp infectious colitis at children is carried out by rules of treatment of intestinal infections (antibiotic treatment, an oral regidratation, reception of bacteriophages, enterosorbents etc.).
At chronic colitis at children, except clinical nutrition, reception of fermental medicines (Pancreatinum), prebiotics and probiotics, enterosorbents, prokinetik is shown (loperamide, ). Antibacterial medicines are appointed according to strict indications. Within therapy of colitis the use of still mineral water, infusions and broths of officinal herbs is recommended to children. In need of a complex of therapeutic actions include IRT, physical therapy (the electrophoresis, mud cure warming compresses on area of a stomach), massage of a stomach and remedial gymnastics.
The forecast and prevention of colitis at children
In case of timely treatment and full rehabilitation sharp colitis at children comes to an end with clinical laboratory recovery. At chronic colitis at children observance of the recommended mode provides long remission. Frequent exacerbations of colitis break physical development of children, their psychosocial adaptation.
Prevention of colitis at children assumes observance of an age diet and diet, full treatment of sharp intestinal infections, helminthic invasions, dysbacteriosis. Dispensary observation of children is made by the pediatrician and the children's gastroenterologist. Carrying out preventive inoculations is allowed during permanent remission of chronic colitis at children.