What are the common causes of abdominal pain and bloody stool. How to recognize symptoms of serious conditions. When should you seek immediate medical attention for digestive issues. What diagnostic tests are used to evaluate abdominal pain and bloody stools. How are different causes of abdominal pain and bloody stool treated.

Understanding Abdominal Pain and Bloody Stool: An Overview

Experiencing abdominal pain accompanied by bloody stool can be alarming and often indicates an underlying health issue that requires medical attention. These symptoms can range from minor, easily treatable conditions to more serious digestive disorders or even life-threatening diseases. It’s crucial to understand the potential causes, recognize warning signs, and know when to seek professional medical help.

Abdominal pain can occur in various locations and may be characterized by different sensations, such as cramping, sharp stabbing pains, or a dull ache. When combined with bloody stool, it’s essential to consider the nature of the blood – whether it’s bright red, dark red, or black and tarry – as this can provide clues about the source of bleeding within the digestive tract.

Common Causes of Abdominal Pain and Bloody Stool

Several conditions can lead to the combination of abdominal pain and bloody stool. Here are some of the most common causes:

1. Hemorrhoids

Hemorrhoids are swollen veins in the rectum or anus that can cause pain, itching, and bleeding during bowel movements. While they’re often not serious, they can be uncomfortable and may require treatment.

2. Inflammatory Bowel Disease (IBD)

IBD includes conditions like Crohn’s disease and ulcerative colitis, which cause chronic inflammation in the digestive tract. Symptoms often include abdominal pain, diarrhea, and bloody stools.

3. Peptic Ulcers

These are sores that develop on the lining of the stomach or small intestine, often caused by H. pylori bacteria or long-term use of certain medications. Peptic ulcers can cause abdominal pain and, in some cases, bloody stools.

4. Diverticulitis

This condition occurs when small pouches in the colon become inflamed or infected. It can cause severe abdominal pain, usually on the left side, and may lead to bloody stools.

5. Colorectal Cancer

While less common, colorectal cancer can cause abdominal pain and bloody stools, especially in later stages. It’s crucial to rule out this possibility, particularly for individuals over 40 or those with a family history of colorectal cancer.

Recognizing Symptoms and Warning Signs

To better understand the potential severity of your condition, it’s important to pay attention to specific symptoms and warning signs associated with abdominal pain and bloody stool:

• Location and nature of abdominal pain (e.g., cramping, sharp, dull)
• Frequency and consistency of bowel movements
• Color and amount of blood in the stool
• Associated symptoms such as fever, nausea, or vomiting
• Duration of symptoms
• Recent changes in diet or medication

Is severe abdominal pain always a sign of a serious condition. Not necessarily, but severe or persistent abdominal pain, especially when accompanied by bloody stools, should be evaluated by a healthcare professional promptly.

When to Seek Immediate Medical Attention

Certain symptoms warrant immediate medical attention. If you experience any of the following, don’t hesitate to seek emergency care:

• Severe, sudden abdominal pain
• Large amounts of blood in the stool
• Black, tarry stools (which may indicate upper gastrointestinal bleeding)
• High fever (above 101°F or 38.3°C)
• Persistent vomiting
• Signs of dehydration (extreme thirst, dark urine, dizziness)
• Rapid heart rate or difficulty breathing

How quickly should you seek medical attention if you notice blood in your stool. If you notice any amount of blood in your stool, it’s best to consult with a healthcare provider within a day or two, unless you’re experiencing severe symptoms that require immediate attention.

Diagnostic Approaches for Abdominal Pain and Bloody Stool

When you visit a healthcare provider for abdominal pain and bloody stool, they will likely perform a series of diagnostic tests to determine the underlying cause. These may include:

1. Physical Examination

Your doctor will palpate your abdomen to check for tenderness, swelling, or masses. They may also perform a digital rectal exam to check for hemorrhoids or other abnormalities.

2. Blood Tests

Blood work can help identify signs of infection, inflammation, anemia, or other systemic issues that might be contributing to your symptoms.

3. Stool Tests

Analyzing a stool sample can detect the presence of blood, parasites, or bacterial infections that might be causing your symptoms.

4. Imaging Studies

Depending on your symptoms and initial test results, your doctor may recommend imaging studies such as:

• Abdominal X-rays
• Ultrasound
• CT scan
• MRI

5. Endoscopic Procedures

In some cases, your doctor may recommend endoscopic procedures to visualize the inside of your digestive tract directly. These may include:

• Colonoscopy: Examines the entire large intestine
• Sigmoidoscopy: Examines the lower part of the colon
• Upper endoscopy: Examines the esophagus, stomach, and upper small intestine

What is the most common diagnostic test for evaluating bloody stools. A colonoscopy is often considered the gold standard for evaluating bloody stools, as it allows direct visualization of the entire colon and can identify the source of bleeding in many cases.

Treatment Options for Abdominal Pain and Bloody Stool

Treatment for abdominal pain and bloody stool depends on the underlying cause. Here are some common approaches:

1. Medication

Depending on the diagnosis, your doctor may prescribe:

• Antibiotics for bacterial infections
• Anti-inflammatory drugs for IBD
• Acid-reducing medications for peptic ulcers
• Pain relievers

2. Dietary Changes

In many cases, modifying your diet can help alleviate symptoms and promote healing. This may involve:

• Increasing fiber intake for hemorrhoids or diverticulosis
• Avoiding trigger foods for IBD or food sensitivities
• Following a specific diet plan recommended by your healthcare provider

3. Lifestyle Modifications

Certain lifestyle changes can help manage symptoms and prevent recurrence:

• Stress reduction techniques
• Regular exercise
• Quitting smoking
• Limiting alcohol consumption

4. Surgical Interventions

In some cases, surgery may be necessary to treat the underlying condition. This could include:

• Removal of polyps or tumors
• Repair of perforated ulcers
• Bowel resection for severe cases of IBD or diverticulitis

How effective are dietary changes in managing conditions that cause abdominal pain and bloody stool. Dietary modifications can be highly effective for many conditions, particularly IBD, hemorrhoids, and diverticulosis. However, the effectiveness varies depending on the specific condition and individual factors.

Preventing Recurrence and Maintaining Digestive Health

Once the immediate issue of abdominal pain and bloody stool has been addressed, it’s important to focus on preventing recurrence and maintaining overall digestive health. Here are some strategies to consider:

1. Regular Health Screenings

Staying up-to-date with recommended health screenings, such as colonoscopies, can help detect potential issues early on. The frequency of these screenings may vary based on your age, family history, and personal risk factors.

2. Balanced Diet

Maintaining a balanced diet rich in fiber, fruits, vegetables, and whole grains can promote digestive health and reduce the risk of various gastrointestinal issues.

3. Hydration

Drinking plenty of water throughout the day helps maintain proper digestion and prevents constipation, which can contribute to hemorrhoids and other digestive problems.

4. Stress Management

Chronic stress can exacerbate many digestive conditions. Implementing stress-reduction techniques such as meditation, yoga, or regular exercise can help maintain digestive health.

5. Medication Management

If you’re taking medications that can affect your digestive system (such as NSAIDs), work with your healthcare provider to find the right balance or explore alternative options.

How often should you have a colonoscopy for preventive screening. For individuals at average risk, it’s generally recommended to start colonoscopy screenings at age 45 and repeat them every 10 years. However, those with higher risk factors may need to start earlier or have more frequent screenings.

Long-term Outlook and Quality of Life Considerations

The long-term outlook for individuals who have experienced abdominal pain and bloody stool varies depending on the underlying cause and the effectiveness of treatment. Here are some important considerations:

1. Chronic Conditions Management

For those diagnosed with chronic conditions like IBD, long-term management strategies are crucial. This may involve ongoing medication, regular check-ups, and lifestyle adjustments to maintain remission and prevent flare-ups.

2. Psychological Impact

Dealing with chronic digestive issues can have a significant psychological impact. It’s important to address any anxiety or depression that may arise and seek support when needed, whether through support groups or professional counseling.

3. Nutritional Considerations

Some digestive conditions may affect nutrient absorption or require dietary restrictions. Working with a registered dietitian can help ensure you’re meeting your nutritional needs while managing your condition.

4. Work and Social Life

Chronic digestive issues can impact work and social activities. Developing strategies to manage symptoms and communicate your needs with employers and friends can help maintain a good quality of life.

5. Ongoing Monitoring

Regular follow-ups with your healthcare provider are essential to monitor your condition, adjust treatments as needed, and catch any potential complications early.

Can individuals with chronic digestive conditions lead normal, active lives. Yes, with proper management and treatment, many individuals with chronic digestive conditions can lead normal, active lives. However, it may require ongoing attention to diet, stress management, and medication adherence.

Emerging Research and Future Treatments

The field of gastroenterology is continually evolving, with new research offering hope for improved treatments and management strategies for abdominal pain and bloody stool. Here are some areas of ongoing research and potential future treatments:

1. Microbiome Research

Studies on the gut microbiome are revealing its crucial role in digestive health. Future treatments may involve targeted probiotics or microbiome modulation to address various digestive disorders.

2. Precision Medicine

Advances in genetic testing and personalized medicine may lead to more targeted treatments based on an individual’s genetic profile and specific disease characteristics.

3. Biologic Therapies

New biologic drugs are being developed for conditions like IBD, offering more targeted approaches to reducing inflammation and promoting healing.

4. Minimally Invasive Surgical Techniques

Ongoing improvements in minimally invasive surgical techniques may lead to faster recovery times and reduced complications for patients requiring surgical interventions.

5. Artificial Intelligence in Diagnostics

AI-powered tools are being developed to assist in the early detection and diagnosis of digestive disorders, potentially leading to more accurate and timely treatments.

How might advances in microbiome research impact the treatment of digestive disorders. Microbiome research could lead to new therapeutic approaches, such as personalized probiotics or targeted interventions to restore a healthy gut microbiome balance, potentially improving outcomes for various digestive conditions.

In conclusion, while abdominal pain and bloody stool can be concerning symptoms, understanding their potential causes, recognizing warning signs, and seeking appropriate medical care are crucial steps in managing these issues effectively. With ongoing advancements in research and treatment options, the outlook for individuals dealing with digestive disorders continues to improve. By staying informed, working closely with healthcare providers, and maintaining a proactive approach to digestive health, individuals can optimize their well-being and quality of life.

Digestive Disorders Associates and MDTEC: Gastroenterology

If you have any digestive complaints, call our office in Annapolis at 410-224-4887 to schedule an appointment with one of our specialists, or use our online booking tool!

It’s perfectly normal to feel concerned if you spot blood in your stool or on the toilet paper after wiping. Bloody stool isn’t a normal occurrence and should be evaluated immediately. Whether you notice a faint red streak or dark blood in your stool, it can be a sign that something is amiss. If you ignore the symptom, whatever condition is causing it may get worse, so getting in to see a gastroenterologist can help get to the bottom of things.

At Digestive Disorders Associates, we see patients with a wide variety of digestive complaints and can provide a comprehensive evaluation for issues such as bloody stools. Sometimes there’s an innocent explanation for finding blood in your stool. The only way to know for sure is to have a thorough examination.

Here are some of the possible reasons behind bloody stools.

Inflammatory bowel disease

Inflammatory bowel disease (IBD) causes chronic inflammation and sores to develop along the digestive tract, and bloody stool is a common symptom. Ulcerative colitis and Crohn’s disease are the two most common forms of IBD. You may have IBD if your bloody stool is accompanied by:

• Bouts of diarrhea that come and go
• Abdominal pain and cramping
• Bloating after eating
• Constipation
• Difficult bowel movements

While there is no cure for IBD, treatments can reduce symptoms and help patients avoid complications. A combination of diet and lifestyle changes, and medication when necessary, can benefit IBD patients.

Peptic ulcers

Bleeding anywhere along the digestive tract can cause blood to appear in the stool. Peptic ulcers are sores that form on the lining of the stomach that commonly cause bloody stool. Long-term use of certain medications and H. pylori, a stomach bacteria, are two common causes of ulcers. Most patients who have ulcers experience some digestive complaints along with diarrhea. You may have an ulcer if you notice:

• Burning stomach pain
• Heartburn
• Nausea
• Gas
• Intolerance to fatty food

Having an empty stomach tends to make stomach ulcer pain worse.

Hemorrhoids  

On the least serious end of the spectrum, hemorrhoids could be responsible for blood in your stool. This common condition occurs when the anus or rectum becomes irritated and swollen. Hemorrhoids often occur from straining during bowel movements.

A low-fiber diet and dehydration can contribute to straining, which puts pressure on the veins in the rectum and anus. When you see one of our providers at Digestive Disorders Associates, a comprehensive evaluation will help rule out more serious causes.

Typical signs of hemorrhoids to look out for include:

• Anal itching and irritation
• Anal swelling
• Pain during bowel movements

Bleeding during bowel movements is the most common sign of hemorrhoids. However, it’s best not to assume that hemorrhoids are the cause of your bloody stool. Consult us for evaluation, especially if you’re over age 40, as blood in your stools could be a sign of a more serious issue.

Colon cancer or other serious condition

While most instances of blood-containing stool aren’t life-threatening, it’s necessary to have an evaluation. Bloody stool can be a sign of a more serious condition, such as colon cancer. Let us know if you experience bleeding along with a sudden change in bowel habits. This may signal a more extensive problem elsewhere in the digestive tract.

It’s important to find out the cause of blood in your stool and rule out serious digestive conditions. Left untreated, bloody stool could lead to dangerous complications. If you have any digestive complaints, call our office in Annapolis to schedule an appointment with one of our specialists.

34-Year-Old Woman With Abdominal Pain and Blood-Streaked Diarrhea

A 34-year-old woman presented to the emergency department for evaluation of a 12-hour history of sudden severe epigastric pain and bilateral leg weakness during exercise associated with nausea and vomiting. She experienced 2 episodes of diarrhea; 1 of which was blood streaked. The patient reported not eating or drinking much that day. She described a few previous less severe episodes of abdominal pain and diarrhea since childhood associated with certain foods. She denied fever or chills but reported a 5-lb intentional weight loss during the past month. She denied changes in her appetite, myalgia, arthralgia, or vision changes. She had no recent travel, sick contacts, or antibiotic drug use. She denied current pregnancy.

The patient was previously healthy; her medical history included recurrent urinary tract infections and infertility, with a previous artificial insemination attempt resulting in a missed abortion. Current medication use includes clomiphene and progesterone vaginal suppository.

At presentation, her vital signs were as follows: temperature, 36.9°C; heart rate, 69 beats/min; respiratory rate, 16 breaths/min; and blood pressure, 98/60 mm Hg. On examination, the patient appeared uncomfortable but was in no acute distress. Her abdomen was soft and nondistended, with positive bowel sounds. She had generalized tenderness in all 4 quadrants, with absence of guarding and rebound tenderness. Her mucous membranes appeared dry. Lower extremity strength was normal. Results of a urine pregnancy test obtained on arrival to the emergency department were negative.

Fecal occult blood testing would not be useful in this patient’s situation. The patient would require further evaluation, regardless of the results of the fecal occult blood test. An abdominal radiograph is useful in cases of acute abdominal pain for quickly identifying intraperitoneal free air. In this patient, however, whose examination was nonfocal and lacked peritoneal signs (absence of guarding and rebound tenderness), an abdominal radiograph is not the best test to diagnose the cause of her symptoms.

Ultrasonography is an accepted method for the evaluation of abdominal pain, especially if the gallbladder or a female pelvic pathologic disorder is suspected based on clinical presentation or examination findings. This patient’s presentation (diarrhea and gastrointestinal [GI] bleeding), her negative urine pregnancy test results, and the diffuse nature of her pain on examination do not point toward either of these causes. If her urine pregnancy test result had been positive, an ultrasound would have been an appropriate next step.

An abdominal CT would be the initial imaging test of choice. Abdominal pain and acute-onset diarrhea raise suspicion for colonic disease in this patient. A CT scan is the preferred initial screening test to rule out a colonic, versus an extracolonic, pathologic disorder. In addition, it provides information on all intra-abdominal and retroperitoneal structures.1 In women of childbearing age, a pregnancy test should be performed before proceeding with CT. Colonoscopy plays an important role in the evaluation of GI bleeding. In patients with ongoing hematochezia, a colonoscopy should be performed as soon as possible. In patients such as this one, in whom there is no sign of active bleeding, a colonoscopy can be performed on a semi-elective basis but would not be the initial diagnostic test.

An abdominal CT showed wall thickening and inflammation of the distal ileum and splenic flexure. The patient was admitted to the hospital for further evaluation. Overnight, her abdominal pain improved, but did not resolve, with supportive therapy. No additional episodes of emesis, diarrhea, or lower extremity weakness were observed.

The clinical presentation and CT findings suggest colitis. The differential diagnosis for the cause of colitis includes infectious, inflammatory, and ischemic etiologies. Imaging studies are nonspecific and do not differentiate between these etiologies of colitis.2

A serum lactate level could refer to either a serum l-lactate or a serum d-lactate level. An elevated serum l-lactate level would indicate either tissue hypoxia (type A lactic acidosis) or decreased clearance of lactic acid, which occurs most commonly with liver disease (type B lactic acidosis). d-Lactate is produced by bacteria in the gut and is metabolized slowly by humans. Patients with short-bowel syndrome can develop lactic acidosis from elevated serum levels of d-lactate.3 An elevated serum lactate level would not confirm the diagnosis of colitis or clarify the underlying etiology.

In the evaluation of suspected colitis, CT has largely replaced barium enema. A barium enema would not provide further diagnostic information beyond what is already known from CT, and residual contrast may hinder further diagnostic evaluations, such as endoscopy.1,4 Endoscopy is the preferred method for confirming the diagnosis and cause of colitis.1,2,4 In this patient, flexible sigmoidoscopy would not allow visualization of the affected areas of bowel; therefore, colonoscopy is the best test to confirm the diagnosis.

Mesenteric angiography would not be the next step in the evaluation of colitis. It may play a role in the evaluation of ischemic colitis if there is isolated right-sided colonic involvement (possible superior mesenteric artery occlusion) or if there is a question as to whether a patient has mesenteric ischemia or colonic ischemia.1,4

A colonoscopy was performed next and showed areas of irregular erosion and ulceration starting at the splenic flexure and involving the distal colon. The mucosa in the distal ileum, as well as the cecum; ascending, transverse, and sigmoid colon; and rectum, appeared normal. A biopsy of the area of segmental colitis showed edema and hemorrhage in the lamina propria and superficial epithelial necrosis.

In patients with findings of colitis on CT, stool antimicrobial assessment (including Clostridium difficile toxin testing) to assess for infectious colitis is often completed before proceeding with colonoscopy. In this case, stool antimicrobial assessment was initiated but not completed before colonoscopy. The patient’s ongoing abdominal pain and the distribution of colonic lesions on CT, which raised concern for skip lesions of Crohn disease, led to the pursuit of early colonoscopy. Stool assessment ultimately revealed few fecal leukocytes and a negative polymerase chain reaction result for Shiga toxin. The stool cultures for enteric pathogens were negative for Salmonella, Shigella, Campylobacter, Yersinia, and Aeromonas.

In ulcerative colitis, one would expect to see mucosal disease (erythema, edema, hemorrhage, or ulceration) starting at the rectum and extending proximally. Biopsy findings would include diffuse crypt architectural irregularity and reduced crypt numbers.5,6 The rectal mucosa was not involved in this case, making ulcerative colitis unlikely. Crohn disease could account for the colonic and distal ileal involvement seen on CT; however, on a colonoscopy one would expect to see a cobblestone pattern of ulcerations enclosing islands of normal mucosa.5 Biopsy findings would include granulomas and focal or patchy inflammation.6

Transient ischemic colitis is the most likely diagnosis in this case. The scattered erosions and ulcerations seen on the colonoscopy, combined with the biopsy findings of superficial mucosal edema, hemorrhage, and epithelial necrosis, are classic.7 Other findings on the colonoscopy in ischemic colitis include edematous and fragile mucosa, scattered erythema, purple hemorrhagic nodules, and sharp demarcation of the area of involved bowel. In severe forms of ischemic colitis, the mucosa appears cyanotic, and pseudomembranes, pseudopolyps, and pseudotumors may be seen. In gangrenous ischemic colitis, bluish-black mucosal nodules may be present.8

The clinical suspicion for infectious colitis was low in this case because the patient had no recent travel or dietary history to suggest exposure to enteric pathogens. Furthermore, results of stool studies were negative. The patient was treated supportively for a diagnosis of transient ischemic colitis based on her colonoscopy and clinical presentation. Her abdominal pain resolved, and she continued to remain free of recurrence of diarrhea or GI bleeding. She did not experience any recurrent lower extremity weakness with ambulation.

The right colon is infrequently involved in ischemic colitis. It most commonly involves watershed areas of the bowel, such as the splenic flexure and rectosigmoid junction.8 In one series, the splenic flexure was involved in 57% of patients, and the sigmoid and rectum were involved in 9%.9 Involvement of the left colon (80%) is much more common than that of the right colon (4.7%).8

The most common presenting symptoms of ischemic colitis include abdominal pain (49%-78%), GI bleeding (62%-77%), and diarrhea (33%-38%).8,9 Age is a risk factor for ischemic colitis, with elderly patients being at a higher risk than young, healthy patients. In addition, females are at higher risk for ischemic colitis than are males. Other risk factors include cardiovascular disease, hypertension, chronic obstructive pulmonary disease, constipation, and the use of predisposing medications (nonsteroidal anti-inflammatory drugs, diuretics, antihypertensives, laxatives, oral contraceptives, and anticonvulsants).1,2,8-10 Hypotension and hypovolemia, not cardiac thromboembolism, are the most common mechanisms by which ischemic colitis occurs.2

This patient’s clinical presentation with abdominal pain, GI bleeding, and diarrhea is consistent with a typical case of ischemic colitis. Her young age, lack of comorbid disease, and absence of predisposing medication use, however, make her case atypical. She was at risk for hypovolemia secondary to poor oral intake and exercise when her symptoms developed, and she was hypotensive at presentation. Her hypotension and hypovolemia were treated by intravenous fluid resuscitation with normal saline on hospital admission. The hypotension responded to fluid rehydration, with no further recurrence during hospitalization.

Most cases of ischemic colitis are of a mild form (transient ischemic colitis) that resolves with supportive measures, including intravenous hydration, hemodynamic stabilization, discontinuation of offending medications, bowel rest, and antibiotic drug therapy.2,4 It can be difficult on initial presentation to distinguish mild forms of ischemic colitis from severe forms that may require surgical intervention. One risk factor for more severe disease associated with worse outcomes is right-sided colonic involvement.11

Eighteen percent of patients develop chronic ischemic colitis.11 They may experience diarrhea, protein-losing enteropathy, or GI bleeding, and their disease may progress to stricture formation or gangrene.4 Malnutrition from protein-losing enteropathy and symptomatic stricture are indications for surgical intervention in patients with chronic ischemic colitis.2

The role of hypercoagulable states in the pathogenesis of ischemic colitis is unclear. There is no evidence that diagnosing and treating a hypercoagulable state in a patient with an initial episode of colonic ischemia is beneficial.

This young woman was treated conservatively with intravenous fluids and morphine. She was counseled regarding the importance of maintaining adequate hydration before, during, and after exercise. She was discharged from the hospital and did not report recurrence of abdominal pain or bloody diarrhea during 1-year follow-up.

Discussion

Ischemic colitis is a relatively uncommon condition, occurring at an incidence of 4 to 44 cases per 100,000 person-years in the general population, with a higher incidence in patients older than 65 years.10 In the young woman described in this case, ischemic colitis was not considered the most likely diagnosis on initial evaluation. The early CT findings of colitis involving the distal ileum and colon suggested an inflammatory etiology, namely, Crohn disease. Colonoscopy proved invaluable in making the diagnosis, as the pathologic findings in inflammatory and ischemic colitis are distinct. With the correct diagnosis, we were able to provide appropriate treatment for this patient.

Most cases of ischemic colitis are mild in severity and resolve with conservative therapy. Of patients whose disease initially resolves, 13% experience a recurrence of ischemia.12 Approximately 20% of patients with ischemic colitis have severe disease and, ultimately, require surgical intervention.4,12 Risk factors for severe disease include right-sided colonic involvement, peripheral vascular disease, atrial fibrillation, tachycardia, absence of GI bleeding, intensive care unit admission, requirement for vasopressor therapy, mechanical ventilation, intraperitoneal fluid on CT, and an increased serum l-lactate level at presentation.12 Clear indications for immediate surgical intervention include peritonitis and pneumoperitoneum.12 Fortunately, this patient remained hemodynamically stable in the hospital, and her symptoms resolved with conservative therapy.

This case raised a question as to the role of hypercoagulable states in ischemic colitis. Although there is no evidence that diagnosing and treating hypercoagulable states in patients with colonic ischemia is beneficial, expert consensus still favors oral anticoagulation in patients with severe or recurrent ischemic colitis in whom thromboembolism, secondary to a hypercoagulable state, is the most likely cause.2 Hypercoagulable states may play a larger role in younger individuals, such as this patient without other risk factors for colonic ischemia. Further study in this area is needed. We hypothesized that our patient’s transient ischemia was secondary to hypotension and hypovolemia, occurring with exercise and inadequate hydration and did not screen for hypercoagulable states. If she were to develop recurrent ischemia, it would be reasonable to screen for hypercoagulable states at that time and treat with anticoagulation if present.

Symptoms of Ulcerative Colitis and How It’s Diagnosed

How Is Ulcerative Colitis Diagnosed?

It’s important to see a doctor if you have some combination of the following symptoms:

• Persistent change in bowel habits (such as diarrhea for several weeks)
• Frequent stools
• Abdominal pain
• Blood or mucus in your stool
• Diarrhea that awakens you from sleep
• Unexplained fever lasting more than a day or two (2)

Your doctor will use your history of symptoms, a physical exam, and a number of tests to make a diagnosis.

At first, your doctor will investigate whether you have ulcerative colitis or another condition, such as an infectious form of diarrhea.

The tests used to diagnose ulcerative colitis can also help determine which type of the disease you have, on the basis of what areas of your colon are affected. (1)

Tests that may be used to diagnose ulcerative colitis and rule out other conditions include:

• Blood tests Your doctor may order these to check for anemia and infection.
• Stool analysis This can rule out conditions that may be mistaken for ulcerative colitis, such as infections caused by bacteria or parasites. White blood cells in your stool can be a sign of ulcerative colitis.
• Colonoscopy A colonoscopy is a procedure that uses a flexible tube with a camera to view the inside of your colon and obtain tissue samples for analysis.
• Flexible sigmoidoscopy Similar to a colonoscopy but less extensive, this procedure uses a flexible tube with a light to view just the lower portion of the colon. A definitive diagnosis of ulcerative colitis is generally made using endoscopy — that is, a colonoscopy or a sigmoidoscopy.
• X-ray A type of imaging, X-ray may be used on your abdominal area to look for serious complications.
• Barium enema This is an X-ray in which the colon is filled with liquid barium before images are taken.
• CT scan A computerized tomography scan, or CT scan, is a type of imaging that may be used on your abdomen or pelvis to see how much of the colon is inflamed and whether serious complications have developed. (2)

Ulcerative Colitis Complications

One of the most serious and potentially life-threatening complications of ulcerative colitis is toxic, or fulminant, colitis, also called acute, severe colitis, or toxic megacolon.

It occurs when a section of the colon becomes dilated and immobile, raising the risk of heavy bleeding, perforation, and peritonitis, an infection of the abdominal lining.

Common symptoms include pain, abdominal distension (bloating), fever, and a rapid heart rate.

In many cases, toxic colitis requires surgery to remove all or part of the colon and rectum. (3)

Possible complications of ulcerative colitis include:

• Back pain In some patients, ulcerative colitis is associated with a severe form of arthritis called ankylosing spondylitis, which affects the spine. The condition can lead to severe, chronic back pain.
• Eye problems Occasionally, people affected by UC will experience inflammation in their eyes. This can manifest in symptoms ranging from mild (redness, tearing, a burning sensation) to severe (blurred vision, headache, and eye pain). (4)
• High blood pressure Certain medications for ulcerative colitis, such as corticosteroids, are associated with a risk of high blood pressure. IBD can also increase the risk of blood clots. (5)
• Bowel cancer People with ulcerative colitis have a higher risk of colorectal cancer than the general population, and those with severe ulcerative colitis have the highest risk. But studies have shown that taking maintenance medication to prevent recurrence of active disease may lower your colon cancer risk. (2,6)
• Fertility issues Women who have undergone surgeries to treat their IBD, particularly colectomies with ileostomies or J-pouches for ulcerative colitis, do appear to have decreased fertility rates, according to the Crohn’s & Colitis Foundation. Generally speaking, though, women whose UC is in remission can become pregnant as easily as other women the same age. (7)

Ulcerative colitis is also associated with:

Signs of an Emergency

Toxic colitis is a life-threatening emergency.

Toxic colitis may occur rapidly and spontaneously for no apparent reason, or as a result of overusing certain kinds of medication, such as antidiarrheal drugs and some pain relievers. (8)

Symptoms of toxic colitis may include:

• Sudden, violent diarrhea
• High fever
• Abdominal pain
• Rebound tenderness (pain as your doctor removes pressure applied to your abdomen)
• Rapid heartbeat
• Altered mental state

Rebound tenderness is a sign of peritonitis, an infection of the lining of the abdomen. (8)

If you have toxic colitis, your doctor will probably hospitalize you for treatment.

In some cases, your doctor may prescribe high-dose, intravenous corticosteroid drugs to control your symptoms.

If this approach fails, your doctor may try other drugs.

In some cases, you will need surgery to remove the diseased portion of your colon. (8)

Can You Die From Ulcerative Colitis?

Ulcerative colitis usually isn’t fatal, according to the Mayo Clinic. But it can cause severe and even life-threatening complications. (2)

This means that ulcerative colitis is considered a serious illness, and you should treat its management and treatment with a similar seriousness.

Getting the right treatments for ulcerative colitis can cause a dramatic reduction in symptoms and possibly lead to lasting remission. (2)

Additional reporting by Jordan M. Davidson

Symptoms of bowel cancer | Cancer Research UK

Symptoms of bowel cancer can include a change in your normal bowel habit or blood in your poo. They can also be symptoms for other conditions, but it’s important to see your doctor.

Bowel cancer can start in the large bowel (colon cancer) or back passage (rectal cancer). It is also called colorectal cancer. 

If you notice any possible cancer symptoms or any changes that are unusual for you, contact your doctor because early cancer diagnosis saves lives. Due to coronavirus fewer people are contacting their doctor. Your local surgery is ready to help you safely. They can talk to you by phone or video link and can arrange for tests. Whatever happens, tell your doctor if your symptoms get worse or don’t get better. Early diagnosis saves lives. Contact your GP now or go to CRUK.org/coronavirus for more information.

Possible symptoms of bowel cancer

The symptoms of bowel (colorectal) cancer in men and women can include:

• bleeding from the back passage (rectum) or blood in your poo
• a change in your normal bowel habit, such as looser poo, pooing more often or constipation
• a lump that your doctor can feel in your back passage or tummy (abdomen), more commonly on the right side
• a feeling of needing to strain in your back passage (as if you need to poo), even after opening your bowels
• losing weight
• pain in your abdomen or back passage
• tiredness and breathlessness caused by a lower than normal level of red blood cells (anaemia)

Sometimes cancer can block the bowel. This is called a bowel obstruction. The symptoms include:

• cramping pains in the abdomen
• feeling bloated
• constipation and being unable to pass wind
• being sick

A bowel obstruction is an emergency. You should see your doctor quickly or go to A&E at your nearest hospital if you think you have a bowel obstruction.

Clive: I’m Clive Barley I’m from Lytham St Anne’s. I’m a retired HR manager. I was diagnosed in 2003 with bowel cancer.

For some reason I happened to kind of notice that I got blood in the stool one day when I went to the toilet. I kept that to myself but then it continued.

So after it had gone on for about a couple of weeks I did speak to my wife. And through the conversations it’s one of those things that you kind of, I don’t know I guess men are a bit like that aren’t they, in terms of this will go away it will sort itself out.

But with a little bit of persistence, I called it nagging, she said I think you better go and get it checked out. At that time you don’t want to kind of think its cancer because that happens to everybody else and not yourself.

When you have that conversation where the consultant tells you that it was caught in the early stages and it hadn’t spread anywhere else. On reflection you have to look back and say well that discussion that took place with my wife really saved my life.

Certainly going through the experience that I’ve been through I can highly recommend go and see the doctor. The early diagnosis of my cancer has led me on to have a wonderful other 9 years and hopefully a lot more years to come in the future.

Blood in poo

Blood in poo (stools or faeces) can be a sign of bowel cancer. But it is often due to other causes. See your GP if you are worried about any symptoms that you think could be caused by cancer in the bowel.

Most often, blood in the stool is from piles (haemorrhoids), especially if it is bright red, fresh blood. Piles are like swollen veins in the back passage. These veins are fragile and can easily get damaged when you pass a bowel motion, causing a little bleeding.

Blood from higher up in the bowel doesn’t look bright red. It goes dark red or black and can make your bowel motions look like tar. This type of bleeding can be a sign of cancer higher up the bowel. Or it could be from a bleeding stomach ulcer for example.

It is important to go to your doctor if you have any bleeding and get checked.

Your doctor won’t think you are wasting their time. It’s very likely that you’ll have a rectal examination. This means the doctor puts a gloved finger into your back passage and feels for anything abnormal. 

Your doctor might send you to the hospital for further tests.

When to see your doctor

Go to see your GP if you are worried about any of the symptoms mentioned above.

Remember these symptoms can be caused by other conditions. Many of these are much less serious than cancer, such as piles (haemorrhoids), infections or inflammatory bowel disease. 

Abdominal Pain (Stomach Pain), Long-term

Stomach ache and abdominal pain

A stomach ache, including stomach cramps or abdominal pain, doesn’t usually last long and isn’t usually caused by anything serious. 

Some common causes of a stomach ache include:

Speak to your pharmacist for advice about medications to help ease symptoms of these conditions.

If you have diarrhoea and vomiting, it will usually clear up by itself within a week.

Read about what to do if you have diarrhoea and vomiting.

When to get medical advice

See your GP or call NHS 111 if you’re worried or need advice about your symptoms.

For example, if:

Call 999 for an ambulance or go to your nearest hospital accident and emergency (A&E) if you:

• have sudden, severe stomach pain
• feel pain when you touch your stomach
• are vomiting blood 
• have bloody or black, sticky stools
• aren’t able to urinate
• have collapsed or can’t breathe
• you’re diabetic and vomiting

If you feel pain in the area around your ribs, read about chest pain for information and advice.

Causes of sudden, severe abdominal pain

Some of the possible causes of sudden, severe abdominal pain include:

• appendicitis – swelling of the appendix that causes agonising pain in the lower right-hand side of your abdomen
• a bleeding or perforated stomach ulcer – a bleeding, open sore in the lining of your stomach
• acute cholecystitis – an inflamed gallbladder, often caused by gallstones
• kidney stones – small stones may be passed out in your wee, but larger stones may block the kidney tubes
• diverticulitis – a type of inflammation in the bowel
• a pulled muscle in your abdomen, or an injury

Causes of long-term or recurring abdominal pain

Some of the possible causes of long-term or recurring abdominal pain include:

Possible causes in children include:

Page last reviewed: 04/07/2017

Next review due: 04/07/2020

Right Lower Abdominal Pain | Right Lower Quadrant

Where is my right lower quadrant?

The right lower quadrant (RLQ) is a section of your tummy (abdomen). Look down at your tummy, and mentally divide the area from the bottom of your ribs down to your pubic hair into four quarters. The quarter on your right side below your belly button is your RLQ.

Abdominopelvic Quadrants

By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

By Blausen.com staff (2014). “Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. 

What is in my right lower quadrant?

Quadrant organs

By Mariana Ruiz Villarreal, modified by Madhero88 [Public domain], via Wikimedia Commons

By Mariana Ruiz Villarreal, modified by Madhero88 [Public domain], via Wikimedia Commons

• Small bowel (ileum).
• The connection between your small bowel and your large bowel (caecum).
• Appendix.
• First part of your large bowel (colon).
• Right ureter (at the back of the other organs).
• Right ovary and Fallopian tube.

And don’t forget the skin, muscles and nerves of that area.

What are the most common causes of right lower quadrant pain?

The list of causes of RLQ pain is extremely long but the following are some of the more common possibilities. They are not in order of how common they are.

What are the gut problems that can cause right lower quadrant pain?

All sorts of common and uncommon problems to do with your guts can give you pain in this area. For example:

Constipation

• If your guts are full of poo (faeces) this can cause discomfort anywhere in your tummy.
• You will normally be aware that you are not opening your bowels as often as usual.
• Your poo will be hard and pellet-like.

See the separate leaflet called Constipation for more information.

Gastroenteritis and food poisoning

• These conditions cause diarrhoea.
• They may also make you sick (vomit).
• Pain may be anywhere in the abdomen (tummy).
• Pain may ease for a while each time some diarrhoea is passed.

See the separate leaflets called Gastroenteritis and Food Poisoning for more information. 

Irritable bowel syndrome (IBS)

• This is very common.
• It tends to cause crampy tummy (abdominal) pains.
• It often causes bloating.
• It comes and goes and may be associated with diarrhoea and/or constipation.

See the separate leaflet called Irritable Bowel Syndrome for more information.

Appendicitis

• Usually the pain starts in the middle of the tummy over the period of an hour or so.
• Typically it moves to the RLQ over the next few hours.
• It tends to be sharper if you cough or move suddenly.
• It may ease a bit if you pull your knees up to your chest.
• You may also feel sick (nausea) and go off your food.
• You may have a temperature (fever) and will feel generally unwell.
• If the appendix bursts then pain can be severe and all over your tummy.

See the separate leaflet called Appendicitis for more information.

Diverticulitis

• This is an inflammation of a pouch or pouches which people who have diverticular disease have in their guts.
• Usually pain from diverticular disease is in the left lower quadrant (LLQ) but it can be on the right or sometimes can be felt higher up.
• It usually comes with a temperature and a change in bowel habit (opening your bowels more or less often than usual for you).

See the separate leaflet called Diverticula (Diverticulosis, Diverticular Disease, Diverticulitis) for more information.

Trapped inguinal or femoral hernia

• A right inguinal or femoral hernia happens when a piece of bowel or other tissue from inside the tummy pushes through a weakness in the muscles of the tummy wall near the right groin.
• It can happen on either side.
• If whatever has pushed through gets stuck and can’t slide back inside the tummy, it is trapped (incarcerated).
• If it happens on the right-hand side, there will be a tender swelling in the right groin.
• It causes pain in the groin and in the tummy, usually on the side of the hernia but it may cause pain over the whole tummy.
• It is common to be sick (vomit).

See the separate leaflet called Hernia for more information.

What is a common kidney problem that can cause right lower quadrant pain?

Kidney infection

• A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, around the side and down to the RLQ.
• You may notice that it hurts when you pass urine and that you need to pass urine more often.
• You may have a temperature.

See the separate leaflet called Kidney Infection (Pyelonephritis) for more information.

What are the problems that only women get that can cause right lower quadrant pain?

Mittelschmerz

• This is pain when you release an egg (ovulation), which is usually about halfway between two periods.
• It can be very severe and stop you short but usually eases over several minutes.
• It will only be felt on one side but can be right or left. You may get similar pain on the same or other side of your tummy at the same point in another cycle.

Pelvic inflammatory disease

• Pain is usually on both sides but may just be in the RLQ.
• Pain is worse during sex.
• There is abnormal bleeding, so bleeding not just at period time but in between periods and often after sex.
• You may feel generally unwell and feverish.
• There is usually a vaginal discharge, which may be smelly.

See the separate leaflet called Pelvic Inflammatory Disease for more information.

Twisted ovary

• Twisted ovary (ovarian torsion) usually only occurs if a fluid-filled sac (cyst) has developed on the right ovary.
• Pain can be constant or intermittent.
• Symptoms can be similar to appendicitis.

See the separate leaflet called Ovarian Cyst for more information.

Endometriosis

• Sometimes endometriosis can cause constant lower tummy pain, although usually it is worse just before, during and for a short while after a period.
• Pain is usually across the lower part of the tummy but it can be just on the right side.

See the separate leaflet called Endometriosis for more information.

Ectopic pregnancy

You should always see a doctor urgently if there is any chance that you may be pregnant and are experiencing right lower quadrant pain. You could have an ectopic pregnancy.

See the separate leaflet called Right Lower Quadrant Pain in Pregnancy for causes of abdominal pain in pregnancy.

What are the problems that only men get that can cause right lower quadrant pain?

Any pain coming from the right side of the scrotum can cause pain in the RLQ but usually the pain in the scrotum will be worse.

Torsion of the testicle

• Torsion of the testicle (testis) causes severe pain in the scrotum and severe lower quadrant pain, usually on one side.
• It most commonly affects teenage boys but young adult men can be affected.
• It is unusual over the age of 25 years but can affect any man at any age.
• The testicle is very tender.
• You should seek urgent medical advice.

See the separate leaflet called Torsion of the Testis for more information.

Epididymo-orchitis

• Epididymo-orchitis is an inflammation of the testicle and/or the tubes surrounding it (epididymis).
• It is caused by a germ (infection).
• The affected side of the scrotum swells and goes very red and tender.

See the separate leaflet called Epididymo-orchitis for more information.

What are the other possible causes of right lower quadrant pain?

Inflammatory bowel disease

Crohn’s disease and ulcerative colitis are forms of inflammatory bowel disease (IBD). IBD is not to be confused with irritable bowel syndrome (IBS) which is very different. These conditions cause the lining of the gut to become inflamed. Diarrhoea (sometimes with blood mixed in) is usually the main symptom.

• Crohn’s disease:
• Any part of the gut can be affected and the pain depends on which part is affected.
• The most common place for it to start is at the end of the small intestine (ileum) causing RLQ pain.
• This is where the appendix is and the symptoms can be very like appendicitis.

See the separate leaflet called Crohn’s Disease for more information.

• Ulcerative colitis
• Diarrhoea is often mixed with mucus or pus.
• Blood mixed with the diarrhoea is common.
• The tummy (abdominal) pain is typically crampy.

See the separate leaflet called Ulcerative Colitis for more information. 

Colon cancer

• Colon cancer is one of the most common cancers in the UK (in contrast, cancer of the small intestine is rare).
• Although it can affect any part of the large bowel (colon), it commonly affects the last part (descending colon) which is on the left-hand side.
• Pain is more likely to be in the left lower quadrant (LLQ) than the RLQ.
• There is usually a change in how often you need to open your bowels and you may notice that you have lost weight, without trying.

See the separate leaflet called Colon, Rectal and Bowel Cancer (Colorectal Cancer) for more information.

Kidney stones

• Kidney stones are hard stones that can form in the kidney, in the tube (the ureter) draining urine from the kidney, or in the bladder.
• A stone that passes into the ureter draining urine from your right kidney may cause pain that starts in your right loin and spreads (radiates) to your groin and RLQ, or into your testicle (testis) if you are a man.
• You may notice blood in your pee.

See the separate leaflet called Kidney Stones for more information.

Shingles

• In some cases you may have pain from shingles before a blistery rash appears.
• Pain tends to be sharp or burning.
• You may not feel quite yourself.
• The tummy (abdomen) is a common place for shingles rash.

See the separate leaflet called Shingles (Herpes Zoster) for more information.

Abdominal aortic aneurysm

• An abdominal aortic aneurysm is a swelling of the largest blood vessel in the body (the aorta) inside the abdomen.
• It doesn’t usually cause any symptoms but can occasionally cause pain before it bursts. The pain is usually felt in your back or the side of your tummy (abdomen) but it can occasionally be felt in the right (or left) lower quadrant.

See the separate leaflet called Abdominal Aortic Aneurysm for more information.

What else could it be?

These lists of possible causes for RLQ are by no means exhaustive and there are many other conditions that can cause pain in the RLQ. Problems in your spine or back could be ‘referred’. Referred pain in this situation means that it is coming from your back but you are feeling it around the front. Muscular pulls and sprains can also affect you in the tummy area. If this is the case, moving the particular muscle would make the pain worse, whereas if you were to lie completely still, it wouldn’t hurt.

Should I see a doctor?

Yes, if you have a pain which doesn’t settle, you will probably need to see a health professional to help you figure out the cause. See a doctor urgently if you:

• Have very severe pain.
• Have persistent sickness (vomiting).
• Have recently lost weight without trying to do so.
• Have persistent diarrhoea.
• Feel giddy, light-headed, faint or breathless.
• Are bringing up blood or have blood in your poo (faeces).
• Have a change from your usual bowel habit. This means you may open your bowels more or less often than usual, causing bouts of diarrhoea or constipation.
• Could be pregnant.

What are the usual tests for right lower quadrant pain?

Your doctor will narrow the (enormous) field of possible RLQ pain diagnoses by talking with you and examining you. They may be able to find the cause simply by doing so. For example, if they find the typical rash of shingles, you will need no further tests to find the cause. The doctor will certainly need to feel your tummy (abdomen) in the area you have the pain, but may also need to examine other parts too, such as the rest of your tummy.

You will probably be asked to provide a sample of urine, to rule out kidney problems.

You may well have to go for blood tests. These might include tests to:

• Check the function of your liver and kidneys.
• Rule out any inflammation or infection in your body.
• Look for anaemia.
• Check your sugar level.

What other tests might be needed for right lower quadrant pain?

Next it will depend on what the examination and the tests above have suggested. In some cases no further tests will be needed – if, for example, your doctor is confident you have constipation or shingles.

If a problem with your large bowel is suspected, you may need an examination with a tube with a camera put into your large bowel (a colonoscopy). A computerised tomography (CT) scan or an ultrasound scan may be helpful to look for diverticula and to look at your kidneys. These tests are also used in women to look at the ovary and tubes. In some cases an X-ray of the tummy may be useful. Further tests include other ‘scopes’ (such as a sigmoidoscopy) and other scans (such as a magnetic resonance imaging (MRI) scan).

If it is thought you have appendicitis, an ectopic pregnancy (women) or a torsion of your testicle (testis) – men, you may only have one or two of these tests before having emergency surgery to treat your problem.

Nobody will need all these tests, and some people may not need any.

What treatment will I need for right lower quadrant pain?

There is no single answer to this until you know what the cause of your pain is. See the relevant leaflet for the condition with which you have been diagnosed. Treatments for a few of the causes of RLQ pain are briefly discussed below.

• Constipation can be treated with medicines, but often changes to your diet are needed to prevent it happening again.
• Gastroenteritis usually doesn’t need any treatment, other than drinking plenty of fluid to compensate for all that is being lost. Occasionally when germs (bacteria) which can be treated with antibiotics are causing the infection, an antibiotic may help.
• Appendicitis is cured with an operation (an appendicectomy).
• Ectopic pregnancy is usually treated by an operation but medical treatment is now more common. This avoids the need for surgery and means the tube is less likely to be permanently damaged.
• Shingles. The pain and rash settle on their own in time, but some people may be advised to take an antiviral tablet to help speed this process up.
• Kidney infections are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for antibiotics and fluids through a drip (intravenously).
• Kidney stones. Small kidney stones pass on their own eventually, in which case you will need to drink plenty of fluids and take strong painkillers. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.

What is the outlook?

Again this depends entirely on the cause of the pain. Some conditions settle very quickly on their own (for example, gastroenteritis), or with the help of antibiotics (for example, a kidney infection). Others can be cured with surgery, such as appendicitis or torsion of the testicle (testis). Some are long-term conditions, for which there is no cure although there are treatments, such those used for people who have Crohn’s disease. Your doctor should be able to give you an idea of the outlook (prognosis) once a diagnosis has become clear.

Differences between ulcerative colitis and Crohn’s disease

Ulcerative colitis – symptoms, causes, treatment

This ailment has recently been encountered more and more often, and not only among the elderly, but also among young people.If before the “stomach” complained mainly of townspeople, today the disease “captures” and rural areas. What are the reasons and how to deal with the situation?

These questions are answered by the gastroenterologist of the OKDC, the head of the center for gastroenterological diagnostics, Candidate of Medical Sciences Natalya Timchenko.

– Natalya Alekseevna, it’s no secret that the effectiveness of the treatment of any disease directly depends on early detection and competent, timely diagnosis.What symptoms should alert a person and tell him that it is time to see a specialist in order to detect an ailment at an early stage?

– The manifestations of ulcerative colitis and their severity are very different. In some patients, for many years, quite a decent state of health remains, and the disease manifests itself only with an admixture of blood in the stool. Such patients often associate this symptom with hemorrhoids, refuse a full examination and are addicted to self-medication. Others, on the contrary, from the very beginning of the development of ulcerative colitis are hospitalized with repeated bloody diarrhea, fecal incontinence, high fever, abdominal pain, palpitations and general weakness.

The most specific symptoms of ulcerative colitis are: blood, mucus and pus in the stool, diarrhea, or vice versa, constipation, which often indicate an inflammatory lesion of the lower parts of the colon. Sometimes patients have a false urge to have bowel movements, nocturnal bowel movements, fecal incontinence, bloating and pain in the left abdomen.

In severe and widespread inflammation, fever, vomiting, heart palpitations, weight loss, dehydration, and loss of appetite appear.In 10% of cases, in addition to the aforementioned intestinal and general symptoms, extraintestinal manifestations occur: articular lesions, various rashes on the skin and mucous membranes – for example, in the mouth, liver and bile duct damage; thrombus formation.

– Symptoms, frankly, are unpleasant. The question immediately arises – why did the disease arise and how to avoid it …

– Despite numerous scientific studies, all the causes of ulcerative colitis of the intestine have not yet been established.It has been suggested that the disease can be provoked by an unidentified infection, although ulcerative colitis is not contagious, or an unbalanced diet with a lack of fiber, genetic mutations, drugs – certain non-hormonal anti-inflammatory drugs, as well as stresses and shifts in the intestinal microflora. Dysbiosis can be a trigger for ulcerative colitis; sedentary lifestyle; a diet low in dietary fiber and high in carbohydrates; dysbiosis; neuropsychic overload.

– Is it possible in this case to take some preventive measures …

– Methods of prevention are well known. You need to eat right, avoiding too fatty, spicy and salty foods, do not abuse alcohol, lead an active lifestyle, without exposing yourself to unnecessary stress, physical and mental overload. And with the slightest discomfort and pain, I recommend that you immediately contact a competent specialist in order to establish an accurate diagnosis and develop an individual treatment tactics.

– What is the mandatory standard of gastroenterological examination today?

These are primarily instrumental types of survey. Gastroscopy and Colonoscopy. The OKDC performs diagnostic gastroscopy and colonoscopy using high-tech video information systems of the expert class “EVIS EXERA 2” and “EVIS EXERA 3” complete with video endoscopes with narrow-spectrum and magnification functions, as well as video archiving of the revealed pathology.

Equipping the endoscopic department of the OKDC allows you to significantly expand the diagnostic capabilities – to obtain an image of the smallest details, to identify and classify structural changes in the mucous membrane of internal organs so as not to miss tumor pathology.

Our specialists perform a wide range of endoscopic examinations and manipulations:

• videoesophagogastroduodenoscopy (VGDS) – assessment of the state of the mucous membrane of the esophagus, stomach and duodenum;

• video colonoscopy (VKS) – assessment of the state of the mucous membrane of the large intestine;

Serious attention is paid to the morphological diagnostics of the detected endoscopic pathology.In almost 100% of studies, a biopsy of the mucosa is performed for cytological and histological studies, and express tests are carried out.

Gastrointestinal endoscopic tissue biopsies are usually performed from any suspicious area. This is the standard that allows early detection of gastrointestinal cancer and its successful treatment. If cell degeneration is detected at the very beginning, then their early endoscopic removal without surgery is possible.

– Is it possible to cope with an illness without surgery?

In the treatment of ulcerative colitis, both conservative and surgical methods are used, the choice depends on the patient’s condition and the nature of the course of the disease.

Drug treatment of ulcerative colitis is based on the use of anti-inflammatory, non-steroidal drugs. In addition, patients are shown the use of symptomatic pain relievers, physiotherapy: interference therapy, diadynamic therapy.

After the period of exacerbation of the disease has passed, the patient should take anti-inflammatory drugs for another six months. Then a control colonoscopy is performed. If there are no inflammatory processes on the mucous membrane of the large intestine, then the treatment process is completed.

Diet food is of great importance in the treatment of ulcerative colitis. If the disease is severe, then when it worsens, the patient is advised to completely abandon food and drink only water.

A diet for ulcerative colitis during an exacerbation is needed to reduce irritation of the intestinal mucosa and to stop diarrhea. Foods that contain fiber and dietary fiber, as well as sour and spicy foods, rough foods, and alcoholic beverages should be excluded from the diet. Since the inflammatory process in the large intestine leads to depletion of the body, the diet for ulcerative colitis outside the period of exacerbation involves the use of high-calorie foods rich in proteins and vitamins.You need to eat at least six times a day in small portions.

Spices, sauces, fried and fatty foods, raw vegetables and fruits are excluded from the diet. You should be careful about the use of dairy products. Allowed: fish, lean meat (turkey, beef, rabbit, chicken) in boiled and baked form, cereals, soups on fat-free fish and meat broth, eggs, rice, potatoes, jelly, jelly from various fruits and berries, dried bread, cottage cheese souffle. You can drink black coffee, tea, cocoa in water, decoctions of bird cherry, rose hips, blueberries.And only in cases of ineffective conservative treatment, surgical intervention is used.

Pelvic stasis syndrome

To change the language click on the British flag first

Pelvic congestion syndrome is based on a congestion of venous blood in the pelvic region, mainly in the so-called small pelvis. This can happen in two ways.

In the simplest case, the veins that drain blood from the pelvis into the inferior vena cava are too narrow, compressed or blocked.
In addition, blood from the left renal vein can be diverted to the pelvic organs (see Nutcracker Syndrome) and then contribute to pelvic vein congestion

Both possibilities often occur together and result in particularly severe symptoms.

1. The following symptoms are observed: abdominal pain (often left-sided)
2. severe pelvic pain (between symphysis and navel)
3. increased menstrual cramps
4. heavy or heavy menstrual bleeding
5. pain during intercourse (dyspareunia)
6. pain in the external genital organs – sometimes irreplaceable in the seizure of the pudendal nerve (pudendal neuralgia)
7. persistent unpleasant sexual arousal
8. congestion in the genital area (especially in women who have had multiple births)
9. vulvar swelling – constant tension inside the vulva
10. pain with intestinal movements
11. urgency and painful urination
12. bloody urine (mainly in the form of invisible traces, detected only under a microscope or using a urine test strip – microhematuria)
13. hemorrhoids – bleeding during bowel movements
14. deep anal pain
15. Varicose veins in the groin and on the external genitals
16. fullness weakness of the left and then the right leg.
17. swollen legs
18. thrombus formation – often predominantly of the left leg
19. erectile dysfunction – sometimes priapism (unpleasant prolonged erection of the penis)
20. varicocele (filling the sac of the scrotum with vermiform venous vessels – sometimes painful, often uncomfortable, sometimes interferes with spermatogenesis)

Since the outflow from the left-sided veins, as a rule, is especially difficult due to lordosis of the lumbar spine and the protruding sacrum, pain is especially common in the left lower abdominal region or left testicle.Blood flow from the left renal vein through the ascending lumbar vein, and the ovarian vein in the pelvis connects to the inferior vena cava, which flows to the right of the spinal column. To get there, the preferred route is by transfusing blood from the pelvic organs into the deep left iliac vein, from where it flows into the left large iliac vein (Vena iliaca communis sinistra), and from there through the so-called cape into the lower iliac cavity of Vienna.

Chronically overstressed veins meander like so-called varicose veins (“varicose veins”) and cause pain that develops in the vein wall itself and in overcrowded organs.Basically, women complain of pain in the left lower abdomen (left ovary area), and men complain of pain in the left testicle.

Sketch of typical supply pathways: Blood from the left kidney works against the forceps, then turns down to the left ovarian vein into a vast pool of retroperitoneal veins around the uterus. From there, through the veins on the right side of the uterus, it reaches the inferior vena cava (MR angiogram)

Upper abdomen cross-section – bottom view Magnetic resonance imaging and ultrasound can show stagnation of the left renal vein with its dilatation and the path of blood through the trunc of reno-rachidin to the veins of the spinal column

Representation of left-sided collateral veins along the spine and brain in MR-angiography

Here pain in the left lower abdomen or in the left testicle is a consequence.Blood flow entering the pelvis through the ascending lumbar vein and the ovarian vein now connects to the inferior vena cava, which runs to the right of the spinal column. To get there, the preferred method is by transfusing blood from the pelvic organs into the deep left iliac vein, from where it flows into the left large iliac vein (Vena iliaca communis sinistra) and from there along the so-called promontory into the lower iliac cavity. The promontorium is the aforementioned hill formed by the connection of the sacrum with the lumbar spine and protruding far forward, especially in women.Blood from the left pelvis and left leg should now cross this hill on one side, but there it is pressed against the bony structures by arteries lying on the veins, mainly to the right pelvic artery. This situation is called the May-Turner constellation after the first descendants, two Swiss doctors.

Please see our Medical Explanation Notes on this site.

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Bowel cancer.With what symptoms you need to urgently run to the doctor | HEALTH

In recent decades, the incidence of colorectal cancer has increased significantly. If we compare the situation with the 60s. last century, then rectal cancer then accounted for 1.2% of all malignant tumors, colon cancer – 1.8%. In 2017, the statistics looks like this: 5.2% and 7.3%, respectively.

The other day, at the Perm Regional Oncological Dispensary, a 74-year-old patient underwent a laparoscopic operation to remove a large right-sided intestinal tumor.Not only oncologists, but also journalists were invited to the surgical intervention, which was broadcast on the screen in 3D.

After successful completion of operation , deputy. Chief Physician of the Perm Regional Oncology Center, Doctor of Medical Sciences, Professor Oleg Orlov spoke about the causes, symptoms and diagnosis of a dangerous disease. Read more about this in the material “AiF-Prikamye”.

Where do they get sick more often?

“The incidence of colorectal cancer is growing in rich industrialized countries, which include Russia,” explains Oleg Orlov.- This is due, first of all, to a change in the structure of food. People often allow themselves delicacies: caviar, sturgeon, red fish, smoked sausages. And such food does not allow the intestines to work actively. For good peristalsis, he needs coarse fiber and fibrous tissue that vegetables and fruits contain. ”

The result of eating delicacies is frequent constipation. And the treatment of the disease is one of the problems of modern health care. This is becoming so relevant that in countries where tourism is well developed, this fact is already taken into account.In hotels, guests are sure to be offered steamed prunes, dried apricots, figs for breakfast.

Risk factors

Constipation is a major risk factor for cancer. If the intestines are emptied daily and in a timely manner, then carcinogenic gases and feces do not have time to actively affect its mucous membrane. And in the case of constipation, the concentration and time of exposure to toxins on the mucous membrane of the colon and rectum increases.

Another risk factor for bowel cancer is chronic colitis, when the inflammatory process manifests itself as a change of constipation and diarrhea.A person experiences discomfort and pain in the abdomen, he often has swelling and seething. There are times when the temperature rises.

“Massive advertisements of medicines that are shown on TV often cause great harm to the patient. To relieve symptoms, a person self-medicates, takes advertised drugs, without really understanding what is happening in his body. As a result, the process of going to a doctor is delayed for years. The following rule should be remembered: if you have health problems, you need to go to a general practitioner.He will already decide whether to examine you or refer you to a narrow specialist, ”says Oleg Alekseevich.

Endoscopic (through puncture) surgery to remove rectal cancer is more gentle. Photo: AiF / Alena Ovchinnikova

Another risk group includes those who have a hereditary disease – familial polyposis. After all, a malignant tumor can develop from a polyp. If one of the relatives had a disease, it would be useful to consult a doctor and undergo a routine examination.

Male or female problem?

Based on experience, bowel cancer is more common in women than in men.Despite the fact that women are more closely monitoring their health, it is rarely possible to detect cancer of the rectum and colon in the early stages. And this is a common problem of detecting oncological diseases: in the early stages, they are asymptomatic. Therefore, many patients come to doctors at best in the second and sometimes even in the third stage of cancer.

A considerable percentage of the sick turn up only when they are diagnosed with the fourth stage of the disease. A person goes to doctors for another problem.He is worried about severe pain in the liver or a persistent cough, and examination reveals that he has metastases in the lungs and liver.

Doctors begin to look for the root cause and often find colon and rectal cancer. When they begin to ask the patient about their well-being in detail, they find out that the problems were a long time ago, but he pulled it to the last with an appeal to the doctor.

“It is impossible to cure the fourth stage, and you definitely need to know about it! Of course, an operation can be performed, but it will be purely palliative in order to prolong the patient’s life, ”the doctor warns.

There is no cure for stage four cancer. An operation can be performed, but it will be purely palliative in order to prolong the patient’s life. Photo: AiF / Alena Ovchinnikova

It is often possible to detect cancer in the early stages, doctors say, during a regular clinical examination in a polyclinic, because a general examination necessarily includes a digital examination of the rectum. Another thing is that patients themselves often refuse to carry out such a diagnosis.

What symptoms should alert you?

There are few signs of colorectal cancer, but if they are, then it is worth making an appointment with a doctor in a timely manner.

What should alert you? Cancer of the right half of the colon is characterized by an unreasonable increase in temperature. She can rise and hold on for several days, then it becomes normal, and after a while the situation repeats again.

Next – dizziness associated with anemia. Since even a small cancer always bleeds, a person gradually develops anemia. You should be on your guard if you notice the presence of dark blood and a large amount of mucus in the stool.

The following symptoms are false desires, when after a bowel movement there is no feeling that it is empty. Also, the patient may be disturbed by point pains in the right half of the abdomen. This is a manifestation of the developed inflammation against the background of a malignant tumor. It happens that the tumor on the right can sometimes be felt by both the patient and the doctor.

With cancer of the right side of the intestine, there is no obstruction, the patient is worried about aching pains, and with cancer of the left side, unfortunately, acute intestinal obstruction may develop.With a sharp acute paroxysmal pain, people end up in emergency surgical departments, and already during the operation they have a tumor.

What does a doctor do?

First of all, a narrow specialist oncologist will conduct a digital examination of the rectum. This will eliminate hemorrhoids and polyps. Then he himself will build a method of examination and treatment. More often, to confirm the diagnosis, an examination, which is usual for such diseases, is prescribed – rectoscopy and colonoscopy.

Many people are concerned about the question: how quickly does rectal cancer develop? According to oncologists, all malignant tumors develop from three to ten years before the onset of clinical manifestations.Therefore, any disease, when detected, will be at least three years old. But how long the process will take from the first to the fourth stage, not a single doctor will tell you. In this matter, everything is individual and depends on the level of tumor malignancy, human immunity and on many other indicators.

How is the operation performed?

Endoscopic (through puncture) surgery to remove rectal cancer is more gentle. They allow the patient to quickly leave the surgical department and begin the treatment prescribed by the doctor.However, endoscopic surgeries are performed in the Perm Territory not as often as abdominal surgeries.

Endoscopic surgeries are performed in the Perm Territory not as often as abdominal surgeries. Photo: AiF / Alena Ovchinnikova

In some cases, the operated patients have relapses. The triggering mechanism for the manifestation of metastases can be stressful situations that occur with a person: seriously ill with the flu, lost a loved one, fired from work, robbed. During such a period, the level of the immune response and immune defense decreases in a person, and cancer cells begin to multiply faster and manifest themselves as distant metastases.

From 50 to 60% of the operated patients with colorectal cancer of the first-third stage survive the five-year milestone. The statistics are as follows: if rectal cancer was removed in the first stage, then more than 80% of patients live longer than five years, in the second – 70%, in the third – 50% and below.

If we talk about cancer prevention, then everyone thinks: do not eat one, do not drink another, and you will be happy. However, there is no primary prevention in oncology. Moreover, you cannot be vaccinated against cancer, for example, against the flu or measles.However, you should definitely listen to the body and consult a doctor in a timely manner with the above symptoms!

Colon cancer | Oncological dispensary of St. Petersburg

General information

Hereditary and sporadic (randomized) colon cancer are distinguished. The development of hereditary cancer is genetically associated with some polyposis or non-polyposis syndromes. Hereditary diseases such as familial diffuse polyposis, Gardner’s syndrome and Turkot’s syndrome are associated with an extremely high risk of developing colon cancer.Hereditary non-polyposis cancer is associated with mutations in genes responsible for DNA repair. By the age of 70, colon cancer is diagnosed in about 80% of carriers of these mutations. In addition, first-degree people with colon cancer have a high risk of developing the disease.

The most important exogenous factors affecting the occurrence of sporadic colon cancer are diet, obesity and physical inactivity (sedentary lifestyle).The incidence of colon cancer is higher in those countries where meat predominates in the diet of the bulk of the population and the consumption of vegetable fiber is limited. Meat food causes an increase in the concentration of fatty acids, which are converted into carcinogenic agents during digestion. A lower incidence of colon cancer is observed in rural areas and countries with traditional plant-based diets (China, India, countries of Central Asia and Central Africa). According to the chemical theory of the origin of colon cancer, the malignant process is due to the mutagenic effect of a number of exo- and endogenous chemicals (carcinogens) on the cells of the intestinal epithelium.The most carcinogenic are polycyclic aromatic hydrocarbons, aromatic amines and amides, nitro compounds, and also metabolites of tryptophan and tyrosine. Carcinogenic substances (benzpyrene) can be formed by improper heat treatment of food, smoking meat and fish. As a result of the effect of carcinogens on the cell genome, point mutations occur, leading to the transformation of cellular protooncogenes into active oncogenes. The latter transform a normal cell into a tumor cell.

Inflammatory bowel disease (IBD) is another proven risk factor for colon cancer. It was found that in patients with Crohn’s disease, colon cancer occurs 2.5 times more often than in healthy people. Also, a high correlation has been proven between ulcerative colitis and colorectal cancer, especially in cases of widespread lesions of the ulcerative process of the colon with a history of the disease for more than 10 years. Colon cancer in such patients is diagnosed in 5.2-30% of cases.

Colon polyps also significantly increase the risk of malignant tumors. The malignancy index of single polyps is 2-4%, multiple (which can be counted) – 20%, villous formations – up to 40%. Colon polyps are rare at a young age, and often occur in older age groups. According to the literature, the incidence of polyps at autopsies is about 30%.

Colon cancer develops in accordance with the basic laws of growth and spread of malignant tumors: relative autonomy and unregulated growth of tumor cells, a decrease in their differentiation, loss of organo- and histotypic structure.At the same time, there are some peculiarities. Thus, the growth and spread of colon cancer occurs significantly more slowly than similar processes, for example, in cancer of the stomach and pancreas. A colon tumor does not spread beyond its wall for a long time.

Stages of colon cancer

There are three stages in the development of the tumor process:

• Stage I and II – the tumor is limited to the large intestine itself (possibly with growth to neighboring organs)
• Stage III – tumor metastases appear in regional lymph nodes
• Stage IV – distant tumor metastases appear (liver, lungs, peritoneum, distant lymph nodes, brain, etc.))

I – III stages can be considered potentially curable. Stage IV is subject to palliative treatment (regarded as a chronic, incurable disease). It should be noted that even at stage IV, prolonged life extension is possible. Currently, there is a certain percentage of patients going through the 10-year milestone from the moment of detection of stage IV colon cancer.

The lower the differentiation of the tumor, the higher its degree of malignancy (faster tumor growth and earlier metastasis).Colon cancer metastasis occurs by lymphogenous (most common), hematogenous and implantation pathways. Lymphogenous metastasis occurs along the vessels feeding the intestine, as well as in the lymph nodes of the mesentery. Hematogenous metastases are most often found in the liver, lungs, and brain. Implantation metastases occur as a result of the growth of all layers of the intestinal wall by the tumor and the spread of tumor cells along the peritoneum (peritoneal carcinomatosis).

Clinical presentation of colon cancer

Colon cancer is a polysymptomatic disease.Its clinical manifestations depend on the localization of the tumor (in the right or left half of the colon), the nature of its growth, the size of the tumor, the stage of the malignant process, and the presence of complications. Early forms of cancer are almost always asymptomatic and are detected during colonoscopy for other diseases or during dispensary examination.

Most patients go to the doctor about the appearance of blood or mucus in the feces, stool disturbances in the form of constipation or, conversely, diarrhea, as well as changes in the shape of feces, due to intestinal discomfort, pain in the abdomen, deterioration of the general condition.

With tumors of the right half of the colon, which may be asymptomatic for a longer time, the first signs of the disease are often malaise, weakness, decreased ability to work, impaired appetite, weight loss, anemia, subfebrile body temperature (up to +37.9 ⁰ C). In some cases, one of the first symptoms is a dense formation in the abdomen on the right, which the patient himself discovered.

For tumors of the left half of the colon, constipation is characteristic, which appeared for no apparent reason and became more frequent over time, an unstable admixture of mucus and dark blood in the stool, feces in the form of sheep feces, unexplained flatulence and episodes of sudden spastic or cramping abdominal pain without clear localization.

Possible complications of colon cancer:

• tumor bleeding;
• acute obstructive colonic obstruction;
• tumor perforation;
• paracancrotic abscess;
• Local spread of the tumor to adjacent organs and tissues with impairment of their functions.

Colon cancer diagnostics

“Diagnosis bona – curatio bona ”

“Bene diagnoscitur, bene curatur ”

The set of diagnostic studies for colon cancer has its own fundamental features.It is not enough to simply identify a tumor. It is extremely important to perform a comprehensive examination with an assessment of the histological variant and the prevalence of the tumor process. The volume of treatment and the sequence of its various stages depend on the results of a correctly formulated diagnosis.

IMPORTANT! If someone says something like, “You have cancer! We urgently need to operate! Going to an oncologist and being examined is a waste of effort and money! ” – CONTACT AN ONCOLOGIST SPECIALIST!

It is wrong to operate on a patient who should start treatment with drug or radiation therapy! An erroneous diagnosis leads to erroneous treatment tactics, and this, in turn, leads to worse prognosis for recovery and further life!

The approximate minimum examination of a patient with a colon tumor should be considered:

1. Complex of clinical laboratory studies: clinical blood test, general urine analysis, glucose, ALT, AST, total bilirubin, total protein, creatinine, amylase, C-reactive protein, PTV + INR, HBsAg, HCV-AT, AT HIV -1.2, antibodies to Trep.Pallidum, CA 19-9, CEA
2. Electrocardiography
3. Examination by a therapist with a conclusion about the presence and severity of concomitant pathology
4. CT of chest and abdomen with contrast
5. Fibrogastroscopy + fibrocolonoscopy
6. Study of histological material (tumor biopsy)
7. Irrigoscopy in the presence of a stenosing tumor, which cannot be covered with an endoscope
8. For women additionally: Ultrasound of the small pelvis + examination by a gynecologist

Based on the results of the initial examination by an oncologist, additional studies and consultations may be required (MRI of the brain, intravenous urography, fibrobronchoscopy, examination by a neurologist, examination by an endocrinologist, etc.).etc.). Their spectrum is strictly individual and depends on the prevalence of the tumor process and the presence of concomitant pathology.

Surgical treatment of colon cancer

Surgery is the main treatment for colon cancer in the absence of distant metastases. The indications for surgery are always absolute. The choice of surgical intervention depends on the location of the tumor, the clinical stage of the disease, the presence or absence of complications, and the general condition of the patient.

The operation should be performed by trained oncologist surgeons in compliance with the basics of oncosurgery – the sheath of the intervention, compliance with ablastic and antiblastic measures. In addition, in order to choose the correct treatment tactics in the future, it is necessary to remove and examine at least 12 lymph nodes.

IMPORTANT! Unfortunately, we regularly face the negative consequences of poorly performed surgical interventions in non-cancer hospitals in the city! Consider carefully the choice of where to undergo planned surgical treatment.

Drug treatment

Adjuvant (prophylactic) polychemotherapy (APCT) is carried out after radical removal of the tumor in the absence of visible tumor foci in the body. Its purpose is to target unrecognized and undetectable tumor micrometastases that could theoretically be present in a patient. APHT begins up to 60 days after the operation. After 60 days, preventive chemotherapy is considered ineffective and unreasonable.

IMPORTANT! Timely start of preventive and other types of treatment is another good reason to undergo treatment in specialized oncological institutions!

Palliative chemotherapy is performed in the presence of intractable tumor foci in metastatic colon cancer.Its tasks are to increase the duration and improve the quality of life by slowing down the progression of the tumor process.

Follow-up after the end of treatment

According to the Order of the Ministry of Health of the Russian Federation No. 915n of November 15, 2012 “On approval of the Procedure for providing medical care to the population in the field of” oncology “”, all patients after special treatment for malignant tumors are subject to lifelong dispensary observation by a district oncologist (located in the polyclinic at the place of residence ).In the first year after the end of treatment, patients should be examined once every 3 months, in the second year – once every 6 months, and starting from the third year of observation – once a year. In addition to examination, patients are shown the performance of appropriate laboratory and instrumental studies (depending on the type and location of the tumor process).

To make an appointment for a consultation and examination with a doctor, please contact the specialist of the contact center:

Unified call center: +7 (812) 607-03-03

Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease of an autoimmune nature, characterized by stenosis of the intestinal segments with the involvement of all layers of the intestinal wall in the pathological process, the formation of fistulas and extraintestinal lesions.

The common name of this disease is “Crohn’s disease”, but up to now other terms are used to denote it: “granulomatous colitis”, “granulomatous enteritis”, “regional colitis”, “transmural colitis”, etc.

The term “Crohn’s disease” seems to be the most apt, as it includes all the many forms of the disease.

Etiology

The etiological factor of the disease has not been established. The role of viruses and bacteria is assumed.The role of genetic factors in the onset of the disease has been more or less proven.

Pathogenesis

Autoimmune mechanisms play a role in the pathogenesis of the disease. Patients have antibodies to the colon tissue, lymphocytes specifically sensitized to the antigens of the colon mucosa. Immune complexes also have a damaging effect. Signs of impaired cellular immunity are determined, in particular, a decrease in the content of T-cells in the peripheral blood.All this leads to pronounced inflammatory changes in the intestines. Macroscopically, inflammatory changes can be single or multiple, with the altered areas alternating with unchanged ones. Changes in the ileum and cecum are more characteristic; the rectum is not always affected. The process captures all layers of the wall, looks like slit-shaped ulcers or cracks. Bowel strictures and pseudopolyposis are common.

Clinical picture and possible complications

Clinic of Crohn’s disease is largely due to the predominant localization of the pathological process.With the defeat of the large intestine, mainly its right sections, the patient has a clinic of the syndrome of the defeat of the colon – abdominal pain, rumbling, bloating, diarrhea with the discharge of semi-liquid stools with a small admixture of blood and mucus, weight loss, joint pain. Crohn’s disease is a long-term chronic course. With the defeat of the end part of the small intestine (terminal ileitis), pain appears in the right ileal region, vomiting, fever, which often leads to surgery due to suspicion of acute appendicitis.Narrowing of the lumen of the small intestine may be accompanied by its obstruction.

The pain is cramping and more pronounced than in ulcerative colitis, the stool is less frequent, there may be no blood in the stool, there are no tenesmus and false desires. If the distal ileum is simultaneously affected, a tumor-like conglomerate is palpated in the right ileum, caused by productive inflammation of all layers of the intestine, mesenteric lymph nodes. Often in the area of ​​the ileocecal angle, intestinal strictures develop, they can also be in other parts of both the small and large intestines.In this case, a rather typical picture of the syndrome of partial and sometimes complete intestinal obstruction develops. An isolated lesion of the small intestine, its attachment to the pathological process in the large intestine leads to the development of a typical picture of the syndrome of enteric insufficiency. The patient loses weight, he has the phenomenon of polyhypovitaminosis, metabolic disorders of varying severity. The development of fistulas is characteristic, especially in the perianal region. In case of damage to the esophagus and duodenum, the clinic may resemble a peptic ulcer, stenosis of the outlet section of the stomach and the initial sections of the duodenum often develops with the corresponding clinic of cicatricial stenosis of the intestine.In addition to local complications – fistulas, intestinal obstruction – extraintestinal manifestations are characteristic of Crohn’s disease – fever, joint damage, skin rashes, eye and liver damage. Of the possible complications, it should be noted perforation of the intestine at the site of ulceration, followed by the formation of an abscess in the abdominal cavity, fistulas, less often with the development of peritonitis.

Diagnostics

Laboratory blood tests reveal anemia as a result of blood loss or the development of malabsorption syndrome; various manifestations of intoxication and inflammation: leukocytosis with stab shift, increased ESR, increased activity of acute phase blood proteins.Like anemia, hypoalbuminemia and electrolyte disturbances are associated with the progression of secondary malabsorption syndrome. During irrigoscopy and passage of barium along the small intestine, segmental lesions of the small and large intestine are revealed, the alternation of affected and unaffected segments. The contours of the intestine are uneven, there are longitudinal ulcers, a thickening of the relief, which creates a picture of “cobblestone pavement”. Segmental narrowing of the affected areas is characteristic (“cord symptom”). As a rule, the decisive word in the diagnosis of Crohn’s disease remains with endoscopic research methods – fibrocolonoscopy, sigmoidoscopy with multiple mucosal biopsies.The need to take the deeper layers of the intestine during biopsy is emphasized. Endoscopic findings depend on the duration and phase of the disease. In the initial period, a dull mucous membrane is determined, erosions are visible on it, surrounded by whitish granulations (like aft). As the duration of the disease in the exacerbation phase increases, the picture changes. The mucous membrane thickens unevenly, deep longitudinal ulcers-cracks are found, the intestinal lumen is narrowed. It is often possible to identify the formed fistulas. With a decrease in the activity of the process, scars are formed at the site of the ulcers and areas of stenosis are formed.Histological examination reveals a picture of nonspecific inflammation, but with a number of features. The entire thickness of the mucous membrane is infiltrated, especially the submucosa. Sarcoid-like granulomas can be identified. Unfortunately, this pathognomonic sign of Crohn’s disease is rarely detected during biopsy examination. Ultrasound examination of the abdominal cavity, computed tomography provide valuable information in the diagnosis of abscesses, which are often found in Crohn’s disease. In the presence of external fistulas, fistulography is indicated.

Differential Diagnostics

Most often Crohn’s disease has to be differentiated from ulcerative colitis, tuberculous intestinal lesions, ischemic colitis, yersiniosis, acute appendicitis. Ulcerative colitis with concomitant paraproctitis or retrograde ileitis can cause a diagnostic error. In addition, even with the use of modern endoscopic and radiological research methods, histological examination of biopsies in about a tenth of cases, it is not possible to distinguish between these two diseases (“undifferentiated colitis”).