There is a small amount of pus with blood after ulceration

A small amount of pus with blood after ulcerative bowel movements is a typical symptom of ulcerative colitis. Many people may not be very familiar with this disease. Its main characteristics are tenesmus, abdominal pain, diarrhea and mucus and blood in the stool. When it occurs, it needs to be treated in time, otherwise various complications will occur, which is particularly harmful. Now let's take a look at the situation of ulcerative colitis.

symptom

Tenesmus

Anorectum, distension of the coccyx, tenesmus and a persistent urge to defecate are not only the concomitant symptoms of ulcerative colitis but also the prodromal symptoms or the first symptoms. Some patients develop typical manifestations of ulcerative colitis after several years of these symptoms. This is because the anorectal canal is the initial site of ulcerative colitis and the "base" of the disease. Autoimmune damage starts from the anorectal mucosal layer and then spreads proximally. The congestion and edema of the rectal mucosa continuously stimulates the pressure receptors, which continuously transmit defecation sensation information to the central nervous system, causing the patient to have prolonged defecation time, squat for a long time, incomplete defecation, and a burning sensation, heaviness, and a foreign body stuck in the true intestine and anal canal.

stomach ache

Inference on the nature of pain: dull pain is caused by inflammatory stimulation of the mucosal layer and is transmitted by chemical receptors; spasms or cramps often occur during intestinal peristalsis, and intestinal patterns can be felt, which is transmitted by pressure receptors; burning pain is caused by inflammation spreading to the outer membrane and mesentery. The surgery confirmed that the intestinal walls at the ulcerated site were obviously congested, red, swollen and brittle. The burning pain was severe and the sensation was localized, which was the result of pain receptor conduction.

diarrhea

About 70% of ulcerative colitis presents or occurs intermittently as diarrhea, with frequent loose stools. The causes of diarrhea are: one, hypermotility of the intestines; two, inflammatory exudation; and three, malabsorption. Chronic ulcerative colitis is mostly manifested by loose and sticky stools, mainly due to the mucosal absorption and transport disorders of water and electrolytes and inflammatory exudation.

Bloody stools with mucus

Chronic ulcerative colitis is characterized by bloody and mucous stools. It is common to have gelatinous blood in the stool at the end of the stool. When the amount of blood is large, it appears as jam or fish belly. The blood is mostly old and rarely fresh. Severe ulcerative colitis or acute ulcerative colitis presents with severe tenesmus and bloody stool.

treat

For patients with fulminant and severe disease, such as those who are not responding well to medical treatment, surgical treatment will be considered.

1. Medical treatment

(1) Bed rest and systemic supportive treatment including fluid and electrolyte balance, especially potassium supplementation. Hypokalemia should be corrected. At the same time, attention should be paid to protein supplementation to improve the overall nutritional status. Total parenteral nutritional support should be given when necessary. Blood transfusions can be given for those with anemia. Milk and dairy products should be avoided as much as possible during gastrointestinal intake.

(2) Drug treatment ① Sulfasalazine salicylic acid preparations are the main treatment drugs, such as Edisal, Mesalazine, etc. ② Commonly used corticosteroids are prednisone or dexamethasone, but it is not currently believed that long-term hormone maintenance can prevent recurrence. During the acute attack period, hydrocortisone or dexamethasone can be used for intravenous drip, and hydrocortisone can be added to normal saline for retention enema every night. The value of hormone therapy during the acute attack period is certain, but there is still disagreement on whether hormones should be used continuously in the chronic stage. Because it has certain side effects, most people do not advocate long-term use. ③The value of immunosuppressants in ulcerative colitis is still questionable. Rosenberg et al reported that azathioprine has no effect on disease control during exacerbations, but it helps reduce the use of corticosteroids in chronic cases. ④ Treatment of diarrhea-type ulcerative colitis with traditional Chinese medicine can be treated with traditional Chinese medicine, and the effect is relatively ideal. At the same time, you should pay attention to your diet and lifestyle habits.

2. Surgical treatment

20% to 30% of patients with severe ulcerative colitis eventually undergo surgery

(1) Indications for surgery Indications for emergency surgery include: ① massive, uncontrollable bleeding; ② toxic megacolon with adjacent or definite perforation, or toxic megacolon that is ineffective after hours rather than days of treatment; ③ fulminant acute ulcerative colitis that is ineffective with steroid hormone therapy, that is, no improvement after 4 to 5 days of treatment; ④ obstruction due to stenosis; ⑤ suspected or confirmed colon cancer; ⑥ recurrent exacerbations of refractory ulcerative colitis, chronic persistent symptoms, malnutrition, weakness, inability to work, inability to participate in normal social activities and sexual life; ⑦ worsening of the disease when the dose of steroid hormones is reduced, so that hormone treatment cannot be stopped for months or even years; ⑧ children suffer from chronic colitis that affects their growth and development; ⑨ severe extracolonic manifestations such as arthritis, pyoderma gangrenosum, or biliary and liver diseases that may be responding to surgery.

(2) Surgical options: There are currently four surgical options available for ulcerative colitis. ① Total colorectal resection and ileostomy; ② Total colectomy and ileorectal anastomosis; ③ Controlled ileostomy; ④ Total colorectal resection and ileal pouch-anal anastomosis.

There is currently no effective long-term prevention or treatment method. Among the four existing types of surgery, radical colorectal resection and ileal pouch-anal anastomosis are relatively reasonable and optional methods.