introduction

The large intestine (lat: colon ), also called colon, is part of the 5-6 meter long intestine of the human, in which the food from its intake through the mouth is transported to excretion in the stool. The large intestine connects to the small intestine, in which most of the nutrients from the food have been absorbed into the body.

The large intestine is the task of thickening. He deprives the digested porridge still most of the water contained and dissolved therein salts (= electrolytes), so that until its end in the rectum (Latin: Rectum) in healthy people only the solid stool remains. In addition, intestinal bacteria are found in the colon, which form important amino acids as a component of proteins and vitamins for humans. All previous sections of the intestine are free of bacteria.

In the large intestine, the food can be cached before it is transported on, as well as mucus are released for better lubricity.

If you look at the stomach from the outside, the colon is like a frame around the abdominal contour. It begins right below in the area of ​​the cecum (lat: caecum ), runs up to the liver under the right costal arch, then moves to the left under the costal arch in the direction of the spleen and then back to the left side of the abdomen to the rectum and Anus to run. An inflammation of the intestine is referred to in the medical jargon as colitis, the ending "-itis" behind the medical term for the organ always describes the inflammation of the organ.

reason

Inflammations of the colon can have many causes that are responsible for either short-term or, in the worst case, life-long inflammation of the colon.

For short-term inflammation, which then cause a typical gastrointestinal flu are usually viruses or bacteria, rarely fungi or unicellular. Since one speaks in infection with pathogenic viruses or bacteria from an infection, this type of disease is called infectious Gastroenterocolitis as an indication of the involvement of the stomach (lat: Gaster ), the small intestine (lat: Enterum ) and the colon (lat: Colon ) of the infection with the bacteria.
The bacteria or viruses responsible for infectious enteritis are mostly E. coli bacteria, Yersinia or Campylobacter bacteria, and Rotaviruses or Noroviruses. These nest in the intestinal mucous membrane, whereupon it inflames and it comes already a short time after absorption of the bacteria by food or contact to diarrhea, nausea and vomiting in those affected. Most of these infections heal by themselves within two weeks and require no treatment other than fluid and salt intake.

A bacteria-only inflammation affecting the colon in Europe is the so-called dysentery of Shigella bacteria. It is not to be confused with the amoebic dysentery, which is triggered by other bacteria and rather occurs in subtropical areas.

Another very sudden inflammation of the colon can cause appendicitis. The cecum itself is the first part of the colon. In appendicitis, however, only a small appendix of the cecum, the so-called appendix (lat: appendix vermiformis ) inflames .

An important cause of permanent inflammation in the colon are the so-called inflammatory bowel diseases. Their most important representatives are ulcerative colitis and Crohn's disease. They differ in terms of their appearance and the course of the disease. Their causes are not fully understood yet, but autoimmune processes against the intestinal mucosa are suspected. Autoimmune means that the body no longer recognizes the intestinal mucosa as belonging to the body and tries to fight it with the help of the immune system, which ends in an inflammation of the battled mucous membrane.
In addition to these causes of inflammatory bowel disease, genetic components, psychological influences and certain nutritional and lifestyle habits are also examined. Crohn's disease can occur throughout the gastrointestinal tract, causing inflammation of the mucous membrane everywhere, while ulcerative colitis is restricted to the colon. In ulcerative colitis, the inflammation is limited to the uppermost mucosal layer while in Crohn's disease it can spread to deeper layers of the intestinal wall.
Both syndromes are bumpy, which means that phases of inflammation and symptoms that are virtually free from inflammation alternate with phases of inflammation. Both diseases are in most cases incurable and require a lifelong recurrent therapy to come to the recurrent inflammatory thrusts.

Likewise recurrent inflammations in the large intestine can cause so-called diverticula. As diverticula, protuberances or sagging of the inner intestinal layers are called outwards. These arise at weak points of the muscles of the intestinal wall, which can be due to increased pressure in the intestine, such as constipation or general connective tissue weakness, the inner parts can evert outward. The resulting small cavities in the intestinal wall can be inflamed, among other things by growing bacteria or pent-up porridge and provide for abdominal pain. Although the diverticula can occur in all sections, they are most commonly found at the end of the colon in the S-shaped sigmoid.

symptoms

Depending on the cause, the signs of inflammation of the colon differ from each other. However, most of them have diarrhea and abdominal pain.

The infectious inflammation by the various disease-causing germs usually begins hours after intake, for example, of foods that carry the germ itself, with nausea and then followed by diarrhea and vomiting. Accompanying fever may occur. These symptoms usually disappear within a few days.

An appendicitis usually begins with stinging or oppressive abdominal pain around the navel, which then typically migrate into the right lower abdomen.

An inflammation of a diverticulum (Latin: diverticulitis ) usually manifests itself with abdominal pain in the affected area, usually in the lower left part of the abdomen where most of the diverticula are located. These inflammations are accompanied by fever and not infrequently, there is blood in the stool of those affected.

A chronic inflammatory bowel disease is usually recognized only in its course. Significant evidence is often persistent diarrhea, which may also include blood in ulcerative colitis. In Crohn's disease, often no blood is visible. In the onset of a chronic inflammatory bowel disease, diarrhea is often accompanied by colicky, ie swelling and dying abdominal pain and fever. The extent of the discomfort depends on the extent of the inflammation of the intestine, which can change constantly as the disease progresses. Due to the permanent inflammation of the intestinal cells, these are limited in their function and as a result of a lack of nutrients in the body can lead to weight loss and deficiency symptoms.

therapy

Medical therapy

An inflammation in the context of a gastrointestinal flu usually ends by itself within a few days to a maximum of two weeks. Drug therapy is not necessary in most cases. Since most cases are caused by viruses and an antibiotic is rarely necessary and should only be used in case of proven bacterial cause.

In all cases it is important to balance the loss of fluid through diarrhea and the loss of important salts in the body. This loss can lead to total dehydration of the body and in extreme cases can be life-threatening. Predominantly vulnerable to dehydration are especially infants or the elderly. A hospital stay is then necessary to compensate for the fluid and salt loss by direct fluid delivery into the vascular system of the body, the so-called "drip".
Outside the hospital, it is important to keep the fluid loss as low as possible by drinking enough. Tea, here herbal teas such as black tea or chamomile tea, are particularly suitable for this, as they have an additional calming effect on the gastrointestinal tract. Cola, which promotes fluid intake in the body due to its high sugar content, is also very well suited.

An appendicitis can only be definitively treated by a distance. With less pronounced signs of inflammation, pain therapy can also wait to see if it heals itself. The inflammation can then recur any time and then necessitate surgery.

Inflammatory bowel disease is harder to treat and can only be cured in the rarest cases. Not infrequently, a chronic inflammatory bowel disease requires a lifelong therapy with drugs. To curb inflammation, cortisone therapy or medication that suppresses the immune system, such as mesasalazine, is often used. This is considered to be very compatible and is available as a suppository. For severe relapses, a drug called azathioprine can also be used. This has a strong inhibitory effect on the human immune system. It works only after taking several months and is also very rich in side effects. In order to prevent relapse, a small dose of the medication must often be taken permanently.
As a non-drug measure, it is important to ensure a balanced diet and foods that cause intolerance, should be avoided. During a spurt light, low-fiber diet is recommended. In severe episodes of ulcerative colitis, it may be necessary to surgically remove portions of the colon to prevent rupture of the intestinal wall by severe inflammation.
In Crohn's disease, one is much more reluctant to a potential removal of intestinal parts, since the inflammation may affect all parts of the intestine and only a removal of certain amounts of the intestine with an adequate digestion are compatible.

The treatment of a diverticulum differs depending on the extent of the inflammation. In mild inflammation can be treated with antibiotics and anti-inflammatory drugs. Patients can positively influence the healing of the inflammation through regular bowel movements, low-fiber diet and adequate fluid intake. With a more severe inflammation, a hospital stay is necessary. In order not to burden the intestine there is a complete food abstention as well as antibiotics, analgesics and anti-inflammatory drugs. However, if there is a risk of rupture of the intestinal wall so the diverticulum must be treated surgically. However, emergency surgery should be prevented and suspicious diverticula removed at an inflammatory interval.

diagnosis

Diagnosis by ultrasound

The diagnosis of a gastrointestinal flu can often be clearly determined by questioning the patient. Usually no further investigation is necessary, as the infection heals itself independently of the causative germ. Only in special cases, a proof of the germ is necessary and so this can be carried out on the basis of the microscopic examination of a stool sample in the laboratory to initiate a special adapted to the germ therapy.

Unfortunately, appendicitis can only be clearly established during the operation. To estimate the probability, however, an ultrasound examination and a blood test can provide clues.

A diverticulitis is made in patients in addition to the questioning by a physical examination, in which a hardening can be felt in the affected part of the intestine. In addition, procedures such as x-rays, ultrasound or computed tomography (= CT) can represent diverticula and the diagnosis can then be made. In these procedures, inflammation, thickening, sagging or even intestinal perforations can often be easily recognized on the images.
Not least in chronic inflammatory bowel disease or diverticula, the colonoscopy provides the crucial clue in the search for the cause. In diverticula, however, this is only allowed in the interval without inflammation. The small camera in the tube can be seen in inflammatory bowel disease at the inflamed areas redness and whitish-yellow deposits. Last uncertainties can usually be clarified in the context of colonoscopy by a small sampling (= biopsy) and microscopic examination. However, the diagnosis of a chronic inflammatory bowel disease may only finally be made if all other causes of inflammation such as bacterial infection are excluded.

forecast

Although complaints such as diarrhea and vomiting are not among the most pleasurable sensations in our body, the symptoms of infectious bowel inflammation, with sufficient attention to the fluid and salt balance, are usually transient and may end within a few days without medication.

The inflammatory bowel diseases are treatable by medication, but in most cases not curable, so that a lifetime of spurts of inflammation must be expected.

Diverticula in the intestine are not dangerous in principle, however, inflammation can lead to the breakthrough of the entire intestinal wall, which can then be life-threatening. Since the diverticula usually become larger in old age, suspicious diverticula should be observed and removed in time.

prophylaxis

The light transmission routes make the prevention of infection with the causative bacteria and viruses of intestinal inflammation very difficult. Among other things, one has to pay particular attention to one's own personal hygiene.
Regular hand washing can reduce the number of germs on the hands enormously, since most pathogens outside the gastrointestinal tract can survive only a very short time. Especially important is the hand washing after the toilet and before the preparation of food in the kitchen.

Only against a small part of the pathogen is a vaccination possible.

The prophylaxis of a chronic inflammatory bowel disease is difficult due to the partially hereditary origin. As with many other intestinal diseases, diseases of the rectum are adversely affected by smoking and nicotine should be avoided in diseases of the intestine.


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