Where is the colon: the symptoms of the disease, treatment methods

The colon is the main division of the large intestine extending from the blind to the rectum. The total length is about 1.4-1.6 meters. Several parts of this education are distinguished:

  • Ascending department (23-25 ​​cm);
  • cross-shared department (54-57 cm);
  • downward department (21-23 cm);
  • Sigmoid gut (46-48 cm).

colon

The inner diameter of the colon gradually decreases as the anal hole approaches the anal hole and ranges from 8 to 4 cm. The intestine is located in the abdominal cavity and has the form of an unlocked ring. It is projected onto the front abdominal wall in all areas, except for the umbilical.

The inner part of the weight formation is represented by the mucous membrane with a plurality of villi, then a submucous base and a layer of smooth muscle cells, providing an adequate peristaltics.

Opinion expert

Tsareva Nadezhda

Therapist, hepatologist, website expert

The studio department of the intestine does not take direct participation in the processes of digestion. It is responsible for the absorption of water and a large amount of salts. The liquid chimule falling from the small intestine becomes more hard, and the final powerful masses are formed.

Diseases of the colon

This intestinal department is inclined to the development of many pathologies. Consider the most common.

Name pathology Etiology and pathogenesis Symptomatics Diagnostics
Non-specific ulcerative colitis - inflammatory defeat with the formation of ulcerative-necrotic defects.

ulcerative colitis

Different reasons (Food allergens entering the impact of vital products of physiological and pathological microflora) lead to the formation of antibodies to epithelial cells. Immune cells destroy the mucous membrane with the formation of an ulcer. Abundant diarrhea is up to 30-40 times a day. In the cartoons, many mucus, pus and blood are determined. The general condition is heavy: permanent pain throughout the thick intestine, the stomach will break and sharply painful when palpation. The appearance of pathologies from other bodies and systems: anemia, liver dystrophy, dehydration. Confirm the diagnosis:
  • detection of antibodies to blood epithelium cells (Ig M and G);
  • colonoscopy (characteristic multiple ulcers on all mucosa);
  • Ultrasound (adhesion process).
Diverticulus - bag-shaped protrusion of the intestinal wall in the abdominal cavity.

Diverticula

May be congenital or acquired. The first type is developing against the background of development anomalies (muscle layer defect). Acquired arises due to chronic constipation, traumatic intestinal injuries, long-term infectious infection processes. Localization: the places of entry of vessels in which there are no smooth muscle cells. No missing. When infection, signs of colitis are detected: pain and bloating, diarrhea, nausea, vomiting, increase body temperature. Usually detected by chance when:
  • colonoscopy;
  • Ultrasound of the organs of a rude cavity;
  • X-ray study.
Polyps are benign proliferative formations, inclined to malignancy in 1% of cases.

Diverticula

Mutation of cells begins against the background of chronic constipation, coarse errors in food (a large number of animal fats, refined oils and the absence of fiber). Less often - the effect of carcinogenic substances used together with food (dyes, preservatives, etc.). Typically, sick complaints are not presented. Sometimes mucous and hemorrhagic separations from the rectum, digestion disorders (diarrhea, constipation, bloating) can be observed. To determine the localization and tumor type establishment, apply:
  • colonoscopy;
  • irrigography;
  • Taking biopsy.
Color cancer - malignant tumor. Faces over 50 years old having hereditary burden on the intestinal oncopathology are sick. Risk factors include:
  • High meat content in the food diet;
  • Harmful production (workers of absurre and wood processing enterprises);
  • immunodeficiency states;
  • Nonspecific ulcerative colitis and Crohn's disease.
Bleeding (in 45% of cases, blood flows from the anal hole after the act of defecation "jet"). Rightly observed pain syndrome, violation of the chair (diarrhea or constipation), tenesms (false urges for defecation).
  • finger study of the rectum;
  • Prrugography;
  • Endoscopic examination with the taking of biopsy material;
  • Hidden blood analysis on hidden blood;
  • CT and MRI.
Anomalies and malformations of development - disorders of embryogenesis, leading to coarse defects of the structure and arrangement of the colon. More often meet: dystopia (change in the location of individual departments), doubling the intestine, stenosis (full overlap of the lumen). The impact of teratogenic factors on the formative fruit. The most dangerous periods are periods from 4 to 5 and from 11 to 13 weeks of organogenesis. The clinical picture is always individual and depends on the degree of violations (from the change of stool to complete intestinal obstruction) Diagnosed at an early age against the background of significant violations of the work of the gastrointestinal tract. Ultrasound, CT, MRI, and colonoscopy can be used to form an accurate diagnosis (children are rare).
Sigmoiditis - inflammatory lesion of the sigmoid intestine The main cause of sigmoiditis is infected with bacterial (less often - viral) agents. The role of predisposing factors is the anatomical features (S-shaped), the presence of a hay or the disease of Crown, the diverticulus. Worried strong gravity pains in the lower abdomen. The act of defecation is painful, there are false urges. The chair is always liquid with an unpleasant smell (up to 10-15 times a day). The overall condition is heavy: hyperthermia (up to 40 degrees), weakness, headaches. The diagnosis is established by endoscopic surveys and part research.

Stages of ulcerative colitis

Treatment of diseases of the colon

When identifying malfunctions, only surgical treatment is shown. During the operation, the passability of the intestinal tube is restored. If an anomaly does not manifest clinically, it is not treated.

If the tumor is suspected, biopsy is taken first with the subsequent histological research to establish the type of proliferation. Benign formations can be removed by endoscopic methods, malignant - only surgically (removal of the affected area with a grip of healthy tissues at least 5 cm).

Diverticulus require antibiotic therapy courses for preventing infectious complications. With perforation of bagask education or the development of phlegmon, the affected portion of the intestine is removed. Access is median laparotomy.

Multiple diverticulas

Nonspecific ulcerative colitis - incurable pathology. Drugs in 80% of cases make it possible to achieve remission and partial healing of peptic formations. Glucocorticosteroids are used (for suppressing an autoimmune process), binders ("fasten" cartoons and prevent dehydration), antibiotics (in order to prevent complications). According to the testimony, infusion therapy is carried out.

Opinion expert

Tsareva Nadezhda

Therapist, hepatologist, website expert

If the amount of colitis is complicated by abscesses, phlegmon, perforation, peritonitis, then surgical intervention is carried out, consisting in the removal of the intestine and the abdominal cavity sanation. Purulent cavities drained. The forecast is usually unfavorable in the development of complications.

Name of the drug Pharmacological group Mode of application
Ceftriaxon

Ceftriaxon

Antibacterial agent of a wide range of action, cephalosporin. 1-2 tablets (1.0) 1 time per day.
Furazolidon

Furazolidon

Non-informous and anti-protocouplea drug, nitrofuran. 2 tablets (0.1) 4 times a day. The maximum duration of treatment is 12 days.
Prednisolone

Prednisolone

Glucocorticosteroid Up to 40 mg per day, 1 time per day.
Tanalbin

Tanalbin

Binding plant of plant origin. 1 tablet (0.5) 2 times a day.
Bismuth nitrate Astringent 0.5 30 minutes before meals 3 times a day.

Crohn's disease

Crohn's disease is a polysishemistry with the development of granulomatous inflammation in the gastrointestinal tract and changes from other organs: joints (arthritis), leather (pyodermium or nodular erythema), eye (uveitis, iris, iridocyclite), mucous membranes (aphthose stomatitis).

Crohn's disease

Meeting frequency differs in different countries. In European states - from 5 to 50 people per 100,000 population. Statistical data in Russia are unknown.

Colon

Etiology and pathogenesis

The main reason is a genetic predisposition. Against the background of various provoking factors (toxins of bacteria, coarse errors in the diet, etc.) there is a failure in the work of the immune system. Local factors are not able to control the flow of the inflammatory process, which normally flows in the thick intestine in response to the presence of microflora.

Clinical picture

Symptomatics of heterogeneous and nonspecific. Pathology continues to be asymptomatic. The following features are then detected:

  1. Disps disappointments. In 5% of patients there are changes in stools (constipation or diarrhea), pain in the area of ​​epigastria, nausea and vomiting.
  2. Pain syndrome. Painful sensations are rarely found (in 3% of cases). They are not intense and localized in the lower quadrants of the abdomen.
  3. Reducing body weight (due to nutrient absorption disorders).
  4. Isolation of mucus and blood from the anal hole. When infection, it is possible to paint the carts in gear.

Diagnostics

Assigns such methods of research as:

  1. Common blood test (reduction of erythrocytes, hemoglobin and hematocrit).
  2. Biochemical blood test (raised by CRH, liver enzymes - Alt and AST).
  3. Research feces (blood, mucus, pus, many undigested dietary fibers).
  4. Ultrasound procedure. Inflammatory changes in the wall (thickening, folding), weakening or enhancing peristaltics, in rare cases - abscesses are noted.
  5. MRI and CT - allow you to establish accurate localization of the focus of defeat and all possible complications.
  6. X-ray study.
  7. Colonoscopy - visual assessment of inflammatory changes.

Treatment

Therapy is aimed at achieving remission and improving the quality of life. Treatment can be drug and surgical (with the development of purulent complications, stenosis, resistance to pharmacological preparations).

In the initial stages, glucocorticosteroids (prednisone) are used, with their ineffectiveness - cytostatics (methotrexate, cereals).

When anemia is identified, iron preparations are recommended (sorbifer). The presence of infectious complications obliges to apply antibiotics (ciprofloxacin, metronidazole).

Sorbifer

Patients often need psychological support and appointment of antidepressants.

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Colon

Colon (colon) It turns out the loop of the small intestine and is divided into the ascending, transverse, descending and sigmoid.

Ascending colon COLON ASCENDENS (Fig. 151, 159, 171) is a continuation of the blind. Its rear surface is not covered with peritoneum and is located on the back wall of the belly on the right. The length of it varies from 12 (with a high position of the blind intestine) to 20 cm. The front surface passes the free ribbon of the colon (Taenia Libera) (Fig. 170, 171, 172), on the rearbed - sunel ribbon (Taenia Omentalis) (Fig. 170), and for not covered with peritoneum rear agent - mesenter tape TAENIA MESOCOLICA) (Fig. 172). When moving to the transverse colon, the right bending of the colon is formed (Flexura Coli Dextra) (Fig. 151, 159).

Cross colon COLON TRANSVERSUM) (Fig. 151, 158, 171) begins in the right hypochondrium at the level of X rib cartilage. Its left and right areas are located superficially ascending and downward colonists. This is the longest department (50 cm) having its own mesentery Mesocolon Transversum) (Fig. 171), attached to the mesenter ribbon of the transverse colon. Over the front surface along the seelnite ribbon passes the student-intestinal bunch (Lig. Gastrocolicum) . Running, the bundle goes into a big gland (Omentum Majus) which covers the transverse hatch in front. Light bend of the colon (Flexura coli sinistra) (Fig. 151, 159) is located in the left hypochondrium, lower and deeper right. When switching to a downward hazard, a sharp angle is formed, fixed by a diaphragm-catering and intestinal ligament (Lig. phrenicocolicum) .

Downward collapse COLON DESCENDENS (Fig. 151) is located on the back of the belly on the left. Its length is 22 cm, and the diameter decreases as the sigmoid colon is approached.

Sigmoid colon COLON SIGMOIDEUM) (Fig. 151, 159, 171) Slies in the left iliac yam, it falls into the cavity of the small pelvis and goes into the rectum at the level of the III of the sacrilate vertebra. On average, its length is 55 cm, but essential individual oscillations are possible. The sigmoid colon forms two loops, one of which lies on the iliac muscle, and the other on the large lumbar muscle. The magnitude of the sigmoid loop depends on the length of the root of the mesentery of the sigmoid bowel (mesocolon sigmoideum) (Fig. 159).

Fig. 151. Digestive apparatus: 1 - parole iron; 2 - teeth; 3 - oral cavity; 4 - throat; 5 - language; 6 - Podium Iron; 7 - Podgnolelyluent iron; 8 - esophagus; 9 - stomach; 10 - liver; 11 - common bile duct; 12 - compressor (sphincter) of the gatekeeper; 13 - gallbladder; 14 - pancreas; 15 - duodenal estate; 16 - steep bending of the duodenum; 17 - left bending of the colon; 18 - the right bending of the colon; 19 - the intention; 20 - ascending colon; 21 - downward colon; 22 - transverse colon; 23 - Ileocecal valve; 24 - blind intestine; 25 - Appendix; 26 - iliac; 27 - Sigmoid colon; 28 - direct intestine; 29 - Outdoor compressor

Fig. 151. Digestive apparatus: 1 - parole iron; 2 - teeth; 3 - oral cavity; 4 - throat; 5 - language; 6 - Podium Iron; 7 - Podgnolelyluent iron; 8 - esophagus; 9 - stomach; 10 - liver; 11 - common bile duct; 12 - compressor (sphincter) of the gatekeeper; 13 - gallbladder; 14 - pancreas; 15 - duodenal estate; 16 - steep bending of the duodenum; 17 - left bending of the colon; 18 - the right bending of the colon; 19 - the intention; 20 - ascending colon; 21 - downward colon; 22 - transverse colon; 23 - Ileocecal valve; 24 - blind intestine; 25 - Appendix; 26 - iliac; 27 - Sigmoid colon; 28 - direct intestine; 29 - Outdoor compressor

Fig. 158. Puritiny stroke scheme: 1 - diaphragm; 2 - liver; 3 - small gland; 4 - pancreas; 5 - stomach; 6 - duodenal estate; 7 - the cavity of the peritoneum; 8 - transverse colon; 9 - skin intestine; 10 - big gland; 11 - iliac; 12 - straight intestine; 13 - Posadivisisoral Space

Fig. 158. Puritini stroke scheme: 1 - diaphragm; 2 - liver; 3 - small gland; 4 - pancreas; 5 - stomach; 6 - duodenal estate; 7 - the cavity of the peritoneum; 8 - transverse colon; 9 - skin intestine; 10 - big gland; 11 - iliac; 12 - straight intestine; 13 - Posadivisisoral Space

Fig. 159. Abdominal bodies: 1 - liver; 2 - stomach; 3 - gallbladder; 4 - spleen; 5 - pancreas; 6 - left bending of the colon; 7 - the right bending of the colon; 8 - upper bending of the duodenal intestine; 9 - the relief of the duodenum; 10 - ascending part of the duodenum; 11 - ascending colon; 12 - iliac; 13 - mesenter of the sigmoid intestine; 14 - blind intestine; 15 - Appendix; 16 - straight intestine; 17 - Sigmoid colon

Fig. 159. Abdominal bodies: 1 - liver; 2 - stomach; 3 - gallbladder; 4 - spleen; 5 - pancreas; 6 - left bending of the colon; 7 - the right bending of the colon; 8 - upper bending of the duodenal intestine; 9 - the relief of the duodenum; 10 - ascending part of the duodenum; 11 - ascending colon; 12 - iliac; 13 - mesenter of the sigmoid intestine; 14 - blind intestine; 15 - Appendix; 16 - straight intestine; 17 - Sigmoid colon

Fig. 170. Sleeping gut and appendix: 1 - gland process; 2 - free ribbon of the colon; 3 - Gautters; 4 - semi-lone collar collar; 5 - ileocecal valve; 6 - blind intestine; 7 - the mesentery of appendix; 8 - Appendix (Cell-shaped process)

Fig. 170. Sleeping gut and appendix: 1 - gland process; 2 - free ribbon of the colon; 3 - Gautters; 4 - semi-lone collar collar; 5 - ileocecal valve; 6 - blind intestine; 7 - the mesentery of appendix; 8 - Appendix (Cell-shaped process)

Fig. 171. Overhead, skinny and iliac intestine: 1 - big gland; 2 - transverse colon; 3 - free ribbon of the colon; 4 - mesenter of the transverse colon; 5 is a skinny intestine; 6 - ascending colon; 7 - blind intestine; 8 - sigmoid colon; 9 - iliac

Fig. 171. Overhead, skinny and ileum: 1 - large gland; 2 - transverse colon; 3 - free ribbon of the colon; 4 - mesenter of the transverse colon; 5 is a skinny intestine; 6 - ascending colon; 7 - blind intestine; 8 - sigmoid colon; 9 - iliac

Fig. 172. Cross colon colon: 1 - Gautters; 2 - sunel ribbon; 3 - gland processes; 4 - free ribbon of the colon; 5 - semi-lubrices of the colon; 6 - mesenter tape

Fig. 172. The transverse colon colon: 1 - Gautra; 2 - sunel ribbon; 3 - gland processes; 4 - free ribbon of the colon; 5 - semi-lubrices of the colon; 6 - mesenter tape

* * *

Colon (colon) borders the loop of the small intestine and is divided into ascending, transverse, downward and sigmoid.

Fig. 171. Stittle, skinny and iliac 1 - big gland; 2 - transverse colon; 3 - free ribbon of the colon; 4 - a mesentery of the transverse colon; 5 - skin intestine; 6 - ascending colon; 7 - blind intestine; 8 - sigmoid colon; 9 - iliac

Fig. 172. Cross colon colon 1 - Gautters; 2 - sunel ribbon; 3 - gland processes; 4 - free ribbon of the colon; 5 - semi-short collar collar; 6 - mesenter tape

Ascending colon (Colon Ascendens) (Fig. 151, 159, 171) is a continuation of the blind. Its rear surface is not covered with peritoneum and is located on the back wall of the belly on the right. The length of it varies from 12 (with a high position of the blind intestine) to 20 cm. On the front surface passes the free ribbon of the colon (Taenia Libera) (Fig. 170, 171, 172), along the rearbed tape (Taenia Omentalis) (Fig. 170), and on the not covered in the peritoneal rear agent - the mesenter tape (Taenia Mesocolica) (Fig. 172). When moving to the transverse colon, the right bending of the colon (Flexura coli dextra) is formed (Fig. 151, 159).

Cross colon (Colon Transversum) (Fig. 151, 158, 171) begins in the right hypochondrium at the level of X rib cartilage. Its left and right areas are located superficially ascending and downward colonists. This is the longest department (50 cm) having its own mesentery (Mesocolon Transversum) (Fig. 171), attached to the mesentery ribbon of the transverse colon. Over the front surface along the seelnite ribbon passes a sewing-intestinal bunch (Lig. Gastrocolicum). Running, the bundle goes into a large gland (Omentum Majus), which covers the transverse colon in front. The left bending of the colon (Flexura Coli Sinistra) (Fig. 151, 159) is located in the left hypochondrium, below and deeper right. When switching to a downward rim, a sharp angle is formed, fixed by the diaphragm-clay-intestinal ligament (Lig. Phrenicocolicum).

Downward collapse (Colon Descendens) (Fig. 151) is located on the rear wall of the belly on the left. Its length is 22 cm, and the diameter decreases as the sigmoid colon is approached.

Sigmoid colon (Colon Sigmoideum) (Fig. 151, 159, 171) Locals in the left iliac hole, falls into the cavity of the small pelvis and goes into the rectum at the level of the III of the sacrilate vertebra. On average, its length is 55 cm, but essential individual oscillations are possible. The sigmoid colon forms two loops, one of which lies on the iliac muscle, and the other on the large lumbar muscle. The magnitude of the sigmoid loop depends on the length of the root of the mesentery of the sigmoid intestine (mesocolon sigmoideum) (Fig. 159).

* * *

The colon, Colon, in its position, as it were, located in the middle of the lower floor of the abdominal cavity loops of the small intestine. The ascending colon is on the right, the transverse one - on top, downward - on the left, sigmoid - on the left and partially below.

Ascending colon , Colon Ascendens, begins on the place of sign in the blind intestine of the ileum, being a continuation of the blind. Separated from a blind intestine with two grooves, which correspond to the bridles of the ileocecal valve. Its rear, devoid of peritoneum is adjacent to the posterior wall of the abdomen, occupying an extreme side position on the right. It starts somewhat below the iliacing ridge, going up vertically, it is first ahead of the square muscle of the lower back, then ahead of the right kidney and comes to the lower surface of the right lobe of the liver; It is bent left and ventral (forward) and goes into a transverse colon. The bending is called the right bend of the colon, Flexura Coli Dextra, and compared to the left bending of the colon, Flexura Coli Sinistra is usually more gentle. Due to the fact that the right bend is directed not only in the frontal, but also in the sagittal plane, the initial part of the transverse colon lies superficially or in front of the ascending (it also applies to the left bending). The length of the ascending colon reaches 20 cm, but the position and length of it is quite variable: often at a high position of the blind intestine, the ascending colon has a length of 12 cm or even less. The lepts on the ascending semicircle are located in the following sequence: on the front surface - free ribbon, Tenia Libera, on the posterior - sunel ribbon, Tenia Omentalis, and on the rear-day - mesenter tape, Tenia Mesocolica.

Cross colon , Colon Transversum, begins in the right hypochred region at the level of X rib cartilage from the right bending of the colon, goes in a somewhat oblique direction to the right left and up into the left hypochritic area. Here is the level of IX rib cartilage or the eighth intercostal, it goes to the downstream guts to the left bend of the colon. The left section of the transverse colon is superficial (centrally) of the descending colon. The middle part of the transverse colon crosses the surning region, forming a bend directed by the book (provistent), so that the ascending and descending colon, along with the transverse, resemble the letter M. The length of the transverse colon reaches 50 cm. This is the longest colon section. It is located intraperitoneally and has its own mesentery, Mesocolon Transversum, starting on the back of the abdomen from the cloth peritoneum.

To the front surface of the transverse colon along the continuation of the posterior oil ribbon, the Tenia Omentalis is attached, the gastrointestinal bunch, Lig. Gastrocolicum, - part of the large seal, Omentum Majus, covering all small intestine departments. As a result of this location, the transverse colon, sheltered in front of the front, with an open cavity of the belly is not visible or only shines. If you turn out the gland together with the transverse colon fixed to its back surface, you can see the rear (dorsal) surface with the free ribbon, Tenia Libera, and the mesenter of the transverse colon, Mesocolon Transversum.

The left bending of the colon, Flexura Coli Sinistra, is located in the left hypochritic region, significantly higher and deeper (doorsally) than the right, immediately under the lower pole of the spleen. The left end of the transverse colon forms a sharp angle with the initial sequel, the vertex of which is fixed by the peritoness leaves, descending from the diaphragm (Lig. Phrenicocolicum).

Downward collapse , Colon Descendens, located on the back of the abdomen, occupying an extreme left position in the side wall. It begins at the top of the left bending and falls along the back wall of the abdomen; its rear, devoid of the peritoneal cover lies ahead of the lateral section of the left kidney and the square muscle of the lower back and comes to the level of the left ileal ridge; Here goes to the next colon section - the sigmoid gut. The descending colon is located laterally from the median stomach plane than ascending. Its length is larger than as-upward, and reaches 22-23 cm. The diameter of the intestine of previous colon departments and at the level of transition to the sigmoid intestine is 4 cm. The number of the Gaister and their depth are reduced; The location of the muscle tapes, the position of the peritoness and the glands is the same as on the ascending colon.

Sigmoid colon , COLON SIGMOIDEUM, is located in the left iliac yam. It begins on top and lateral at the level of the rear edge of the ileal ridge. By forming two hinges, of which one, proximal, located on the iliac muscle, convex part is drawn by the book, and the other, distal, located on a large lumbar muscle, is upward, the sigmoid colon is sent to the right (medial) and down, drives through the border line and It enters the cavity of a small pelvic, where at the level of the III of the sacrilate vertebra goes into the rectum. The length of the sigmoid colon is an average of 54-55 cm, it is subject to significant individual fluctuations (from 15 to 67 cm); The diameter of it is about 4 cm. The sigmoid colon is located intraperitoneally and has a mesentery.

In the structure of the walls of the blind and colon there are its own characteristics. Full of three layers - peritonevos, muscle and mucous membranes - consist only those colon departments that are intraperitoneally, namely: blind, transverse colon, sigmoid colon and upper third of the rectum; Ascending colon and descending colon (in some cases, the blind intestine) have perky cover on three sides: lateral, front and medial. Colon

The area of ​​the rear wall of the ascending rim and downstream colon on the width of 2-3 cm is deprived of a serous shell; The mesenteric parts of the colon - the transverse and sigmoid colon - they have a narrow, deprived of the peritoneal strip along the mesente attachment line. In the location of the groove on the colon, the serous shell follows the wall behind the deepening.

In rare cases, the lower departments of the ascending and downstream guts can be covered with a serous shell on all sides and even form mesenters.

Muscular shell, Tunica Muscularis, all over the colon forms two layers - an outer longitudinal layer, Stratum Longitudinale, and internal circular, circular layer, Stratum Circulare. The longitudinal layer on most of the stretch is assembled in the tape. The black-shaped process has a solid two-layer muscle cover, which is weaker than in other departments.

The mucous membrane, Tunica Mucosa, consists of the epithelial cover with the underlying of its basal membrane, its own connective tissue layer and the muscle plate of the mucous membrane, Lamina Muscularis Mucosae, under which the sublifted base is lying, Tela Submucosa.

The mucous membrane epithelium consists of cylindrical cells with a large amount of glassworms. The mucous membrane of the colon contains intestinal glands, Glandulae Intestinales, but deprived of a villio. Alone lymphatic follicles are located all over the mucous membranes, Folliculi Lymphatici Solitarii. Accordingly, the location of the transverse groove the mucous membrane forms the semi-lobby collapse of the colon, the Plicae semilunares coli.

The location of the ileum in the thick - ileocecal hole, Ostium IleoCeCale, there are two permanent folds of the wifth walls, mainly from the circular muscular layer. They form an ileocecal valve, Valva IleoCecalis. The edges of the hole are fascinated and continued in the form of a bridle of the ileocecal valve, Frenulum Valvae IleoCecalis located on the boundary of the blind and ascending colon. Based on the damper, the muscular layer is more developed, forming a kind of foil.

The mucous membrane of a worm-like process is characterized by an abundance of lymphoid tissue forming an almost solid layer in the form of group lymphatic follicles of a worm-like process, Folliculi Lymphatici Aggregati Appendicis Vermiformis.

Atlas of human anatomy . Academician.ru . 2011. .

Color cancer - a malignant tumor, which is more often formed in people aged 40-70 years. The disease for a long time flows asymptomatic or manifested by the intestinal dysfunction. For this reason, the tumor is more often detected in the late stage of the oncological process, when difficulties arise with the implementation of radical operational intervention.

  • For the diagnosis and treatment of colon tumors, all conditions are created in the Yusupov Hospital:

  • European level of comfort chambers;

  • The newest diagnostic equipment of the expert class, which has a high resolution;

  • High level qualifications of doctors;

  • Application of international protocols and standards for the treatment of malignant neoplasms of the colon;

  • Attentive attitude of medical personnel to the wishes of patients and their relatives.

Patients needing palliative care may be in the hospice. Heavy calaim cancer cases are discussed at a meeting of the Expert Council. Doctors and candidates of medical sciences, doctors of the highest qualifying category take part in his work. Leading specialists in the field of oncology collegiates produce patient tactics.

abdominal-pain-2821941_1280.jpg

Cause of the development of the disease

The exact causes of the colon cancer scientists have not yet established. The malignant tumor can develop against the background of precancerous diseases: family and acquired polyposes, naval tumors and adenomatous polyps. To provoking tumor formation factors researchers relate the following pathological processes:

The disease can develop in disruption and food composition. The neoplasm is more often evolving in people who eat a large amount of meat and meat products. The inner flora can produce carcinogenic substances from animal fats. There is also a violation of the passage of intestinal content with insufficient use of fresh vegetables, fruits, products that contain a large amount of fiber.

Views

Macroscopically distinguish between two forms of malignant neoplasms of the colon - exofite and endophyte. The first form of cancer is characterized by an increase in the tumor into the intestinal lumen. It can have the appearance of a node or polypa, more often found in the right half of the colon, in shape resembles a cauliflower. Endophic tumor in most cases is formed in the left half of the colon. It infiltrates the intestinal wall, gradually captures it throughout the circumference and causes a circular narrowing. On tumors are often formed ulcers.

Morphologists distinguish the following histological types of malignant laugheries of the colon:

  • Adenocarcin;

  • Mucous cancer;

  • Solid cancer.

The colon cancer metastashes late. This allows surgeons-oncologists to produce radical operational interventions even at large neoplasm sizes. The tumor is too involved in the inflammatory process. He often goes to a fiber that surrounds the intestines. Metastases can be in regional lymph nodes for a long time. They are removed during the operation with mesenter.

Symptoms

The colon is a segment of the colon. The main functions of the colon - secretion, absorption and evacuation of the intestinal content. The colon has the greatest length. It consists of an ascending, descending, transverse and sigmoid colon, has a hepatic bending, a splenic bending. Color cancer is one of the common malignant diseases in developed countries, the population of which consumes an excessive amount of animal fats, a lot of meat and very few fresh vegetables and fruits.

Symptoms of the disease become more pronounced as the tumor and intoxication of the body increases. The clinical picture is diverse, depends on the localization, the forms of the tumor, various aggravating circumstances. The left-sided colon cancer is characterized by a rapid narrowing of the gossip, the development of its obstruction. Right-sided colon cancer is characterized by anemia, intense abdominal pain. In the early stages of the development of cancer, symptoms are similar to various diseases of the gastrointestinal tract, which often does not allow the correct diagnosis in a timely manner. The symptoms of the colon cancer include:

  • belching;
  • non-systematic vomiting;
  • gravity in stomach after meals;
  • nausea;
  • flatulence;
  • Pain in the abdomen;
  • constipation or diarrhea;
  • change in the nature of the chair, its shape;
  • feeling of discomfort, incomplete intestinal emptying;
  • Iron-deficiency anemia.

Often, the colon cancer is accompanied by the addition of infection and the development of the inflammatory process in the tumor. Stomach pain can resemble pain in acute appendicitis, the temperature often rises, blood tests show an increase in ESP and leukocytosis. All these symptoms often lead to a medical error. The early manifestations of the colon cancer are intestinal discomfort, whose symptoms often refer to the diseases of the gallbladder, liver, pancreas. Publishes for catering cancer are not treatable, which becomes an important symptom of the development of an oncological disease. The left-sided colon cancer cancer is much more accompanied by intestinal disorders than right-sided cancer.

Publishes when cancer sewing can be replaced by diarrhea, the stomach swells, the belching and rumbling in the abdomen. Such a state can disturb for a long time. Appointment of diet, treatment of intestinal work disorder does not bring results. The most pronounced symptoms of the abdomen and constipation, characteristic of the cancer of the rectosigmoid intestinal department, appear in the early stages of cancer development.

The intestinal obstruction in the sewing cancer is an indicator of the late manifestation of the oncological disease, more often occurs during the left-sided form of cancer. The right sector of the intestine has a large diameter, a thin wall, in the right section contains fluid - the obstruction of this department occurs in the late stages of cancer. The left sector of the intestine has a smaller diameter, it contains soft hollow masses, with the growth of the tumor there is a narrowing of the intestine and the blockage of the lumen of the feasible masses occurs - intestinal obstruction is developing.

When palpation, doctors are determined in the right half of the stomach stationary, slightly painful tumor. Due to the smaller diameter of the descending intestine, dense consistency of the feces, endophyte growth with a narrowing of the intestinal lotication during cancer of this localization often develops intestinal obstruction. The colon cancer can be complicated by bleeding, intestinal obstruction, perforation (sprinkling the intestinal wall), germinating the neoplasm in neighboring organs, the inflammation of the tumor.

With the right-sided form of cancer, patients often detect the tumor themselves when palpation of the abdomen.

Blood in Kale

Patients make complaints for the presence of impurities in the feces: blood, pus, mucus. Blood discharges during the colon cancer are more often noted with exofic types of tumors, begin with the breakdown of the tumor, refer to late manifestations of malignant education. In some cases, the appearance of blood in feces is the only sign of cancer, especially if the tumor is located in the left half and the spray corner of the colon.

Depending on the location of the tumor, Cal may have a different look. With the defeat of the ascending bowel, the feces have a brown color or a party-shaped chair is observed. Called masses mixed with blood - a sign of a tumor located in the region of the spleen corner and the adjacent departments of the descending intestine. Under the defeat of the final seashore, unchanged (alaty or dark red), blood covers the feces.

Blood discharges during the colon cancer are more often noted with exofic types of tumors, begin with the breakdown of the tumor, refer to late manifestations of malignant education.

Cancer of the rising colon

The cancer of the ascending divistee is characterized by severe pain syndrome. The pain in the abdomen also bother with a blind intestine. This symptom is one of the signs of cancer of these segments of the colon.

Cancer of the sealer bending of the colon

By virtue of its anatomical arrangement of the cancer of the spleen bend of the colon is poorly determined by palpation. Also poorly determined by the sepid bent cancer. Most often, the examination is carried out in the standing position or in the half-sidet position. Such a study with a primary examination of the patient allows you to obtain information on the presence, the size of the tumor and the location of its localization.

Cross-colon cancer

Cross-colon cancer develops less frequently than cancer of a sigmoid or blind intestine. When the growing tumor of the cross-colon is affected by right shear, medium, left rimberry and lower mesenteric lymph nodes. The symptoms of the cross-colon cancer are the loss of appetite, the feeling of gravity in the top of the abdomen, belching, vomiting. Such symptoms are more likely characterized by cancer of the right side of the transverse colon.

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Complications

Coloring cancer causes heavy and life-threatening complications:

  • Bleeding;
  • Intestinal obstruction;
  • Perforation (spout of the intestinal wall);
  • Germination of neoplasm in neighboring bodies;
  • Inflammation of the tumor.

Bleeding from the colon in the presence of malignant neoplasms is rarely abundant. Basically, blood is mixed with wheel masses and is determined using laboratory studies.

The intestinal obstruction in most patients serves as the first manifestation of the disease. It is obtaceous intestinal obstruction (the growing tumor narrows the clearance of the colon).

A large danger to the patient represents the intestine perforation. The spinning arises either in the field of tumor during ulceration or decay, or proximal (above) as a result of excessive stretching of the intestinal wall content. When the tumors of the colon, the patient's state of the patient is sharply deteriorated sharply deteriorating, it is often with a fatal outcome.

Large difficulties for diagnosis and treatment are inflammatory and incoding processes in the fiber, which surrounds the tumor of the colon. The infection most often amazes the overgrown fiber of the ascending and downward departments of the colon, which are deprived of a serous shell. In the presence of inflammation, patients impose complaints of pain in the lower back and the posterior departments of the abdominal wall. They increase the body temperature. When palpation, doctors determine the tension of muscles and pain in the field of the front abdominal wall and the lower back.

Diagnostic methods

The doctors of the Oncology Clinic of the Yusupov Hospital establish a diagnosis of "crash cancer" based on the analysis of the clinical picture of the disease, data of physical examination, endoscopic and radiological studies, biopsy results. The following changes may occur in the blood test:

  • Anemia (decrease in the number of erythrocytes and hemoglobin);

  • Hypoproteinemia (decrease in protein concentration);

  • Increase the erythrocyte sedimentation rate;

  • Hypoprotrombinemia (reduction of platelets);

  • Decrease of hematocrit.

With the help of laboratory analysis, the presence of hidden blood in feces. During irrigoscopy (x-ray studio study of the large intestine with contrasting of the barium mixture), the location, size, length and the nature of the tumor growth are determined. On radiographs, the characteristic signs of a malignant tumor of the colon:

Colonoscopy (endoscopic study) allows you to examine all colon waste departments, produce a biopsy. Plots of tissues with pathologically changed sections of the intestines are sent to the morphological laboratory to verify the histological type of cancer. With the help of a colonoscopy made using the latest devices, the oncologists of the Yusupov hospital detect the initial stages of the colon cancer, inaccessible to other research methods.

To eliminate the presence of metastases in the liver, radioisotope scanning is carried out. The results of the study of the doctors of the oncology clinic are taken into account in determining the stage of the tumor process and drawing up a plan of operational intervention. Positron-electronic computed tomography (PET-CT) is performed in suspected metastase. If you cannot establish an accurate diagnosis using these diagnostic methods, oncologists perform exposive laparotomy.

Before surgery, the surgeon is carried out differential diagnosis of colon cancer with the following diseases:

  • Tuberculosis;

  • Crohn's disease;

  • Aktinomikosis.

If the tumor is located in the left half of the colon, they exclude Amebiaz, diverticulitis, nonspecific ulcerative colitis. When damaged by a malignant tumor of the liver angle, a differential diagnosis with a tumor of the liver or the right kidney, calculous cholecystitis, is carried out. If oncologists are suspected of cancer of the sealer bending of the colon, exclude the tumor and the cyst of the spleen, the tail of the pancreas or the left kidney.

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Treatment

Oncologists of the Yusupov Hospital remove a malignant tumor of the colon with the help of surgical intervention. A resection of the affected area of ​​the colon is carried out along with the mesentery, lymphatic nodes are also removed. If the ascending gut cancer is found, the treatment passes through right-hand hemicultomy. In the same method, the tumor of the blind intestine is removed. The surgeon removes the lymphatic apparatus, the entire right half of the colon, including a third of the cross-colon, ascending, blind intestine and the hepatic bend section.

Preparation for surgical intervention

Regardless of the nature and volume of the operation, the doctors of the oncology clinic conduct common and special preoperative training, which largely ensures the success of surgery. With the help of modern infusion funds, violations of the water and electrolyte balance are eliminated, the protein level is normalized, the control of hypochromic anemia and intoxication is carried out. Patients conduct intravenous infusion of drugs and blood components, glucose with vitamins, electrolyte solutions. At the same time, activities are carried out aimed at improving the function of vital organs (hearts, lungs, adrenal glands, liver, kidneys).

Special preparation is aimed at removing the mechanical passage of the carte. Patients are given to taking laxatives, put enemas, suppress pathogenic microflora, which is in abundance in the intestinal contents, drugs.

For preoperative preparation of a large intestine, an element diet is used. For 3-5 days before surgery, doctors prescribe special preparations that contain all the vital ingredients of food in refined form.

Palliative resection

In the absence of technical ability to perform a radical surgery operation, palliative resection of the colon is carried out. The choice of palliative intervention depends on the following factors:

  • Localization of the neoplasm;

  • Degree of propagation of the tumor;

  • Anatomical features of the location of the primary hearth;

  • Complications of the tumor process;

  • The general condition of the patient.

If it is impossible to remove the tumor of the right half of the colon, the surgeons are superimposed by bypass ileotranspersonomy. In case of non-cultural neoplasms of the descending intestine and the spray corner, we create bypass transversosygmoreastomy. In case of detection of the tumor of the final colon, impose a proximal coogent, one-baulous two-barbecue anti-patious rear pass.

Chemotherapy

Chemotherapy in the treatment of caravan cancer is applied with different purposes - to reduce the tumor before surgical intervention, suspension of its growth, destruction of cancer cells, metastases. Colorectal cancer is a rather resistant tumor to cytostatic. Chemotherapy for catering cancer is prescribed by a doctor, depending on the size of the tumor and the presence of metastases, is carried out by courses.

With the damage to regional lymph nodes, germination is an adjuvant chemotherapy by germination. If there is a potential risk of developing metastases into other organs, the maximum active chemotherapy is carried out. After several treatment cycles with antitumor drugs, the state of metastases is estimated and foci is removed. After surgery, adjuvant chemotherapy is used.

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Metastase

The colon cancer is most often metastasized into regional lymph nodes not immediately, but after a long time after the development of the tumor. The tumor often sprouts into neighboring fabrics and organs. Color cancer is generalized, with penetrating metastases in the lungs, the liver requires a consultation of a thoracic surgeon, a surgeon-hepatologist.

Non-spectable caravan cancer is characterized by germination of a tumor into bone structures, main vessels. An assessment is to remove the tumor; If surgery is impossible, palliative treatment (chemotherapy) is used.

Originally resectable metastatic foci are removed surgically with the subsequent conduct of palliative chemotherapy. Also, as treatment, systemic chemotherapy is carried out before the operation to remove metastases, after surgery, the treatment of chemotherapy continues.

Forecast

The forecast in the absence of metastases into regional lymph nodes is optimistic. Five-year survival is about 80%. If there are metastases in regional lymph nodes, about 25% of patients live for more than five years.

When the first signs of the violation of the colon function appear, sign up for the reception to the oncologist of the Yusupov hospital, calling the phone number of the contact center. The identification and treatment of caravan cancer at an early stage of the disease improves the forecast and contributes to the patient's cure.

Siverticulus of intestines

Siverticulus of intestines - These are the prevailing sticking of the wall thick, less often the small intestine of a congenital or acquired character. Most often occurs asymptomatic form of the disease. Explicit clinical forms of pathology are manifested by uncertain pains in the abdomen, dyspeptic phenomena, bleeding. For diagnostics use irrigography, colonoscopy, rectoroscopy, ultrasound and CT abdominal organs. Specific therapy includes the use of a dieting with an increased tissue content, the purpose of antispasmodics, prokinetics, antibacterial drugs, lactulose. With complicated course of the disease, surgical treatment is required.

General

Intestinal diverticulus can have a congenital (with the hereditary pathology of the connective tissue) or acquired (associated with the age weakness of intermediate fibers) nature. In the small intestine, the diverticulus are rarely found - in 1% of patients, while in most cases the meckel diverticulus is revealed containing the tissues of the stomach or pancreas. The intestines diverticulus are more often multiple and located in the left half of the colon (in 70% of cases).

In young age, the diverticulosis detect only in 5% of cases, aged from 40 to 60 years - in 30% of the population, and after 80 years, the frequency of damage to the intestinal diverticulus is more than 65%. Pathological protrusion may be complicated by inflammation, bleeding, perforation, but almost never accompanied by malignation. In recent years, the participation of diverticulosis cases in developed countries is noted, which is associated with a change in dietary habits, an exception from the ration of fiber and useful food fibers.

Siverticulus of intestines

Siverticulus of intestines

Causes

A variety of factors can lead to the emergence of congenital and acquired intestinal diverticulus, but they are based on all the weak tissue. With congenital connective tissue diversion, the diverticulus is usually multiple, are located not only in the intestines, but also other organs (stomach, bladder, etc.). In the first years of the disease, the wall of congenital diverticulos is represented by all layers of the intestinal wall, but with age, muscle fibers are atrophically.

The emergence of acquired intestinal diverticulus contributes:

  • Power errors (use of semi-finished products, irregular meals, exclusion from the ration of fiber, fresh fruits and vegetables)
  • Avitaminosis
  • Permanent constipation
  • Disorders of intestinal motility
  • sedentary lifestyle
  • obesity..

Any of the above reasons leads to an increase in intranicious pressure, the propagation of the mucous membrane and submucosal layers of the intestine between muscle fibers, the formation of a long-distance formation with a diameter of 3-5 cm.

Patanatomy

In the small intestine, the diverticulus of meckel is most often found - congenital incomplete infection of the yolk duct, in connection with which about 50 cm from the Baugin's flaps on the wall of the intestine, a finger-shaped protrusion is formed, a widely connected to the intestine. Sometimes single diverticulus are formed in a duodenalist - near the Paters of the nipple or in the bulb of the duodenum (most often it happens against the background of the duodenal disease of the DPK). Other localization of the diverticulosis of the small intestine is rare enough.

In the thick intestine, the diverticulus is preferably formed in the sigmoid and left half of the transverse colon. Most often formations are located in two rows, one on each side along the mesentery. The colon diverticulus tend to progression with age - an increase in the pressure in the intestine, stagnant of calm contents have a pulsing (squeezing) effect, which is why there are all new and new anti-sshind veins.

Classification

There are congenital and acquired forms of intestinal diverticulus.

  1. Congenital diverticulose Often the multiple, protrusion is localized in various organs. Also, the diverticulus can act as a component of the congenital triad of the Senta, combined with a diaphragmal hernia and a biliary disease.
  2. Acquired diverticulas With age, almost 80% of the population are formed. They can be traction (with adhesive diseases), false (in the absence of muscle fibers in the vesception wall) formed against the background of diseases and intestinal injuries.

Localization distinguishes the diesel cells of the thin and thick bowel. For flow, they allocate asymptomatic, clinically explicit and complicated diverticulus.

Symptoms of intestinal diverticulus

Diverticulus in most cases do not manifest a long time, revealing randomly upon examination about other diseases. Clinically explicit forms most often indicate the possibility of developing complications. The appearance of symptoms and complications in the diverticulosis is associated with a violation of the intestinal wall motility, stagnation of intestinal content, both in the intestine and in the absorption cavity, an increase in intranicious pressure. All of these factors lead to an increased bacterial disorder (more than 1 million cells in ml), the formation of roasting stones, the thinning of the intestinal wall in the locations of the vessels.

Clinically diverticulus of the small intestine is manifested by uncertain pain in the abdomen, chronic diarrhea. The protrusion of the large intestine wall is also able to cause abdominal pain, more in its left half, often associated with defecation and disappearing after it. Chair instability is characterized by the disease - constipation is constantly alternate with diarrhea and periods of a normal chair. In case of inspection, the carts are formed in the form of balls surrounded by mucus. Patients are worried about elevated meteorism, abundant exhibition of intestinal gases.

Complications

With a long-term embarrassing content in the diverticulas, irreversible changes in the intestinal wall occur, the intestinal flora is activated and the diverticulite occurs - one of the most frequent complications of this disease. Chronic inflammatory process can exist for a long time, causing frequent recurrent bleeding, local peritonitis with the formation of adhesions, fistula connecting the bowel cavity with a vagina, bladder, leather. In case of adhesive disease, there is sometimes intestinal obstruction.

The pronounced inflammation in the cavity of the diverticulus can lead to the perforation of its wall, the outlet of the intestinal content in the abdominal cavity with the formation of the interchequctic abscess, and in severe cases - spilled peritonitis. Perforation of the intestinal diverticulus is characterized by a clinic of the "acute abdomen", which is very often confused with a sharp appendicitis. The diagnostic error is usually detected only during the operation on which the intestine diverticulus is found.

Diagnostics

To suspect the presence of intestinal diverticulus is quite difficult, since this disease does not have a specific clinical picture. Most often, the protrusion is found by chance, when searching for the cause of anemia, the exclusion of intestinal tumors. In order to clarify the diagnosis:

  • Analyzes. In case of suspicion of diverticular disease, a gastroenterologist appoints a number of laboratory research: a general blood test determines inflammatory changes and anemia, the feces analysis on hidden blood helps to identify intestinal bleeding in time, and the coolant and bacteriological examination of the kala diagnose the intestinal dysfunction, digestion digestion and increased bacterial disorder.
  • X-ray diagnostics. Patients with this disease require irrigography, preferably with double contrast. In the X-ray, there will be visible to the protrusion of the intestinal wall, communicating with the cavity of the intestine. It should be remembered that in the presence of complications of the intestine diverticulines, you first need to make an overview radiography of the abdominal organs, make sure there are no signs of perforation, and only then appoint irrigography.
  • End endoscopy. The use of endoscopic diagnostic methods (colonoscopy, rectoroscopy) is shown only after the sign of signs of inflammation is shown. Colonoscopy is an indispensable method for finding a source of bleeding, however, it may contribute to the appearance of complications of the disease. The advantage of endoscopic techniques is the ability to conduct biopsy, morphological research of biopsyats.

For differential diagnosis with other diseases, ultrasound, CT, MSCT of the abdominal organs may be required. The intestinal diverticulus should be differentiated with ectopic pregnancy, hypochromic anemia, pseudo-membrane colitis, irritable bowel syndrome, crown disease, acute appendicitis, celiac disease, intestinal cancer, ischemic colitis.

CT OBP. The diverticulus of the horizontal part of the 12-ross, filled with partially contrast, partially gas.

CT OBP. The diverticulus of the horizontal part of the 12-ross, filled with partially contrast, partially gas.

Treatment of intestinal diverticulus

Treatment of patients with an uncomplicated form of diverticulosis is carried out in the gastroenterology department, and in the occurrence of severe complications - in a surgical hospital. He is hospitalized patients with acute or exacerbation of chronic diverticulitis, intoxication, high fever, severely accompanying pathology, inability to enterural nutrition, as well as over the age of 85. If there is an acute abdomen clinic, an urgent surgery is carried out.

Conservative treatment

If the patient accidentally revealed asymptically flowing the intestine divertic, the appointment of special treatment is not required. In the presence of uncomplicated diverticulus, a rich fiber diet, spasmolytics, prokinetics are prescribed. In compliance with all recommendations on therapy of the disease, a persistent clinical effect is usually achieved. If the patient has developed diverticulitis, the use of intestinal antiseptics, antibiotics, osmotic laxatives is recommended.

To normalize the opening of the intestine, it is necessary to abandon the cleansing enema, the uncontrolled use of laxatives. The positive effect is achieved and when the mode of moderate physical exertion is introduced into the mode - they help strengthen the muscular corset of the torso, normalize intestinal motility. To reduce the pressure in the lumen of the intestine, a diet is appointed, rich in fiber (except for very coarse fibers - pineapple, persimmon, turnips, radishes). The amount of fiber in the diet increases to 32 g / l. It is necessary to eliminate gaseous products, legumes, carbonated drinks. To achieve the necessary effect, no less than two liters of water should be used daily.

The use of stimulating laxatives, antiquity based on morphine in diverticulas is contraindicated, as they provoke further disruption of intestinal motility, exacerbate the course of the disease. Osmotic laxatives are prescribed to improve the passage of dietary masses - they increase the volume of carte masses and accelerate their promotion along the digestive tract. In diarrhea, sorbents and binders are prescribed, to relieve meteorism - the preparations of Simeticon.

Acute diverticulite requires the patient's hospitalization into a surgical hospital, the appointment of disintellation and plasma-substituting agents, antibacterial drugs. Treatment lasts at least two to three weeks, after discharge from the hospital, supporting therapy is similar to that which is carried out with uncomplicated diverticulas.

Surgery

Surgical treatment is shown in the development of threatening life of complications: perforation, abscess, intestinal obstruction, profound bleeding, the formation of fistulas. Also, the planned operation is prescribed with recurrent bleeding and diverticulitis. Usually resection of a part of the intestine, affected by the diverticulosis, with the imposition of anastomosis. In difficult situations, a colostom is superimposed to facilitate the outflow of the carte masses, and after stabilization of the state, a reconstructive operation is carried out.

Prediction and prevention

Forecast in the presence of intestinal diverticulus is usually favorable, but sometimes this disease leads to the development of the threatening life of complications. Diverticulitis occurs about a quarter of the patients. The effectiveness of its treatment at the first episode is the highest - up to 70%, with the third episode, the effectiveness of therapy is reduced to 6%. The prevention of innate intestinal diverticulines does not exist. It is possible to prevent the development of acquired diverticulus by normalizing the mode and diet, use of a sufficient amount of fiber and liquid, using moderate physical exertion.

The colon is approximately 4/5 from the total length of the colon. It distinguishes four departments: ascending, transverse, downward and sigmoid colon. The latter goes into the rectum.

The colon cancer is among the most common oncological diseases. Typically, this pathology is denoted by the term "colon cancer". Tumor neoplasms of thick and rectum are combined into one group of oncological diseases and called colorectal cancer.

Usually the emergence of a malignant tumor of the colon precedes the occurrence of a benign neoplasm - polypa. There are different types of polyps, they possess different potential to mischief. Risks are rising with age, so everyone who is 50 years and more is recommended to undergo a screening endoscopic study - a colonoscopy.

Depending on which an anatomical department arose a tumor, isolated cancer in a transverse colon, ascending and downward, sigmoid.

Causes of developing cancer cancer

It is impossible to say for sure why a concrete person in the colon occurred a malignant tumor. Cancer is always the result of a certain set of mutations in the cell, but that they led to these mutations - the question for which it is difficult to answer.

Some risk factors that increase the likelihood of colorectal cancer are distinguished:

  • Age. The risk of becoming accepted after 50 years. Apparently, this is due to the fact that over time, more genetic defects accumulate in human body cells.
  • Heredity. If your relatives (parents, sisters, brothers, children) were diagnosed with malignant colon tumors, your risks are also increased.
  • Unhealthy food. The development of cancer contributes to the "West" diet, in which there are many red and recycled meat, fast food, semi-finished products, little fruit, vegetables and fiber. Especially many carcinogens in food, cooked by frying, grilled, barbecue.
  • Low physical activity. In the increased risk group, people who lead a "sitting" lifestyle.
  • Excess weight. People who have an overweight body or obesity are more often sick of the colon cancer, and they have worse than the forecast.
  • Smoking. Smoking, excessive passion for alcohol contributes to the development of malignant tumors in the intestine.
  • Hereditary diseases. Parents can transfer some mutations to children who make them more predisposed to the development of cancer. The most common hereditary diseases from this group: Lynch syndrome, as well as family adenomatous polyposis.
  • Chronic colon : ulcerative colitis, Crohn's disease.

None of these factors cause a colon cancer with one hundred percent probability. Each of them only to a certain extent increases the risks. You can influence some of these factors, for example, to start well eat, refuse alcohol and cigarettes, play sports.

Other factors, such as heredity, inflammatory diseases of the intestine, can not be influenced. You need to know about your risks and regularly check. You can take screening on modern equipment in the European clinic.

Classification

The most common variety of colon cancer and in general colorectal cancer - Adenokarcinoma . It develops from iron cells that are located in the mucous membrane. Adenokarcinomas are presented by more than 96% of the malignant neoplasms of the colon. In this group, tumors allocate a number of subgroups. The most aggressive of them - Muzzle и Pisne-cell milking cancer . Such patients have the most unfavorable forecast.

Stage Cancer Cancer

The colon cancer is classified in stages, depending on the size and depth of germination of the primary tumor (T), the presence of foci in regional lymph nodes (N) and remote metastases (M). Allocate five main stages:

  • Stage 0. - "Cancer in place." A small tumor, which is located within the mucous membrane, does not germinate deeper.
  • Stage I. - A tumor, which sprouted into the sublifting base or in the muscular layer of the intestine walls.
  • Stage II. - The tumor, which sprout in the deep layers of the wall of the colon (IIA), sprouted it through and spread into neighboring organs (IIb), or there is a small tumor, as in stage I, and foci in 1-3 nearby lymph nodes (IIIC).
  • Stage III It is divided into three substards: IIIa, IIIB and IIC, depending on how deeply the tumor sprout into the wall of the intestine, and how much the lymph nodes affected.
  • Stage IV : There is metastasis in one body (for example, liver or lungs) or in a group of lymph nodes, which is far from the intestines (IVA), or there are metastases in more than one organ or group of lymph nodes (IVB), or the cancer spread over the surface of the peritoneum ( IVC). At the same time, the size of the primary neoplasm is not important, and how deep it sprout into the wall of the colon.

How is the metastasis of cancer from the colon?

Cancer Cancer may spread to other organs in different ways:

  • Implantation path - when cancer cells penetrate into neighboring organs, which are in contact with the intestine, "sprawling" on the surface of the peritoneum.
  • Some cancer cells are separated from the primary tumor, penetrate the blood or lymphatic vessels, migrate to lymphatic nodes or other organs. Such methods of metastasis are called Hematogenic и Lymphogenic .

Most often metastase with colon cancer are found in lungs and liver, less often - in the bones, brain.

Symptoms

Thick colon cancer often exists for a long time without causing any symptoms. But even when the symptoms arise, they are nonspecific and resemble signs of many other diseases. If you are bothering disorders from this list, most likely you do not have cancer, but you need to visit the doctor and pass the examination:

  • constipation or diarrhea that are stored for several days;
  • Changing the appearance of the chair: if it became dark, like a dead, or subtle, like a pencil;
  • blood impurities in the chair;
  • After visiting the toilet, there is a feeling that the gut was empty not completely;
  • pain, spasms in the stomach;
  • Unfortunate weakness, feeling of fatigue, inexplicable weight loss.

Cancer Cancer Complications

If the tumor blocks the clearance of the colon, the patient develops Intestinal obstruction . This condition is manifested in the form of a lack of stool, strong pain in the abdomen, nausea, vomiting, strong deterioration of the general condition. The patient immediately requires medical care, otherwise it can happen necrosis (death) The sector of the intestine, will develop peritonitis.

If the tumor leads to constant bleeding, anemia develops. The patient becomes pale, constantly experiencing weakness, he is bothering headaches, dizziness. In severe cases, blood transfusion is required.

Metastation of intestinal cancer in the liver threatens with a violation of bile outflow and development Mechanical jaundice - States in which the skin and mucous membranes acquire a yellowish tint, worried about the skin itching, abdominal pain, the general state is worse. Until the bile outflow is not restored, it becomes impossible to carry out active antitumor treatment.

A condition in which cancer cells apply over the surface of the peritoneum is called Carcanomatosis while developing ascites - accumulation of fluid in the stomach. This complication develops with the colon cancer of the IVC stage. Ascites worsens the patient's condition, it makes it difficult to treat and sharply negatively affects the forecast.

In the European clinic, there is everything necessary for the effective struggle with the complications of malignant tumors of the colon. In case of emergency conditions, patients receive treatment in full in the separation of intensive therapy. Our surgeons perform palliative operations, set stents in intestinal obstruction. With a mechanical jaundice, we carry out drainage, stenting biliary tract. Under ascite, our doctors perform laparocentsis (evacuation of fluid through the puncture), set peritoneal catheters, conduct systemic and intraperitoneal chemotherapy.

At the IVC stage of the colon cancer, when the trouser carcetrosis develops, the surgeons in the European clinic use an innovative treatment method - hyperthermic intraperitone chemotherapy (Hipec). All major tumors are removed, then the abdominal cavity is washed with a solution of a chemotherapy preparation, heated to a certain temperature - it helps to destroy small foci. According to the results of world practice, Hipec can extend the life of an oncological patient up to several years.

Diagnostic methods

If the patient is concerned with the symptoms that may indicate the colon cancer, the doctor first acts will prescribe an ultrasound of the abdominal cavity organs and colonoscopy. These studies will help to detect a tumor, and during colonoscopy you can carry out a biopsy - to obtain a fragment of pathologically modified tissue and send to the laboratory. Biopsy is the most accurate method of cancer diagnosis.

Colonoscopy is an effective screening method. It helps to detect polyps and gut cancer in the early stages. It is recommended to undergo all people over 50 years old. In the European clinic, the colonoscopy is performed by the doctors of the expert level on the latest equipment from leading manufacturers. We have a procedure in a state of "medication sleep", so you will not experience unpleasant sensations.

After cancer is diagnosed, you need to install it step. For this apply CT, MRI, PET scan. Metastases are detected using chest radiography. If there are metastases in the liver, an angiography is used - x-ray study, during which a contrast solution is introduced into the blood vessels.

Additionally, the doctor may assign an analysis of the chair to hidden blood, a common and biochemical blood test to identify anemia, evaluate the liver functions. Blood tests on oncomarkers are usually carried out in the process of treatment to monitor its effectiveness.

Differential diagnosis

Symptoms arising from carafe cancer can disturb with many other pathologies. Most often, malignant tumor has to differentiate with diseases such as intestinal infections, chronic inflammatory processes, hemorrhoids, irritable bowel syndrome.

Treatment methods

With catering cancer, different treatment options are possible. The doctor chooses the optimal tactics, depending on the stage of the malignant tumor, its localization, the general state of the patient, the presence of certain complications of certain complications. Surgical interventions are performed, various types of antitumor drugs are used, ray therapy courses are carried out.

Chemotherapy

Chemotherapy for malignant colon tumors can pursue different purposes:

  • Neoadjuvant chemotherapy Assign to surgical intervention to reduce the size of the tumor and simplify its removal.
  • Adjuvant chemotherapy It is carried out after surgery to destroy the remaining cancer cells and reduce the risk of recurrence.
  • As the main method of treatment Chemotherapy is used at late stages of cancer, in palliative purposes.

With malignant neoplasms of colon, various types of chemotherapy products are used: Capecitabine, 5-fluorouracil, oxaliplatin, irinotecan, triflowin / typiracyl (combined drug). Most often, two or more drugs are simultaneously used, it helps increase the effectiveness of treatment.

Targeted drugs They act more targeted compared to classical chemotherapy: they are directed to certain target molecules that help cancer cells uncontrollably multiply and maintain their livelihoods. Most often, two groups of targeted drugs are used for malignant intestinal tumors:

  • Inhibitors VEGF. - substances by which cancer cells stimulate angiogenesis (Education of new blood vessels). This group includes: ZIV-AFLIBERCT (CALTRAP), Ramuzirumab (Cyramz), Bevacizumab (Avastin). They are used with the progressive cancer cancer, administered intravenously once in 2 or 3 weeks, usually combined with chemotherapy.
  • EGFR inhibitors - Protein-receptor, which is on the surface of cancer cells and causes them uncontrollable. This group includes drugs such as Zetuximab (Erbitux), Panitumumab (Vectibix). EGFR inhibitors are introduced intravenously once a week or a week.

In some cases, drugs are used from the group Inhibitors of control points . They block molecules that interfere with the immune system to recognize and attack cancer cells. This group of drugs include: pembrolizumab (Keitruda), Nivolumab (aspad), upilimumab (eper). Usually they are used for non-meteable, metastatic cancer, when ineffective chemotherapy, if recurrence occurred.

In order to understand which drugs will be effective in a particular patient, you need to understand what properties have cancer cells, which mutations have occurred in them, and at the expense of what substances they have acquired the ability to be uncontrolled reproduction. This helps

Molecular genetic analysis

- Drawing up a "molecular portrait" of cancer. Thanks to our cooperation with leading foreign laboratories, such a study can be performed in the European clinic. We know how to increase the effectiveness of antitumor treatment and what to do if it stopped helping.

Surgery

In some cases (stage 0 - "Cancer in place", sometimes Stage I) Cancer Cancer can be removed during colonoscopy. Unfortunately, this opportunity is rare. Most often have to do Kolactomy - Partial or complete removal of the colon. The volume of surgical intervention depends on the localization, and the size of the tumor. Usually at the same time remove at least 12 nearby lymph nodes. The remaining ends of the intestine are sewn - impose anastomosis .

Kekectomy can be performed in an open method (through a section) or laparoscopically (through puncture in the abdominal wall).

Sometimes anastomosis does not work immediately. In such cases impose temporary COLOGY or Ilestomy - The area of ​​the colon or the iliac is stitched to the skin and form a hole for the separation of the chair. In the future, it is stomed.

If the tumor blocks the intestinal lumen, and it cannot be removed, superimposed with a worst one. The intestinal passability can be restored with a stent - metal frame in the form of a hollow cylinder with a mesh wall. Such operations are called Palliatives : They are directed not to remove cancer, but to combat symptoms, improving the patient's condition.

Surgeons in the European clinic perform various types of radical and palliative interventions. The specialists of our endoscopy branch have extensive experience in the installation of stents in the intestine, bile ducts and other hollow organs. In the interventional surgery department, radio frequency ablation is performed, chemophymbolization during metastases in the liver.

Radiation therapy

Radiation therapy can be assigned to ( neoadyvante ), after ( Adjuvant ) Operations at the intestine or as the main method of treatment with metastatic cancer, to combat symptoms.

If the radiation therapy is combined with chemotherapy, then such treatment is called Chemology therapy .

Forecast

The main indicator by which the forecast of cancer diseases and other organs is determined during cancer and other organs - five-year survival. It shows the percentage of patients who remained alive five years after they were diagnosed.

Five-year survival in colorectal cancer depends on the stage:

  • With localized cancer (It did not spread beyond the intestinal wall - stage I, IIA and IIB) - 90%.
  • When cancer, spreading to neighboring organs and regional lymph nodes (Stage III) - 71%.
  • With metastatic cancer (Stage IV) - 14%.

As can be seen from these numbers, malignant tumors of the colon in the early stages are most successfully treated, and in the event of metastases, the forecast deteriorates sharply. However, these indicators are only approximate. They are calculated on the basis of statistics among patients who have cancer in the colon was diagnosed five years ago and earlier. During this time, some changes occurred in oncology, new technologies, preparations appeared.

You can never give up hands. Even with a launched cancer with metastases, the patient can help, extend his life, get rid of painful symptoms. Doctors of the European Clinic are taken for the treatment of any patients. We know how to help.

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