DIVERTICULOZA COLONIC

Simptomatologie

Asimptomatic

Dureri, flatulen, modificri tranzit

Complicaii:
- abces, peritonit
- perforaie
- fistule
- stricturi
- hemoragie
Colonoscopie
Clism baritat
COLONUL IRITABIL
Boal funcional caracterizat prin durere abdominal i tulburri de tranzit n absena oricrei alte
afeciuni organice.
Importan

Prevalen ntre 7 27% n populaia general

Motiv frecvent de consultaie

Costuri: 34 miliarde euro n 8 ri industrializate

1SII = 1 DZ (756 euro)

Mecanisme patogenice
1. Factori genetici
- agregare familial educaie?
- nivele Il 10
- polimorfism al transportatorului de recaptare a serotoninei (bl psihiatrice)
2. Factori psiho-sociali
- exacerbarea tulb. funcionale, dar i consecin a acestora
3. Tulburri de motilitate
- rspuns motor anormal (nu explic durerea)
4. Hipersensitivitatea visceral (hiperalgezia visceral, alodinie, senzitizare)
5. Inflamaia
- celule inflamatorii n mucoas
- debut dup un episod infecios acut
6. Axa creier - intestin
PET
- RMN funcional
TABLOU CLINIC
tulburri de tranzit: diaree/ constipaie
dureri abdominale: frecvent caracter colicativ, sau discomfort abdominal
balonarea frecvent, ameliorat de emisia de gaze
emisie de mucus

DIAGNOSTIC -ROMA III (2006)

Simptome n ultimele 3 luni, dar cu debut n urm cu cel puin 6 luni

Sindromul durerii abdominale funcionale a devenit entitate aparte i nu mai aparine SII

Crearea a dou noi categorii de tulburri funcionale la nou-nscut i copil

Subtipurile de SII se bazeaz pe consistena materiilor fecale

Diagnostic pozitiv

95%
- criteriile Roma
- anamnez neg
- examen fizic normal
- teste de laborator uzuale normale
Distensia intestinal cu balon
Dg de SII nu este un diagnostic de excludere!!
Criterii ce dicteaz nevoia de explorri suplimentare

Vrsta peste 45 ani

Rectoragie

Scdere ponderal

Diaree continu

Anemie

Febr

Istoric scurt sau atipic

AHC
- rectoscopie, colonoscopie, irigografie
- EDS
- ecografie abdominal i pelvin pt. patologia pancreasului, colecistului, organelor genitale
- evaluarea (radiologic, videocapsul) a intestinului subire
- examen materii fecale
- biopsie duoden
- test respirator pentru intolerana la lactoz
TRATAMENT: dificil datorit componentei psihice.
1.Dietetic: se evit alimentele care produc simptome; n caz de constipaie, diet bogat n fibre
2. Medicamentos:
-antidiareice: Loperamid, difenoxilat
- laxative: polietile n glicol, sorbitol, lactulos
-antispastice: trimebutine, mebeverin, bromur de otiloniu etc
- mediatori serotoninergici
agoniti: tegaserod
antagoniti: alosetron (colit ischemic), cilansetron
- sedative, antidepresive triciclice
- probiotice
3. Alternative terapeutice: hipnoz, acupunctur
A questionnaire was sent to people suffering from IBS (Dancey & Backhouse, 1993). They were asked how
having IBS affected their lives. These are some of the findings.

The vast majority of sufferers complained that IBS was not explained fully enough to them - in some instances
the sufferers did not even know what IBS meant. At the time of diagnosis, most had not heard of IBS. People
wanted information about the condition and how to cope with it.
Some people were afraid that their symptoms were due to other more serious disease such as cancer or severe
ulcerative colitis.
Sufferers reported that IBS affected their work - three-quarters said they had been absent from work due to IBS.
Nearly half of sufferers said that having IBS affected their sex lives.
IBS sufferers felt isolated, over half knew no one else with IBS. Most said they did not talk about IBS to other
people and some made great efforts not to let anyone know about their problems. Even when in pain, sufferers
tried to hide their distress.
Nearly 70% of sufferers said that travel was restricted because of the frequent need to find a toilet. Concern
about getting to a toilet could keep sufferers housebound.
Most respondents said that stress made their IBS worse and had modified their lifestyle as a result.
Having IBS affected all aspects of sufferers lives; work, leisure, travel and relationships. Sufferers wanted more
information about IBS, its possible causes and treatment, and a greater appreciation of their condition.
Reference:
Dancey CP, Backhouse S. Towards a better understanding of patients with irritable bowel syndrome. J Adv Nurs
1993; 18: 1443-50.
Twelve key clinical questions have been suggested by Drossman to be asked during a first consultation to help
to determine the nature of the condition and to help plan management. These include questions about the type
of pain experienced by the patient and its history, the patients understanding of the illness, and the possible
involvement of psychological and psychosocial factors. Other questions to be asked include the effect the
disorder is having on the daily physical, psychological, and social activity of the patient and the reason for the
patients visit or referral.
Reasons for the visit may include a worsening of functional status or new circumstances exacerbating the
condition e.g. a change in diet or a concurrent medical disorder; concerns about having a serious disease; stressrelated factors; a psychiatric co-morbidity such as depression or anxiety; impaired daily function e.g. recent
inability to work or to socialise; a hidden agenda e.g. laxative abuse, to obtain narcotics, to gain disability
benefits or the justification of illness to family or co-workers; or any combination of these.
The physician may also have to consider referral, perhaps because a colonoscopy or other procedure is required
to complete an evaluation or because additional assessments are needed (e.g. psychological or psychiatric).
References:
Drossman DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern
Med 1995; 123: 688-97.
Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: A technical review for practice
guideline development. Gastroenterology 1997; 112: 2120-37.