Pseudomembranous colitis

　　Clostridium difficile and its toxins are the pathogenic factors of this disease, but the efficacy of the stool toxins is not parallel to the severity of the disease. This indicates that the bacterial toxins are not the only factor affecting the severity of the disease. The use of broad-spectrum antibiotics, especially lincomycin, clindamycin, ampicillin, and oxacillin, inhibits the normal flora in the intestines, allowing Clostridium difficile to multiply rapidly and produce toxins, causing the disease. The disease can also occur after surgery, especially after gastrointestinal cancer surgery, and in patients with other serious diseases such as intestinal obstruction, malignant tumors, uremia, diabetes, heart failure, sepsis, and so on. These cases generally have extremely low resistance and immune ability, or they receive antibiotic treatment due to the need for the disease, leading to changes in the internal environment of the body, intestinal flora imbalance, which is conducive to the proliferation of Clostridium difficile and pathogenesis.

　　Pseudomembranous colitis usually starts abruptly, with mild cases having only mild diarrhea, and severe cases can present in an acute type, with rapid progression of the disease. Severe cases can lead to hypovolemic shock. Hypovolemic shock is caused by a large loss of body fluid in the body or blood vessels, leading to a sudden decrease in effective blood volume, resulting in a decrease in blood pressure and microcirculatory disorders. It is manifested by dizziness, pale complexion, cold sweat, cold extremities, restlessness or apathy, severe cases may faint, even become unconscious, rapid pulse, and a decrease in blood pressure, rapid breathing, cyanosis, oliguria, and even anuria. Severe cases can lead to death.

　　The onset age of pseudomembranous colitis is mostly in the age group of 50 to 59 years, with slightly more females than males. The onset is usually abrupt, with mild cases having only mild diarrhea, and severe cases can present in an acute type, with rapid progression of the disease. The clinical manifestations of pseudomembranous colitis include fever, abdominal pain, nausea, abdominal distension, massive diarrhea, green seawater-like or yellow egg yolk-like loose stools, and detached pseudomembranes. After diarrhea, abdominal distension decreases, pulse quickens, blood pressure drops, breathing becomes rapid, signs of dehydration appear, mental confusion occurs, abdominal tenderness, abdominal muscle tension, intestinal distension, and decreased bowel sounds.

　　1, Diarrhea is the most common symptom, usually occurring within 4 to 10 days after the application of antibiotics, or within 1 to 2 weeks after discontinuation of medication, or within 5 to 20 days after surgery. The degree and frequency of diarrhea vary. In mild cases, stools occur 2 to 3 times a day and can recover spontaneously after discontinuing antibiotics. In severe cases, there may be a large amount of diarrhea, with more than 30 stools a day, and sometimes diarrhea can last for 4 to 5 weeks. A few cases may excrete plaque-like pseudomembranes, and blood in stool is rare.

　　2, Abdominal pain is a common symptom, sometimes very severe. It may be accompanied by abdominal distension, nausea, vomiting, and may be misdiagnosed as acute abdomen, surgical anastomotic leakage, and so on.

　　3. Toxicemia manifestations include tachycardia, fever, delirium, and disorientation. Severe cases often occur with hypotension, shock, severe dehydration, electrolyte imbalance, metabolic acidosis, oliguria, and even acute renal insufficiency.

　　Patients who must use antibiotics should be vigilant, and early detection should be followed by timely treatment to reduce the occurrence of severe pseudomembranous colitis. Rational use of antibiotics should be promoted, and the abuse of antibiotics should be杜绝. Antibacterial drugs are also known as 'antibacterial agents', a class of drugs used to inhibit bacterial growth or kill bacteria. In cases where there is no ambiguity, antibacterial drugs can also be abbreviated as 'antibiotics'. Antibacterial agents are not the same as antibiotics; antibiotics are actually just a class of antibacterial agents. Antibacterial drugs include not only penicillins, tetracyclines, and other antibiotics, but also antifungal drugs and sulfonamides, quinolones, and other drugs.

　　During or shortly after the use of antibiotics, especially after the use of lincomycin or clindamycin, sudden onset of anemia-free mucous diarrhea or deterioration of the condition after abdominal surgery should be considered as the disease. Diagnosis can be quickly obtained by sigmoidoscopy, where pseudomembranes are seen and stool cytotoxin determination is positive.

　　1. Laboratory examination

      Peripheral blood leukocyte count is increased, usually above 10,000 to 20,000/mm3, even up to 40,000/mm3 or higher, with neutrophils predominating. Routine stool examination shows no specific changes, only white blood cells, and gross hematochezia is rare. There may be hypoalbuminemia, electrolyte imbalance, or acid-base imbalance. Special culture conditions of stool bacteria can reveal growth of Clostridium difficile in most cases. Detection of stool cytotoxins has diagnostic value. Dilute the filtrate of the patient's stool with different multiples, place it in tissue culture medium, and observe the cytotoxic effect. A dilution of 1:100 or above is of diagnostic significance. The antitoxin neutralization test for Clostridium sordellii is often positive.

　　2. Endoscopic examination

      When highly suspected of the disease, endoscopic examination should be performed promptly. The disease often involves the left half of the colon, while the rectum may not be affected. Sigmoidoscopy is one of the important diagnostic methods. If the lesion is in the right half of the colon, then fiberoptic colonoscopy is needed. In cases where typical lesions are not found in the early stage, repeat endoscopic macroscopic observation is required. In early stages or with timely treatment, endoscopy may show no typical findings, the intestinal mucosa may be normal, or only have mild congestion and edema. Severe cases may show increased fragility of the mucosa and obvious ulcer formation, with a yellowish or greenish pseudomembrane covering the mucosal surface.

　　3. X-ray examination

      When highly suspected of the disease, endoscopic examination should be performed promptly. The disease often involves the left half of the colon, while the rectum may not be affected. Sigmoidoscopy is one of the important diagnostic methods. If the lesion is in the right half of the colon, then fiberoptic colonoscopy is needed. In cases where typical lesions are not found in the early stage, repeat endoscopic macroscopic observation is required. In early stages or with timely treatment, endoscopy may show no typical findings, the intestinal mucosa may be normal, or only have mild congestion and edema. Severe cases may show increased fragility of the mucosa and obvious ulcer formation, with a yellowish or greenish pseudomembrane covering the mucosal surface.

　　If pseudomembranous colitis can be diagnosed early, treated in time, and attention is paid to diet and lifestyle, most patients can recover, and clinical symptoms and signs can be improved and disappear. Patients can eat light food, consume semi-liquid food that is easy to digest, and can also consume yogurt containing probiotics. In severe cases or those with severe nausea and vomiting, fasting is required, and parenteral nutrition is given. After symptoms are relieved, normal diet can be gradually resumed.

　　In addition to Western medicine treatment and surgery for pseudomembranous colitis, it can also be treated with the following traditional Chinese medicine methods.

　　Formula one

　　Dialectic: summer dampness external syndrome, heat entering the营, toxic heat is strong, tends to attack the pericardium, dampness and heat block the middle, clear and turbid are not differentiated, leading to excessive diarrhea.

　　Treatment method: clear heat and detoxify, cool blood and remove spots, assist with differentiation.

　　Formula name: Qingre Jiedu Lishui Decoction.

　　Composed of 60 grams of Lianhua, 18 grams of Huanqiao, 24 grams of Danpi, 9 grams of Chishao, 15 grams of Gongying, 30 grams of Bajiangcao, 18 grams of Yuanshen, 12 grams of Maidong, 18 grams of Tianhuafen, 12 grams of Xiacai Gen, 60 grams of Huashizhike, 15 grams of Cheqianzi, 30 grams of Shiyi, 30 grams of Baixianpi.

　　Use it for decoction, 1 dose per day, 3 times a day.

　　Formula two

　　Dialectic: deficiency of the spleen and excessive dampness, unclear differentiation of clear and turbid.

　　Treatment method: invigorate the spleen and drain dampness, differentiate the clear and turbid.

　　Formula name: Sanyang Lishui Decoction.

　　Composed of 12 grams of Dangshen, 6 grams of Baizhu, 12 grams of Fuling, 9 grams of Puli, 9 grams of Shanyao, 12 grams of扁豆, 6 grams of Roudoukou, 12 grams of Shudi, 9 grams of Maidong, 4.5 grams of Wuweizi, 9 grams of Chenpi, 3 grams of Tongcao, 12 grams of Cheqianzi, 3 grams of Rougui, 2.4 grams of Ge Gen.

　　Use it for decoction, 2 doses per day, 4 times a day.

　　Formula three

　　Dialectic: deficiency of the spleen and kidney, yang deficiency and tendency to collapse.

　　Treatment method: warm and invigorate the spleen and kidney, return the yang and solidify the qi.

　　Formula name: Dangling Jianggen Decoction.

　　Composed of 9 grams of Dangshen, 15 grams of Fuling, 9 grams of fried Baizhu, 6 grams of Roudoukou, 6 grams of Wujiu, 4.5 grams of Guizhi, 3 grams of Fuzi, 3 grams of prepared ginger, 4.5 grams of braised Ge Gen.

　　Use it for decoction, 1 dose per day, 3 times a day.

　　Formula four

　　Dialectic: spleen yang is damaged, transformation and transportation are impaired, and ascending and descending are abnormal.

　　Treatment method: warm the middle and expel cold, benefit the spleen and stomach.

　　The formula name is Ginseng and Baizhu Fuzi Decoction.

　　Composed of 3 grams of ginseng, 12 grams of Baizhu, 8 grams of Fuzi, 8 grams of dried ginger, 5 grams of prepared licorice.

　　Use it for decoction, 1 dose per day, 3 times a day.