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Pseudomembranous Enterocolitis - Causes, Symptoms and Treatments
Pseudomembranous enterocolitis is all acute inflammation and necrosis or thc small and large intestines, which usually affects the mucosa but may extend into submucosa and, rarely, other layers. Marked by severe diarrhea, this rare condition is generally fatal in 1 to 7 days from severe dehydration and from toxicity, peritonitis, or perforation.
Causes of Pseudomembranous enterocolitis:
The exact cause of pseudomembranous enterocolitis is unknown; however, Clostridium difficile is thought to produce a toxin that may playa role in its development. Pseudomembranous enterocolitis has occurred postoperatively in debilitated patients who undergo abdominal surgery and in patients treated with broadspectrum antibiotics. Whatever the cause, necrotic mucosa is replaced by a pseudomembrane filled with staphylococci, leukocytes, mucus, fibrin, and inflammatory cells.
Signs and symptoms of Pseudomembranous enterocolitis:
Pseudomembranous enterocolitis begins suddenly with copious watery or bloody diarrhea, abdominal pain, and fever. Serious complications, including severe dehydration, electrolyte imbalance, hypotension, shock, and colonic perforation, may occur in this disorder.
Diagnosis of Pseudomembranous enterocolitis:
Diagnosis is difficult in many cases because of the abmpt onset of enterocolitis and the emergency situation it creates, so consideration of patient history is essential. A rectal biopsy through sigmoidoscopy confirms pseudomembranous enterocolitis. Stool cultures can identify C. difficile. Other conditions to consider are ulcerative colitis and Crohn's disease.
Treatment of Pseudomembranous enterocolitis:
A patient receiving broad-spectrum antibiotic therapy must discontinue antibiotics at once. Effective treatment usually includes oral metronidazole. Oral vancomycin is usually given for severe or resistant cases. A patient with mild pseudomembranous enterocolitis may receive anion exchange resins, such as cholestyramine, to bind the toxin produced by C. difficile. Supportive treatment must maintain fluid and electrolyte balance and combat hypotension and shock with pressors, such as dopamine and levarterenol. The value of systemic corticosteroids is not established. In extreme cases, subtotal colectomy has been required as a life saving measure.
Special considerations of Pseudomembranous enterocolitis:
- Monitor vital signs, skin color, and level of consciousness. Report signs of shock immediately.
- Record fluid intake and output, including fluid lost in stools. Watch for dehydration (poor skin turgor, sunken eyes, and decreased urine output).
- Check serum electrolytes daily, and watch for clinical signs of hypokalemia, especially malaise, and weak, rapid, irregular pulse.
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