Pseudomembranous enterocolitis is an acute inflammation and necrosis of the 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 due to severe dehydration and toxicity, peritonitis, or perforation.
The exact cause of pseudomembranous enterocolitis is unknown; however, Clostridium difficile is thought to produce a toxin that may play a role in its development. Pseudomembranous enterocolitis has occurred postoperatively in debilitated patients who undergo abdominal surgery and in patients treated with broad-spectrum antibiotics. Whatever the cause, necrotic mucosa is replaced by a pseudomembrane filled with staphylococci, leukocytes, mucus, fibrin, and inflammatory cells.
Incidence of antibiotic-associated diarrhea varies from 5% to 39%, depending on the antibiotic. Pseudomembranous enterocolitis complicates 10% of these cases.
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 is difficult in many cases because of the abrupt 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.
A patient receiving broad-spectrum antibiotic therapy must discontinue antibiotics at once. Effective treatment usually includes 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.
Careful observation for signs of worsening is essential.
❑ Monitor the patient’s vital signs, skin color, and level of consciousness. Immediately report signs of shock.
❑ Record fluid intake and output, including fluid lost in stools. Watch for dehydration (poor skin turgor, sunken eyes, and decreased urine output).
❑ Check serum electrolyte levels daily, and watch for clinical signs of hypokalemia, especially malaise, and a weak, rapid, irregular pulse.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Necrotizing enterocolitis (Professional Guide to Diseases (Eighth Edition))
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