ULCERATIVE COLITIS

 

INTRODUCTION: Ulcerative colitis is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum. It is a serious disease, accompanied by systemic complications and a high mortality rate; approximately 5% of patients with ulcerative colitis develop colon cancer. It is characterized by multiple ulcerations, diffuse inflammations, and desquamation or shedding of the colonic epithelium, with alternating periods of exacerbation and remission. Bleeding occurs from the ulceration and the mucosa becomes edematous and inflamed, with continuous lesions and abscesses.

INDIVIDUALS MOST AFFECTED: Ulcerative colitis most commonly affects people of Caucasian and Jewish heritage.

CLINICAL MANIFESTATIONS: Predominant symptoms: diarrhea, passage of mucus and pus, left lower quadrant abdominal pain, intermittent tenesmus, and rectal bleeding. Bleeding may be mild or severe; pallor, anemia, and fatigue result. Anorexia, weight loss, fever, vomiting, dehydration, cramping, and feeling an urgent need to defecate. Hypocalcemia may occur. Rebound tenderness in right lower quadrant. Skin lesions, eye lesions (uveitis), joint abnormalities, and liver disease.

ASSESSMENT AND DIAGNOSTIC METHODS: Assess for tachypnea, tachycardia, hypotension, fever, and pallor. Abdomen is examined for bowel sounds, distention, and tenderness. Stool examination to rule out dysentery, occult blood test. Abdominal x-rays, computed tomography (CT), magnetic resonance imaging (MRI). Sigmoidoscopy or colonoscopy and barium enema. Blood studies (low hematocrit and hemoglobin, high white blood cell count, decreased albumin level, electrolyte imbalance).

MEDICAL MANAGEMENT: Medical treatment for both Crohn’s disease and ulcerative colitis is aimed at reducing inflammation, suppressing inappropriate immune responses, providing rest for a diseased bowel so that healing may take place, improving quality of life, and preventing or minimizing complications.

NUTRITIONAL THERAPY: Initial therapy consists of diet and fluid management with oral fluids; low-residue, high-protein, high-calorie diets; supplemental vitamin therapy; and iron replacement. Fluid and electrolyte balance may be corrected by intravenous (IV) therapy. Additional treatment measures include smoking cessation and avoiding foods that exacerbate symptoms, such as milk and cold foods.

PHARMACOLOGIC THERAPY: Sedative, antidiarrheal, and antiperistaltic medications. Aminosalicylates: sulfasalazine; effective for mild or moderate inflammation. Corticosteroids such as, oral: prednisone; parenteral: hydrocortisone; topical: budesonide. Immunomodulator agents such as, azathioprine. Biologic agents such as, infliximab.

SURGICAL MANAGEMENT: When nonsurgical measures fail to relieve the severe symptoms of inflammatory bowel disease, surgery may be recommended. A common procedure performed for strictures of the small intestines is laparoscope-guided strictureplasty. In some cases, a small bowel resection is performed. In cases of severe Crohn’s disease of the colon, a total colectomy and ileostomy may be the procedure of choice.

RELATED;

1.  ANTIEMETIC AGENTS    

2. CONSTIPATION    

3. DIARRHEA

4.  INFLAMMATORY BOWEL DISEASE

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