Ulcerative colitis and its treatment

A type of inflammatory bowel disease that causes inflammation ulcers in the inner lining of the colon rectum.

Causes-

1. Autoimmune triggering the body to inflame the colon.
2. High fat diet.
3. Milk allergy
4. Stress and illness.
5. Viral and bacterial infection.
6. NSAIDS

Types of ulcerative colitis-

1. Ulcerative proctitis- affect the area of rectum.
2. Proctus sigmoiditis- affect the area of rectum and sigmoid.
3. Left sided colitis- it affect rectum sigmoid and descending.
4. Pancolitis- sever case affect all colon.

What happened to large intestine when ulcer forms- (pathophysiology)-

Inflammation in large intestine leads to the cell damage and kill cells of the lining. Which leads to the ulcer formation. These ulcer formation cause the bleeding , pus formation which leads to the fever , diarrhea and anemia due to blood loss. Patient have abdominal pain due to inflammation. Colon can't do it's function of absorption of water which may lead to the dehydration, fluid electrolytes imbalance and decreased appetite and leads to weight loss.

Patient have frequent bowel movements so feel urgent frequency.

Sign and symptoms-

1. Urgent bowel movements.

2. Low RBCs cause anemia .

3. Weight loss due to improper digestion of food.

4. Cramps in abdomen which are very painful. This is due to inflammation and after taking food this pain becomes more severe.

5. Electrolyte imbalance occur due to dehydration because large intestine fail to absorb water.

6. Fever due to pus formation and infections.

7. Rectal bleeding.

8. Severe diarrhea with blood pus mucosa.

Complications-

1. Scars in the lining get flare up again after healing that cause  pseudo polyps, scar tissue and narrowing.

2. With sever case large intestine starts to loose it's pouch like structure called hustra which help to chum food properly and leads to colon become smooth called lead pipe sign.

3. Rupture of intestine due to hole formation after ulcers leads to leakage of bacteria , pus into abdominal cavity which leads to peritonitis.

4. Toxic megacolon occur due to the overwhelming inflammation which dilate colon and that become paralyzed and can't work properly. Which is very life threatening condition.

5. Patient is also in risk of colon cancer.

Diagnosis- 

1. Colonoscopy

2. Barium enema.

Treatment- 

1. Surgery in severe cases including.

Proctocolectomy - surgical removal of rectum and all part of colon.

Ileostomy - surgical opening of ileum.

Ileoanal Anastomosis with J pouch - in this rectum removal and pouch create that attached to ilium which allows stool to pass from small intestine to Anus without Ostomy.

2. Medications- 

A . Anti inflammatory - 5 Amino salicylate (sulfate salazine) most important and these are first line treatment and can't given to patient have allergy with sulfa.

B. Corticosteroid (predinsone) these are not used long term and have trapped off because have side effect e.g Increased glucose level , thinning of skin , bruising and osteoporosis.

C. Immuno suppressors- these are strong drugs and are used in severe cases of ulcerative colitis. Common drug is Azathiarine. ( Imuron)

These drugs decreased immune system and have great risk to development of the cancer.

D. Immuno modulators ( Adalimumab, Humaria).- 

They blocks TNF which is protien play role in inflammation.

 

Diet- 

Patient care-

1. Monitor vital signs .

2. Monitor bowel movement , sounds and 

frequency.

3. Focus to complications e.g . Peritonitis , toxic megacolon , abdominal pain , bloating , fever, increased heart rate , Increased respiratory rate .

4. Keep NPO and administrator IV fluid.

5. Food not given included high fiber because they require lot of digestion , nuts , popcorn , raw fruit and vegetables. Dairy , spicy and high fat food.

6. Easy to digest food includes low fiber high protien diet.

7. Regular colon cancer screening should done.

8. Ostomy care should provide to patient.