ULCERATIVE COLITIS

Descriptive Definition of ulcerative colitis

Is a chronic ulcerative and inflammatory disease of the mucosa and submucosal layers of the colon and rectum.

It is most common in young and middle adults but it can occur at any age.

Some clients can recover dramatically but to others it can continue in a fairly mild form for years

It may also run a rapid cause and patient die of hemorrhage, peritonitis or profound debility

Pathophysiology of Ulcerative Colitis

·         The inflammation generally begins distally near the rectum.

·         It tends to remain confined but if it progresses, it spreads upwards in a continuous fashion towards the caecum without sparing healthy tissue in its path

·         The mucosa bleeds easily

·         Superficial abscesses form in depression within the mucosa

·         Sometimes the ulceration is so intense that it leaves large areas of the colon without mucosa

·         Sometimes it causes megacolon a condition that causes the bowel to become extremely dilated, thin and atonic that is lacking motility a condition if unrelieved may cause bowel perforation. In addition the lesions have a tendency to undergo malignant changes when the disease has been active for 10 years or more.

Causes

·         Exact cause is unknown

Predisposing factors are:

·         Infections

·         Allergy

·         Emotional stress

·         Autoimmunity

Signs,  Symptoms and diagnostic findings of Ulcerative Colitis

·         The onset is usually abrupt

·         Severe diarrhea of 12 or more bowel movements per day;  fecal matter containing blood and mucus

·         Diarrhea accompanied with cramps

·         Anorexia

·         Extreme weakness

·         The urge of passing stool is very sudden that it can lead to incontinence if it comes during sleep.

Diagnostic findings

·         Barium enema and proctosigmoidoscopy help to locate the lesions

·         A biopsy which will reveal the appearance of abnormal cells

·         Stool for culture will show no infection or parasite

·         Stool will show presence of blood

·         Serum electrolyte and complete blood count may be abnormal

Management of a Patient with Ulcerative Colitis

Medical management

·         Medical treatment is primarily supportive

·         The diet may be normal but need increase of calories

·         Avoid anything that can irritate the bowel such as raw fruit and vegetable or highly seasoned foods

·         Give blood transfusion and iron to correct anemia

·         Parenteral fluids may be needed

·         Supplementary vitamins may be prescribed

·         Sedatives and tranquilizers can be given to relive anxiety and promote rest

·         Anticholinergics that slow peristalsis or those drugs that coat and soothe the mucosa may be ordered

·         Corticosteroids given orally, rectally or intravenously may relief the symptoms. To maintain a remission they should be taken for a long time although they are potentially dangerous

·         Psychotherapy is of help because of the long term illness and unpredictability of the outcome.

Surgical management

·         Surgery is done if:

• Other treatment fails
• The colon perforates

·         Operation is a total colectomy that is removal of the entire colon and rectum and a permanent ileostomy which is an opening between the ileum and skin of the abdomen for elimination of the stool.

Nursing management

·         Prepare client for diagnostic tests

·         Implement fluids and drugs as prescribed

·         Any sudden onset of abdominal distension is reported at once

·         If steroids bring complication they should be stopped gradually.

·         Control intake and output if output exceeds intake I.V fluids should be considered

·         Maintain an adequate nutritional intake

·         Administer antidiarrhoea and antispasmodics

·         Eliminate unnecessary activity

·         Assist client to clean the anal area

·         Allay the patient’s anxiety by attending him with dignity and respect and frequent visits.  Answer all his questions

·         Assist the client to cope with the condition

·         Teach the client and family during discharge on diet, about drugs, techniques on rectal hygiene and skin care, signs to report to the hospital that is worsening of the condition and recommendation for regular medical checkups.