Ulcerative colitis

  1. Can anyone recomend a book or an article that goes in depth to the pathophysiology of ulcerative colitis? Any suggestions would be appreciated.
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  2. 10 Comments

  3. by   Tim-GNP
    I like the lippincott manual of nursing practice. I hope this helps:

    Ulcerative colitis is a chronic idiopathic inflammatory disease of the mucosa and, less frequently, the submucosa of the colon and rectum. The exact cause of ulcerative colitis is unknown- some arugue Viral or bacterial organisms, others argue that it has an immunologic basis, others say psychosomatic. and others refer to a histamine mediated allergy. Who is right??? who knows! They also claim that there is a family history- with peak incidence between 20-40 years of age. Here is a very brief review:

    Clinical Manifestations
    1.Diarrhea (may be bloody or contain pus and mucus), tenesmus (painful straining), sense of urgency, and cramping
    2.Multiple crypt abscesses of intestinal mucosa that may become necrotic and lead to ulceration
    3.Increased bowel sounds; abdomen may appear flat, but as condition continues, abdomen may appear distended
    4.There often is weight loss, fever, dehydration, hypokalemia, anorexia, nausea and vomiting, iron-deficiency anemia, and cachexia (general lack of nutrition and wasting with chronic disease)
    5.Abdominal pain
    6.The disease usually begins in the rectum and sigmoid and spreads upward, eventually involving the entire colon. Anal area may be excoriated and reddened; left lower abdomen may be tender on palpation.
    7.There is a tendency for the patient to experience remissions and exacerbations.
    8.Very high frequency of secondary and often multiple colon cancer

    The Diagnostic Evaluation should include:
    1.Stool examination to rule out bacillary or amebic dysentery; fecal analysis positive for blood during active disease.
    2.Complete blood count--hemoglobin and hematocrit may be low due to bleeding, WBC may be increased; increased prothrombin time possible.
    3.Flexible proctosigmoidoscopy and/or colonscopy with biopsy confirms diagnosis.
    4.Barium enema x-ray to assess extent of disease and detect pseudopolyps, carcinoma, and strictures.
    5.Decreased serum levels of potassium, magnesium, and albumin may be present.

    Proper Medical Management:

    1.Bed rest, IV fluid replacement, clear liquid diet.
    2.For patients with severe dehydration and excessive diarrhea, hyperalimentation is recommended to rest the intestinal tract and restore nitrogen balance.
    3.Treatment of anemia--iron supplements for chronic bleeding, blood replacement for massive bleeding.

    Sulfasalazine (Azulfidine)--mainstay drug for acute and maintenance therapy. Dose-related side effects include vomiting, anorexia, headache, skin discoloration, dyspepsia, and lowered sperm count.

    Oral salicylates, such as mesalamine (Pentasa), olsalazine (Dipentum)--appear to be as effective as sulfasalazine.
    a. Nephrotoxicity can occur with mesalamine; diarrhea with olsalazine.

    Mesalamine enema available for proctosigmoiditis; suppository for proctitis.

    Corticosteroids--primary agent used in the management of inflammatory disease
    a. Prednisolone (Delta-Cortef)--IV, to induce remission of acute severe disease.
    b. Prednisone (Orasone)--orally, for moderate to severe disease.
    c. Hydrocortisone (Cortef)--enema used for proctitis and left-sided colitis.

    Antidiarrheal medications may be prescribed to control diarrhea, rectal urgency and cramping, abdominal pain; their use is not routine.

    Surgical Measures
    1. Surgery is recommended when patient fails to respond to medical therapy, if clinical status is worsening, for severe hemorrhage, or for signs of toxic megacolon.
    2. Surgical procedures include:
    a. Subtotal colectomy and ileostomy and Hartmann's pouch
    b. Total proctocolectomy with end-ileostomy
    c. Total colectomy with continent ileostomy (Kock or BCIR)
    d. Total colectomy with ileal reservoir-anal anastomosis (Fig. 16-5).
    3. The surgical goal is to remove entire colon and rectum to cure patient of ulcerative colitis.

    Complications [because God knows, you always have to have those]:


    1. Perforation, hemorrhage, toxic megacolon

    2. Abscess formation, stricture, anal fistula

    3. Malnutrition, anemia, electrolyte imbalance

    4. Skin lesions (erythema nodosum, pyoderma gangrenosum)

    5. Arthritis, ankylosing spondylitis

    6. Colon malignancy

    7. Liver disease

    8. Eye lesions (uveitis, conjunctivitis)

    Nursing Assessment
    1. Review nursing history for patterns of fatigue and overwork, tension, family problems that may exacerbate symptoms.
    2. Assess food habits that may have a bearing on triggering symptoms (milk intake may be a problem).
    3. Determine number and consistency of bowel movements, any rectal bleeding present
    4. Listen for hyperactive bowel sounds, assess weight.

  4. by   -jt
    [QUOTE]Originally posted by Tim-GNP:
    [B]I like the lippincott manual of nursing practice. I hope this helps:

    The exact cause of ulcerative colitis is unknown- some arugue Viral or bacterial organisms, others argue that it has an immunologic basis, others say psychosomatic. and others refer to a histamine mediated allergy. Who is right???

    They all are except for the psychosomatic theory now. But finding which is the cause of a particular case is not as important as managing it. UC is not as devastating as Crohns disease & is more manageable & easier to live with. It comes & goes & usually doesnt require surgery. The psychsomatic theory has pretty much been ruled out lately because of research & cell studies which lean more towards an autoimmune response (like lupus and arthritis are autoimmune responses), an allergic trigger, or a genetic predisposition. Psychosomatic causes were found in Irritable Bowel Syndrome which is different from UC although has similar syptoms. Children can have UC, Crohns, or Irritable Bowel Syndrome too. UC can be in remission for years or decades and people lead a normal life much more so than in Crohns Disease but they also have a greater risk of colon cancer - maybe up to 300% and need annual colonscopies. A famous professional football player (forget his name) has UC, the actor who plays Mack Scorpio on General Hospital also has it as does Gary Collin's wife MaryAnne Mobley. All are spokespersons. You can get more info from the Crohns & Colitis Foundation - they have a website.
  5. by   Zee_RN
    Interesting little note for ya...I have confirmed this with two different gastroenterologists at the hospital and from my husband and brother-in-low who have colitis: quitting smoking EXACERBATES colitis...badly. My brother-in-law can be in a complete remission (years w/o symptoms) and if he quits smoking, even with nicotine patch, he gets terrible flare-up...to the point of needing IV steroids. Goes on for months,not just the initial "stress" of withdrawal from cigarettes. MDs don't know why (besides stress) and researchers have not determined which component of the cigarette (nicotine has been ruled out) is involved.
  6. by   Tim-GNP
    Which, then, could add to the psychosomatic theory. If nicotine replacement fails to prevent the symtpoms, maybe there is more to the psychophysiologic theories then just a few research pieces. Perhaps related to stress of lifestyle changes??? I know when I quit smoking I was sick for about 6 weeks [non-specific complaints, I just felt like crap] Who knows???

    Nonetheless, that is very interesting-- what is your brother-in-law & husband going to do??? I would be more afraid of lung ca than the exacerbation of colitis... Do any of the meds work for them for the exacerbation???
  7. by   fergus51
    Thanks for all the info. A friend of mine wants to know exactly what the immunological developments are. She already knows the inflammation part and is wondering if anyone knows what type of immunity is implicated in UC (hummoral, cell-mediated...)
    (she used to teach pathphys and has been diagnosed with UC recently). Thanks again guys.
  8. by   -jt
    [QUOTE]Originally posted by Zee_RN:
    [B]Interesting little note for ya...I have confirmed this with two different gastroenterologists at the hospital and from my husband and brother-in-low who have colitis: quitting smoking EXACERBATES colitis...badly. >>

    This result was actually reported after a research study by MDs in England. The study was published in a medical journal a couple of years ago. But so far, I havent seen it work. I dont remember the details of the study but they looked at the possibilty of stress from quitting smoking as a factor. The problem with that theory was that their statistics showed that non-smokers (people who have never smoked, as well as people who have quit)had a much higher incidence of developing UC than smokers. Their statistics showed that UC is a non-smokers disease. Non-smokers never have to quit, so the stress factor of quitting smoking doesnt come into the equation for them, yet they still have a higher incidenece of the disease. I think the stress of quitting might add to the exacerbation because any kind of stress does that in this disease. I know UC people who took up smoking after that study was published but it didnt make any difference in their symptoms but I remember that study too.
  9. by   Zee_RN
    What do they do? Well, my brother-in-law smokes about a pack a day because he cannot face the time-off from work and the bloody BMs day-in and day-out. Even the prednisone didn't work last time...only smoking does. When he smokes, he doesn't require any medication to control his UC. My husband, fortunately, has only "a touch" of UC. He is not on any medications and just noticed that a few things he eats (e.g., if he eats ice cream several nights in a row) he will have a mild flare-up. He smokes about a pack a day but that is purely obstinancy--not colitis control (I can't stand it!!!). But when he does try to quit, he bleeds.
  10. by   Kicker
    I'm a nursing student doing a case study on a patient with ulcerative colitis. Can anyone help me with an appropriate daily diet plan for a patient with uc?

    [This message has been edited by Kicker (edited April 20, 2001).]
  11. by   cseekatz
    I am a nursing student and our teacher asked us what would be the first and most important complication of ulcerative colitis? Bleeding ( H&H WBC's) or electrolyte imbalance (NA K+ ect.)?
    Quote from Tim-GNP
    I like the lippincott manual of nursing practice. I hope this helps:

    Ulcerative colitis is a chronic idiopathic inflammatory disease of the mucosa and, less frequently, the submucosa of the colon and rectum. The exact cause of ulcerative colitis is unknown- some arugue Viral or bacterial organisms, others argue that it has an immunologic basis, others say psychosomatic. and others refer to a histamine mediated allergy. Who is right??? who knows! They also claim that there is a family history- with peak incidence between 20-40 years of age. Here is a very brief review:

    Clinical Manifestations
    1.Diarrhea (may be bloody or contain pus and mucus), tenesmus (painful straining), sense of urgency, and cramping
    2.Multiple crypt abscesses of intestinal mucosa that may become necrotic and lead to ulceration
    3.Increased bowel sounds; abdomen may appear flat, but as condition continues, abdomen may appear distended
    4.There often is weight loss, fever, dehydration, hypokalemia, anorexia, nausea and vomiting, iron-deficiency anemia, and cachexia (general lack of nutrition and wasting with chronic disease)
    5.Abdominal pain
    6.The disease usually begins in the rectum and sigmoid and spreads upward, eventually involving the entire colon. Anal area may be excoriated and reddened; left lower abdomen may be tender on palpation.
    7.There is a tendency for the patient to experience remissions and exacerbations.
    8.Very high frequency of secondary and often multiple colon cancer

    The Diagnostic Evaluation should include:
    1.Stool examination to rule out bacillary or amebic dysentery; fecal analysis positive for blood during active disease.
    2.Complete blood count--hemoglobin and hematocrit may be low due to bleeding, WBC may be increased; increased prothrombin time possible.
    3.Flexible proctosigmoidoscopy and/or colonscopy with biopsy confirms diagnosis.
    4.Barium enema x-ray to assess extent of disease and detect pseudopolyps, carcinoma, and strictures.
    5.Decreased serum levels of potassium, magnesium, and albumin may be present.

    Proper Medical Management:

    1.Bed rest, IV fluid replacement, clear liquid diet.
    2.For patients with severe dehydration and excessive diarrhea, hyperalimentation is recommended to rest the intestinal tract and restore nitrogen balance.
    3.Treatment of anemia--iron supplements for chronic bleeding, blood replacement for massive bleeding.

    Sulfasalazine (Azulfidine)--mainstay drug for acute and maintenance therapy. Dose-related side effects include vomiting, anorexia, headache, skin discoloration, dyspepsia, and lowered sperm count.

    Oral salicylates, such as mesalamine (Pentasa), olsalazine (Dipentum)--appear to be as effective as sulfasalazine.
    a. Nephrotoxicity can occur with mesalamine; diarrhea with olsalazine.

    Mesalamine enema available for proctosigmoiditis; suppository for proctitis.

    Corticosteroids--primary agent used in the management of inflammatory disease
    a. Prednisolone (Delta-Cortef)--IV, to induce remission of acute severe disease.
    b. Prednisone (Orasone)--orally, for moderate to severe disease.
    c. Hydrocortisone (Cortef)--enema used for proctitis and left-sided colitis.

    Antidiarrheal medications may be prescribed to control diarrhea, rectal urgency and cramping, abdominal pain; their use is not routine.

    Surgical Measures
    1. Surgery is recommended when patient fails to respond to medical therapy, if clinical status is worsening, for severe hemorrhage, or for signs of toxic megacolon.
    2. Surgical procedures include:
    a. Subtotal colectomy and ileostomy and Hartmann's pouch
    b. Total proctocolectomy with end-ileostomy
    c. Total colectomy with continent ileostomy (Kock or BCIR)
    d. Total colectomy with ileal reservoir-anal anastomosis (Fig. 16-5).
    3. The surgical goal is to remove entire colon and rectum to cure patient of ulcerative colitis.

    Complications [because God knows, you always have to have those]:


    1. Perforation, hemorrhage, toxic megacolon

    2. Abscess formation, stricture, anal fistula

    3. Malnutrition, anemia, electrolyte imbalance

    4. Skin lesions (erythema nodosum, pyoderma gangrenosum)

    5. Arthritis, ankylosing spondylitis

    6. Colon malignancy

    7. Liver disease

    8. Eye lesions (uveitis, conjunctivitis)

    Nursing Assessment
    1. Review nursing history for patterns of fatigue and overwork, tension, family problems that may exacerbate symptoms.
    2. Assess food habits that may have a bearing on triggering symptoms (milk intake may be a problem).
    3. Determine number and consistency of bowel movements, any rectal bleeding present
    4. Listen for hyperactive bowel sounds, assess weight.
  12. by   cseekatz
    perhaps it has to do with vasoconstriction?
    Quote from Zee_RN
    What do they do? Well, my brother-in-law smokes about a pack a day because he cannot face the time-off from work and the bloody BMs day-in and day-out. Even the prednisone didn't work last time...only smoking does. When he smokes, he doesn't require any medication to control his UC. My husband, fortunately, has only "a touch" of UC. He is not on any medications and just noticed that a few things he eats (e.g., if he eats ice cream several nights in a row) he will have a mild flare-up. He smokes about a pack a day but that is purely obstinancy--not colitis control (I can't stand it!!!). But when he does try to quit, he bleeds.

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