ULCERATIVE COLITIS

 Form of inflammatory bowel disease

 Disease of the intestine, specifically the large intestine or the colon that includes
characteristics of ulcers, or open sores in the colon

 Intermittent disease with period of exacerbated symptoms and relatively symptom-free

 Has no known cause

TYPES: classified to the extent of the involvement

Distal Colitis- potentially treatable with enemas

 Proctitis- involvement limited to the rectum

 Proctosigmoiditis- involvement limited to the rectosigmoid colon, the portion of the colon
adjacent to the rectum

 Left-sided colitis- descending colon, which runs along the patients left side up to the
splenic flexure and the beginning of the transverse colon

Extensive Colitis- inflammation extending beyond the reach of enemas:

 Pancolitis- involvement of the entire colon, extending from the rectum to the cecum
beyond which small intestine begins.

Classified to the severity of the disease

 Mild disease correlates with fewer than four stools daily, with or without blood, no
systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR). There
may be mild abdominal pain or cramping. Patients may believe they are constipated
when in fact they are experiencing tenesmus, which is a constant feeling of the need to
empty the bowel accompanied by involuntary straining efforts, pain, and cramping with
little or no fecal output. Rectal pain is uncommon.

 Moderate disease correlates with more than four stools daily, but with minimal signs of
toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal
pain, and low grade fever, 38 to 39 °C (100 to 102 °F).

 Severe disease, correlates with more than six bloody stools a day, and evidence of
toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR.

 Fulminant disease correlates with more than ten bowel movements daily, continuous
bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement
and colonic dilation (expansion). Patients in this category may have inflammation
extending beyond just the mucosal layer, causing impaired colonic motility and leading
 to toxic megacolon. If the serous membrane is involved, colonic perforation may ensue.
Unless treated, fulminant disease will soon lead to death.

CAUSES:

 Genetic factors

 Environmental factors

 Autoimmune disease

CLINICAL MANIFESTATIONS:

 Diarrhea mixed with blood mucus

 Weight loss

 Blood on rectal examination

 Abdominal pain

 Mild discomfort to severely painful cramps

 Painful, arthritic knees in teenager

 Aphthous ulcers of the mouth

 Ophthalmic

• Iritis or uveitis which is inflammation of the iris

• Episcleritis

 Musculoskeletal

• Seronegative arthritis, which can be a large-joint oligoarthritis (affecting one or

two joints), or may affect many small joints of the hands and feet

• Ankylosing spondylitis, arthritis of the spine, Sacroiliitis, arthritis of the lower

spine

 Cutaneous (related to the skin):

• Erythema nodosum, which is a panniculitis, or inflammation of subcutaneous

tissue involving the lower extremities

• Pyoderma gangrenosum, which is a painful ulcerating lesion involving the skin

 Deep venous thrombosis and pulmonary embolism

  Autoimmune hemolytic anemia

 clubbing, a deformity of the ends of the fingers

 Primary sclerosing cholangitis, a distinct disease that causes inflammation of the bile
duct

DIAGNOSIS:

 Complete blood count

 Electrolyte studies and renal function test

 Liver function test

 X-ray

 Urinalysis

 Stool culture

 Erythrocyte sedimentation rate

 C-reactive protein

 Endoscopy

 Colonoscopy

 Sigmoidoscopy

MANAGEMENT:

 Topical management is appropriate for some patients with active disease. This is usually
the case for those with proctitis and often the case if the disease extends into the
sigmoid.

 For those with more extensive disease, oral or parenteral therapy are the mainstays of
treatment, although some of these patients may get additional benefit from topical
therapy.

Leukophoresis (extracorporeal removal of leukocytes from the blood) may be beneficial in

carefully selected patients with ulcerative colitis.

 Bewar of antimotility drugs (e.g. codeine, loperamide), and antispasmodic drugs, which
may precipitate paralytic ileus and megacolon in active ulcerative colitis.

 Aminosalicylates- Sulfasalazine (Azulfidine), Mesalazine, Balsalazide (Colozal or

Colozide), Olsalazine (Dipentum)
Corticosteroids- Cortisone, Prednisone, Prednisolone, Cortifoam, Hydrocortisone,
Methylprednisolone, Beclometasone, Budesonide.

 Immunosuppressive drugs- Mercaptopurine, Azathiopine, Methotrexate, Tacrolimus,

Thioguanine

Surgical Management

 The procedure of choice in acute fulminant ulcerative colitis is a subtotal colectomy

leaving a long rectal stump.

 Indications for colectomy:

• Toxic megacolon; surgery should be performed within 24 hours unless the

condition resolves.

• Severe ulcerative colitis that fails to respond to corticosteroid therapy within

seven to 10 days.

• Chronic persisting colitis in a non-acute setting on the grounds of poor

therapeutic response and poor quality of life.

• High-grade dysplasia or cancer

Nursing Management

 Keeping the patient hydrated and comfortable

 Encourage patient to engage on open-ended conversation and attempt to explore how

the patient sees the situation

 Educate the patient on nutrition and how to handle stress in life

• Dietary fiber

• Oatmeal is commonly prescribed

• Avoid greasy foods, fried foods, nuts or fruits with seeds

 Restricting the physical activity of the patient

 Smoking cessation
 CASE ANALYSIS
ULCERATIVE COLITIS

SUBMITTED BY: SUBMITTED TO:

RODELYN L. ELNAR MRS. AMY GARCIA

BSN III-A CLINICAL INSTRUCTOR