Ulcerative colitis

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Ulcerative colitis a type of inflammatory bowel disease that causes chronic inflammatory of the digestive tract mainly on the colon and rectum characterized by abdominal pain, diarrhea and rectal bleeding.

Symptoms:

Symptoms of ulcerative colitis depend on the extent on the disease process.

1. diarrhea mixed with blood and mucus
2. weight loss
3. Abdominal pain
4. Unexplained fever

Classification:

• Ulcerative proctitis: In this form of disease inflammation is confined to the Rectum. Rectal bleeding, rectal pain, tenesmus may be the sing of this condition.

• Proctosigmoidits: In this form of disease confined to the rectum and the lower end of the colon .Bloody diarrhea, abdominal pain is the symptoms associated with this condition.

• Left-sided colitis: Inflammation extends to rectum, up the left side through the sigmoid colon. Bloody diarrhea and abdominal pain is present.

• Pancolitis: Involves the entire colon .Bloody diarrhea abdominal pain and weight is the main symptoms of this condition.

• Fulminant colitis: Life threating condition affects the whole colon and cause severe bloody diarrhea, abdominal pain, dehydration and shock.

Causes:

Causes of this disease are still unknown but believed some risk factors;

1. Genetic factor
2. Environmental factor
3. Diet (low in dietary fiber diet)
4. Autoimmune disease
5. Drugs( Isotretinoin, Ibuprofen, naproxen, diclofenac

Diagnosis:

This disease is diagnosed by complete history and physical examination, to help confirm a diagnosis different tests should be needed:

1. Blood test : For hemoglobin level (anemia), infection and ESR
2. Routine stool test : Present of white blood cell
3. Colonoscopy: Extend of the disease and for the biopsy.
4. Sigmoidoscopy
5. Barium enema
6. X-ray : To rule out toxic megacolon
7. CT scan: To rule of the complication.

Complications:

• Perfuse bleeding
• Perforated megacolon
• Liver complication
• Arthritis
• Osteoporosis
• Colon cancer

Management:

Different modality of the treatments;

1. Diet and life style changes (Limit dairy products, avoid problem foods, eat small meals, drink plenty of liquids, exercise, stress reduction technique, regular breathing exercise, smoking helps reduced the symptoms however overall health risk form smoking need to be consider  ).
2. Drugs (Sulfasalazine, Mesalamine, balsalazide, corticosteroids, azathioprine, mercaptopurine, cyclosporine, Infliximab, Antibiotics, anti-diarrheals, Pain relieves, Nicotine patches, Iron supplements).
3. Surgery : Indication for surgery

• Not respond to medical treatment
• Chronic disease with anemia, frequent stools urgency and tenesmus
• Steroid dependent diseaseSevere dysplasia  on colonoscopy
• Present of complication

Types of surgery: Proctocolectomy and ileostomy, Rectal and anal dissection, Restorative proctocolectomy with an ileoanal pouch, colostomy and ileorectal anastomosis, ileostomy with a continent intra abdominal pouch (kock’s procedure) and ileotomies.

Conclusion: It is an inflammation of large bowel, presented with rectal bleeding, crampy abdominal pain, diarrhea which is diagnosed by history, physical examination  and different test .Managed with both medications and surgery.

References:

1. medicinenet.com
2. mayoclinic.com
3. en.wikipedia.org
4. digestive.niddk.nih.gov
5. ccfa.org
6. ulcerativecolitis.org.uk
7. nlm.nih.gov

Filed Under: Surgery

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