STUDY QUESTIONS

1. What is a reasonable explanation for pallor in this patient? 

 The patient was diagnose with Ulcerative Colitis which define as inflammation of
colon and rectum accompanied by the presence of blood in stool. IBD
Inflammatory bowel disease (IBD) is a group of disorders that cause chronic
inflammation (pain and swelling) in the intestines. IBD includes Crohn’s disease
and ulcerative colitis. Both types affect the digestive system. Treatments can help
manage this lifelong condition.
(https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease-
overview)

2. What is the difference between upper GI bleeding and

lower GI bleeding?

 The initial evaluation of a patient with suspected upper gastrointestinal bleeding

begins with assessment of hemodynamic status, identification of potential risk
factors, and appropriate triage of level of care.
 Upper gastrointestinal hemorrhage is a medical condition in which heavy
bleeding occurs in the upper parts of the digestive tract: the esophagus (tube
between the mouth and stomach), the stomach or the small intestine. This is often
a medical emergency. It occurs when the lining of these organs is damaged, for
example by ulcers, tears, or if a blood vessel becomes weak and bursts.
 This condition is more common in elderly people and people with other medical
conditions, such as liver conditions or blood clotting disorders. The symptoms
might differ depending on the cause of the bleeding but often include vomiting
blood and passing dark tarry stools.

(https://ada.com/conditions/upper-gastrointestinal-hemorrhage/)

Signs of bleeding in the upper digestive tract include:

 Bright red blood in vomit

 Vomit that looks like coffee grounds
 Black or tarry stool
 Dark blood mixed with stool
 Lower gastrointestinal bleeding (LGIB) can present as an acute
and life-threatening event or as chronic bleeding, which might
manifest as iron-deficiency anemia, fecal occult blood or
intermittent scant hematochezia.

  Bleeding from the small bowel has been shown to be a distinct

entity, and LGIB is defined as bleeding from a colonic source.
Acute bleeding from the colon is usually less dramatic than
upper gastrointestinal hemorrhage and is self-limiting in most
cases.
(https://www.nature.com/articles/nrgastro.2019.167)

Lower GI bleeds can cause several noticeable symptoms, including :

 Bright red blood drops, smears, or clots in the stool.
 Abdominal cramps or pain.
 Faintness and dizziness.
 Unexplained exhaustion or weakness.
 Unusual paleness.
 Shortness of breath.

3.Compare Ulcerative Colitis from Crohn’s Disease based on

the CRP response.

 Creactive protein (CRP) is known to most clinicians as a

marker of inflammation but has many other functions besides
this. CRP acts as an opsonin and activates complement leading
to phagocytosis of nuclear components and bacterial
sequences.

 Ulcerative colitis and Crohn's disease are the two main forms
of inflammatory bowel diseases. They are both conditions
characterized by chronic inflammation of the digestive tract.
Although they share many similarities, there are key
differences between the two diseases.
The differences between ulcerative colitis and Crohn's disease
are:

 Ulcerative colitis is limited to the colon while Crohn's disease

can occur anywhere between the mouth and the anus.

 In Crohn's disease, there are healthy parts of the intestine

mixed in between inflamed areas. Ulcerative colitis, on the
other hand, is continuous inflammation of the colon.

 Ulcerative colitis only affects the inner most lining of the colon
while Crohn's disease can occur in all the layers of the bowel
walls.
(https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-
2362.1982.tb02244.x)

4. Is surgery warranted in this patient? 

 The patient responded well to the given medications. After one week of
medication, his colitis symptoms began to improve, and he was discharged. His
bowel movement had improved by the time of his outpatient review two weeks
later. In his case surgery isn't necessary. Most people who have mild colitis can
control their symptoms with medicine. Treatment for ulcerative colitis can
include medicine, changes in diet, or surgery. The doctor may recommend
ulcerative colitis surgery if other treatments are ineffective. Surgery isn't usually
done for mild colitis.

(https://www.sciencedirect.com/science/article/pii/S1521691818300283)

5. What diet is best for ulcerative colitis?

Your dietary needs may change when you’re in a flare. In general, the best foods
for people with this condition include:

 Low fiber fruits like bananas and cooked fruits

 Non-cruciferous vegetables like asparagus, potatoes, and cucumbers
 Refined grains like white pasta, white rice, oatmeal, and certain breads
 Lean protein sources like fish, chicken, lean pork, eggs, and tofu
Foods to avoid

Certain foods may aggravate your symptoms, including these:

 fruits with seeds and skins

 dairy products
 spicy foods
 caffeine
 nuts
 alcohol
 fried or greasy food

(https://www.healthline.com/health/ulcerative-colitis-take-control/diet-plan-
recipes)