ULCERATIVE COLITIS

 Ulcerative colitis is a recurrent ulcerative and

inflammatory disease of the mucosal and
submucosal layers of the colon and rectum.
 The incidence of ulcerative colitis is highest in
Caucasians.
Age between 30 and 50 years .
It is a serious disease, accompanied by systemic
complications and a high mortality
rate. Eventually, 10% to 15% of the patients
develop carcinoma
 The diseease usually begin rectal area,and may
involve large intestine over time
Causes and risk factor
 Unknown
 Immunological factor
 Stress
 Environmental agent such as pesticides,
tobacco, radiation, food additives may
precipitate exacerbation
 Family history
PATHOPHYSIOLOGY
 Ulcerative colitis affects the superficial mucosa of the
colon and is characterized by multiple ulcerations,
diffuse inflammations, shedding of the colonic
epithelium.
• Bleeding occurs as a result of the ulcerations. The
mucosa becomes edematous and inflamed.
 The lesions are contiguous, occurring one after the
other. Abscesses form, and infiltrate is seen in the
mucosa and sub mucosa with clumps of neutrophils in
the crypt lumens (ie, crypt abscesses).
• The disease process usually begins in the rectum and
spreads proximally to involve the entire colon.
• Eventually, the bowel narrows, shortens, and thickens
because of muscular hypertrophy and fat deposits
Clinical manifestation
• diarrhea,
• lower left quadrant abdominal pain,
• intermittent tenesmus, and rectal bleeding. The bleeding
may be mild or severe, and pallor
• anorexia, weight loss, fever, vomiting,
• dehydration, as well as cramping,
• the feeling of an urgent need to defecate, and the passage of
10 to 20 liquid stools each day. The disease is classified as
mild, severe, or fulminant,
• Hypocalcemia and anemia frequently develop. Rebound
tenderness may occur in the right lower quadrant.
Extraintestinal symptoms include skin lesions
• (eg, erythema nodosum),
• eye lesions (eg, uveitis), joint abnormalities
• (eg, arthritis), and liver disease.
Diagnostic evaluation
 blood and stool examination
Endoscopy may reveal , inflamed mucosa with
exudate and ulceration
Biopsy
Barium enema - A barium enema may show
mucosal irregularities, fistulas, shortening of
the colon, and dilation of bowel loops.
 CT scanning, magnetic resonance imaging,and
ultrasound can identify abscesses and perirectal
involvement
Abdomianal x ray
Medical Management – same management of crohns disease
Surgical management
• Total Colectomy With Ileostomy. An ileostomy, the surgical
creation of an opening into the ileum or small intestine
(usually by means of an ileal stoma on the abdominal wall), is
commonly performed after a total colectomy (ie, excision of
the entire colon).It allows for drainage of fecal matter (ie,
effluent) from the ileumto the outside of the body
• Total Colectomy With Continent Ileostomy. Another
procedure involves the removal of the entire colon and
creation of the continentileal reservoir (ie, Kock pouch). This
procedure eliminates the need for an external fecal collection
bag.
• Total Colectomy With Ileoanal Anastomosis. A total
colectomy with ileoanal anastomosis is another surgical
procedure that eliminates the need for a permanent
ileostomy. It establishes an ileal reservoir, and anal sphincter
control of elimination is retained. The procedure involves
connecting a portion of the ileum to the anus (ie, ileoanal
anastomosis) in conjunction with removal of the colon and the
rectal mucosa.
• Nursing Management
• Nursing management of patients with IBD may be medical,
surgical,or both. Patients in the community setting or those
recently diagnosed may primarily require education about diet
and medications and referral to support groups. Hospitalized
patients with long-standing or severe disease also require
careful monitoring,
• parenteral nutrition, fluid replacement, and possibly emergent
surgery. The surgical procedures may involve a fecal diversion,
with attendant needs for physical care, emotional support, and
extensive teaching about management of the ostomy.
Assessment
• The nurse takes a health history to identify the onset,
duration,and characteristics of abdominal pain; the presence of
diarrhea orfecal urgency, straining at stool (tenesmus), nausea,
anorexia, or weight loss; and family history of IBD.
• It is important to discuss dietary patterns, including the
amounts of alcohol, caffeine, andnicotine containing products
used daily and weekly.
• The nurse asks about patterns of bowel elimination, including
character, frequency, and presence of blood, pus, fat, or
mucus.
• It is important to note allergies and food intolerance,
especially milk (lactose) intolerance. The patient may identify
sleep disturbances if diarrheao pain occurs at night.

• Assessment includes auscultating the abdomen for bowel

sounds and their characteristics; palpating the abdomen for
distention, tenderness, or pain; and inspecting the skin for
evidence of fistula tracts or symptoms of dehydration.
• The stool is inspected for blood and mucus.With
regional enteritis, pain is usually localized in the right
lower quadrant, where hyperactive bowel sounds can be
heard because of borborygmus ( a rumbling or gurgling
noise made by the movement of fluid and gas in the
intestine) and increased peristalsis. Abdominal
tendernes sis noticed on palpation. The most prominent
symptom is intermittent pain that occurs with diarrhea
but does not decrease after defecation.
• Pain in the periumbilical region usually indicates
involvement of the terminal ileum. With ulcerative
colitis, the abdomen may be distended, and rebound
tenderness (it refers to pain upon removal of pressure
rather than application of pressure to the abdomen)
may be present. Rectal bleeding is a significant sign.
NURSING DIAGNOSES
• Diarrhea related to the inflammatory process
Acute pain related to increased peristalsis and GI inflammation
• Deficient fluid volume deficit related to anorexia, nausea,and
diarrhea
• Imbalanced nutrition, less than body requirements, related to
dietary restrictions, nausea, and malabsorption
• Activity intolerance related to fatigue
• Anxiety related to impending surgery
• Ineffective coping related to repeated episodes of diarrhea
• Risk for impaired skin integrity related to malnutrition and
diarrhea
• Risk for ineffective therapeutic regimen management related
to insufficient knowledge concerning the process and
management of the disease