Ulcerative colitis

Ulcerative colotis (brief description)

• It causes inflammation and ulcers in the inner lining of colon and
rectum
• It has no cure
• Starts in the rectum
• Patients with ulcerative colitis will experience flare ups or remission
(intense pain)
• Cause is still unknow but it can be triggered by Genetic and
environmental factor
4 types of ulcerative colitis
• Ulcerative colitis- inflammed rectum
• Proctosigmoiditis- inflamed colon and sigmoid
• Pancolitis- inflamed entire colon
• Left side colitis- inflamed descending, sigmoid and rectum
Pathophysiology
•
Kayo na bahala magadjust sa picture nato, pathophysiology din
yan with explanation HAHAHHAHAHAA
Diagnostic tests
•  Clinical history
• physical examination
• Laboratory tests
• Endoscopy (Gastroscopy/Colonoscopy)
• X-ray findings
• Tissue biopsy (pathology)
Macroscopic features
• Mucosa is : - erythematous, has a granular surface that looks like a
sand paper
• In more severe diseases: - hemorrhagic, edematous and ulcerated
• In fulminant disease a toxic colitis or a toxic megacolon may develop
( wall become very thin and mucosa is severly ulcerated)
clinical presentation
• Bloody diarrhea(hallmark)
• Tenesmus (cramping rectal pain)
• Patients with proctitis (condition in which the lining tissue of the
inner rectum becomes inflamed) usually pass fresh blood or
bloodstained mucus either mixed with stool or streaked onto the
surface of normal or hard stool
clinical presentation
• When the disease extends beyond the rectum, blood is usually mixed
with stool or grossly bloody diarrhea may be noted
• When the disease is severe, patients pass a liquid stool containing
blood, pus, fecal matter
• Other symptoms in moderate to severe disease include: anorexia,
nausea, vomiting, fever, weight loss
Mild ulcerative colitis
• Gradual onset Infrequent diarrhea (more than 5 movements a day)
• Intermittent rectal bleeding Stool may be formed or too loose in
consistency
• Fecal urgency, tenesmus, left lower quadrant pain relieved by
defecation
Moderate ulcerative colitis
• More severe diarrhea with frequent bleeding Abdominal pain &
tenderness but not severe
• Mild fever , anemia & hypoalbuminemia
Severe ulcerative colitis
• Severe diarrhea with >6- 10 bloody bowel movements /day
• Severe anemia , hypovolemia ,impaired nutrition & hypoalbuminemia
• Abdominal pain & tenderness
Nursing diagnosis
• Diarrhea related to malabsorption of the bowel as evidenced by kayong umalam
para mareview
• Risk for deficient fluid volume as evidenced by Excessive losses through normal
routes (severe frequent diarrhea, vomiting)
• Acute pain related to Hyperperistalsis, prolonged diarrhea, skin/tissue irritation,
perirectal excoriation, fissures, fistulas as evidenced by Reports of colicky/cramping
abdominal pain/referred pain, restlessness and facial mask of pain
• Imbalanced Nutrition: Less Than Body Requirements related to Hypermetabolic
state as evidenced by weight loss
• Anxiety related to Physiological factors/sympathetic stimulation (inflammatory
process) as evidenced by Increased tension, distress, apprehension
SURGICAL MANAGEMENT 
• Subtotal colectomy and ileostomy and Hartmann’s pouch
• Total Protocolectomy with end ileostomy
• Total Colectomy with continent ileostomy
• Total colectomy with ileal reservoir – anal anastomosis
SURGICAL MANAGEMENT 
• Bowel Resection with Anastomosis
• Partial Colectomy; temporary end ileostomy and Hartmann’s Pouch or
ileorectal anastomosis (spares rectum)
• Total Proctocolectomy with end ileostomy for severe disease in colon
and rectum
Pharmacological Management
• Sulfasalazine –
To inhibit inflammatory process
Azulfidine (Pfizer)
• Mesalamine-
Given via enema or sup and only effective in colon
Masacol tablet
• Corticosteroids - To reduce inflammation
• Metronidazole-
To treat infection in perianal disease
• Antidiarrheal Agents-
To control diarrhea
Loperamide, Racecadortril
Nursing Management (IBD)
• Monitor frequency and consistency of stools to evaluate volume
losses and effectiveness of therapy
• Monitor diet therapy; weight patient daily
• Monitor electrolytes, especially potassium due to diarrhea
• Monitor I&O.
• Monitor abdominal pain – frequency, location duration
• WOF cardiac dysrhythmias and muscle weakness by loss of
electrolytes
Nursing Management (IBD)
• Provide small frequent feedings to prevent distention of the gastric
pouch
• Advise to increase OFI; 1L/day is minimum intake to meet body fluid
needs.
• Clean rectal area and apply ointments as needed to decrease
discomfort from skin breakdown