Sunday, January 15, 2006

ulcerative colitis

Ulcerative colitis is an inflammation and ulceration of the colon. The mucosa of the colon becomes hyperemic (engorged with blood), thickened, and edematous. The ulceration can be so extensive that large areas of the colon are denuded of mucosa.
The etiology of the disease is obscure. Some physicians believe that ulcerative colitis is a disease of multiple causative factors, which may include infection, allergy, autoimmunity, and emotional stress. The term idiopathic, meaning of unknown cause, is often used to describe this disease. Ulcerative colitis is most common during young adulthood and middle life, but it can occur at any age. It affects both men and women. Ulcerative colitis is especially dangerous in the elderly.
Its onset may be gradual or abrupt. The patient has severe diarrhea (12-20 or more bowel movements per day) and expels blood and mucus along with fecal matter. Weight loss, fever, severe electrolyte imbalance, dehydration, anemia, and cachexia (constitutional disorder, general ill health, and malnutrition) may follow. The patient may experience anorexia (loss of appetite), nausea, and vomiting, as well as extreme weakness. The urge to defecate is so abrupt that the patient may experience incontinence. This disease may be present in a mild form for years, or it may be rapid and cause death from hemorrhage, peritonitis (inflammation of the membrane lining the abdomen), or debility. The patient may experience a sudden dramatic recovery and remain free of the disease for years or have a recurrence. Diagnosis is made by history and physical examination, proctoscopy, sigmoidoscopy, X-ray examination, and examination of the stool. Diseases such as cancer, amebic dysentery or diverticulitis, which could cause the same symptoms, should be eliminated with the studies.
Treatment is supportive and includes providing rest for the bowel, giving it an opportunity to heal, and correcting anemia and malnutrition. Some patients can be managed medically and helped into remission and others require a total colectomy and permanent ileostomy.
A bland diet is prescribed and foods such as raw fruits and vegetables or highly seasoned foods are usually eliminated. A nourishing diet of protein foods, such as meat and eggs served in small frequent meals are important. A record is kept of the quantity and type of food intake and output and the number and character of bowel movements. Blood transfusions and iron are given to correct anemia. Parenteral fluids and electrolytes may be prescribed. Supplementary vitamins to correct diet deficiencies may be given.
Drugs that slow peristalsis (rhythmic contraction of smooth muscle) such as atropine or tincture of belladonna, or drugs used to coat and soothe the mucosa, such as kaolin and pectin, may be ordered. Sedatives and tranquilizers help the patient to relax and rest. A sudden onset of abdominal distention should be reported at once.
Corticosteroid drugs may be given if the patient does not respond to other measures. Dramatic relief of symptoms often occurs following their use. The patient must be maintained on as low a dosage as possible to maintain the remission.
Rossman, I. Clinical Geriatrics, 3rd ed. Philadelphia: J. B. Lippincott Co., 1986.
Scherer, J. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.

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