ULCERATIVE COLITIS (INFLAMMATORY BOWEL SYNDROME)

Question 1

ulcerative colitis may manifestation how

Answer 1

-erythema nodosum, pyoderma gangrenosum, thromboembolic
events.
-peripheral arthritis, spondylitis or sacroiliitis, episcleritis or uveitis, hepatitis and sclerosing cholangitis

Question 2

What is ulcerative colitis

Answer 2

a chronic, recurrent disease characterized by diffuse mucosal inflammation involving abnormal activation of the immune system affecting the colon.

(a) Ulcerative colitis invariably involves the rectum and may extend proximally in a continuous fashion to involve part or all of the colon.
(b) There is mucosal inflammation and ulceration of the colon in UC which may bleed.

Question 3

a lifelong illness that can have profound emotional and social impacts on the individual.

Answer 3

Inflammatory bowel disease

Question 4

The common end pathway of ulcerative colitis is

Answer 4

inflammation of the mucosa of the

intestinal tract, causing ulceration, edema, bleeding, and fluid and electrolyte loss.

Question 5

Ulcerative colitis is more common in what types of patients

Answer 5

• nonsmokers and former smokers. Disease

- severity may be lower in active smokers and may worsen in patients who stop smoking.

Question 6

involving the rectum or left colon, there may be bloody diarrhea and fecal urgency, which may mimic the symptoms of ulcerative colitis

Answer 6

Infectious colitis

Question 7

Symptoms of ulcerative colitis

Answer 7

(a) Bloody diarrhea is the hallmark.
1) asked about stool frequency, presence and amount of rectal bleeding, cramps, abdominal pain, fecal urgency, and tenesmus.
2) Physical examination should focus on the patient’s volume status as determined
by orthostatic blood pressure and pulse measurements and by nutritional status.
3) On abdominal examination, look for tenderness and evidence of peritoneal inflammation.
4) Red blood may be present on digital rectal examination.
(b) Mild to moderate disease- have a gradual onset of infrequent diarrhea (less than five movements per day) with intermittent rectal bleeding and mucus.
1) Stools may be formed or loose in consistency.
2) Because of rectal inflammation, there is fecal urgency and tenesmus.
3) Left lower quadrant cramps relieved by defecation are common, but there is no significant abdominal tenderness.
(c) Moderate disease
1) Have more severe diarrhea with frequent bleeding.
2) Abdominal pain and tenderness may be present but are not severe.
3) There may be mild fever, anemia, and hypoalbuminemia.
(d) Severe disease
1) Have more than six to ten bloody bowel movements per day, resulting in severe anemia, hypovolemia, and impaired nutrition with hypoalbuminemia.
2) Abdominal pain and tenderness are present.

Question 8

Differential Diagnosis

Answer 8

(1) Crohn’s
(2) Intestinal Obstruction
(3) Anorectal Disease
(4) Anal Fissure
(5) Anal Fistula
(6) Peptic Ulcer
(7) Appendicitis
(8) Ulcerative Colitis
(9) Inflammatory Gastroenteritis
(10) Inflammatory Diarrhea
(11) Diverticulosis

Question 9

Lab

Answer 9

(a) CBC, serum albumin and electrolytes, inflammatory markers (ESR and CRP), stool bacterial culture, C difficile toxin assay, and examination for ova and parasites.

Question 10

RAD

Answer 10

Colonoscopy

Question 11

Treatment

Answer 11

(a) There are two main treatment objectives:
1) To terminate the acute, symptomatic attack
2) to prevent recurrence of attacks.
(b) Antidiarrheal agents should not be given in the acute phase of illness but are safe and helpful in patients with mild chronic symptoms.
1) Loperamide (Imodium) 2 mg PO may be given up to four times daily.
(c) Mild to moderate disease
1) Eat a regular diet but limit their intake of caffeine and gas- producing vegetables.
2) Treatment as recommended by GI
(d) Severe Disease
1) Discontinue all oral intake for 24- 48 hours or until the patient demonstrates
clinical improvement.
2) All opioid or anticholinergic agents should be discontinued.
3) Restore circulating volume with fluids, correct electrolyte abnormalities, and
consider transfusion for significant anemia (hematocrit 25-28%).
4) Abdominal examinations should be repeated to look for evidence of worsening distention or pain.

Question 12

Disposition

Answer 12

(1) MEDEVAC

(2) Refer to GI

Question 13

Initial Care

Answer 13

Terminate the immediate attack via treatment protocol (in treatment section.)
need to be assessed by higher echelon of care. This cannot be disagnosed in
outpatient setting.