Ulcerative colitis

Ulcerative colitis is a chronic, or long lasting, disease that causes inflammation  irritation or swelling and sores called ulcers on the inner lining of the large intestine. 

CAUSES OF ULCERATIVE COLITIS 

The exact cause of ulcerative colitis is unknown. Researchers believe the following factors may play a role in causing ulcerative colitis: 

• Overactive intestinal immune system
• Genes
• Environment 

SIGN AND SYMPTOMS

The most common signs and symptoms of ulcerative colitis are diarrhoea with blood or pus and abdominal discomfort. Other signs and symptoms include 

 • An urgent need to have a bowel movement 

• Feeling tired 

• Nausea or loss of appetite 

• Weight loss 

• Fever 

• Anaemia - a condition in which the body has fewer  red blood cells than normal

TYPES
Proctitis: involves only the rectum(a)

Proctosigmoiditis: involves the rectum and sigmoid colon(b)

(the lower segment of the colon before the colon)

Distal Colitis: Involves only the left side of the colon(c)

Pancolitis: Involves the entire colon(d)

Backwash ileitis: Involves the distal ileum

DIAGNOSIS 

A health care provider diagnoses ulcerative colitis with the following: 

• Family history 

• Physical exam 

• Lab tests 

• Endoscopies of the large intestine 

       • The health care provider may perform a series of medical tests to rule out other bowel disorders, such as irritable bowel syndrome, Crohn's disease, or celiac disease, that may cause symptoms similar to those of ulcerative colitis 

PHYSICAL EXAM

•  Checks for abdominal distension, or swelling 

• Listens to sounds within the abdomen using a stethoscope 

• Taps on the abdomen to check for tenderness and pain

LAB TESTS 

A health care provider may order lab tests to help diagnose ulcerative colitis, including blood and stool tests. 

• Anemia 

• Inflammation or infection somewhere in the body 

• Markers that show ongoing inflammation 

• Low albumin, or protein—common in patients with severe ulcerative colitis 

• Stool tests to rule out other causes of GI diseases, such as infection.

ENDOSCOPE OF LARGE INTESTINE

     • Endoscopies of the large intestine are the most accurate    methods for diagnosing ulcerative colitis and ruling out other possible conditions, such as Crohn's disease, diverticular disease, or cancer. Endoscopies of the large intestine include 

     • Colonoscopy 

• Flexible sigmoidoscopy

TREATMENT

While no medication cures ulcerative colitis, many can reduce symptoms. The goals of medication therapy are 

• Inducing and maintaining remission

•  Improving the person’s quality of life
• Many people with ulcerative colitis require medication therapy indefinitely, unless they have their colon and rectum surgically removed. 

• Health care providers will prescribe the medications that best treat a person's symptoms: 

•  Aminosalicylates = balsalazide, mesalamine 

• Corticosteroids = budesonide, prednisone 

• Immunomodulators = azithioprine, 

• Biologics, also called anti-TNF therapies 

• Other medications

DOSES 

• Prednisone (0.75 mg/kg/day for 4 weeks then 0.5 mg/kg/day for 4 weeks then 0.25 mg/kg/ day for up to 12 weeks then tapered if possible) 

• Mesalamine (800 mg twice daily for 12 months) and 

• Ciprofloxacin (500-750 mg twice daily for 6 months) 

SURGERY 

Some people will need surgery to treat their ulcerative colitis when they have 

• Colon cancer 

• Dysplasia, or precancerous cells in the colon 

• complications that are life threatening, such as megacolon or bleeding 

• No improvement in symptoms or condition despite treatment 

• Continued dependency on steroids 

• Side effects from medications that threaten their health

PROCTOCOLECTOMY ANS ILEOSTOMY

• Aproctocolectomy is surgery to remove a patient's entire   colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileum—the last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient's abdomen and attaches it to the skin, creating an opening outside of the patient's body. The stoma most often is located in the lower part of the patient's abdomen, just below the belt line 

Summary of Ulcerative Colitis