Ulcerative Colitis
An inflammatory, commonly chronic disease, ulcerative colitis affects the mucosa of the colon. It usually begins in the rectum and sigmoid colon and may extend upward into the entire colon; it rarely affects the small intestine, except for the terminal ileum. Ulcerative colitis produces congestion, edema (leading to mucosal friability), and ulcerations. Severity ranges from a mild, localized disorder to afulminant disease that can cause many complications.
Ulcerative colitis occurs primarily in young adults, although children and the elderly are also at risk. It affects females and males equally and is more prevalent among Jews and those belonging to higher socioeconomic groups. The incidence of the disease is unknown; however, some studies indicate that as many as 1 out of 1,000 persons is affected. Onset of symptoms seems to peak between ages 15 and 30 and again between ages 50 and 70.
Causes
Although the etiology of ulcerative colitis is unknown, it may be related to an abnormal immune response in the GI tract, possibly associated with food or bacteria. Stress was once thought to be a cause of ulcerative colitis. Studies show that, although it’s not a cause, stress can increase the severity of an attack. Although no specific organism has been linked to the disease, infection hasn’t been ruled out as a cause.
Complications
Ulcerative colitis may lead to a variety of complications, depending on the severity and site of inflammation. Nutritional deficiencies are the most common complication, but the disease can also lead to perineal sepsis with anal fissure, anal fistula, perirectal abscess, hemorrhage, and toxic megacolon. A patient with ulcerative colitis has an increased risk of various arthritis types (40 times more prevalent in this group than in the general population) and cancer (if the disease has persisted more than 10 years since childhood).
Other complications include coagulation defects resulting from vitamin K deficiency, erythema nodosum on the face and arms, pyoderma gangrenosum on the legs and ankles, uveitis, pericholangitis, sclerosing cholangitis, cirrhosis, possible cholangiocarcinoma, ankylosing spondylitis, loss of muscle mass, strictures, pseudopolyps, stenosis, and perforated colon, leading to peritonitis and toxemia.
Assessment
Usually, the patient’s history will reveal periods of remission and exacerbation of symptoms. During an exacerbation, the patient generally reports mild cramping, lower abdominal pain, and recurrent bloody diarrhea—as often as 10 to 25 times daily. He may also experience nocturnal diarrhea. During these periods, hemay complain of fatigue, weakness, anorexia, weight loss, nausea, and vomiting.
On inspection, the patient’s stools may appear liquid, with visible pus and mucus. Check for blood in the stools—a cardinal sign of ulcerative colitis. Abdominal distention may be present in fulminant
disease. Palpation may disclose abdominal tenderness. A rectal examination may reveal perianal irritation, hemorrhoids, and fissures. Rarely, rectal fistulas and abscesses may be evident.
disease. Palpation may disclose abdominal tenderness. A rectal examination may reveal perianal irritation, hemorrhoids, and fissures. Rarely, rectal fistulas and abscesses may be evident.
CollaborationMultidisciplinary care for the patient with ulcerative colitis
Caring for a patient with ulcerative colitis requires a multidisciplinary approach. Nursing care may include blood transfusions, I.V. fluid replacement, administration of iron supplements or other medications, dietary counseling, emotional care and, possibly, postoperative care. A dietitian can help the patient identify foods to avoid because of their irritant effects and provide information about balanced diets and food preparation. A gastroenterologist, a surgeon, and an anesthesiologist will provide care for the patient who requires surgery. An enterostomal nurse will be involved if the patient requires an ostomy. Home care services may be required to assist the patient with a new ostomy in the home environment. A home infusion nurse may be needed if the patient requires total parenteral nutrition at home. Spiritual support services, a social worker, or a psychologist may assist the patient as he learns to cope with this chronic disease and, if indicated, with alterations in body image related to an ostomy.
Referral to stress management, meditation, or yoga instruction may help reduce the patient’s stress level to minimize the severity of future attacks. The social worker may also provide the patient and his family information about support groups in the community related to ulcerative colitis and, if applicable, ostomies.
Diagnostic tests
Sigmoidoscopy confirms rectal involvement in most cases by showing increased mucosal friability, decreased mucosal detail, and thick inflammatory exudate.
