Ulcerative colitis

DONE BY :- HAMAD EMAD THUHAYR

SUPERVISOR BY :- DR. MOHAMMED SADDIQE

2ST BGM SOEPLE 4

Contents

Soepel

Introduction

Etiology

Histology

pathophysiology

Sings and Symptomes

Diagnosise

Complications

Prognosis

Treatment

References

SOEPEL

SUBJECT:

A 35-year-old female from Saudi. She is married has 2 children aged 3 and 8 years. They are both well. lives and born in Unaizah.

 Over the last 2–3 days she has become weak with the persistent diarrhea and her abdomen has become more painful and bloated over the last 24 h.

 she has a year-long history of intermittent diarrhea which has never been bad enough for her to seek medical help in the past. However, she has become much worse over 1 week with episodes of bloody diarrhea 10 times a day. She has had some cramp lower abdominal pain which lasts for 1–2 h and is partially relieved by defecation. She took 2 days of amoxicillin after the diarrhea began with no improvement or worsening of her bowels.

She has no relevant previous medical history. Up to 1 year ago, her bowels were regular. There is no disturbance of micturition or menstruation.

 In her family history, she thinks one of her maternal aunts may have had bowel problems.

She travelled to Egypt on holiday 6 months ago but has not travelled elsewhere.

SOEPEL

OBJECTIVE:

taking history, physical examination ( General and abdominal )

EVALUATION (DD):

Ulcerative colitis ,Crohn’s disease infectious, enterocolitis celiac sprue.

PLAN:

Blood tests, Stool sample, Colonoscopy, Flexible sigmoidoscopy, Barium enema ,X-ray and CT scan.

ELABORATION:

drug therapy or surgery.

LEARNING GOALS:

ulcerative colitis

Introduction

Ulcerative colitis:-

is an idiopathic chronic inflammatory disease of the colon that follows a course of relapse and remission. In a small number of cases, ulcerative colitis is associated with extra-intestinal features.

Site of UC:-

1. Distal disease (left-sided colitis).

2. More extensive disease.

3. Some patients with pancolitis may have involvement of the terminal ileum due to an incompetent ileocaecal valve.

Epidemiology:-

The incidence of uc is stable at 6-15\100000 annually, with a prevelance of 80-150\100000.

Etiology

The aetiology is unknown. Ulcerative colitis is probably an autoimmune condition triggered by colonic bacteria causing inflammation in the gastrointestinal tract.

A family history is present in around 25-40% of children; siblings of an individual with Crohn's disease are 17-35 times more likely than the general population to develop the condition.

There is concern that non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of relapse or exacerbation of inflammatory bowel disease (IBD) - ulcerative colitis and Crohn's disease - but the evidence is not strong.

The risk of IBD is increased in women using oral contraceptives but the absolute increase in risk is very low.

The risk of ulcerative colitis is decreased in smokers.

histology

The severity of the disease may also be quite variable histologically, ranging from minimal to florid ulceration and dysplasia.

Carcinoma may develop. The typical histological (microscopic) lesion of ulcerative colitis is the crypt abscess, in which the epithelium of the crypt breaks down and the lumen fills with polymorphonuclear cells.

The lamina propria is infiltrated with leukocytes. As the crypts are destroyed, normal mucosal architecture is lost and resultant scarring shortens and can narrow the colon. 

pathophysiology

Sings and Symptomes

Diarrhea

rectal bleeding

tenesmus

passage of mucus

abdominal pain

other symptoms: anorexia, nausea, vomiting, fever, weight loss

Test and Diagnosis

Blood tests, check for anemia or infection and type of inflammatory bowel disease

Stool sample, The presence of white blood cells in your stool indicates an inflammatory disease, possibly ulcerative colitis.

Colonoscopy, take small samples of tissue (biopsy) for laboratory analysis.

Flexible sigmoidoscopy, uses a slender, flexible, lighted tube to examine the sigmoid, the last portion of colon.

Barium enema

X-ray

CT scan. reveal how much of the colon is inflamed.

Complications

Severe bleeding

A hole in the colon (perforated colon)

Severe dehydration

Liver disease (rare)

Kidney stones

Osteoporosis

Inflammation of your skin, joints and eyes

An increased risk of colon cancer

A rapidly swelling colon (toxic megacolon)

Prognosis

Ulcerative colitis is a lifelong condition, with unpredictable relapses and remissions.

Mortality is slightly higher than in the general population.

One study in Norway found that:- 

The cumulative colectomy rate after ten years was 9.8%.

83% of people initially had relapsing disease but half were relapse-free after five years.

About 20% of people with proctitis or left-sided colitis progressed to extensive colitis.

The prognosis for acute severe colitis depends on their initial response to corticosteroid treatment.

Treatment

Nutritional therapies :

- total parenteral nutrition

Surgical therapy

- indications: intractable disease, fulminant disease, toxic megacolon, colonic perforation, massive colonic hemorrhage, colonic obstruction, colon cancer prophylaxis, colon dysplasia or cancer

References

Kumar & clark’s- clinical medicine- 8 edition- page 272-282.

https://www.jhmicall.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Disease_ID=2A4995B2-DFA5-4954-B770-F1F5BAFED033&GDL_DC_ID=D03119D7-57A3-4890-A717-CF1E7426C8BA

http://www.patient.co.uk/doctor/ulcerative-colitis-pro