ulcerative colitis

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Ulcerative Colitis. Sheila Mulhern & Stephanie Howard. Overview & Statistics. Irritable Bowel Disease (IBD) is a chronic condition of immune response and inflammation of the GI tract Two most common forms are ulcerative colitis and Crohn’s disease - PowerPoint PPT Presentation

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Ulcerative ColitisSheila Mulhern & Stephanie HowardOverview & StatisticsIrritable Bowel Disease (IBD) is a chronic condition of immune response and inflammation of the GI tractTwo most common forms are ulcerative colitis and Crohns diseaseUlcerative colitis is a chronic disease of inflammation affecting the lining of the colon and the rectumMore than 1.5 million Americans have Crohn's disease or ulcerative colitis, the most common forms of inflammatory bowel disease.Video http://www.youtube.com/watch?v=FjUke8TMwhU&feature=related CDC StatisticsIBD doesnt have a medical cure and commonly requires a lifetime of careIBD is one of the five most prevalent gastrointestinal disease burdens in the USIBD has an overall health care cost of more than $1.7 billionIBD accounts for more than 700,000 physician visits, 100,000 hospitalizations, and disability in 119,000 patients in the USUlcerative Colitis

Is a chronic Inflammatory Bowel Disease (IBD) which only affects the lining of the colon

The lining of the colon becomes inflamed and develops tiny open sores, or ulcers that produce pus and mucus

Digestive FunctionsStructureActivityFunctionsLumenBacterial activityBreaks down undigested nutrients to be expelled as feces or absorbed and detoxified in liver; synthesizes certain B vitamins and vitamin KMucosaSecretes mucus

AbsorptionLubricates colon andprotects mucosaSolidifies feces and contributes bodys water balanceMuscularisHaustral ChurningPeristalsisMass peristalsisDefecation reflexSeries of muscular contractions that moves the contents through large intestines to rectum for eliminationEtiologyThe exact cause of ulcerative colitis is unknown, proposed causes includes; genetics, immune reactions and environmental factors Genetically susceptible individuals have abnormalities of humoral and cell-mediated immunity or generalize enhanced reactivity against commensal intestinal bacteria and this deregulated mucosal immune response predisposes these individuals to colonic inflammationImmune reactions to foreign substances (antigens) that stimulate the bodies defense to produce inflammation that continues without control progressing into IBD/UCEnvironmental factors such as sulfate-reducing bacteria which produce sulfides, are found in large numbers of patients with UC than in other peopleClinical ManifestationsUlcerative Colitis (UC)symptoms may vary depending on the severity of inflammation or its location For therapeutic and prognostic purposes, Doctors usually classify UC according to its location and presentationThe severity of the symptoms often correlates with the anatomic extent of the disease, another parameter that will guide treatment The Mayo scoring system is one instrument that has been used to judge disease severity and monitor patients during therapy. Scores range from zero to 12, with higher scores correlating with more severe disease.Ulcerative Colitis SymptomsHalf of the patients have mild symptoms, others have more severe attacks that occur often. Symptoms vary in severity and may start slowly or suddenly Bowel movements become looser and more urgentPersistent diarrhea accompanied by abdominal pain and blood in the stoolTenesmus (rectal pain)Bloody stoolCrampy abdominal painLoss of appetiteWeight lossLow energy and fatigueChildren suffering with UC may have delayed growth and developmentOther UC SymptomsFeverGastrointestinal bleedingJoint pain and swellingMouth sores (ulcers)Nausea and vomitingSkin lumps or ulcers

Possible Complications of Ulcerative ColitisSevere bleedingAnemiaMalabsorption of nutrientsPerforated colon (hole in colon)Severe dehydrationKidney stonesLiver disease (rare)OsteoporosisInflammation of skin, joints and eyesIncrease risk of colon cancerRapidly swelling colon (toxic megacolon)Risk FactorsSex According (The Crohns and Colitis Foundation of America) UC is more common in women than men, but the Mayo Clinic studies found Ulcerative Colitis to be about equalAge UC occurs at any age, but most often in the 30s with a second peak in the 50s and 60sRace or ethnicity UC affects all ethnic groups, but more common in Caucasians and Ashkenazi Jewish descentFamily History Youre at a higher risk if you have first degree family members (parents, siblings, child etc.) Medications have been cited as possible linked to UC, such as Isotretinoin use to treat scarring cystic acne that doesn't respond to other treatments. Sold under brand names Accutane, Amnesteem, Claravis and Sotret, also Tetracycline. Goals of Treating UCInduce and maintain remissionPrevent reoccurrenceControl impact of complicationsImprove nutritional statusImprove quality of lifeCorrect with surgery if necessaryUnderstanding Quality of LifeMay avoid travel or activityFear of being in publicLimited social interactionNeeds to plan ahead for bathroom locations, medications or personal suppliesMay resist exerciseAvoidance of foodsSupport group: Crohns and Colitis Foundation of America (CCFA)

UC vs. Crohns Disease

In UC, inflammation is limited to the colon and continuous.In Crohns disease inflammation can occur anywhere along the GI tract, most common areas are the terminal ileum and the colon. Pattern is patchy.UC vs. Crohns DiseaseComparison factorUCCDType of IBDYesYesPrevalenceAbout equalAbout equalArea affectedColonColon and small intestineLesionsShallow ulcerationsDeep ulcerationsUlceration patternContinuous, snake-likePatchySurgical option25-40% will ultimately have surgery66-75% will eventually undergo surgeryColorectal cancer riskHigher than CDLower than UCAbnormal Colonoscopy Results Analysis

Diagnosis: Tests for Ulcerative ColitisColonoscopy with biopsy is used to diagnose UCOther tests which can supplement diagnosisBarium enemaFecal sampleComplete blood count (CBC)C-reactive protein (CRP)Sedimentation rate (ESR)

Treatment: MedicationsAnti-inflammatory first step in treatmentSulfazine (Azulfidine), Mesalamine (Asacol, Lialda), Corticosteroids (prednisone)Immune System suppressors reduce inflammation by targeting immune system response Azathioprine (Azasan, Imuran), Mercaptopurine (Purinethol), Cyclosporine (Gengraf, Neoral),Infliximab (Remicade) blocks inflammatory pathwaysAdditional medications: Antibiotics, anti-diarrheal, mild pain relievers (Tylenol/ acetaminophen; excludes Advil, Motrin, aspirin), iron supplementsTreatment: SurgerySurgery needed if medication treatment is unresponsiveThe CCFA estimates this option is used for 25-40% of casesSurgery is considered a cure two main optionsProctocolectomy ileostomyIleoanal anastomosisTreatment: SurgeryProctocolectomy IleostomyRemoval of the large intestine and rectum, leaving the lower end of the small intestine (the ileum). The anus is sewn closed and the doctor makes a small opening called a stoma in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body. The surgery that creates the opening to the intestine is called an ileostomy.Stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma. The bag is emptied several times a day.Proctocolectomy Ileostomy

Hospital stay ranges from several days to two weeks after surgeryFor those who cant tolerate anesthesia for long periods (age, illness)Treatment: SurgeryIleoanal anastomosisSome or all of thecolonand the diseased lining of the rectum is removed. The end of the small intestine (the ileum) is connected to the anal canal. This allows bowel movements without an ostomy.

Proctocolectomy vs Ileoanal Anastomosis

Nutritional RisksMalabsorption, maldigestionDehydrationProtein deficiency, loss of lean muscle massVitamin and mineral deficienciesVitamin D and calcium deficiency, risk for osteopenia and osteoporosis

Guidelines for Medical Nutrition TherapyEnergy needs of UC patients are not generally increasedDisease increases BMR and physical activity decreasesProtein requirements may be increasedInflammation treatment drugs induce negative nitrogen balance and cause a loss of lean muscle massAdditional protein loss in ulcers and tissue damage from diseaseIncrease protein 1.3-1.5 g/kg/daySupplements of omega fatty acids Shown to reduce disease activity for inflammation and immune responseGuidelines for Medical Nutrition TherapyReduce excessive intake of lactose, fructose and sorbitol may contribute to abdominal cramping, gas and diarrheaAvoid foods that are not well toleratedUse foods containing prebiotics and probioticsFindings are still being investigated but many show beneficial bacteria is introduced and reduces chemicals causing inflammationSome studies didnt show a difference when a placebo was usedStudies still trying to show whether they actually alter GI microflora and immunologic response in the gutGuidelines for Medical Nutrition TherapySupplements needed folate, B6, B12, minerals and trace mineralsReplace those lost due to maldigestion, malabsorption, drug-nutrient interaction or inadequate intakeFolic acid needed to digest proteinSupplements needed zinc, potassium, seleniumDue to aggravation from diarrhea Supplements of vitamin D and calciumDue to intermittent corticosteroids (inflammation/ immune)Find alternate sources: fortified soy milk, fortified juices, yogurtAt risk for osteopenia and osteoporosisReduce fiber intake, moderate as neededEnteral formula or parenteral nutrition if necessaryGuidelines for Medical Nutrition TherapyEat several small meals instead of three large mealsAvoid caffeine, alcohol, fried, spicy intakeAvoid gas forming, sulfer containing foods lactose, eggs, carbonated beverages, certain vegetables and fruitDrink plenty of fluidsLow residue More refined grains, white pasta, white rice, soluble fiber (oatmeal, applesauce no sugar added)Avoid tough, fibrous fruits

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