ULCERATIVE COLITIS
ULCERATIVE COLITIS
• is an inflammatory bowel disease that causes long-lasting inflammation
and ulcers (sores) in your digestive tract. Ulcerative colitis affects the
innermost lining of your large intestine (colon) and rectum. Symptoms
usually develop over time, rather than suddenly. Ulcerative colitis can
be debilitating and can sometimes lead to life-threatening
complications. While it has no known cure, treatment can greatly
reduce signs and symptoms of the disease and even bring about long-
term remission.
PATHOPHYSIOLOGY
• Ulcerative colitis happens when your immune system makes a mistake.
Normally, it attacks invaders in your body, like the common cold. But
when you have UC, your immune system thinks food, good gut
bacteria, and the cells that line your colon are the intruders. White
blood cells that usually protect you attack the lining of your colon
instead. They cause the inflammation and ulcers.
SIGNS AND SYMPTOM
• The main symptom of ulcerative colitis is bloody diarrhea. There might
be some pus in your stools, too.
OTHER PROBLEMS INCLUDE:
DIAGNOSTIC:
• Your doctor will likely diagnose ulcerative colitis after ruling out other possible
causes for your signs and symptoms. To help confirm a diagnosis of ulcerative
colitis, you may have one or more of the following tests and procedures:
• Stool sample. White blood cells in your stool can indicate ulcerative colitis. A
stool sample can also help rule out other disorders, such as infections caused by
bacteria, viruses and parasites.
• Colonoscopy. This exam allows your doctor to view your entire colon using a
thin, flexible, lighted tube with an attached camera. During the procedure, your
doctor can also take small samples of tissue (biopsy) for laboratory analysis.
Sometimes a tissue sample can help confirm a diagnosis.
• X-ray. If you have severe symptoms, your doctor may use a standard X-ray of
your abdominal area to rule out serious complications, such as a perforated
colon.
• CT scan. A CT scan of your abdomen or pelvis may be performed if your
doctor suspects a complication from ulcerative colitis. A CT scan may also
reveal how much of the colon is inflamed.
SURGICAL MANAGEMENT
• Colectomy.
• Surgery to remove the entire colon
• Proctocolectomy
• Surgery to remove both the colon and rectum is a proctocolectomy. Both can be
used to treat ulcerative colitis. These surgeries are also performed to eliminate the
threat of colon cancer. Colon cancer is common in people with ulcerative colitis.
Proctocolectomy is considered the standard treatment when surgery for ulcerative
colitis is needed.
• If the entire colon is removed, the surgeon may create an opening, or stoma, in
the abdominal wall. The tip of the lower small intestine is brought through the
stoma. An external bag, or pouch, is attached to the stoma. This is called a
permanent ileostomy. Stools pass through this opening and collect in the pouch.
The pouch must be worn at all times.
• Pelvic Pouch or Ileal Pouch Anal Anastomosis (IPAA)
• This is a procedure that does not require a permanent stoma. This surgery is also called
a restorative proctocolectomy. The patient is still able to eliminate stool through the
anus. In this procedure, the colon and rectum are removed. Then the small intestine is
used to form an internal pouch or reservoir -- called a J-pouch -- that will serve as a
new rectum. This pouch is connected to the anus. This procedure is frequently done in
two operations. In between the operations the patient needs a temporary ileostomy.
• The continent ileostomy, or Kock pouch
• is an option for people who would like their ileostomy converted to an internal
pouch. It's also an option for people who do not qualify for the IPAA procedure. In
this procedure, there is a stoma but no bag. The colon and rectum are removed, and
an internal reservoir is created from the small intestine. An opening is made in the
abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To
drain the pouch, the patient inserts a catheter through the valve into the internal
reservoir. This procedure, however, is not the preferred surgical treatment for
ulcerative patients. That's because of its uncertain results and the potential need for
additional surgery.
NURSING INTERVENTIONS FOR
ULCERATIVE COLITIS
• Monitor VS, patient’s bowel movements (what does it look like and its
frequency), keep patient hydrated, monitor daily weights (for weight loss), focus
on GI assessment (bowel sounds: hyperactive, hypoactive, or absent, tenderness)
• Signs and symptoms of toxic megacolon: abdominal distention, fever, diarrhea,
abdominal pain, dehydration, tachycardia, hypoactive or absent bowel sounds
• Signs and Symptoms of peritonitis: distention or abnormal bloating, increased
heart rate, tachypnea, pain (note toxic megacolon can lead to peritonitis)
• May be NPO with IV hydration…advance diet per MD order as symptoms
subside…will typically start with clear, fulls, and then solids
• Diet Education:
• Watch foods that can cause a “flare-up” or should be avoided during a “flare-up”:
• High-fiber foods (they require a lot of digestion and the gut needs to rest)
• Food hard to digest like: nuts, raw vegetables or fruits (cooked are better)
• Allergen type foods: dairy or certain foods that the person may be intolerant
too like wheat, fish
• Avoid spicy, high-fat foods, gluten, gas causing foods like onions, beans etc.
• Foods to eat during “flare-up” or to prevent one:
• Low fiber (easier on the gut to digest), high-protein and stay hydrated
• Importance about regular screening of colon cancer
• If patient had surgery, educate about ostomy placement: know the nursing pre
and post care, how to provide ostomy care (diet, how to change pouching
system, stoma care etc.)
