Ulcerative Colitis

Ulcerative colitis is a chronic disease in which the colon is inflamed and full of wounds, leading to episodes of bloody diarrhea, cramps and fever turbuhu.

Ulcerative colitis may start at any age, but usually begin between 15 and 30-years. A small group of people has the first attack between the ages of 50-70 years.

Unlike Crohn's disease, ulcerative colitis usually does not affect the full thickness of the bowel and never affects the small intestine. The disease usually begins in the rectum and sigmoid colon (the lower end of the colon) and eventually spreads partially or completely through the colon. In some people the very early affected the entire colon.

About 10% of people who have ulcerative colitis have only one attack. However, some of these cases may actually be undetected infection before the real ulcerative colitis.

The cause of ulcerative colitis is unknown, but inheritance and overactive immune responses in the intestine could be factors that contribute to the occurrence of the disease.

Symptoms

The attack can be sudden and heavy provoking fierce diarrhea, very high temperature, abdominal pain and peritonitis (inflammation of the inner surface of the abdomen). During such an attack, a person is seriously ill. More often attack begins gradually and the person has a need vacuity chairs, mild cramping in the lower abdomen and visible blood and mucus in the stool.

When the disease is confined to the rectum and sigmoid colon, the stool can be normal or hard and dry, however, comes from the rectum during bowel movements or between the mucus with a large number of red and white blood cells. General symptoms such as fever, were mild or non-existent.

If the disease spreads further along the colon, the stool is fluffy and a person can have 10-20 bowel movements a day. Often a person has severe rectal spasms that accompany the need for emptying the chairs. At night there is no relief. The chair can be watery and contain pus, blood and mucus. Often almost entirely made up of blood and pus.A person may also have a fever and poor appetite and may lose weight.

Complications

Bleeding, the most common complication, often leading to anemia due to iron deficiency. In almost 10% of people with ulcerative colitis, rapidly advancing first attack becomes very serious with massive bleeding, failure and disseminated infections.

In Toxin colitis, particularly dire complications damaged the entire thickness of the intestinal wall. Damage caused by ileus, a condition in which the stop motion intestinal wall and the intestinal contents can not move on their way.Comes to stretching the stomach. As the toxic colitis worsens, the colon loses muscle tension and within days, or even hours, it begins to spread. X-ray abdomen in paralyzed areas of bowel gas shows. When the colon is very stretched, a condition called toxic megacolon. A person is seriously ill and may have a high fever. A person has pain and tenderness in the abdomen and a high number of white blood cells. However, the people who get fast, effective treatment for their symptoms, he died less than 4% of people. If early break hose, there is a risk of death.

Risk of colon cancer is higher in people with long-term extended ulcerative colitis. Risk of colorectal cancer is highest when the entire colon is affected and the person has ulcerative colitis for more than 10 years, regardless of disease activity.

People with a high risk of cancer recommended colonoscopy (colon searches Hose observation) at regular intervals, better during periods without symptoms. During colonoscopy taken tissue samples from the entire colon for microscopic examination. Colorectal cancer each year can get 1 in 100 people with this disease. Most survive if the cancer diagnosis is set in the early stages.

Such as Crohn's disease, ulcerative colitis is associated with diseases that affect other parts of the body. When ulcerative colitis causes outbreak of intestinal symptoms, a person may have inflammation of the joints (arthritis), inflammation of the sclera (episcleritis), inflamed skin nodules (erythema nodozum) and blue-red painful sores on the skin containing pus (pyoderma gangrenozum). When ulcerative colitis does not cause intestinal symptoms, the person may still have inflammation of the spine (ankylosing spondylitis), inflammation of the pelvic joints (sacroiliitis), and inflammation inside the eye (uveitis).

Although people with ulcerative colitis usually have less interference with the functioning of the liver, only about 1% -3% have symptoms of mild to severe liver disease. Severe disease can include inflammation of the liver (chronic active hepatitis), inflammation of the bile ducts (primary sclerosing cholangitis), that it narrows and eventually closes.Inflammation of the bile duct can occur many years before any intestinal symptoms of ulcerative colitis, and this increases the risk of bile duct cancer.

Diagnosis

In establishing a diagnosis anointing the sick with symptoms and searches chairs. Blood tests indicate anemia, increased white blood cell count, low albumin and elevated erythrocyte sedimentation rate. The diagnosis is confirmed by sigmoidoscopy (search sigmoid colon Hose observation) and allows the doctor to directly observe the weight of inflammation. Even during periods without symptoms, bowel rarely looks normal, and take a sample of tissue for microscopic examination indicates chronic inflammation.

X-ray abdomen may indicate the severity and extent of disease. X-ray examination of barium enema and colonoscopy (search entire colon Hose observation) usually does not work before the start of treatment, because there is a risk of leakage, hose when running in the active stages of the disease. However, when the disease is usually calm examines the entire colon to determine the extent of the disease and the exclusion of cancer. To do this, perform a colonoscopy or X-ray after giving barium enema.

Inflammation of the colon has many causes other than ulcerative colitis. The doctor needs to determine whether the inflammation caused by infection by bacteria or parasites. Stool samples that are obtained during sigmoidoscopy are examined under the microscope and work culture of the bacteria. Blood samples were analyzed to determine whether a person has acquired parasitic infections, such as during the trip.

Tissue samples taken from the lining of the rectum and examined microscopically. The doctor checks the STD and rectum, such as gonorrhea, herpes virus or Chlamydia infection, especially if the patient is a male homosexual. In older people with atherosclerosis, inflammation can cause poor blood supply to the colon. Colorectal cancer rarely causes fever or ejection of pus from the rectum, but the doctor has to consider cancer as a possible cause of bloody diarrhea.

Treatment

Treatment helps in controlling inflammation, reducing symptoms and replace lost fluids and nutrients. One should avoid raw fruits and vegetables to reduce physical injury inflamed lining of the colon. Symptoms can be reduced diet without dairy products and ulcers to try. Iron supplements can alleviate anemia caused permanent loss of blood in faeces.

In relatively mild diarrhea taken anticholinergic drugs or low-dose loperimida or diphenoxylate. With stronger diarrhea may require higher doses of tincture of opium or diphenoxylate odorless, loperamide or codeine. In severe cases, the doctor carefully monitors the patient's medication against diarrhea to avoid toxic megacolon.

To decrease the inflammation in ulcerative colitis and for the prevention of the symptoms of his full-scale often used sulfasalazine, mesalamine or olsalazin. These medicines are usually taken by mouth, but can be given as an enema, or as suppositories.

People with moderate to severe disease who are not tied to the bed, commonly used corticosteroids such as prednisone in the mouth. Prednisone in fairly high doses often leads to a dramatic recovery. After prednisone suppress inflammation in ulcerative colitis, sulfasalazine, mesalamine or olsalazin are also often given. Gradually reducing the dose of prednisone and eventually abolish prednisone. Prolonged treatment with corticosteroids almost always cause side effects, although most of them disappear when they stop taking the drug. When mild or moderate ulcerative colitis is limited to the left colon (descending colon) and rectum, can be given enemas with corticosteroids or mesalamine.

If the disease becomes severe, the person is placed in the hospital and given intravenous corticosteroids. People with severe bleeding from the rectum must receive blood transfusions and intravenous fluids.

To maintain the improved condition of patients with ulcerative colitis who would otherwise have had to be on long-term treatment with corticosteroids, used to azathioprine and mercaptopurine. Some people who survived severe attacks, and did not respond to treatment with corticosteroids, cyclosporine is given, but about half of these people eventually need surgical treatment.

Surgical treatment

Toxic colitis is an emergency situation. Immediately as soon as the doctor discovers or suspects threatening toxic megacolon, breaks with all drugs against diarrhea, the patient does not give anything to eat, through the nose slid tube into the stomach or small intestine and attach to occasionally draw, and all the fluids, nutrition and drugs are given intravenously. The patient is closely monitored with regard to indicators of peritonitis or rupture (break) hoses.If these measures are not successful in improving the patient's condition for 24-48 hours, required emergency surgery: it removes almost all or most of the colon.

Once the diagnosis of cancer or in the colon find precancerous changes in the surgical procedure done without urgency. This surgical procedure can be done due to narrowing of the colon or growth retardation in children. The most common reason for surgical treatment was unchanged chronic disease that would otherwise be made by a person disabled or chronically addicted to high doses of corticosteroids.

In rare cases, surgical treatment necessary to do some problems associated with colitis not hose, such as pyoderma gangrenozum.

Full removal of the colon and rectum for good cure ulcerative colitis. Living with a permanent ileostomy (surgically created connection between the lowest part of the small intestine and the opening in the abdominal wall) and ileostomna bags are traditional cost of such treatment. However, there are various other methods, of which the most common procedure called ileo-anal anastomosis. In this procedure removes the colon and rectum most, and of the small intestine makes little rezorvoar and attached to the remaining rectum just above the anus. This process maintains the retention chairs, although some effects can occur, such as the inflammation of the reservoir.