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Surgery - Ulcerative Colitis
Overview
big bowel-related inflammatory illness that is chronic, recurrent, and intermittent.
Etiology
Not sure. The immune system's reaction to bacterial or self-antigens, environmental variables, altered neutrophil function, and abnormalities in epithelial cell integrity are among the theories. Genetic vulnerability (chromosomes 12, 16) is another.
15% had a positive family history of IBD. correlated with primary sclerosing cholangitis and elevated serum pANCA.
Epidemiology
1/1500 is the prevalence (in the developed world). greater frequency in Caucasians and Ashkenazi Jews.
Rare prior to age 10, peak onset age between 20 and 40 years. equal gender ratio until age 40, after which it rises for men.
History
mucous or bloody diarrhea (frequency of stools correlated with disease severity). Urgency and tenesmus. Abdominal cramps before to bowel movement, fever, and weight loss. Extra-GI manifestations' symptoms.
Examination
Indices of low iron levels dehydration and anemia. Clubbing. discomfort in the abdomen and tachycardia.
On a PR examination, there is blood, mucus, and soreness. symptoms that are extra-gastrointestinal.
Investigations
Blood: reduced albumin, elevated CRP or ESR, increased WCC, decreased Hb, crossmatch if significant blood loss, and LFT.
Stool: A differential diagnosis of infectious colitis is culture. The illness severity marker faecal calprotectin.
AXR: To exclude megacolon that is hazardous (see hazardous Megacolon).
Colonoscopy or flexible sigmoidoscopy (including biopsy): assesses dysplasia identification, severity, and histological confirmation.
Barium enema: lack of haustral pattern (lead-pipe or hosepipe look), featureless constricted colon, mucosal ulcers with granular appearance and filling deficiencies (pseudopolyps) (see Fig. 13). In cases of acute exacerbations, colonoscopy and barium enema may be hazardous (risk of perforation).
Management
Activity markers include decreased Hb and Alb, elevated ESR or CRP, and frequency of diarrhea (less than four is mild, four to six is moderate, and more than six is severe), bleeding, and fever.
Acute exacerbation: parenteral nutrition may be required, antibiotics, IV rehydration, IV corticosteroids, bowel rest, and DVT prevention. Keep a careful eye on your vital signs and fluid balance. Low threshold for proctocolectomy and ileostomy if toxic megacolon develops, as perforation has a thirty percent death rate.
Reversible illness: rectal steroids and/or oral 5-aminosalicylic acid (5-ASA) derivatives, such as sulphasalazine. Oral 5-ASA and oral prednisone for moderate-to-severe illness. Azathioprine, cyclosporine, 6-mercaptopurine, and infliximab (anti-TNF monoclonal antibody) induce immunosuppression.
Suggestion: Educating and supporting patients. management of the consequences. routine colonoscopy observation.
Surgical: Recommended in cases where medical treatment fails, problems arise, or colonic cancer is to be prevented. Ileostomy with proctocolectomy or development of an ileoanal pouch
Complications
Digestive: bleeding, poisonous megacolon, splinter, colonic cancer (in patients with advanced disease for more than a decade), gallstones, and PSC.
The following extra-gastrointestinal symptoms (10–20%) include amyloidosis, arthropathy, renal calculi, sacroiliitis, erythema nodosum, pyoderma gangrenosum, osteoporosis (due to steroid treatment), and ankylosing spondylitis.
Prognosis
a normal life expectancy condition that relapses and resolves periodically.
The following are poor prognostic variables (ABCDEF): fever (>38 °C in the first 24 hours), dilated bowel loops, elevated CRP, blood pressure, elevated albumin (<30 g/L), and intestinal dilation.
Overview
big bowel-related inflammatory illness that is chronic, recurrent, and intermittent.
Etiology
Not sure. The immune system's reaction to bacterial or self-antigens, environmental variables, altered neutrophil function, and abnormalities in epithelial cell integrity are among the theories. Genetic vulnerability (chromosomes 12, 16) is another.
15% had a positive family history of IBD. correlated with primary sclerosing cholangitis and elevated serum pANCA.
Epidemiology
1/1500 is the prevalence (in the developed world). greater frequency in Caucasians and Ashkenazi Jews.
Rare prior to age 10, peak onset age between 20 and 40 years. equal gender ratio until age 40, after which it rises for men.
History
mucous or bloody diarrhea (frequency of stools correlated with disease severity). Urgency and tenesmus. Abdominal cramps before to bowel movement, fever, and weight loss. Extra-GI manifestations' symptoms.
Examination
Indices of low iron levels dehydration and anemia. Clubbing. discomfort in the abdomen and tachycardia.
On a PR examination, there is blood, mucus, and soreness. symptoms that are extra-gastrointestinal.
Investigations
Blood: reduced albumin, elevated CRP or ESR, increased WCC, decreased Hb, crossmatch if significant blood loss, and LFT.
Stool: A differential diagnosis of infectious colitis is culture. The illness severity marker faecal calprotectin.
AXR: To exclude megacolon that is hazardous (see hazardous Megacolon).
Colonoscopy or flexible sigmoidoscopy (including biopsy): assesses dysplasia identification, severity, and histological confirmation.
Barium enema: lack of haustral pattern (lead-pipe or hosepipe look), featureless constricted colon, mucosal ulcers with granular appearance and filling deficiencies (pseudopolyps) (see Fig. 13). In cases of acute exacerbations, colonoscopy and barium enema may be hazardous (risk of perforation).
Management
Activity markers include decreased Hb and Alb, elevated ESR or CRP, and frequency of diarrhea (less than four is mild, four to six is moderate, and more than six is severe), bleeding, and fever.
Acute exacerbation: parenteral nutrition may be required, antibiotics, IV rehydration, IV corticosteroids, bowel rest, and DVT prevention. Keep a careful eye on your vital signs and fluid balance. Low threshold for proctocolectomy and ileostomy if toxic megacolon develops, as perforation has a thirty percent death rate.
Reversible illness: rectal steroids and/or oral 5-aminosalicylic acid (5-ASA) derivatives, such as sulphasalazine. Oral 5-ASA and oral prednisone for moderate-to-severe illness. Azathioprine, cyclosporine, 6-mercaptopurine, and infliximab (anti-TNF monoclonal antibody) induce immunosuppression.
Suggestion: Educating and supporting patients. management of the consequences. routine colonoscopy observation.
Surgical: Recommended in cases where medical treatment fails, problems arise, or colonic cancer is to be prevented. Ileostomy with proctocolectomy or development of an ileoanal pouch
Complications
Digestive: bleeding, poisonous megacolon, splinter, colonic cancer (in patients with advanced disease for more than a decade), gallstones, and PSC.
The following extra-gastrointestinal symptoms (10–20%) include amyloidosis, arthropathy, renal calculi, sacroiliitis, erythema nodosum, pyoderma gangrenosum, osteoporosis (due to steroid treatment), and ankylosing spondylitis.
Prognosis
a normal life expectancy condition that relapses and resolves periodically.
The following are poor prognostic variables (ABCDEF): fever (>38 °C in the first 24 hours), dilated bowel loops, elevated CRP, blood pressure, elevated albumin (<30 g/L), and intestinal dilation.
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