ULCERATIVE CHOLITIS

Pathophysiology:

1. Patho Pathway for UC:

Chronic inflammation ➜ Immune dysregulation ➜ Abnormal immune response ➜

Inflammation and ulcers in the mucosal lining of the colon and rectum ➜ Bloody diarrhea,

abdominal pain, and mucosal damage

 Causes:

 Genetic predisposition: Family history of UC increases the risk.

 Environmental factors: Diet, stress, and certain infections might trigger UC.

 Immune system dysfunction: Abnormal immune response against the gut flora.

Signs and Symptoms:

 Abdominal pain and cramping: Due to inflammation and ulceration.

 Bloody diarrhea: Resulting from mucosal damage.

 Fatigue and weight loss: Malabsorption and chronic inflammation.

 Fever: Common during flare-ups.

 Rectal bleeding: A hallmark symptom.

 Urgency to defecate: Frequent and urgent bowel movements.

Diagnostic Tests:

 Colonoscopy: To visualize the extent of inflammation.

 Biopsy: To confirm inflammation and rule out other conditions.

 Blood tests: For anemia, inflammation markers (CRP, ESR).

 Stool tests: To rule out infections or parasites.

Non-Pharmacological Management:
 Dietary changes: Low-residue, low-fiber diet during flare-ups.

 Stress management: Stress can exacerbate symptoms.

 Regular exercise: Helps reduce inflammation and stress.

Pharmacological Management:

1. Aminosalicylates (e.g., Mesalamine):

 Mechanism: Anti-inflammatory action in the colon.

 Side effects: Headache, nausea, abdominal pain.

 Nursing Interventions: Monitor for abdominal pain, assess for allergic reactions.

2. Corticosteroids (e.g., Prednisone):

 Mechanism: Suppresses immune response and inflammation.

 Side effects: Weight gain, mood changes, osteoporosis.

 Nursing Interventions: Monitor weight, assess for mood swings.

3. Immunomodulators (e.g., Azathioprine):

 Mechanism: Modulates the immune system.

 Side effects: Increased risk of infection, liver toxicity.

 Nursing Interventions: Monitor for signs of infection, liver function tests.

4. Biologic therapies (e.g., Infliximab):

 Mechanism: Targets specific immune pathways.

  Side effects: Risk of infections, infusion reactions.

 Nursing Interventions: Monitor for infusion reactions, signs of infections.

Surgical Treatment:

 Colectomy: Surgical removal of the colon may be necessary in severe cases

unresponsive to medication.

Nursing Diagnoses:

1. Risk for Imbalanced Nutrition related to malabsorption secondary to UC.

 Evidence by: Weight loss, anemia, dietary restrictions.

2. Acute Pain related to inflammation and ulceration in the colon.

 Evidence by: Abdominal pain, cramping, urgency to defecate.

3. Risk for Impaired Skin Integrity related to frequent bowel movements and

diarrhea.

 Evidence by: Rectal bleeding, skin irritation.

Nursing Interventions:

1. Risk for Imbalanced Nutrition:

 Monitor nutritional status: Assess weight and intake.

 Collaborate with dietitian: Plan a suitable diet during flare-ups.

 Educate on supplements: Discuss vitamins or iron supplements if necessary.

 2. Acute Pain:

 Administer prescribed pain relief: Monitor effectiveness.

 Provide comfort measures: Heat or cold therapy for abdominal pain.

 Teach relaxation techniques: Breathing exercises to manage pain.

3. Risk for Impaired Skin Integrity:

 Skin assessment: Regularly inspect for signs of irritation or breakdown.

 Promote perineal hygiene: Use gentle cleansing methods.

 Apply barrier creams: Protect the skin from irritation due to frequent bowel movements