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Ulcerative enterocolitis Prepared by Junaid Hamid
DefinitionIt is a chronic, reapsing and remitting, nonspecific inflammatory disease of the colon,characterized by suppurative ulceration ofthe colon.
Epidemiology• 5 to 10 per 100000 in a year• Age 10 to 40 years• More common in females• Less common in smokers than in non smokers
Pathology• Retrosigmoid region in 50 % cases• Left sided involving rectum, sigmoid and descending colon in 30 %• May involve the whole colon called as total colitis in 20% cases
• The mucosa is red inflammed and bleeds easily. With severe disease there is xtensive ulceration with inflammatory polyps.• Microscopically the mucosa has inflammatory cell infiltrate with goblet cell depletion
Clinical features…• Emotional stress, intercurrent infection, gastroenteritis, antibiotics and NSAIDs are all the precipitating factors.• First attack is severe and then exacerbations and remissions occur.• In mild form there is gradual onset of infrequent diarrhea with rectal bleeding. There is also left lower quadrant cramps relieved by defecation.
Clinical features…contd.• In moderate case there is more severe diarrhea with frequent. Abdominal pain and tenderness is also present. Mild fever anemia and hypoalbuminemia.• In severe disease 6 to 10 bloody diarrhea per day. Severe anemia, hypovolemia, abdominal pain and tenderness.
In chronic colitis the bowel is permanentlydamaged by fibrosis and there is loss of theabsorbing property of the bowel.There is a persistent diarrhea.
Investigations• blood count od RBCs and leukocytes.• ESR elevated• Stool culture• Sigmoidoscopy• Plain x ray of the abdomen• colonoscopy
Complications• Ischiorectal abscess• Formation of fistula (rectovaginal)• Constriction of rectum or colon• Toxic dilation in severe acute attack• Carcinoma of colon
Treatment• Avoid caffeine and gas producin vegs.• Fibers decrease diarrhea.• Antidiarrheals should be avoided in acute attack.
Treatment….contd• Mesalazine enema 4 grams at bed time• Hydrocortisone enema 80 to 100 mg• Sulfasalazine 500 mg twice daily and inreased gradually to 2 grams daily.• Steroids are used if the patient is not improving.
Treatment….contd• If no improvement still then avoid oral intake and use total parenteral nutrition.• Restore circulatory volume with fluids and blood as needed.
Treatment….contd• Corticosteroid therapy methylprednisolone• Immunosuppressive therapy iv cyclosporine or azathioprine in remission• Surgical treatment in patients who do not respond to corticosteroids and other therapy. Removal of colon and rectum (proctocolectomy) with connecting ileum to the body surface (ileostomy)