For 2nd year B.Sc Nursing students

1. ULCERATIVE
COLITIS
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing Sciences

2. Definition :
It is a long term condition, characterized by inflammation &
ulceration of the colon and rectum.
It is a chronic ulcerative & inflammatory disease of mucosal and
submucosal layers of colon.
The inflammatory changes begin in the rectum & progress
proximally through colon.
It affects both the gender equally, peaks between the ages of 15 and
25 years.

4. Etiology :
- Idiopathic
- Autoimmune disease : celiac disease, lupus erythematosus,
rheumatoid arthritis
- Genetic factors : it is influenced by multiple genes.
- Environmental factors like diet (consumption of refined sugar,
vitamin B6 & unsaturated fat contribute to minimal extent), some
medications (NSAID’s)
- Sulfur restricted diet
- Alcoholism
- Infection by mycobacterium avium & paratuberculosis.

6. Pathophysiology :
Due to etiological factors
Mucosa of colon becomes hyperemic & edematous
Multiple abscess develop in crypts of Lieberkuhn
Advancement of disease leads to breaking of crypts into mucosa
Formation of ulceration
Destroying the mucosal epithelium
Clinical features

7. Clinical Manifestations :
- Bloody Diarrhoea (4 – 5 stools per day)
- Abdominal pain
- Mild lower abdominal cramping
- Acute perforations
- Fever
- Malaise
- Anorexia
- Weight loss
- Anemia
- Dehydration

8. Diagnostic studies :
- History collection & Physical examination
- Complete Blood Count
- Serum electrolytes
- Renal Function Test
- Liver Function Test
- C – Reactive protein
- Stool examination (culture & sensitivity)
- Barium enema
- Abdominal X-Ray

9. - Stool for occult blood
- Ultrasound
- CT Scan
- MRI
- Endoscopy (sigmoidoscopy & colonoscopy)
- Biopsy

10. Complications :
Intestinal :
• Massive Hemorrhage
• Malabsorption
• Stricture of colon (Transverse)
• Perforation
• Toxic megacolon (dilation & paralysis of colon)
• Colorectal cancer

11. Extra intestinal :
• Peripheral Arthritis
• Ankylosing spondilitis
• Osteoporosis - Finger clubbing
• Erythema Nodosum
• Aphthous Ulcers (in mouth)
• Gallstones & Renal stones
• Osteoporosis
• Primary sclerosing cholangitis
• Amyloidosis

12. Management :
Goals of treatment are :
- Rest the bowel
- Control the inflammation
- Combat the infection
- Correct the malnutrition
- Alleviate stress
- Provide symptomatic treatment

13. Drug Therapy :
Category Action Drugs
Antimicrobial Treat / prevent secondary
infection
Metronidazole,
Sulfasalazine
Corticosteroids Decrease inflammation Prednisone,
Hydrocortisone
Anticholinergics Decrease GI secretions Propantheline
Sedatives Reduce anxiety Diazepam
Antidiarrheal Decrease GI Motility Diphenoxylate
Hematinics Correct iron deficiency Oral ferrous Sulphate,
ferrous gluconate

14. Surgical Therapy :
Indications :
o If the patient fails to respond to medications
o Massive bleeding, perforation, stricture or obstruction
o Tissue changes that suggest dysplasia
o If exacerbations are frequent

15. 1) Total proctocolectomy with permanent ileostomy:
It is a one stage operation involving removal of colon, rectum & anus
with closure of Anus.
The end of terminal ileum is brought out through the abdominal wall
and forms a stoma or an ostomy.

16. 2) Total Proctocolectomy with continent ileostomy : Kock pouch
 This method eliminates the need for patient to wear external pouch
over stoma.
 In this procedure, an internal pouch in the distal segment of ileum is
made surgically, the intestine is split, a fold is made & one way
nipple valve is created and sutured into place on the abdomen.
 The pouch acts as reservoir & it is drained at regular interval.
 A catheter stay in place for upto 3 – 4 weeks.
 After the removal of catheter, one way valve is created. Patient
determines frequency by changes in sensation or pressure in pouch.

17. 3) Total colectomy & ileal anal reservoir :
• It involves total colectomy & an ileoanal anastomosis with
formation of an ileal anal reservoir.
• It is a combination of two procedures performed approximately 8 to
12 weeks apart.
• Initial procedure includes colectomy, rectal mucosectomy, ileal
reservoir construction, ileoanal anastomosis & temporary ileostomy.
• The second surgery involves closure of ileostomy & adaptation of
reservoir.

20. Post operative procedure care :
- Routine observation of patients for any signs of hemorrhage,
abdominal abscess, small bowel obstruction, dehydartion….
- Abdominal drainage tube is removed within 4 days of surgery.
- Urinary catheter is removed 5 days after the surgery.
- Kegal exercise & pelvic floor exercises are recommended several
weeks later postoperatively.
- Perianal skin care should be taken.
- Written information to be provided about stoma care at the time of
discharge.

21. Nutritional therapy :
Goals :
• To provide adequate nutrition without exacerbating symptoms
• To correct & prevent malnutrition
• To replace fluid & electrolyte loss
• To prevent weight loss.
 Patient is kept on NPO in the early / acute stage.
 When food permitted, high calorie, high protein, low residue diet
with vitamin & iron supplements is prescribed.
 Low residue diet provides food low in fiber, which results in reduced
amount of fecal matter.

22. Nursing Management :
 Diarrhea related to irritated bowel & intestinal hyperactivity.
 Imbalanced Nutrition, less than body requirement related to
decreased intake & decreased absorption of nutrients
 Anxiety related to possible social embarassment & unfamiliar
environment.
 Impaired skin integrity related to surgical intervention
 Ineffective coping related to lifestyle changes & chronic disease.
 Ineffective therapeutic regimen management related to lack of
knowledge on appropriate lifestyle adjustments & nutritional
therapy.

23. Thank you