powerpoint presentation on etiology, nutritional management of ulcerative colitis.

1. ULCERATIVE COLITISULCERATIVE COLITIS
BY V.S.DEEPIKA RANIBY V.S.DEEPIKA RANI
B.Sc Final yearB.Sc Final year

2. Erosion in the lining of colonErosion in the lining of colon
(mucosa and sub mucosa)(mucosa and sub mucosa)

3.  It is characterized by inflammation andIt is characterized by inflammation and
ulceration of colon resulting in frequent passageulceration of colon resulting in frequent passage
of stools with blood and mucus.of stools with blood and mucus.
 It is confined to colon and rectum.It is confined to colon and rectum.

4. INCIDENCEINCIDENCE unknown causeunknown cause
at any ageat any age
predominates in middlepredominates in middle
and higher incomeand higher income
groups.groups.

5. CAUSESCAUSES
Mental conflicts and emotional
stress
Allergy to certain foods
Largely seen in Non smokers
and Ex-smokers

6. Nitric oxide synthesis is increased in U.CNitric oxide synthesis is increased in U.C
NO is produced from arginine by nitric oxideNO is produced from arginine by nitric oxide
synthase.synthase.
U.C is assosiated with increase in mucosalU.C is assosiated with increase in mucosal
vasodilation.vasodilation.

7. CLINICAL FINDINGSCLINICAL FINDINGS
 Mucosa becomes fragile.Mucosa becomes fragile.
 In early stages mucosa is edematous andIn early stages mucosa is edematous and
hyperemic.hyperemic.
 In severe stage, necrosis and frank ulceration ofIn severe stage, necrosis and frank ulceration of
mucosa occur.mucosa occur.

8. SymptomsSymptoms
 Attack of dysentery.Attack of dysentery.
 Exacerbations and remissions.Exacerbations and remissions.
 Loss of water, electrolytes, blood and protein.Loss of water, electrolytes, blood and protein.
 Weight lossWeight loss
 DehydrationDehydration
 FeverFever
 AnemiaAnemia
 Abdominal painsAbdominal pains

9.  AnorexiaAnorexia
 Metabolic rate is increasedMetabolic rate is increased
 Liver damageLiver damage
 Constipation-distal irritability and spasm.Constipation-distal irritability and spasm.

10. CAUSES OF NUTRITIONCAUSES OF NUTRITION
PROBLEMSPROBLEMS
MECHANISMMECHANISM
Decreased nutritional intakeDecreased nutritional intake
Increased nutritional lossesIncreased nutritional losses
Nutritional interference by drugsNutritional interference by drugs
CONTRIBUTINGCONTRIBUTING
FACTORFACTOR
Anorexia, nausea, painAnorexia, nausea, pain,,
restrictive/unbalanced diet.restrictive/unbalanced diet.
Malabsorption, intestinal resection,Malabsorption, intestinal resection,
bacterialbacterial over growth, bile saltover growth, bile salt
deficiency, drugs.deficiency, drugs.
DiarrheaDiarrhea
BleedingBleeding
Protein-losing enteropathyProtein-losing enteropathy
Intestinal lymphangiectasiaIntestinal lymphangiectasia
Corticosteroids, sulfasalazine,Corticosteroids, sulfasalazine,
cholestyraminecholestyramine

11. NEED FOR NUTRITIONALNEED FOR NUTRITIONAL
CARECARE
 MalnutritionMalnutrition
insufficient food consumptioninsufficient food consumption
excessive nitrogen lossesexcessive nitrogen losses
- blood, mucus and necrotic- blood, mucus and necrotic
colonic mucosacolonic mucosa
-electrolyte loss in feces-electrolyte loss in feces
 Absorptive areas are destroyedAbsorptive areas are destroyed
ulcerations of mucosa and scar tissuesulcerations of mucosa and scar tissues
 Tissue repair and restore normal functioningTissue repair and restore normal functioning

12. DIETARY PRINCIPLESDIETARY PRINCIPLES
 Individual attentionIndividual attention
 Diet- highly individualized, nutritionally adequateDiet- highly individualized, nutritionally adequate
 Small 6 to 8 feedingsSmall 6 to 8 feedings
 Based up on severity of disease it ranges fromBased up on severity of disease it ranges from
TPNTPN
nasogastric feeding of E.Fnasogastric feeding of E.F
oral ingestion of E.Doral ingestion of E.D
exclusion of regular foodsexclusion of regular foods
fiber supplementationfiber supplementation
high fiber diet.high fiber diet.

13. DIETARYDIETARY
RECOMMENDATIONRECOMMENDATION
 Chronic U.CChronic U.C
fistulas, obstruction or abscesses.fistulas, obstruction or abscesses.
TPNTPN
- intestinal atrophy- intestinal atrophy
- invasion of bacteria- invasion of bacteria

14.  Small intestine is not involved.Small intestine is not involved.
 Oral or Enteral feedingOral or Enteral feeding
- integrity of intestinal epithelium- integrity of intestinal epithelium
 Prep. – protein concentratePrep. – protein concentrate
eg. Complan.eg. Complan.

15.  Low residue dietLow residue diet
- high in protein and energy.- high in protein and energy.
 Exclusion of Irritating foods –nuts, legumes,Exclusion of Irritating foods –nuts, legumes,
raw fruits, etc.raw fruits, etc.
 In acute U.C – Strict low residue dietIn acute U.C – Strict low residue diet
- fecal stasis.- fecal stasis.
 Fiber content – high fiber diet.Fiber content – high fiber diet.
 Soluble fibers and pectinsSoluble fibers and pectins

16.  Calories : 2000 – 2500 kcalCalories : 2000 – 2500 kcal
 Proteins : 100 g/dayProteins : 100 g/day
mixed dietmixed diet
high quality protein foodshigh quality protein foods
eg. tender meats, fish, poultry etc.eg. tender meats, fish, poultry etc.

17.  Carbohydrates : soups, etcCarbohydrates : soups, etc
 Fats : normalFats : normal
fried foods are notfried foods are not
easily digested.easily digested.
 Vitamins : commercial prep.Vitamins : commercial prep.
(orally or injections)(orally or injections)

18. MineralsMinerals
 Mineral loss must be marked.Mineral loss must be marked.
 Unless marked – fatal outcomeUnless marked – fatal outcome
 Sodium : large volume of fecesSodium : large volume of feces
extra salt in food, saline infusion.extra salt in food, saline infusion.
 Potassium :Potassium :
Symptoms- weakness, hypotonia, abdominalSymptoms- weakness, hypotonia, abdominal
distension, E.C changes.distension, E.C changes.
potassium citrate orallypotassium citrate orally

19.  Iron : 30g/dayIron : 30g/day
oral route if not toleratedoral route if not tolerated
AnemiaAnemia
 Intra muscular injectionsIntra muscular injections
 Blood transfusionBlood transfusion
 Fluids : liberal intakeFluids : liberal intake
1200 – well hydrated1200 – well hydrated

20.  Calcium : Rapid bone lossCalcium : Rapid bone loss
-milk exclusion-milk exclusion
-steroid therapy-steroid therapy
 calcium salts – orallycalcium salts – orally
FOODS TO BE AVOIDEDFOODS TO BE AVOIDED
spices, stale foods,spices, stale foods,
irritant foods - legumes, nuts etc.irritant foods - legumes, nuts etc.

21. Psychological aspectsPsychological aspects
 They are significantThey are significant
 Therapy for depression, relaxation can benefitTherapy for depression, relaxation can benefit
the patient.the patient.
 Exercise is important adjunct.Exercise is important adjunct.

22. U.C AND CANCERU.C AND CANCER
 Constipated patients – lump in right colon.Constipated patients – lump in right colon.
 Risk of cancer is increased in cases lasting moreRisk of cancer is increased in cases lasting more
than 7 years.than 7 years.