This document provides an overview of ulcerative colitis including its definition, causes, risk factors, clinical manifestations, diagnostic evaluations, management, complications, and nursing care considerations. Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation and ulcers in the lining of the large intestine. It is characterized by periods of remission and relapse of symptoms such as abdominal pain and bloody diarrhea. Diagnostic evaluations include physical exams, lab tests, stool exams, endoscopies, and imaging. Treatment involves medications to induce and maintain remission as well as nutrition management and potentially surgery for severe cases.

1. MS.MUTHU RAJATHI, M.SC (N)
ASST., PROFESSOR
DEPARTMENT OF MEDICAL SURGICAL NURSING
GANGA INSTITUTE OF HEALTH SCIENCES
COIMBATORE

2. ULCERATIVE COLITIS

3. INTRODUCTION
• Belongs to the wide spread category of inflammatory
bowel disease.
• Only pathological, endoscopical changes differs it
from crohn’s disease.
• Course of remitting and relapsing disease.
CROHNS
DISEASE
ULCERATIVE
COLITIS
INFLAMMATORY BOWEL DISEASE

4. SIGNIFICANT ANATOMY & PHYSIOLOGY

5. SIGNIFICANT ANATOMY & PHYSIOLOGY
Last part of the GI tract.
The large intestine is about 5 feet long in adults.
Absorbs water and any remaining nutrients from
partially digested food passed from the small
intestine.
The large intestine changes waste from liquid to a
solid matter called stool.
The rectum is located between the lower, or
sigmoid, colon and the anus
Ulcerative colitis affects only the large intestine part.

6. DEFINITION
INFLAMMATION IRRITATION ULCERATION
CHRONIC INFLAMMATORY DISEASE.
“INFLAMMATION, IRRITATION AND
ULCERATIONS LINING THE WALL OF THE LARGE
INTESTINE .”

7. DEFINITION
Chronic inflammatory disease in the inner lining of
the intestine which leads to ulceration and bleeding
in the intestinal tissue.
“Ulcerative colitis is a chronic inflammatory
condition characterized by relapsing and remitting
episodes of inflammation limited to the mucosal
layer of the colon”.

8. DEFINITION
Is an inflammatory bowel disease (IBD)
marked by gastrointestinal (GI) mucosal
inflammation due to altered microbiota,
increased intestinal permeability, and
immune system dysfunction.

9. FEATURES OF ULCERATIVE COLITIS
 MACROSCOPIC CHANGES
 Continuous inflammation
 Reddened & Inflamed intestinal mucosa
 Evidence of inflammatory polyps
 MICROSCOPIC CHANGES
 Alterations in the crypt architecture
 Crypt abscess
 Goblet cell depletion
 Inflammatory infiltrations in the lamina proporia

10. INCIDENCE AND PREVALENCE
• AGE : most common in 15 – 30 yrs of age; people
above 60 yrs are also in the risk category.
• Gender : both the gender are equally affected.
• Family history of ulcerative colitis
• Statistics : 6.02 per 100000 population in India.
• Personal Habits : Smoking & Alcoholism not
influencing the prevalence of the disease.

11. CLASSIFICATION
ULCERATIVE PROCTITIS
Inflammation in the rectum.
PROCTOSIGMOIDITIS
Inflammation in the rectum
along with sigmoid colon.

12. CLASSIFICATION
DISTAL PROCTITIS
Inflammation beyond the rectum
and as far proximally as the
splenic fixture.
PANULCERATIVE COLITIS
Inflammation of the entire
colon.

13. CAUSES AND RISK FACTORS
Environmental
factors
Immune
factors
Genetic
suscepti
bility

14. CAUSES AND RISK FACTORS –
Auto immune reaction
Immune
response
Autoimmune
reaction towards
intestinal mucosa
Fight against
Viral and bacterial
infection in the
intestinal mucosa
Inflammatory
process
Does not stop once
the infection
resolves which
causes intestinal
mucosal damage

15. CAUSES AND RISK FACTORS –
Genetic factors
Genetic
composition
Family history of
ulcerative colitis
Susceptible genes
increases the risk of
ulcerative colitis

16. CAUSES AND RISK FACTORS –
Environmental factor
E
N
V
I
R
O
N
M
E
N
T
A
L
F
A
C
T
O
R
S
Antibiotics
NSAIDs
Oral contraceptives
Certain foods
Stress
Emotional distress
Poor dietary pattern
Smoking

17. PATHOPHYSIOLOGY
Due to any cause
Mucosal cell
damage
Inflammation &
desquamation of
the colonic
epithelium
Edematous of
intestinal mucosa
Vascular pattern
impairment
Chronic tissue
injury
Bleeding
Excessive loss of
body fluids
Shock

18. GRADING OF ULCERATIVE COLITIS –
Truelove & witt Criteria
CRITERIA MILD MODERATE SEVERE
BOWEL
MOVEMENTS
Less than 4
episodes
4 – 6 episodes More than 8
episodes
BLOOD IN
STOOL
Minimal Mild to severe Visible blood
PYREXIA No No Yes
ANEMIA No No Yes
ESR Less than 30 30 More than 30
PULSE >
90bPM
No No Yes

19. CLINICAL MANIFESTATIONS
Warning Symptoms
Chronic Diarrhea
Blood in Stools
Abnormal weight loss
Tenesmus
Abdominal pain

20. CLINICAL MANIFESTATIONS
Fever
Dehydration
Abdominal tenderness
Abdominal distention
Abdominal mass
Tachycardia
Hypotension
Fatigue
Passage of
mucopurulent
exudates
Nocturnal
defecationVomiting
Signs of dehydration

21. CLINICAL MANIFESTATIONS –
Extra intestinal symptoms
Skin :
Erythema nodosum
Pyoderma gangrenosum
Gall bladder :
Cholelithiasis
Sclerosing cholangitis
Joints :
Spondylitis
Sacroillitis
Peripheral arthritis
Liver :
steatosis
Mouth :
Stomatitis
Aphthous ulcer
Circulation :
Phlebitis
Kidneys:
Nephrolithiasis
UTI
Eyes :
Episcleritis
Uveitis

22. DIAGNOSTIC EVALUATION –
Physical examination
• Abdominal tenderness
• Bowel sounds
• Abdominal distention
• Signs of toxic shock
• Signs of bleeding

23. DIAGNOSTIC EVALUATION
Complete blood profile
Complete metabolic
profile
Inflammatory markers
Stool assays
Serological series
Leukocytosis
Anemia
Thrombocytosis

24. DIAGNOSTIC EVALUATION
Complete blood profile
Complete metabolic
profile
Inflammatory markers
Stool assays
Serological series
Hypo
albuminemia
Hypo
magnesemia
Hypokalemia
Elevated ALP

25. DIAGNOSTIC EVALUATION
Complete blood profile
Complete metabolic
profile
Inflammatory markers
Stool assays
Serological series
Elevated ESR &
CRP
Fecal
calprotectin – to
identify the
mucosal healing.

26. DIAGNOSTIC EVALUATION
Complete blood profile
Complete metabolic
profile
Inflammatory markers
Stool assays
Serological series
Fecal ,
Blood
Ova and
parasites
Viral load
Bacterial culture
Leukocytes

27. DIAGNOSTIC EVALUATION
Complete blood profile
Complete metabolic
profile
Inflammatory markers
Stool assays
Serological series
P – ANCA
Serological
marker.
Positive in 60 –
80% patients
Identifies the
early need for
surgery.

28. DIAGNOSTIC EVALUATION –
Plain abdominal X Ray
• Useful in fulminant or severe colitis.
• Due to the thickening of colonic wall, thumb printing
appearance will be visible.
• In toxic mega colon, the bowel dilatation with loss of
haustral markings.
Thumb printing appearance Mega colon

29. DIAGNOSTIC EVALUATION –
Barium Enema
• Useful ulcerative colitis, polyps and masses.
• Appears as granular and shortened colon.

30. DIAGNOSTIC EVALUATION – CT scan
• Shows colonic wall thickening.

31. DIAGNOSTIC EVALUATION –
Colonoscopy
• Shows,
– Mucosal inflammation
– Loss of vascular pattern
– Inflammatory Pseudopolyps
– Contact bleeding
– Superficial ulceration

32. DIAGNOSTIC EVALUATION –
Colonoscopy
• Shows,
– Mucosal inflammation
– Loss of vascular pattern
– Inflammatory Pseudopolyps
– Contact bleeding
– Superficial ulceration

33. DIAGNOSTIC EVALUATION –
Flexible sigmoidoscopy

34. MANAGEMENT
Induction of remission
Maintenance of
remission
Prevention of
complications

35. MANAGEMENT – pharmacolgical therapy
5 - Aminosalicytes
Corticosteroids
Thiopurine
Cyclosporine
Biological therapy
Eg : Sulfasalazine,
Mesalamine
Exhibitis results in
remission induction and
maintainance.
Sulfasalazine
suppositries is a prefered
therapy for rectal
ulcerations.

36. MANAGEMENT – pharmacolgical therapy
5 - Aminosalicytes
Corticosteroids
Thiopurine
Cyclosporine
Biological therapy
Eg : methylprednisolone,
hydrocortisone,
Budesonide (new)
Used in acute treatment
of moderate to severe
colitis.
40 – 60mg/day
Rectally administered
steroid enemas for flares of
symptoms.

37. MANAGEMENT – pharmacolgical therapy
5 - Aminosalicytes
Corticosteroids
Thiopurine
Cyclosporine
Biological therapy
Eg : Azathioprine 2 -
2.5mg/kg/day
6 mercaptopurine 1-
1.5mg/kg/day
Effective for
maintenance of remission.
Very slow onset of
action.

38. MANAGEMENT – pharmacolgical therapy
5 - Aminosalicytes
Corticosteroids
Thiopurine
Cyclosporine
Biological therapy
Effective for severe
ulcerative colitis.
Dose : 2-4mg/kg/day
Continuous infusion.

39. MANAGEMENT – pharmacological therapy
5 - Aminosalicytes
Corticosteroids
Thiopurine
Cyclosporine
Biological therapy
ANTI TNF :
Its an IGG monoclonal
antibody directed against TNF.
It is a less toxic
alternative to cyclosporine for
patients with severe ,steroid
refractory disease
Effective for both
induction and maintenance of
remission.
PREPARATIONS –
Infliximab - induction
of remission:
5 mg/kg IV at weeks 0, 2,6.
Maintenance: 5 mg/kg IV every
8 weeks

40. MANAGEMENT – SURGICAL THERAPY
PROCTOCOLECTOMY WITH END ILEOSTOMY

41. MANAGEMENT – SURGICAL THERAPY
RESTORATIVE PROCTOCOLECTOMY WITH
ILEO ANAL POUCH

42. MANAGEMENT – SURGICAL THERAPY
PAN PROCTOCOLECTOMY

43. MANAGEMENT – Nutritional therapy
Lactose
free diet
Low
fiber
diet
Low
salt
diet
Low fat
diet
High
caloric
diet

44. MANAGEMENT – Nutritional therapy
• low residue , high protein, high caloric diet
• Vitamin supplements
• Iron replacement
• IV fluids
• Avoid milk
• Avoid cold foods and smoking
• TPN nutrition

45. COMPLICATIONS
osteoporosis
Colon
cancer
Toxic
megacolon
Primary
sclerosing
cholangitis
Malnutrition
Vitamin &
Mineral
deficiency

46. NURSING MANAGEMENT
• Diarrhea related to inflammation of the bowel mucosa as evidenced
by increased bowel sounds.
• Fluid volume deficit related to loss of body fluids secondary to
diarrhea and rectal bleeding as evidenced by signs of dehydration.
• Imbalanced nutrition less than body requirement related to fear
that eating may cause diarrhea as evidenced by reluctant to eat
• Impaired anal skin integrity related to repeated episodes of
diarrhea as evidenced by redness in the anal skin.
• Risk for shock related to profuse bleeding.
• Risk for exacerbation related to poor adherence with the
therapeutic regimen.

47. REFERENCE
• LEWIS , TEXTBOOK OF MEDICAL SURGICAL NURSING
• BRUNNER & SUDDHARTH’S , TEXTBOOK OF MEDICAL SURGICAL
NURSING
• JOYCE.M.BLACK, TEXTBOOK OF MEDICAL SURGICAL NURSING
• ANTONY.S , BOOK OF ANATOMY & PHYSIOLOGY
• WWW. GASTRICASSOCIATION.COM
• WWW. PUBMEDINDIA.COM
• www. Crohnscolitis.foundation.org