Ulcerative Colitis

1. Welcome To Our Case Study
Presentation
Presentation on Ulcerative Colitis

2. Ulcerative colitis
Subject: Medical and Surgical Nursing -1
Paper -1: Medical and Surgical Nursing
 Presented by--
 Group: TheCaregivers(Group B)
 BSc In Nursing 2nd Year
 College of Nursing Sher-e-Bangla Nagar Dhaka-1207
 Presented to-
 Sharmishtha Shill
 Nursing Instructor
 (CoNSBN)

3. Patient Information:
 Patient Name : Rupom Islam
 Age : 21 years
 Sex : male
 Profession : student
 Reg No : 2023012007
 Date of admission : 7-12-2023
 Diagnosis : ulcerative Colitis disease
 Ward no : 412
 Bed no : 07
 Marital status : Unmarried
 Educational Level : HSC
 Patient address : Shymoli
 Permanent address : Sylhet

4. Patient’s illness history
 Chief complaints:
 Rectal bleeding
 Frequent stools and mucous discharge from the rectum.
 Abdominal Pain
 History of Present illness :
 According to patient statement –
 Patient was apparently normal before 6 months
 . He developed abdominal pain, high fever with chill and loss of appetite and taken to a hospital where
he was diagnosed having chronic constipation. On admission his BP=130/90, Pulse rate=72/min. He was
treated for fever and abdominal pain and shifted to ward. After reducing fever and abdominal pain he
was discharged after 2 days.
 Past Medical History:
 1. Over the last few months he noticed his
 bowel habits had become more erratic.
 2. He had episodes of diarrhoea.
 3. He noticed bright red blood in his stools, pains also noted on defecation.
 4. He also faced weight loss.

5. Patient’s illness history cont...
 Family History:
 He lives in a joint family. No family history of diabetes mellitus, hypertension,
epilepsy, asthma etc.
 Diet History:
 Low fiber food intake.
 Less water intake
 Addicted to spicy food
 Patient’s Habit:
 Chain Smoker
 Alcohol

6. General Examination
 Vital Signs:
 1. Temperature : 102 degree. F
 2. Blood Pressure : 90/130 mmHg
 3. Pulse : 71 bits per minute
 4. Respiration : 17 breath per minute
 General appearance:
 Nourishment : Malnourished
 Body build : Weak
 Skin color : Pale
 Activity : Less physical activity
 Consciousness: Conscious
 Movement : pain during movement
 Weight : 72 kg
 Height : 167 cm


7. Systemic Examination
 Gastrointestinal System
 Inspection : Bloating of abdomen
 Palpation : Abdominal tenderness
 Percussion : Tapping the body to elicit sound
 Auscultation : Hypoactive bowel sounds
 Abdominal girth : Enlarged
 Pain : Present in abdomen
 Nausea : Absent
 Diarrhea : Present
 Constipation : Absent
 Vomiting : Absent

8. Systemic Examination
Neurological system
Mental status : Stressful
Sensation of pain : Severe pain
Tremors or seizures : Absent
Dizziness : Absent

10. Introduction
 Ulcerative colitis is a disease in which the lining of the colon
(the large intestine) becomes inflamed and develops sores
(ulcers), leading to bleeding and diarrhea. The inflammation
almost always affects the rectum and lower part of the colon,
but it can affect the entire colon.
 Ulcerative colitis is most common in North America and Western
Europe.The mean standardised incidence of ulcerative colitis in
Bangladesh (3 cases/year) was marginally lower than in
Europeans (62 cases/year).
 Although ulcerative colitis cannot be cured without removing
the colon, it can usually be controlled. Most people with
ulcerative colitis are able to live active lives.

11. What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes
inflammation and ulcers (sores) in the lining of the digestive tract(specially
in colon and rectum)
 • The inflammation usually begins in the rectum and spreads upwards to
involve all or part of the large intestine (colon).
 • Ulcerative colitis can cause a variety of symptoms, including abdominal
pain, diarrhea, rectal bleeding, and fatigue.

12. Types of ulcerative colitis
 1. Ulcerative colitis : Inflammation is confined to the area closest
to the anus (rectum) and rectal bleeding may be the only sign of the
disease
 2. Proctosigmoiditis: Inflammation involves the rectum and sigmoid
colon the lower end of the colon. Signs and Symptoms include
bloody diarrhea, abdominal cramps and pain and an inability to
move the bowels in spite of the urge to do so.
 3. Left sided colitis : Inflammation extends from the rectum up
throw the sigmoid and descending colon. Sign and symptoms include
bloody diarrhea, abdominal cramping and pain on the left side, and
urgency to defecate.
 4. Pan-colitis : This type often affects the entire colon and causes
bouts of bloody diarrhea that may be severe, abdominal cramps and
pain, Fatigue, and significant weight loss.

13. Clinical features/ Signs and symptoms of ulcerative
colitis
The most common symptoms of ulcerative colitis include:
 Abdominal pain
 Diarrhea
 Rectal bleeding
 Fatigue
 Weight loss
 Fever
 Night sweats
 Joint pain
 Skin lesions
 Abdominal pain
 Urgency to have a bowel movement Tenesmus (a feeling
of incomplete bowel emptying)

14. Causes of ulcerative colitis
 The exact cause of ulcerative colitis is unknown.
 It is thought to be caused by a combination of genetic and environmental
factors.
 People with a family history of IBD are more likely to develop ulcerative colitis.
 Ulcerative colitis may also be triggered by certain infections or medications.
 Risk factors for ulcerative colitis:
 There are several factors that can increase your risk of developing ulcerative
colitis, including:
 Age: Ulcerative colitis is most common in people between the ages of 15 and
35.
 Family history: People with a family history of ulcerative colitis or Crohn's
disease are at increased risk of developing the disease.
 Race: Ulcerative colitis is more common in people of Ashkenazi Jewish descent.
 Smoking: Smoking increases the risk of developing ulcerative colitis and makes it
more difficult to treat.

15. Complications of ulcerative colitis
 The complications of ulcerative colitis are classified into two
types, they are-
 1.Intestinal
 2. Extraintestinal
 Intestinal complications of ulcerative colitis are- Hemorrage,
Strictures perforation, toxic megacolon and colonic dilation.
 Extraintestinal complications of ulcerative colitis are those
that occur outside the gastrointestinal tract. These include
anemia, mouth sores, inflammation of the eyes or joints
(arthritis), osteoporosis, skin conditions, liver conditions, and
cancer.

16. Pathophysiology of ulcerative colitis
To begin with multiple ulcers, with proctitis and colitis
These ulcers extend into the deeper layer
Spasm of the bowel
Stricture of the colon
Permanently contracted colon
In between ulcers, epithelial thickening occurs which appears like polyps.
Pseudopolyposis

17. Diagnosis of ulcerative colitis
Some tests that may be helpful in diagnosing ulcerative colitis include:
• Stool tests: These tests can check for blood, mucus, or pus in your stool.
• Colonoscopy: This is a procedure that allows your doctor to see the
inside of your colon and rectum.
• Sigmoidoscopy: This is a procedure that allows your doctor to see the
inside of your lower colon and rectum.
• Biopsy: This is a procedure that removes a small sample of tissue from
your colon and rectum so that it can be tested for ulcerative colitis.

18. And some Imaging scans make the gut regions
visible to identify inflammation. These are-
• Magnetic Resonance Enterography (MRE).
• CT scan of the abdomen may be carried out if ulcerative
colitis is suspected and can differentiate UC from Crohn’s
disease.
• Plain X-rays rule out significant complications such as a
megacolon or a perforated colon and are useful as a first-
line imaging modality.
• Double-contrast barium enema can detect early mucosal
changes.

19. Treatment of ulcerative colitis
 There is no cure for ulcerative colitis, but there
are a number of treatments that can help to
control the symptoms and prevent complications.
The type of treatment will vary depending on the
severity of the symptoms.
 Mild to moderate ulcerative colitis may be
treated with medication, such as:
 Anti-inflammatory drugs
 Immunosuppressants
 Antibiotics
 •Probiotics

20. Medication
• There are several types of medication that can be used to treat
ulcerative colitis. These medications work by reducing inflammation in
the colon and rectum. Some of the most common types of medication
used to treat ulcerative colitis including-
 Aminosalicylates: These medications are available in oral and topical
forms. They work by reducing inflammation in the colon and rectum.
 Corticosteroids: These medications are available in oral and rectal
forms. They work by reducing inflammation in the colon and rectum.
 Immunomodulators: These medications work by suppressing the
immune system. They are typically used to treat people who have not
responded to other medications.
 Biologics: These medications are a newer type of treatment that work
by targeting specific proteins in the body that are involved in
inflammation.

21. Treatment for Severe ulcerative colitis
Severe ulcerative colitis may require more aggressive treatment,
such as:
 • Hospitalization
 • Intravenous medication
 • Surgery
Surgery
 Surgery may be recommended for patients who have stopped
responding to their medication. Other patients choose to
undergo surgery to improve their quality of life. Some patients
become dangerously ill and require emergency surgery.

22. Ulcerative Colitis Surgical Procedure
The standard surgical procedure to treat ulcerative colitis is a
proctocolectomy.This surgery removes both your colon and your rectum
(collectively called the large intestine).
There are two types of proctocolectomy procedures used to treat
ulcerative colitis.
1.Proctocolectomy with ileal pouch-anal anastomosis: Removal of the
colon and rectum, and creation of an internal pouch that eliminates the
need for a permanent external ostomy.
2.Proctocolectomy with end ileostomy: Removal of the colon, rectum,
and anus and creation of an external ostomy.

23. Nursing Process and Management of Ulcerative Colitis

24. Nursing Management of Ulcerative Colitis
 A Holistic Approach Nursing plays a crucial role in supporting patients with
Ulcerative Colitis (UC), a chronic inflammatory bowel disease affecting the colon.
 Here's an overview of nursing management for UC,
1. Assessment:
 Medical history: Gather details about symptom onset, severity, flares, past
surgeries, medications, allergies, and family history of IBD.
 Physical examination: Assess vital signs, abdominal pain/tenderness, stool
characteristics (frequency, consistency, blood, mucus), and signs of dehydration or
malnutrition.
 Psychosocial assessment: Evaluate the emotional impact of UC, coping mechanisms,
support systems, ability to manage daily activities, and concerns about body image
and intimacy.
 Diagnostic tests: Stool tests, blood tests, colonoscopy, and biopsies may be needed
to confirm diagnosis and assess disease severity.

25. 2. Nursing Diagnoses:
 Based on the assessment, common nursing diagnoses for UC patients
might include:
 Acute pain related to inflammation.
 Impaired elimination (diarrhea) related to colonic inflammation.
 Activity intolerance related to fatigue and malnutrition.
 Deficient knowledge about UC and its management.
 Anxiety related to the unpredictable disease course and potential
complications.

26. Care Planning and Implementation:
 The care plan should address the identified diagnoses and focus on:
 Pain management: Medications and non-pharmacological interventions like heat
therapy or massage.
 Symptoms management
 Diarrhea management: Antidiarrheal medications and dietary modifications.
 Nutritional support: Ensuring adequate calorie and fluid intake through dietary
counseling or enteral/parenteral nutrition.
 Education:
 Providing clear information about UC, medications, disease management
strategies, and potential complications.
 Encouraging self-monitoring of symptoms and triggers. Teaching coping
mechanisms for stress and anxiety

27.  Psychosocial support:
 Connecting patients with support groups or individual therapy.
 Addressing concerns about body image and intimacy.
 Promoting adherence to treatment and fostering a positive outlook.
4. Monitoring and Evaluation:
 Regularly monitor the patient's response to treatment and any changes in
symptoms, including:
 Pain control and medication effectiveness.
 Stool frequency and consistency.
 Nutritional status and hydration.
 Adherence to medication and dietary recommendations.
 Potential complications like dehydration, electrolyte imbalances, and
anemia.

28. Preventive measures of ulcerative colitis
 There is no specific diet that can cure ulcerative colitis. However, there are
some foods that may trigger symptoms, so it is important to identify and avoid
these foods. Some common triggers include:
 Spicy foods
 Fatty foods
 Dairy products
 Alcohol Carbonated Drinks
Lifestyle changes
 There are several lifestyle changes that can help to manage the symptoms of
ulcerative colitis and prevent complications. These changes include:
 Getting enough rest
 Managing stress
 Quitting smoking
 Exercising regularly

29.  Not drinking carbonated drinks.
 Not eating high fiber foods. Such as pop corn, vegetable skin and
nuts. Drinking more liquids.
 Eating more frequent, smaller meals Keeping a food diary that
identities foods that cause symptoms.
 Ulcerative colitis is a serious but manageable condition.
 With the right treatment and lifestyle changes, most people with
ulcerative colitis can live long and healthy lives.

30. Conclusion
 Nurses work closely with physicians, dietitians, and other
healthcare professionals to provide comprehensive care for UC patients.
Remember:
 Each UC patient is unique, and the nursing approach should be
individualized based on their specific needs and circumstances.
 Building trust and rapport with the patient is essential for effective
communication and adherence to treatment plans.
 Compassion, empathy, and active listening are crucial in
supporting patients through the challenges of living with UC.
 By providing holistic care that addresses physical, emotional, and social
needs, nurses can significantly improve the quality of life for people
living with Ulcerative Colitis.

31. References
 https://en.wikipedia.org/wiki/Ulcerative_colitis
 https://www.uptodate.com/contents/ulcerative-colitis-beyond-the-basics
 https://www.wikidoc.org/index.php/Ulcerative_colitis_history_and_symptom
s
 Download/A_Child_with_Ulcerative_Colitis_case study
 https://www.cureus.com/articles/160367-quality-of-life-of-patients-with-
inflammatory-bowel-disease-in-bangladesh#!/
 https://bard.google.com/chat/1b7a1cf952e6beff
 Copilot with GPT-4 (bing.com)

32. Any question?

33. for Your Attention