A Simple Guide to Ulcerative Colitis

A Simple Guide to Ulcerative Colitis
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What is Ulcerative Colitis?
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Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.


Who is affected by Ulcerative Colitis?
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Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites

Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.

Those above the age of 60 years have more severe symptoms and signs.

It occurs equally in men and women and can be found in families.

What is the Cause of Ulcerative Colitis?
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The exact cause of Ulcerative Colitis is not known.

It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.

Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.


What are the Symptoms and signs of Ulcerative Colitis?
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Symptoms:
The symptoms can range from mild to severe.

Mild cases (about 50%)usually have:

1.an insidious onset

2.lower abdominal pain

3.Slight blood stained diarrhea

4.malaise

In the more severe cases, the main symptoms may be:

1.abrupt onset

2.severe diffuse abdominal pain

3.Bloody diarrhea

4.fever

5.shock

6.fatigue

7.weight loss

8.loss of appetite

9.loss of body fluids and nutrients

10.joint pain

Signs:
1.Abdominal distension and tenderness

2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter

3.pallor due to anemia

4.Wasting of muscles

5.skin lesions

How do you make the Diagnosis of Ulcerative Colitis?
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1.A history of lower abdominal pain , bloating and bloody diarrhea

2.The physical exam consists of
a.palpation of the abdomen for tenderness

b.digital rectal exam to detect tenesmus or blood.

3.stool may be tested for blood

4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon

6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.

What are the complications of Ulcerative Colitis?
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Bowel complications:

1.Strictures of colon

2.Fistula

3.Toxic dilatation(toxic megacolon)

4.Perforation of the colon

5.hemorrhage

6.shock

7.rarely carcinoma(5%)

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.Skin: eczema


What is the treatment of Ulcerative Colitis?
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Mild Cases:
Medications:

1.Antidiarrheal and bulk forming agents

2.Antispasmotic medication for spasm of the colon

3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.

5.Correction of anemia

6.Regular hemoglobin, blood counts and liver function tests

Severe cases:

1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary

2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.

3.Sulphasalazine (immuno-suppressant) given indefinitely

4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

5.Antibiotics in toxic megacolon syndrome

5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.

In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.

Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.


What is the prognosis of Ulcerative Colitis?
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The prognosis depends on the severity of the disease

Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.

5% will die within the first year.

75% will have recurrence for the rest of their life.

Only 10% will have remissions lasting 15 years.

A Simple Guide to Foot Care

A Simple Guide to Foot Care
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What is Foot Care?
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Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.

Therefore taking care of the foot is very important especially in diabetic patients.

Foot care is an important tool in prevention of foot problems at all ages.


What is important in Foot care?
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Footwear:

1.Shoes should fit comfortably.

2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses

3.The toe box should be wide and high enough to accomodate any exostosis or contractures.

4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.

5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.

6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.

7.Specially constructed shoes may be necessary for patients with deformities of the foot.

8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.

Socks:

1.Socks or stocking should fit comfortably and kept dry at all times

2.Tight constricting stocking should not be worn.

3.Loose stockings which can wrinkle should also be avoided

Foot:

1.Inspect and clean foot daily.

2.wash feet daily with bland soap and lukewarm water.

Pat dry gently and thoroughly especially between the toes after wash.

Do not rub the foot vigorously.

3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails

4.moisturise feet daily to prevent dryness and cracking of skin

5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.

6.examine feet daily for scratches, cuts, blisters and corn

7.use a mirror to check the sole of your feet

8.Avoid going barefoot

9.Seek prompt treatment for cuts and sores

10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)

General Measures:

1.Smoking should be avoided as it causes constriction of the blood vessels

2.Avoid extreme temperatures such as excessive heat or cold

3.Home surgery should avoided in diabetes and those with vascular disease.

Avoid cutting calluses or corns yourself.

Also avoid applying strong chemicals to calluses or corn.

Instead try changing the weight bearing stresses on the foot.

4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.

Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.

If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.

Raise the foot and exercise the foot to improve blood circulation.

5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection

6.Good balanced diet and a healthy lifestyle is important.