2. INTRODUCTION
• Colitis occurs when your large intestine is
inflamed. It can cause pain and other
symptoms, including ulcers, bloating, and
diarrhea. Different types of colitis require
different treatments.
• Colitis is inflammation of your colon, also
known as your large intestine. If you have
colitis, you’ll feel discomfort and pain in your
abdomen.
3. DEFINITION
• Colitis is swelling (inflammation) of the large
intestine (colon).
OR
• Colitis is the inflammation of the lining of the
colon.
• Colitis is defined as infection and inflammation of
the large intestine.
4. Incidence
• In the United States, about 1 million people are
affected with ulcerative colitis (UC). The
annual incidence is 10.4-12 cases per 100,000
people, and the prevalence rate is 35-100 cases
per 100,000 people. Ulcerative colitis is three
times more common than Crohn disease.
5. TYPES OF COLITIS
• Ulcerative colitis
• Pseudo membranous colitis
• Ischemic colitis
• Microscopic colitis
• Allergic colitis in infants
• Proctosigmoiditis
• Left-sided colitis
• Pan colitis
6. • Ulcerative colitis is a chronic inflammatory bowel
disease (IBD) in which abnormal reactions of the
immune system cause inflammation and ulcers on the
inner lining of your large intestine.
7. • Pseudo membranous colitis, a severe
inflammation of the inner lining of the large
intestine, manifests as an antibiotic-associated
colonic inflammatory complication
8. • Ischemic colitis occurs when blood flow to part of
the large intestine is temporarily reduced.
9. • Microscopic colitis is a chronic inflammatory bowel disease
(IBD) in which abnormal reactions of the immune system
cause inflammation of the inner lining of your colon.
10. • Allergic colitis is a condition in which your baby's
immune system overreacts to the proteins found in
cow's milk, leading to inflammation in the colon.
11. • Proctosigmoiditis. Inflammation involves the
rectum and sigmoid colon — the lower end of
the colon. Symptoms include bloody diarrhea,
abdominal cramps and pain, and an inability to
move the bowels despite the urge to do so.
This is called tenesmus.
12. • Left-sided colitis. Inflammation extends from the
rectum up through the sigmoid and descending
portions of the colon. Symptoms include bloody
diarrhea, abdominal cramping and pain on the left
side, and urgency to defecate.
13. • 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.
14. CAUSES
• Infectious colitis is caused by a viral, parasitic
or bacterial infection. Salmonella and E.
coli are common causes. Most people get it
from eating or drinking contaminated food or
water. It’s usually temporary, but some people
may need antibiotics to treat certain infections.
• Pseudo membranous colitis. This type of
colitis is usually caused by a specific
bacterium known as C. diff (clostridioides
difficile).
15. • Inflammatory bowel diseases (IBD) are a
group of conditions that cause chronic
inflammation in your colon. They
include ulcerative colitis, microscopic
colitis and Crohn’s disease. These conditions
don’t have a direct cause. Doctors believe they
are a type of autoimmune disease, which
means they cause your immune system to
malfunction and attack its own tissues.
16. • Radiation colitis is a side effect of radiation
therapy, which is used to treat certain types
of cancer. It’s usually temporary, but some people
develop long-term symptoms.
• Diversion colitis is a side effect that can occur in
people who've had a colostomy. It happens in the
part of your colon that's no longer being used.
17. • Infection, for example, caused by bacteria like C.
Difficile, viruses, and parasites;
• Inflammatory bowel disease like crohn's disease
and ulcerative colitis,
• Ischemic colitis caused by decreased blood supply;
• Microscopic colitis (lymphocytic/collagenous colitis);
• Allergic reactions.
18. • PATHOPHYSIOLOGY
• Due to various etiological factors
• Invasion of bacteria and virus and parasites
• Release of neutrophis, eosinophils and
basophils.
• Result in Infection and inflammation of the
large intestine
• Result in formation of fibrous tissue and
number of sign and symptoms
19. CLINICAL MANIFESTATION
• Abdominal pain
• Blood in your stool
• Ongoing diarrhea that doesn't respond to
nonprescription medications
• Diarrhea that awakens you from sleep
• An unexplained fever lasting more than a day
or two
20. • Abdominal pain,
• Cramping,
• Diarrhea, with or without blood in the stool (one of the
hallmark symptoms of colitis).
• Associated symptoms depend upon the cause of colitis and
may include
• Fever,
• Chills,
• Fatigue,
• Dehydration,
• Eye inflammation,
• Joint swelling,
• Canker sores,
• Skin inflammation.
21. COMPLICATIONS
• Severe bleeding
• Severe dehydration
• A rapidly swelling colon, also called a toxic megacolon
• A hole in the colon, also called a perforated colon
• Increased risk of blood clots in veins and arteries
• Inflammation of the skin, joints and eyes
• An increased risk of colon cancer
• Bone loss, also called osteoporosis
22. MANAGEMENT
• Endoscopic procedures with tissue biopsy are the only
way to definitively diagnose ulcerative colitis. Other
types of tests can help rule out complications or other
forms of inflammatory bowel disease, such as Crohn's
disease.
• To help confirm a diagnosis of ulcerative colitis, you may
have one or more of the following tests and procedures:
23. • Lab tests
• Blood tests. Your provider may suggest blood tests to
check for anemia — a condition in which there aren't
enough red blood cells to carry adequate oxygen to
your tissues — or to check for signs of infection or
inflammation.
• Stool studies. White blood cells or certain proteins in
your stool can indicate ulcerative colitis. A stool
sample also can help rule out other disorders, such as
infections caused by bacteria, viruses and parasites.
24. • Endoscopic procedures
• Colonoscopy. This exam allows your provider to
view your entire colon using a thin, flexible, lighted
tube with a camera on the end. During the procedure,
tissue samples are taken for laboratory analysis. This
is known as a tissue biopsy. A tissue sample is
necessary to make the diagnosis.
• Flexible sigmoidoscopy. Your provider uses a
slender, flexible, lighted tube to examine the rectum
and sigmoid colon — the lower end of your colon. If
your colon is severely inflamed, this test may be
preferred instead of a full colonoscopy.
25. • Imaging procedures
• X-ray. If you have severe symptoms, your provider
may use a standard X-ray of your abdominal area to
rule out serious complications, such as a megacolon
or a perforated colon.
• CT scan. A CT scan of your abdomen or pelvis may
be performed if a complication from ulcerative colitis
is suspected. A CT scan may also reveal how much of
the colon is inflamed.
26. • Computerized tomography (CT)
enterography and magnetic resonance (MR)
enterography. These types of noninvasive
tests may be recommended to exclude any
inflammation in the small intestine. These tests
are more sensitive for finding inflammation in
the bowel than are conventional imaging
tests. MR enterography is a radiation-free
alternative.
• Barium enema
• Colonoscopy
27. TREATMENT
• Ulcerative colitis treatment usually involves either
medication therapy or surgery.
• Anti-inflammatory medications
• Anti-inflammatory medications are often the first step
in the treatment of ulcerative colitis and are
appropriate for most people with this condition.
These include:
• 5-aminosalicylates. Examples of this type of
medication include sulfasalazine (Azulfidine),
mesalamine (Delzicol, Rowasa, others), Which
medication you take it — by mouth or as an enema or
suppository — depends on the area of your colon
that's affected.
28. • Corticosteroids. These medications, which include
prednisone and budesonide, are generally reserved for
moderate to severe ulcerative colitis that doesn't
respond to other treatments. Corticosteroids suppress
the immune system. Due to the side effects, they are
not usually given long term.
29. OTHER MEDICATIONS
• Anti-diarrheal medications. For severe diarrhea,
loperamide (Imodium A-D) may be effective. If
you have ulcerative colitis, do not take anti-
diarrheal medications without first talking with
your health care provider. These medications may
increase the risk of an enlarged colon (toxic
megacolon).
• Pain relievers. For mild pain, your provider may
recommend acetaminophen (Tylenol, others) —
but not ibuprofen (Advil, Motrin IB, others),
naproxen sodium (Aleve) and diclofenac sodium,
which can worsen symptoms and increase the
severity of disease.
30. • Antispasmodics. Sometimes health care
providers will prescribe antispasmodic
therapies to help with cramps.ex- cantil,
artane.
• Iron supplements. If you have chronic
intestinal bleeding, you may develop iron
deficiency anemia and be given iron
supplements.
31. • Surgery
• Surgery can eliminate ulcerative colitis and
involves removing your entire colon and rectum
(proctocolectomy).
• In most cases, this involves a procedure called
ileoanal anastomosis (J-pouch) surgery. This
procedure eliminates the need to wear a bag to
collect stool. Your surgeon constructs a pouch
from the end of your small intestine. The pouch is
then attached directly to your anus, allowing you
to expel waste in the usual way. This surgery may
require 2 to 3 steps to complete.
32. • Proctocolectomy with end ileostomy:
Removal of the colon, recturm, and anus and
creation of an external ostomy.
33. COMPLICATION OF SURGERY
Pouchitis
• Inflammation of the pouch is most common
complication of j-pouch surgery. Pouchitis is
treated with antibiotics.
Symptoms of pouchitis may include:
• Diarrhea
• Crampy abdominal pain
• Increased stool frequency
• Fever
• Dehydration
• Joint pain
34. NURSING MANAGEMENT
• Position the patient comfortably. The left side
of the abdomen or the rectum often hurts in
colitis. ...
• Instruct on appropriate medications. ...
• Administer opioids and adjuvants. ...
• Encourage psychotherapy. ...
• Encourage the patient to avoid triggering
factors. ...
• Relieve rectal pain.
35. NURSING DIAGNOSIS
• Diarrhea May be related to Inflammation,
irritation, or malabsorption of the bowel,
Presence of toxins Possibly evidenced by
Increased bowel sounds/peristalsis,
Hyperactive bowel sounds, Frequent, and often
severe, watery stools (acute phase).
• Desired Outcomes
• The client will report a reduction in the
frequency of stools and return to more normal
stool consistency.
36. • Nursing Diagnosis-2
• Risk for Deficient Fluid Volume may be related to
• Excessive losses through normal routes (severe
frequent diarrhea, vomiting), Hypermetabolic state
(inflammation, fever), Restricted intake
(nausea/anorexia), Hemoconcentration; altered
serum sodium
• Desired Outcomes
• The client will maintain adequate fluid volume as
evidenced by moist mucous membranes, good skin
turgor, and capillary refill; stable vital signs; balanced
I&O with the urine of normal concentration/amount.
• The client will demonstrate behaviors to monitor and
correct deficits, as indicated when the condition is
chronic.
