WHAT IS ULCERATIVE COLLITE?
Ulcerative colitis is a large bowel disease. The large intestine is the part of the intestine after the small intestine.
Ulcerative colitis is a chronic digestive system disease with silent and active periods.
Ulcerative colitis causes inflammation and ulcers in the mucosa that lays the inner surface of the colon.
· The symptoms of ulcerative colitis vary according to the location and severity of the disease.
· Ulcerative colitis is divided into three groups according to the site of involvement.
· Distal Type: Only the last part of the large intestine (rectum and sigmoid colon) is involved.
· Left Type: The left part of the large intestine up to the spleen is involved.
· Pancolitis: The entire large intestine is sick.
Disease activation index was developed to evaluate drug efficacy in ulcerative colitis.
· 4 variables are evaluated in ulcerative colitis disease activity index. The frequency of stools is the amount of blood in the stool, the endoscopic appearance of the colon mucosa and the physician's evaluation.
· The appearance of endoscopic disease often correlates with the clinical picture in ulcerative colitis. However, distal colitis is an exception.
· Disease severity in ulcerative colitis is evaluated by endoscopy.
· Endoscopic index (0-12).
WHAT IS ULSERATIVE PROTITIS?
Ulcerative proctitis is a ulcerative colitis disease limited to the rectum alone.
· In ulcerative proctitis, there are complaints of bloody mucus defecation and feeling of full rectum (tenesm), rectal pressure defecation in the active period but not being able to relax after defecation.
· In ulcerative proctitis, pain may be in the left lower abdomen and anal pain may occur.
· The activity is determined by rectal examination.
· In the treatment of ulcerative proctitis, regional preparations have suppository, liquid enema, foam and gel enema forms.
What are the causes of ulcerative colitis?
· The cause of ulcerative colitis is still unknown
· Factors held responsible:
Genetic predisposition, Immune system regulation and environmental factors (smoking, infection exposure, hygienic factors, diet, occupation, breastfeeding and microorganisms.)
SYMPTOMS OF ULCERATIVE COLLIT
· Blood collection by defecation, bloody defecation
· Especially bloody and mucous diarrhea
Constipation (especially with rectal bleeding in some distal ulcerative colitis)
· Slight fever, severe fever and toxic colitis.
· Tension in the rectum (Tenesmus)
· Bowel secretion and purulence in feces
· Fatigue, weakness,
· Weight loss
· Anemia (Iron deficiency anemia)
· Inflammation of the outer layer of the eye (Episcleritis) or inflammation of the lens (Iritis) outside the digestive system
Painful swelling (erythema nodosum) and ulcers near the ankle (Pyodermagangrenosum) may occur in the skin, especially in the areas below the knee.
· There may be pain in the hip and spine joints even if there is no disease.
· Inflammation of the liver and biliary tract may occur. Inflammation in the liver improves with intestinal inflammation but sclerosing cholangitis affecting the biliary tract does not.
COMPLICATIONS OF ULCERATIVE COLIT
The most common serious complications of ulcerative colitis are massive bleeding, intestinal perforation, toxic megacolon, stenosis, and lesions around the anal canal.
Massive bleeding:
· Intense bleeding due to disease activity.
· Most of the bleeding stops spontaneously.
· In case of heavy bleeding, consult your doctor immediately.
· Inpatient treatment is required.
Perforation:
· Perforation due to disease activity in the intestinal wall.
· Perforations are the most common cause of complications.
· In patients with active severe disease, sudden, severe, pain and gas spread to the whole abdomen can occur with stool can not be removed.
· In this case, seek medical advice immediately.
· Urgent surgery is required.
Toxic Megacolon:
Toxic mega colon is the enlargement of the large intestine above normal.
· Diagnosis is made when the bowel diameter is above 6 cm in the abdominal X-ray.
· The most common reason for hospitalization in inflammatory bowel diseases is the development of toxic mega colon in patients.
Toxic megacolon may occur early or late in ulcerative colitis.
· Rarely, it may be an initial symptom of the disease.
Toxic megacolon is mostly seen in patients with pancolitis.
· In cases where the disease is active, patients should not undergo bowel x-ray and colonoscopy, and these tests may cause toxic megacolone.
· In patients with active disease; abdominal pain and sudden diarrhea.
· If there is a sudden decrease in the number of defecation with abdominal distension pain, consult your doctor immediately.
Perianal lesions:
· Cracks in the anus, abscesses and hemorrhoids around the anus.
· There is a crack in the gland (anal fissure); severe anal pain occurs during and especially after defecation.
· The pain increases especially after defecation and is intolerable for hours or even all day long.
Bleeding in the anal fissure is rare and adheres to the paper.
· Constipation and diarrhea should be avoided in anal fissure.
· If the anal fissure persists for more than a month, the wound becomes deeper. Increases pain and itching. This indicates the development of chronic anal fissure.
Bleeding in hemorrhoids may be in the form of red fresh blood with feces and spraying.
Prerianal abscess is painful (throbbing) red around the breech, swelling occurs.
Severe pain occurs during defecation.
He could be on fire.
If these symptoms occur, consult your doctor immediately.
Surgically, the abscess must be drained.
stricture
Clinically significant stenosis in ulcerative colitis is rare.
· Strictures are common in patients with widespread disease and non-remission symptoms.
· The number of defecation and stool incontinence increase in patients with stenosis.
TREATMENT IN ULCERATIVE COLITIS
Medication :
The aim of drug therapy for ulcerative colitis is to prevent / suppress the inflammatory activity of the colon mucosa and to silence the disease. Treatment of ulcerative colitis and Crohn's disease varies according to the location and activity of the disease. However, the disease cannot be cured completely Depending on the severity of the disease, one or more drugs may be preferred.
CORTICOSTEROIDS (Deltakortril®, Budenofalk Prednol®)
In the active phase of acute ulcerative colitis, corticosteroid drugs (Deltakortril®, Budenofalk Prednol®) help reduce inflammation, reduce abdominal pain, reduce fever, reduce diarrhea and improve appetite. Corticosteroids are very effective, but at high doses and prolonged use, they cause undesirable side effects such as percentage rounding, increased appetite, high blood pressure, diabetes, gastric ulcer, muscle thinning, bone loss and changes in mental state. Locally effective Budesonide Budenofalk side effects are quite low.
SULFASALAZINE (Salazopyrine):
It may cause skin rash, headache, stomach aches, nausea and anemia in some patients due to sufapiridin in its content. may reduce the dose of your medicine or may need to be changed.
ASA GROUP DRUGS (Salofalk):
Side effects of this group of drugs are lower. Rarely, diarrhea, headache and skin rash may occur.
AZATHYROPRINE (Imuran):
Drugs such as azathiopurine (Imuran®), which affect the immune system, are used to prevent activation of the disease in the long term. This drug that affects the immune system is used as maintenance therapy. In order to observe the side effects, the drug is started at low doses; side effects that may occur as a result of gradual dose increase over time are observed. During treatment, symptoms such as nausea, flu-like symptoms, weakness, abdominal pain, skin rash and anemia can be seen in a very small number of patients.
Antibiotics such as METRANIDAZOL OR CIPROFLAXOCINE are used for the treatment of ulcerative colitis.
CONDITIONS REQUIRING SURGERY IN ULCERATIVE COLLIT
· Intense bleeding
· Toxic megacolon at risk of puncture or perforated
Fulminant acute ulcerative colitis that does not respond to steroid treatment
· Intestinal obstruction due to stenosis
· Presence or suspicion of colon cancer
· If drug cannot be given due to systemic complications due to drug treatment
· Inability to control the disease
· In cases of developmental delay seen in pediatric patients, surgery is required.
NUTRITION IN ULCERATIVE COLLIT
· Special diet has little role in the treatment of ulcerative colitis.
· There are no identified diets that cause or exacerbate the disease.
· Follow a healthy, balanced diet with high protein and calorie foods according to your doctor's recommendations.
· If you have diarrhea, you should avoid foods that have softening properties (raw fruit and vegetables, concentrated fruit juices, etc.).
· You should avoid drinks that contain large amounts of caffeine (coffee, tea, chocolate, instant coffee, etc.).
· Your doctor will decide if you need to increase or decrease the fiber foods in your diet.
ISSUES TO KNOW ABOUT ULSERATIVE COLLIT
Ulcerative colitis; chronic chronic disease.
· Treatment improves patient complaints and intestinal disease
· Occasional disease recurrence
· The patient may need to use his / her medication under the supervision of a doctor for the recommended period and sometimes continuously.
Ulcerative colitis is an inflammatory disease, not contagious.
· Patients with ulcerative colitis should consult their physician before conception.
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