Epidemiology and Pathophysiology of Ulcerative Colitis - Research Paper Example

? Ulcerative colitis Introduction The proper and normal functioning of the gastrointestinal tract is central to the normal functioning of the human body. The gastrointestinal tract serves to provide as means of providing nutrients to the cells of the body. The unprocessed and unutilized part of the food is evacuated from the body by the lower portion of this tract. The small and large intestines are referred to as bowels and their normal motility and performance is essential to maintain the integrity of the digestive system. The dysfunction of the bowels can result in constipation, diarrhoea and faecal incontinence. The underlying causes of bowel dysfunction maybe primarily associated with the bowel inflammatory conditions or it may result from other secondary factors which include injuries to the spinal cord, as a result of the side effects of certain medications or due to certain endocrine disorders as well as improper diets and infectious agents. Proper diagnosis and management of bowel dysfunction is essential for the health of the patient. The treatment is related to the type and the extent of the disease. Ulcerative Colitis is a type of inflammatory bowel disease which affects the gastrointestinal system. Ulcerative colitis is an inflammatory disease which primarily affects the colon and its respective layers. In most of the cases it is seen that ulcerative colitis only affects the mucosa and sub-mucosa of the colon but in severe cases the layer of muscularis externa may also be affected. It is a disease which is different from the Crohn’s Disease in terms of continuity from the rectum. Crohn’s Disease is not continuous from the rectum whereas Ulcerative Colitis is continuous from the rectum. This paper would further revolve around Ulcerative colitis and present findings about it (Kumar et al 2005). Epidemiology In a population of 100,000 people Ulcerative colitis can be found in 4 to 12 percent of the population in the United States, Great Britain and Scandinavia. It has also been found that ulcerative colitis affects the females more than the men and it is found more in the Whites than the blacks in United States. The smokers who have left smoking are also more prone to ulcerative colitis (Kumar et al 2005). Pathophysiology The inflammatory disease extends from the rectum to the entire colon. It develops from a small inflammatory granule in the lamina propria of the colon and this extends continually all over the colon then. At first the mucosa of the colon may exhibit signs of reddening all over but soon after it would also show granules. As the inflammation grows in the mucosa it is seen that the distal colon gets affected the most in the beginning. As the mucosa is being destroyed a part of it tries to re-grow and this forms isolated poles of mucosa growing in the colon. These poles are then called pseydopolyps. Tunnels may also be created in between the mucosal linings. The surface on the serosa of the colon is not affected usually. In the late stages of ulcerative colitis it is seen that toxic megacolon develops. In some cases it is also seen that the ulcer extends up to the muscularis propria and the neural plexus. Toxic megacolon is a condition in which the colon is greatly affected destroying the neuromuscular function of the colon. Crypt abscesses are also found in the ulcer as neutrophils may gather in the layers. The ulcer then extends from the lamina propria to layers of submucosa and mucosa. It is also characterized by large epithelial changes in the layers which can trigger carcinoma of the colon. Dysplasia and atypia are also found in some cases of ulcerative colitis. Patients with ulcerative colitis suffer from bloody diarrhea which may occur only for days and then stop. But this bleeding may recur after a span of period which is known as the asymptomatic period in patients with ulcerative colitis. The bleeding diarrhea can at times be so lethal that it is to be handled with emergency care (Kumar et al 2005). The first manifestation of the disease is when the patient is suffering from abdominal cramps and excessive bleeding while defecating. The disease is also characterized by constipation in some patients as it affects the normal peristaltic movement in an individual. Ulcerative colitis can be divided into two forms depending on the severity of the disease. The patients who are suffering from a milder type of ulcerative colitis usually do not exhibit active signs and symptoms. These patients do not undergo regular bleeding while defecating but rather go through a time in which this occurs. The patients who are in the late stages of ulcerative colitis may have all the signs and symptoms of the disease and they usually have to undergo an operation to remove the colon. The disease can also lead to death if not cured in the late stages. One of the most important cause of ulcerative colitis is cancer. Dysplasia affects the walls of the colon and it may mask the damage to the DNA done in the colon. It is characterized by damage to DNA and this affects the ability of DNA to repair itself in the intestinal wall (Chen et al 2003). Ulcerative colitis may be caused by diet or hereditary factors. Smoking and drinking have thought to be associated with ulcerative colitis along with the genetical factors (Stein 2010; Kumar et al 2005). Diagnosis It can be diagnosed with the help of tests which analyze the condition of the mucosal surface of the large intestine. Colonoscopy is done to find out about the mucosal surface of the intestine which would help the physician to see as to if the surface is inflamed or not. Presence of pseudopolyps may also indicate the presence of ulcerative colitis in a patient. Stool tests are also done to find out the presence of blood and other materials in the fecal matter which would indicate the presence of ulcerative colitis. Patients with ulcerative colitis are often treated with corticosteroids which help to relieve the inflammatory effects of the ulcer. Aminosalicylates, ampicillin and ciprofloxin are the names of the groups which are used to treat ulcerative colitis these days. If patients cannot be cured with efficient medical therapy then it is recommended that these patients should undergo colonectomy. As ulcerative colitis can lead to cancer in late stages colon should be removed if the ulcer is not being cured (Kumar et al 2005; Crohn’s & Colitis 2010; Katzung 2007). Effects of Ulcerative Colitis on People Ulcerative colitis can also have a mental effect on the individuals suffering from it. Individuals suffering from it often undergo abdominal cramps along with diarrhea and this would create a sense of fear inside them to be in public. This situation can be tackled if one makes sure that the place to where he is going has the facilities of restrooms. People also tend to carry extra clothing with them so that they can avoid embarrassing situations in the public. The problems associated with ulcerative colitis make it difficult for a person to travel. Hence it is necessary that the patient consults his doctor before travelling so that he does not have to face any problem. Moreover it is also necessary that the patient takes his medications along while on the trip. Some individuals who find out about their disease cannot take the intensity and get emotional whereas some are able to cope up with the findings of their disease (Crohn’s & Colitis 2010). Bowel Dysfunction Overview In the conditions of bowel dysfunction it is important that proper history of the patient should be taken. This should include questions about the dietary habits of the person which is to assess the presence of a balanced diet. The onset of the symptoms along with the relieving and aggravating factors should also be assessed. The intensity as well as the particular time when the problem is encountered should also be noted. The patients should be asked for any medications that he is taking. Also any previous surgical operations as well as previous injuries and problems should be questioned about. This assists in finding the underlying condition for the pathology and assists in reaching a proper diagnosis and treatment. It is important that a nurse should recognize the difficulty experienced by the patient with regards to bowel dysfunction. Many reasons associated with such issues might not be discussed and it is the duty of the nurse to provide proper counselling to the patients and make them comfortable. The nurses should provide attention to the problems of the sufferers and provide them practical suggestions and ensure them about their heath. In the long run the patient should be asked questions about their problem on a regular basis and issues should not be left on the basis that the nurse believes that they are already known. Conclusion Ulcerative colitis is a disease characterized by inflammation of the mucosa and submucosa of the colon and if not treated with appropriate therapy then it may lead to a severity in the disease. Individuals suffering from ulcerative colitis at times face a difficulty in coping up with the factors of the disease. It is also seen that if ulcerative colitis is not cured it may lead to the cancer of colon in the late stages. Thus it is recommended by the physicians that the colon should be removed if ulcerative colitis is not being cured. Bibliography Top of Form Chen, Ru, Peter S. Rabinovitch, David A. Crispin, Mary J. Emond, Kent M. Koprowicz, Mary P. Bronner, and Teresa A. Brentnall. "Dna Fingerprinting Abnormalities Can Distinguish Ulcerative Colitis Patients with Dysplasia and Cancer from Those Who Are Dysplasia/cancer-Free." The American Journal of Pathology. 162.2 (2003): 665. Print. Bottom of Form Crohn’s & Colitis Foundation of America Accessed on 23 September 2011. Kumar, Vinay, Abul K. Abbas, Nelson Fausto, Stanley L. Robbins, and Ramzi S. Cotran. Robbins and Cotran Pathologic Basis of Disease. Philadelphia: Elsevier Saunders, 2005. Patricia Stein "Ulcerative colitis—diagnosis and surgical treatment". AORN Journal. FindArticles.com. 23 September 2011. http://findarticles.com/p/articles/mi_m0FSL/is_2_80/ai_n6159714/ Katzung, Bertram G. Basic and Clinical Pharmacology. New York: McGraw Hill Medical, 2007. Print. Read More