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Ulcerative - Medical Malpractice
Ulcerative colitis is a bowel disease affecting the large colon. It causes ulcers to form in the large colon and rectum and inflammation of the lining of the colon. Diarrhoea is the most common symptom because the lining of the colon cannot do its job of absorbing water in the colonic lumen. When the disease affects just the lining of the rectum and sigmoid colon, it is called "ulcerative proctitis". When it involves the entire colon, it is called "pancolitis". If only the left side of the colon is affected, the disease is called "limited" or "distal colitis".
Ulcerative is an inflammatory bowel disease like Crohn's disease. The inflammation is due to an autoimmune disease in which autoantibodies are attacking parts of the normal human tissue. It is similar to Crohn's disease and only a biopsy can tell the difference at times. Crohn's disease also differs from ulcerative colitis in that ulcerative colitis only affects the colon and Crohn's disease can affect other parts of the digestive tract.
Ulcerative colitis can occur at any age but usually begins around age 15 to 30. It occurs less frequently between ages 50 and 70. Women and men get the disease equally and it seems to run in families. About 20 percent of people with UC have ulcerative colitis in the family. It is seen in higher numbers among Caucasians and among those of Jewish ancestry.
The major symptoms of ulcerative colitis include bloody diarrhoea and abdominal pain. The secondary symptoms include fatigue, anaemia, weight loss, rectal bleeding, loss of appetite, skin lesions, dehydration, joint pain and growth retardation in kids who have the disease. Half of all people will have few symptoms that are mild and tolerable. Others have severe symptoms that involve the entire body and have arthritis, liver disease, osteoporosis and eye inflammation. The immune system appears to be related to these out-of-colon symptoms.
Ulcerative colitis is caused by an abnormal immune system. It isn't related to food sensitivity or emotional stress. The stress of living with the disease, however, can make the symptoms worse at times.
The diagnosis of ulcerative colitis depends on a complete history and physical examination. A blood test may show anaemia and a high white blood cell count. Stool samples show excess white blood cells in the stool indicative of inflammation of the digestive tract. A stool sample can also rule out other causes of bloody diarrhoea such as bacterial colitis. A colonoscopy and flexible sigmoidoscopy are the gold standard for ulcerative colitis. These are camera studies that can look at the colon, visualize the ulcers and take samples of the colon for biopsy and evaluation under the microscope. There are changes you can see under the microscope that are classic for UC. X-rays like a barium enema or a CT scan of the colon can show changes of ulcerative colitis.
The treatment of ulcerative colitis is different depending on the severity of the disease. Treatment is adjusted for individual symptoms. There are several medications used to treat the symptoms. One is aminosalicylates such as 5 aminosalicylic acid or 5-ASA. Sulfasalazine is a medication that combines sulfapyridine and 5-ASA. Side effects include heartburn, nausea, vomiting, diarrhoea and headache. Related agents include mesalamine and olsalazine. The latter two have fewer side effects. These medications can be given orally or by an enema. This is the first class of medications used. Corticosteroids are also used to calm the immune system. They can be given orally, by IV or by an enema. They make suppositories of steroid medications as well. They can cause side effects, including acne, weight gain, high blood pressure, facial hair, diabetes, loss of bone mass and mood swings. Steroids work best for exacerbations and short term use only.
Immunomodulators include 6 mercaptopurine and azathioprine. These are secondary use medications that act directly on the immune system. They have side effects of hepatitis, pancreatitis, low white blood cell count and an increase in risk of infection. There other medications a person may take for pain or diarrhoea.
About 25 to 40 percent of all patients with ulcerative colitis need to have a colectomy to remove the colon. This can be because of severe bleeding, severe pain, colon rupture, or to reduce the risk of colon cancer. Ulcerative colitis patients have a high risk of colon cancer and need frequent colonoscopies to reduce their risk. An ileostomy is then performed to attach the ileum to the abdominal wall via a stoma. An ileoanal anastomosis can be performed so the person can have bowel movements the regular way. The bowel movements are usually diarrhoeal in nature, however.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here