ULCERATIVE ULCERATIVE COLITISCOLITIS

BY V.S.DEEPIKA RANIBY V.S.DEEPIKA RANIB.Sc Final yearB.Sc Final year

Erosion in the lining of Erosion in the lining of colon (mucosa and sub colon (mucosa and sub

mucosa)mucosa)

It is characterized by inflammation It is characterized by inflammation and ulceration of colon resulting in and ulceration of colon resulting in frequent passage of stools with frequent passage of stools with blood and mucus.blood and mucus.

It is confined to colon and rectum.It is confined to colon and rectum.

INCIDENCEINCIDENCE unknown cause unknown cause

at any ageat any age

predominates in predominates in middlemiddle

and higher income and higher income

groups.groups.

CAUSESCAUSES

Mental conflicts and emotional stress

Allergy to certain foods

Largely seen in Non smokers and Ex-smokers

Nitric oxide synthesis is increased in Nitric oxide synthesis is increased in U.CU.C

NO is produced from arginine by nitric NO is produced from arginine by nitric oxide synthase.oxide synthase.

U.C is assosiated with increase in U.C is assosiated with increase in mucosal vasodilation.mucosal vasodilation.

CLINICAL FINDINGSCLINICAL FINDINGS

Mucosa becomes fragile.Mucosa becomes fragile. In early stages mucosa is edematous In early stages mucosa is edematous

and hyperemic.and hyperemic. In severe stage, necrosis and frank In severe stage, necrosis and frank

ulceration of mucosa occur.ulceration of mucosa occur.

SymptomsSymptoms

Attack of dysentery.Attack of dysentery. Exacerbations and remissions. Exacerbations and remissions. Loss of water, electrolytes, blood Loss of water, electrolytes, blood

and protein.and protein. Weight lossWeight loss DehydrationDehydration FeverFever AnemiaAnemia Abdominal painsAbdominal pains

AnorexiaAnorexia Metabolic rate is increasedMetabolic rate is increased Liver damageLiver damage Constipation-distal irritability and Constipation-distal irritability and

spasm.spasm.

CAUSES OF NUTRITION CAUSES OF NUTRITION PROBLEMSPROBLEMS

MECHANISMMECHANISM

Decreased nutritional Decreased nutritional intakeintake

Increased nutritional lossesIncreased nutritional losses

Nutritional interference by Nutritional interference by drugsdrugs

CONTRIBUTING CONTRIBUTING FACTORFACTOR

Anorexia, nausea, painAnorexia, nausea, pain, , restrictive/unbalanced restrictive/unbalanced diet.diet.

Malabsorption, intestinal Malabsorption, intestinal

resection, bacterialresection, bacterial over over growth, bile salt growth, bile salt deficiency, drugs.deficiency, drugs.

DiarrheaDiarrhea

BleedingBleeding

Protein-losing enteropathyProtein-losing enteropathy

Intestinal lymphangiectasiaIntestinal lymphangiectasia

Corticosteroids, Corticosteroids, sulfasalazine, sulfasalazine, cholestyraminecholestyramine

NEED FOR NUTRITIONAL NEED FOR NUTRITIONAL CARECARE

MalnutritionMalnutrition insufficient food consumptioninsufficient food consumption excessive nitrogen lossesexcessive nitrogen losses - blood, mucus and necrotic- blood, mucus and necrotic colonic mucosacolonic mucosa -electrolyte loss in feces-electrolyte loss in feces Absorptive areas are destroyedAbsorptive areas are destroyed ulcerations of mucosa and scar tissuesulcerations of mucosa and scar tissues Tissue repair and restore normal Tissue repair and restore normal

functioningfunctioning

DIETARY PRINCIPLESDIETARY PRINCIPLES Individual attentionIndividual attention Diet- highly individualized, nutritionally adequateDiet- highly individualized, nutritionally adequate Small 6 to 8 feedingsSmall 6 to 8 feedings Based up on severity of disease it ranges from Based up on severity of disease it ranges from TPNTPN nasogastric feeding of E.Fnasogastric feeding of E.F oral ingestion of E.Doral ingestion of E.D exclusion of regular foodsexclusion of regular foods fiber supplementationfiber supplementation high fiber diet.high fiber diet.

DIETARY DIETARY RECOMMENDATIONRECOMMENDATION

Chronic U.C Chronic U.C

fistulas, obstruction or fistulas, obstruction or abscesses.abscesses.

TPN TPN

- intestinal atrophy- intestinal atrophy

- invasion of bacteria- invasion of bacteria

Small intestine is not involved.Small intestine is not involved. Oral or Enteral feeding Oral or Enteral feeding

- integrity of intestinal - integrity of intestinal epitheliumepithelium

Prep. – protein concentrate Prep. – protein concentrate

eg. Complan.eg. Complan.

Low residue dietLow residue diet

- high in protein and energy.- high in protein and energy. Exclusion of Irritating foods –nuts, Exclusion of Irritating foods –nuts,

legumes, raw fruits, etc.legumes, raw fruits, etc. In acute U.C – Strict low residue diet In acute U.C – Strict low residue diet

- fecal stasis.- fecal stasis. Fiber content – high fiber diet.Fiber content – high fiber diet. Soluble fibers and pectins Soluble fibers and pectins

Calories : 2000 – 2500 kcalCalories : 2000 – 2500 kcal Proteins : 100 g/dayProteins : 100 g/day

mixed dietmixed diet

high quality protein high quality protein foods foods

eg. tender meats, fish, eg. tender meats, fish, poultry etc.poultry etc.

Carbohydrates : soups, etcCarbohydrates : soups, etc Fats : normalFats : normal

fried foods are not fried foods are not

easily digested.easily digested. Vitamins : commercial prep.Vitamins : commercial prep.

(orally or injections)(orally or injections)

MineralsMinerals

Mineral loss must be marked.Mineral loss must be marked. Unless marked – fatal outcomeUnless marked – fatal outcome Sodium : large volume of fecesSodium : large volume of feces

extra salt in food, saline extra salt in food, saline infusion.infusion.

Potassium : Potassium :

Symptoms- weakness, hypotonia, Symptoms- weakness, hypotonia, abdominal distension, abdominal distension, E.C changes. potassium E.C changes. potassium citrate orallycitrate orally

Iron : 30g/dayIron : 30g/day

oral route if not toleratedoral route if not tolerated

AnemiaAnemia Intra muscular injectionsIntra muscular injections Blood transfusionBlood transfusion Fluids : liberal intakeFluids : liberal intake

1200 – well hydrated 1200 – well hydrated

Calcium : Rapid bone lossCalcium : Rapid bone loss

-milk exclusion -milk exclusion

-steroid therapy-steroid therapy calcium salts – orallycalcium salts – orally

FOODS TO BE AVOIDEDFOODS TO BE AVOIDED

spices, stale foods,spices, stale foods,

irritant foods - legumes, nuts etc.irritant foods - legumes, nuts etc.

Psychological aspects Psychological aspects

They are significantThey are significant Therapy for depression, relaxation Therapy for depression, relaxation

can benefit the patient.can benefit the patient. Exercise is important adjunct.Exercise is important adjunct.

U.C AND CANCERU.C AND CANCER

Constipated patients – lump in right Constipated patients – lump in right colon.colon.

Risk of cancer is increased in cases Risk of cancer is increased in cases lasting more than 7 years.lasting more than 7 years.