Name of the Diseases
Ulcerative colitis (UC):
A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and
possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually
intermittent (acute exacerbation with long remissions), but some individuals (30%–40%) have continuous
symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa.
Overview
Pathophysiology
Ulcerative colitis affects the superficial mucosa of the colon and is characterized by multiple ulcerations,
diffuse inflammations, and desquamation or shedding of the colonic epithelium. Bleeding occurs as a result of
the ulcerations. The mucosa becomes edematous and inflamed. The lesions are contiguous, occurring one
after the other. Abscesses form, and infiltrate is seen in the mucosa and submucosa, with clumps of
neutrophils found in the lumens of the crypts (i.e., crypt abscesses) that line the intestinal mucosa (). The
disease process usually begins in the rectum and spreads proximally to involve the entire colon. Eventually,
the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits. Because the
inflammatory process is not transmural (ie, it affects the inner lining only), fistulas, obstruction, and fissures
are uncommon (Baumgart & Sandborn, 2007).
Anatomy
Nursing Assessment
The patient should be assessed for tachycardia, hypotension, tachypnea, fever, and pallor. Other assessments
address the level of hydration and nutritional status. The abdomen is examined for bowel sounds, distention,
and tenderness. These findings assist in determining the severity of the disease. The stool is positive for
blood, and laboratory test results reveal low hematocrit and hemoglobin levels in addition to an elevated
white blood cell count, low albumin levels, and an electrolyte imbalance. Elevated anti neutrophil
cytoplasmic antibody levels are common (Baumgart & Sandborn, 2007). Abdominal x-ray studies are useful for
determining the cause of symptoms. Free air in the peritoneum and bowel dilation or obstruction should be
excluded as a source of the presenting symptoms. Sigmoidoscopy or colonoscopy and barium enema are
valuable in distinguishing ulcerative colitis from other diseases of the colon with similar symptoms. A barium
enema may show mucosal irregularities, focal strictures or fistulas, shortening of the colon, and dilation of
Ulcerative colitis (UC):
A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and
possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually
intermittent (acute exacerbation with long remissions), but some individuals (30%–40%) have continuous
symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa.
Overview
Pathophysiology
Ulcerative colitis affects the superficial mucosa of the colon and is characterized by multiple ulcerations,
diffuse inflammations, and desquamation or shedding of the colonic epithelium. Bleeding occurs as a result of
the ulcerations. The mucosa becomes edematous and inflamed. The lesions are contiguous, occurring one
after the other. Abscesses form, and infiltrate is seen in the mucosa and submucosa, with clumps of
neutrophils found in the lumens of the crypts (i.e., crypt abscesses) that line the intestinal mucosa (). The
disease process usually begins in the rectum and spreads proximally to involve the entire colon. Eventually,
the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits. Because the
inflammatory process is not transmural (ie, it affects the inner lining only), fistulas, obstruction, and fissures
are uncommon (Baumgart & Sandborn, 2007).
Anatomy
Nursing Assessment
The patient should be assessed for tachycardia, hypotension, tachypnea, fever, and pallor. Other assessments
address the level of hydration and nutritional status. The abdomen is examined for bowel sounds, distention,
and tenderness. These findings assist in determining the severity of the disease. The stool is positive for
blood, and laboratory test results reveal low hematocrit and hemoglobin levels in addition to an elevated
white blood cell count, low albumin levels, and an electrolyte imbalance. Elevated anti neutrophil
cytoplasmic antibody levels are common (Baumgart & Sandborn, 2007). Abdominal x-ray studies are useful for
determining the cause of symptoms. Free air in the peritoneum and bowel dilation or obstruction should be
excluded as a source of the presenting symptoms. Sigmoidoscopy or colonoscopy and barium enema are
valuable in distinguishing ulcerative colitis from other diseases of the colon with similar symptoms. A barium
enema may show mucosal irregularities, focal strictures or fistulas, shortening of the colon, and dilation of
