ULCERATIVE COLITIS SYMPTOMS Diarrhea due to increased secretion and decreased absorption of water and electrolytes; unabsorbed fatty

ty acids and bile salts 2 types of diarrhea may occur with UC. The first type is caused by severe rectal inflammation and is characterized by fecal urgency and frequent passage of small amounts of stool mixed with blood, pus, and mucus. High-volume, watery diarrhea may also occur. This is caused by distraction of the mucosal layer, resulting in loss of Sodium and water absorption and reduced motility, which in turn results in loss of the normal back and forth contractions that promote fluid reabsorption. The acute inflammation reduces motility. Weight loss and hyperphagia due to decreased absorption of fat, protein, and carbohydrates Bulky-foul smelling tools caused by decreased fat absorption. Muscle wasting, edema caused by decreased protein absorption Flatulence, borborygmi, abdominal distention due to fermentation of carbohydrates by intestinal bacteria Abdominal pain due to small intestine stricture, infiltration of the pancreas, intestinal ischemia Bone pain due to decreased calcium absorption Muscle cramps, weakness because of excess potassium loss Rectal Bleeding result of mucosal ulceration, vascular engorgement, and highly vascular granulation tissue. Anemia - caused by severe bleeding (rectal)

*the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits. COMPLICATIONS 1. Hemorrhage lower gastrointestinal bleeding results from erosion of the bowel wall. 2. Abscess formation localized pockets of infection develop in the ulcerated bowel lining. 3. Toxic megacolon paralysis of the colon causes dilation and subsequent bowel obstruction. Toxic megacolon result from a spread of the mucosal inflammation to the submucosal, muscular, and possible the serosal layers of the colon. The smooth muscle is paralyzed, which permits the colon to passively dilate, and the barrier function of the epithelium appears to be loss, permitting uptake of bacterial toxics and angina; another factor is severe inflammation compounded by excessive use of narcotics or anticholinergic drugs by vigorous colonic preparation for surgery and diagnostic exam. - The inflame process extends into the muscularis, inhibiting its ability to contract and resulting in colonic distention. Sx. Include fever, abdominal pain, distention, vomiting and fatigue.If the patient with toxic megacolon does not respond within 24 to 72 hours to medical management with nasogastric sution, IV fluids with electrolytes, corticosteroids, and antibiotics, surgery is required. Total colectomy (excision of the entire colon) is then indicated 4. Malabsorption essential nutrients cannot be absorbed through the diseased intestinal wal, causing anemia and malnutrition. 5. Bowel obstruction obstruction results from toxic megacolon or cancer 6. Fistulas can occur anywhere but usually track between the bowel and bladder. Pyuria and fecaluria result.

7. Colorectal cancer client with UC for 7 to 10 yr or longer have a high risk for colorectal cancer. This complication accounts for about one third of all deaths related to ulcerative colitis 8. Extraintestinal complications (e.g. arthritis, hepatic and biliary disease,oral and skin lesions). The cause is unknown.