Infection of Colon
Idiopathic (a diseases that come from an unknown cause) and chronic intestinal inflammation. Ulcerative colitis (UC) is a mucosal disease that usually involves rectum and may affect other organ proximally close to all or some part of the colon.
NB: There are many other common infective which may result to present of blood in the stools e.g. amoebiasis, schistosomiasis, and dysentery e.g. shigellosis, which should be excluded.
Firstly Surveillance colonoscopy should be conducted for patient, the purpose of the test is to isolate abnormal development of organs or cells or an abnormal structure resulting from such growth (dysplasia). The colonoscopy surveillance is required every one to two years in chronic ulcerative colitis of above 10 years duration. But a patients which the disease is only limited to rectum, do not need the colonoscopy surveillance.
Electrolyte, haematinic and nutritional deficiencies of the patient should be corrected via enteral or parenteral route.
Loperamide should not be avoided during (acute flare) sudden recurrence or worsening of symptoms due to the risk of toxic megacolon.
Mild to moderate disease:
- Sulfasalazine 1-2g should be ge given orally 6 hourly.
Make sure that FBC (full blood count) is monitor regularly.
If by taken sulfasalazine, there is no improvement, add 1.5mg/dl of Prednisone orally daily.
Once the symptoms have improved, reduce the dosage to 5 mg/week and should last for three months.
In case of severe disease admit patient, and Intravenous corticosteroids, e.g.:
- Hydrocortisone, IV, 100 mg should be given 6 hourly.
Failure to respond within 10 days of intravenous corticosteroids infusion, emergency colectomy (The surgical procedure that require total remove of all or some part of the large intestine or colon) should be carried out on the patient.
2 mg/kg daily of Azathioprine should be given orally base on Specialist prescription. The treatment should be Continue until usage corticosteroids can be reduced.
On the above case, a patients with limited disease that is not often require inpatient treatment. They usually appear well systemically.
The patient should be given 1g/day of Mesalazine rectally base on Specialist prescription. Or 1.5 mg/kg daily of prednisone orally for 14 days.
Maintenance of remission
The patient should given 500 mg of sulfasalazine orally for 12 hourly. or May be titrated with 1 g of sulfasalazine for 6 hourly. But Patients with recurrent severe attacks to maintain remission,
Should be given 2 mg/kg of Azathioprine, orally per day under Specialist prescription until there is an improvement of the condition.
Below are the case that require you to refer the patient an advanced medical care centre;
Confirmation of diagnosis.
Initiation of long-term therapy.
Fulminant colitis needs hospital admission and surgery may be required.
All patients with a severe worsening of symptoms should have abdominal X-rays. Markers
Symptom Worsening of case
Tachycardia; abnormally rapid heartbeat over 100 beats per minute.
Patient with temperature above 38ºC.
Patient with 6 bloody stools per day.
Patient dilated colon or small bowel on X-ray.
Patient with toxic megacolon (transverse colon diameter above 6 cm on X-ray examination), patient of these need hospital admission and the following medical emergency been given; parenteral fluids, corticosteroids, antibiotics and nasogastric suction, for colonic dilation. If it does not resolve the condition within 24 hours then emergency colectomy is should be carried on the patient.
The risk of line of small holes for tearing at a particular place is high. And finally
Surgery is required.