| Disease |
ULCER |
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| Quotation |
“Well better a semicolon, than a full stop”.
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| Definition |
A Chronic inflammatory disease of colon and rectum of unknown aetiology, characterized by intermittent bloody diarrhea, lower abdominal cramps and pain.
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| Prognosis |
Variable- A chronic disease that lasts a life time, with 5% mortality from initial attack. Most people live a normal a life span, and colon cancer is the most serious of long term risk. The risk for colon cancer seems to increase after the first 10 years and hence after that period, regular scopies should be done with segmental biopsies to look for dysplasia. Colitis limited to left side, or only proctitis would mean a favorable prognosis. Proctocolectomy can be curative.
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| General Measures |
Replacing nutritional losses and blood volume.
Educating the patient on nature of disease.
Adequate group and individual psychological support.
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| Advice to Patient |
Has to be informed on the nature of illness, the risks inherent in treatment.
Risk of development of cancer after some years of illness, and the scope for surgical therapy in a resistant case. Has to be educated on usual misconceptions about surgery.
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| Follow Up |
Regular scheduled follow up.
Keep looking out for complications. Periodic sigmoidoscopy to detect early malignancy.
Annual liver test.
Cholangiography for cholestasis (in view of primary sclerosing cholangitis as a complication.)
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| Inadequate Response |
Could be chronic phase, a relapse or an unconnected enterocolitis.
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| Prevention |
Annual colonoscopy with biopsy evalution to detect early malignant changes. While overt cancer would call for colectomy, dysplasias of a low grade would call for surveillance every 3-6 months, and high grade dysplasias (with mass) would warrant colectomy.
Prevention of relapse by putting the patients who have gone into remission on long-term Sulfasalazine ( 1gm b.i.d) |
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| Reference From |
www.niddk.nih.gov/health/digest/pubs/colitis/colitis.html |
