Colitis Overview

Ulcerative colitis
Last updated: Jan 27, 2015
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Summary
Overview

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Definition
Epidemiology
Aetiology
Pathophysiology
Classification

Prevention
Secondary

Diagnosis
History & examination
Tests
Differential
Step-by-step
Guidelines
Case history

Treatment
Details
Step-by-step
Emerging
Guidelines
Evidence

Follow Up

Recommendations
Complications
Prognosis

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Summary

Form of inflammatory bowel disease that affects the rectum and extends proximally. Characterised by
diffuse inflammation of the colonic mucosa and a relapsing, remitting course.

Patients commonly experience bloody diarrhoea, chronic diarrhoea (or both), lower abdominal pain,
faecal urgency, and extraintestinal manifestations, particularly those related to activity of the colitis.

Diagnosis requires endoscopy with biopsy and negative stool culture.

Relapses are often associated with pathogens; therefore, stool should be obtained for culture in all
cases of disease flare-up.

Treatment aims to induce and maintain remission. Drug choice and formulation depends on the
severity and extent of disease.

Toxic megacolon can occur with associated risk of perforation. Bowel adenocarcinoma is a
complication in 3% to 5% of patients.

Patient CommentsRead 31 CommentsShare Your Story

Colitis is a term used to describe inflammation of thecolon. There are a variety of

causes of colitis including infections, poor blood supply (ischemia),
and autoimmune reactions.
The colon is located in the abdominal cavity and is divided into the following parts:
the cecum, the ascending colon, the transverse, the descending colon, the sigmoid, the
rectum, and the anus. The right colon includes the cecum and ascending colon. The left
colon includes the transverse segment to the sigmoid.
The colon (large bowel or large intestine) is responsible for collecting and storing the
waste products of digestion. It is a long muscular tube that pushes undigested food
towards the anus for eventual elimination as a bowel movement. Food is digested in the
stomach into a liquid slurry that passes through the small intestine where the nutrients
are absorbed into the body for use. When the liquid mixture enters the colon, it mixes
with mucus and normal bacteria that reside in the colon. The wall of the colon has
numerous layers. There is a smooth muscle layer that wraps the outside and is
responsible for squeezing the undigested food through the length of the colon. The
inner layer, or mucosa, comes into contact with the fluid and allows the absorption of
water and electrolytes, which helps to solidify the feces (poop). The mucosal layer is
where the colon inflammation occurs and is responsible for the symptoms of colitis.
As with any other organ, the colon has a blood supply with arteries delivering oxygen
rich blood and nutrients to it, and veins that drain carbon dioxide and lactic acid from it.
Diseases that decrease blood supply can cause inflammation of the colon. Continue
Reading

Colitis Causes

Inflammation of the colon can be caused by a variety of illnesses and infections. Some
of the most common causes are discussed below.
Infectious Colitis

Viruses and bacteria can cause colon infections. Most are food-borne illnesses or "food
poisoning." Common bacterial causes include Shigella, E
Coli, Salmonella andCampylobacter. These infections may cause bloody diarrhea and
can result in significant dehydration.
Parasites such as giardia can cause significant diarrhea. The parasite can enter the
body when infected water is swallowed. The source may be from recreational water
such as rivers, lakes, and swimming pools. It may also be contaminated from a water
well or cistern.
Pseudomembranous colitis is caused by the bacteria Clostridium difficile (C. difficile).
This disorder is often seen in patients who have recently been taking antibiotics for an
infection. The antibiotic alters the normal bacteria present in the colon and allows an
overgrowth of the Clostridium bacteria.Clostridium bacteria produce a toxin that
causes diarrhea. This is an infection, and often there is a fever present. The diarrhea is
usually not bloody.
Ischemic Colitis

The arteries that supply blood to the colon are like any other artery in the body. They
have the potential to become narrow due to atherosclerosis (just like blood vessels in
the heart, which can cause angina, or narrowed vessels in the brain can cause
a stroke). When these arteries become narrow, the colon may loose its blood supply
and become inflamed.
The colon can also lose its blood supply for mechanical reasons. A couple of examples
include volvulus, where the bowel twists on itself, or an incarcerated hernia, where a
portion of the colon gets trapped in an outpouching of the abdominal wall, which
prevents blood from flowing to the affected portion.
In individuals who are at risk for decreased blood flow to the colon, ischemic colitis can
occur if the blood pressure falls. This may occur withdehydration, anemia, or shock.
Ischemia or lack of blood supply causes significant pain, fever, andbloody bowel
movements.
Inflammatory Bowel Disease

There are two types of inflammatory bowel disease, ulcerative colitis, andCrohn's
disease.
Ulcerative colitis is thought to be an autoimmune illness in which the body's immune
system attacks the colon and causes inflammation.Ulcerative colitis begins in the
rectum and may gradually spread throughout the colon. The signs and symptoms
include abdominal pain and bloody bowel movements.

Crohn's disease may involve any part of the digestive tract from theesophagus and
stomach, through to the small and large intestine all the way to the rectum. It often has
skip lesions, that is diseased areas are interspersed with healthy areas of tissue.
Microscopic Colitis

Two diseases make up this group of colon inflammation, collagenous colitis and
lymphocytic colitis. In these diseases, the inflammation is caused when the colon wall
becomes engorged with either collagen or lymphocytes.Watery, non-bloody
diarrhea is the most common symptom.
This is an uncommon illness that is seen more frequently in older women. The cause is
unknown but an autoimmune potential may exist.
Chemical Colitis

If chemicals are instilled into the colon, inflammation and damage can occur. One of the
complications of an enema is inflammation of the mucosal lining of the colon caused by
harsh chemicals. Continue Reading
Colitis Symptoms
Patient CommentsRead 35 CommentsShare Your Story

Symptoms of colitis will depend upon the type of colitis that is present, but in general,
colitis most often is associated with abdominal pain and diarrhea.
Other symptoms of colitis that may or may not be present include

Blood in the bowel movement may or may not be present. Diarrhea can sometimes cause hemorrhoids, which can bleed. However, blood with a
bowel movement is not normal and the affected person should contact their health care practitioner or seek other medical care.

Tenesmus may exist; this is the constant urge to have a bowel movement.

The abdominal pain may come in waves, building to diarrhea, and then waning.

There may be constant pain.

Fever, chills, and other signs of infection and inflammation may be present depending upon the cause of colitis. Continue Reading

Colitis Diagnosis

The diagnosis of colitis begins with a thorough history by a physician or health care
practitioner. Since the symptoms are usually abdominal pain and diarrhea, it is
important to learn about the onset andduration of symptoms, and any other complaints
or symptoms the patient may have. Since most causes of diarrhea are
relatively benign and self-limiting, questions may be asked to search for some of the
causes listed above.
An important concern is whether there is blood in the bowel movement (stool). While
this may lead to the diagnosis of colitis,colon cancer is another important cause ofblood

in the stool, and this symptom should not be ignored (as mentioned previously, blood
with a bowel movement or in the stool is not normal and should not be ignored).
Some questions asked of the patient may include:
1.

the time of onset of symptoms,

2.

the duration of pain,

3.

the frequency of diarrhea, and

4.

whether there are any other associated complaints.

Other questions may include lifestyle, especially if an infectious cause is being

considered. Recent travel, unusual diet, or the use of noncommercial water (for
example, drinking from a well or river water on a camping trip) may point the diagnosis
to bacterial infections such asShigella, Campylobacter, or Yersinia; or parasite
infections such as giardia. Recent use of antibiotics may direct the health care
practitioner to considerClostridium difficile as the cause.
The past medical history is also important to assess the risk factors forperipheral
vascular disease or narrowing of the arteries. These includesmoking, high blood
pressure, high cholesterol, and diabetes. This may give direction to explore ischemic
bowel as the cause for colitis.
Physical examination will focus on the abdomen. The physician will feel for areas of
tenderness, for masses, or abnormally enlarged organs like theliver, spleen, and kidney.
While unpleasant, the rectal examination is of utmost importance. Using a finger, the
physician feels inside the rectum, trying to find a mass or tumor. As well, the color and
consistency of stool can be evaluated and if it is not grossly bloody, can be tested for
occult blood (blood that is present but cannot be seen with the naked eye).
Vital signs are an important part of the physical examination. Temperature, blood
pressure, pulse, and respiratory rate will help guide the direction of testing. If the vital
signs are not stable, that is the blood pressure is low or the pulse rate too fast, a crisis
may be imminent. The physician may need to intervene acutely and delay some of the
diagnostic evaluation until the patient is stabilized. Orthostatic vital signs, where the
blood pressure and pulse rate are taken both lying and standing may assist with
detecting dehydration.
Laboratory

Blood testing will help assess the stability of the patient and look for potential issues
associated with colitis.

A complete blood count (CBC) will assess the red blood cell count, thewhite blood cell count, and the number of platelets. The red blood cell count
will help define the amount of bleeding. White blood cell counts elevate when the body is undergoing stress including the stress of infection. Platelets help
blood to clot, so knowing the platelet number in a patient with bleeding is useful.

Electrolyte abnormalities can occur with diarrhea. Low sodium and potassium levels may be seen and may cause symptoms far removed from the
initial colitis complaints.

Kidney function may be assessed by measuring the BUN (blood urea nitrogen) and creatinine levels.
Stool samples may be collected for culture, looking for infection as the cause of colitis. The history will assist the health care practitioner decide the
tests to order and what cultures would be appropriate.

Colonoscopy

If a specific cause of colitis is not readily apparent, then colonoscopy may be

considered. A gastroenterologist will insert a long flexible camera into the anus and
examine the full length of the colon. The appearance of the colon by itself may be
enough to make the diagnosis. Biopsies (small pieces of tissue) may be taken from the
lining of the colon and examined by a pathologist (a medical doctor specializing in the
diagnosis of tissues) to help confirm the diagnosis. Microscopic colitis (lymphocytic and
collagenous) can only be diagnosed with biopsy of the affected area.
Colonoscopy is an essential cancer screening test and is especially important for those
patients who have had blood in their stool that cannot be explained by another
diagnosis.
Imaging

Computerized tomography (CT) may be used to image the colon and the rest of the
abdomen. Different types of colitis have distinctive patterns that may help a radiologist
recognize a specific diagnosis. A CT scan may be ordered urgently if the history and
physical examination performed by the health care practitioner leads to concern that an
urgent or emergent problem exists that may require surgery.
On occasion a barium enema or other imaging tests may be used to evaluate the
anatomy of the colon. Continue Reading
Colitis Treatment
Patient CommentsRead 3 CommentsShare Your Story

The definitive treatment of colitis is dependent upon the cause. Many cases require little
more than symptomatic care, including clear fluids to rest the bowel and medications to
control pain. Some patients become acutely ill and will need intravenous (IV) fluids and
other interventions to treat their illness.

Infections: Infections that cause diarrhea and colitis may or may not require antibiotics, depending upon the cause. Viral infections resolve with the
supportive care of fluids and time. Some bacterial infections likeSalmonella also do not need antibiotic therapy; the body is able to get rid of the infection on its
own. Other bacterial infections like Clostridium difficile always require treatment with antibiotics.

IBD: Inflammatory bowel diseases (IBDs) like ulcerative colitis and Crohn's disease, are often controlled by a combination of medications that are
used in a step-wise approach. Initially, anti-inflammatory medications are used, and if these are less than successful, medications that suppress the immune
system can be added. In the most severe cases, surgery may be required to remove all or parts of the colon and small intestine.

Ischemic colitis: Treatment of ischemic colitis is initially supportive, using intravenous fluids to rest the bowel and prevent dehydration. If adequate
blood supply to the bowel isn't restored, surgery may be required to remove parts of the bowel that have lost blood supply.

Diarrhea and abdominal pain: Most causes of colitis present with diarrhea and crampy abdominal pain. These symptoms are also found with mild
illnesses like viral enteritis (inflammation of the colon). Initial treatment at home may include a clear fluid diet for 24 hours, rest, andacetaminophen (Tylenol) as
needed for pain. Often symptoms resolve quickly and no further care is needed.

Loperamide (Imodium) is an effective medicine to control diarrhea. Acetaminophen

or ibuprofen can be used for pain control.
Depending upon the cause of the colitis, medication may be prescribed to control or
cure symptoms. Antibiotics may be helpful in colitis caused by some infections. Antiinflammatory and immune suppression drugs can be used to control the symptoms
of inflammatory bowel disease. Continue Reading
Colitis Treatment
Patient CommentsRead 3 CommentsShare Your Story

The definitive treatment of colitis is dependent upon the cause. Many cases require little
more than symptomatic care, including clear fluids to rest the bowel and medications to
control pain. Some patients become acutely ill and will need intravenous (IV) fluids and
other interventions to treat their illness.

Infections: Infections that cause diarrhea and colitis may or may not require antibiotics, depending upon the cause. Viral infections resolve with the
supportive care of fluids and time. Some bacterial infections likeSalmonella also do not need antibiotic therapy; the body is able to get rid of the infection on its
own. Other bacterial infections like Clostridium difficile always require treatment with antibiotics.

IBD: Inflammatory bowel diseases (IBDs) like ulcerative colitis and Crohn's disease, are often controlled by a combination of medications that are
used in a step-wise approach. Initially, anti-inflammatory medications are used, and if these are less than successful, medications that suppress the immune
system can be added. In the most severe cases, surgery may be required to remove all or parts of the colon and small intestine.

Ischemic colitis: Treatment of ischemic colitis is initially supportive, using intravenous fluids to rest the bowel and prevent dehydration. If adequate
blood supply to the bowel isn't restored, surgery may be required to remove parts of the bowel that have lost blood supply.

Diarrhea and abdominal pain: Most causes of colitis present with diarrhea and crampy abdominal pain. These symptoms are also found with mild
illnesses like viral enteritis (inflammation of the colon). Initial treatment at home may include a clear fluid diet for 24 hours, rest, andacetaminophen (Tylenol) as
needed for pain. Often symptoms resolve quickly and no further care is needed.

Loperamide (Imodium) is an effective medicine to control diarrhea. Acetaminophen

or ibuprofen can be used for pain control.
Depending upon the cause of the colitis, medication may be prescribed to control or
cure symptoms. Antibiotics may be helpful in colitis caused by some infections. Antiinflammatory and immune suppression drugs can be used to control the symptoms
of inflammatory bowel disease. Continue Reading
Colitis Surgery

Surgery may be required for ischemic colitis, Crohn's disease, or ulcerative colitis,
depending upon the severity of the illness and the response to more conservative nonsurgical treatments.
In ulcerative colitis, removal of the colon cures the disease.

For other illnesses, usually the part of the colon that is at risk or damaged is
removed. Continue Reading

Colitis Prevention

Infectious colitis remains a common ailment worldwide, affecting millions daily. The lack
of clean drinking water and adequate sanitation are the main causes, leading to
thousands of potentially preventable deaths each day. In developed countries, poor
hand washing and poor kitchen hygiene allow the potential for infectious colitis.
Prevention lies in cleanliness.
Inflammatory bowel diseases are difficult to prevent at the present time. The likely
causes are heredity and perhaps an abnormal auto-immune response to an unknown
stimulus in the body.
Since ischemic colitis is caused by narrowing of the blood vessels to the bowel,
decreasing the risks for other types of circulatory problems such as peripheral vascular
disease, heart attack, and stroke will also decrease the risk for ischemic colitis. The
common risk factors are smoking and poor control of high blood pressure,
high cholesterol levels, anddiabetes. Continue Reading
http://www.medicinenet.com/dengue_fever/article.htm
RINT ARTICLE HIGHLIGHTER

Dengue Fever Symptoms and Signs

Primary symptoms of dengue appear three to 15 days after the mosquito bite and include the following:

high fever and severe headache,

with severe pain behind the eyes that is apparent when trying to move the eyes.
Other associated symptoms are:

joint pain,

muscle and bone pain,

rash,

and mild bleeding.

Many affected people complain of low back pain. The lymph nodes of the neck and groin may be swollen. Young children and people infected for the first time typically have
milder symptoms than older children and adults.
Read more about symptoms and signs of dengue fever

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
Symptoms include as severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rash. The presence of
fever, rash, andheadache (the "dengue triad") is characteristic of dengue fever.

Dengue is prevalent throughout the tropics and subtropics.

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is
directed toward relief of the symptoms (symptomatic treatment).
The acute phase of the illness with fever and myalgias lasts about one to two weeks.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal
pain, hemorrhage (bleeding), and circulatory collapse (shock).

The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.

There is currently no vaccine for dengue fever.

What is dengue fever?

Reader Stories

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Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows
a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen lymph nodes (lymphadenopathy), and
rash. The presence of fever, rash, and headache (the "dengue triad") is particularly characteristic of dengue. Other signs of dengue fever
includebleeding gums, severe pain behind the eyes, and red palms and soles.
Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused
by one of five serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that
particular viral serotype to which the patient was exposed.
Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and
musclepain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their
postures and gait.
Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include headache, fever, rash, and evidence of hemorrhage in the
body. Petechiae (small red or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible
signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock
syndrome. Continue Reading

Summary

Globally important arboviral infection transmitted by the Aedes genus of mosquito (primarilyAedes
aegypti, but also A albopticus), found in tropical and subtropical regions of the world.

Endemic in more than 100 countries, particularly the South-east Asian region, Western Pacific region,
and the Americas.

Incubation period is 3 to 14 days (average 7 days).

Clinical features include fever, headache, myalgia/arthralgia, and skin flushing/rash, together with
leukopenia, thrombocytopenia, and elevated LFTs.

Severe thrombocytopenia, haemorrhage, and plasma leakage are the key diagnostic features of the
more severe forms of infection.

Confirmatory tests include viral antigen or nucleic acid detection and serology.

Fluid therapy and the identification of the critical phase are the most important aspects of
management.