Colitis
Colitis Information
Inflammation of the colon.
amebic colitis Amebiasis
- antibiotic-associated colitis
- Antibiotic-induced diarrhea. SEE: pseudomembranous colitis.
- pseudomembranous colitis
- Colitis associated with antibiotic therapy and, less commonly, with chronic debilitating illnesses in adult patients in the community.It is caused by one of two exotoxins produced by Clostridium difficile, which is part of the normal intestinal flora. Broad-spectrum antibiotics disrupt the normal balance of the intestinal flora and allow an overgrowth of strains that produce toxins. The exotoxins damage the mucosa of the colon and produce a pseudomembrane composed of inflammatory exudate. The symptoms-foul-smelling diarrhea with gross blood and mucus, abdominal cramps, fever, and leukocytosis-usually begin 4 to 10 days after the start of antibiotic therapy. The disease is treated by discontinuing previously prescribed antibiotics and beginning therapy with oral metronidazole; use of vancomycin should be limited to patients who do not respond to metronidazole. Diarrhea may reappear in approx. 20% of patients after treatment, necessitating a second course of therapy.
- radiation colitis
- Colitis due to damage of the bowel by radiation therapy.The symptoms are those of an inflamed bowel: pain, cramps, diarrhea, and rectal bleeding. Malabsorption may develop as a result of permanent injury to the mucosa.
- ulcerative colitis
- An inflammatory bowel disease marked pathologically by continuous inflammation of the intestinal mucosa, which typically involves the anus, rectum, and distal colon, and sometimes affects the entire large intestine.It occurs most often in patients during the second or third decade of life, although a second cluster of cases occurs in patients in their sixties. The disease is associated with an increased incidence of cancer of the colon.
What are the symptoms of Colitis?
Bloody diarrhea and pain with the passage of stools are characteristic. In severe cases, patients may have more than 6 bloody bowel movements in a day. Iron deficiency anemia often develops as a result.
Treatment of Colitis
Aminosalicylate drugs and corticosteroids decrease symptoms and improve inflammation. Patients with refractory disease may require colectomy.
Nursing Information
The patient suffering from colitis is prepared for diagnostic studies and is told that they can be uncomfortable and fatiguing. He or she is assisted to understand and participate in treatment goals: controlling inflammation, maintaining or restoring fluid and electrolyte balance, receiving adequate nutrition and replacing nutritional losses, and preventing complications. The nurse or dietitian teaches the patient about dietary intake, which should be high-caloric, non-spicy, caffeine-free, and low in high residue foods and milk products. Actual dietary and caloric intake must be documented. If the patient is unable to take fluids by mouth, intravenous (IV) fluid and electrolyte replacement are instituted as prescribed. Fluid intake and output are monitored, particularly for frequency, volume, and characteristics of diarrhea. The patient is monitored for dehydration and electrolyte imbalances, particularly hypokalemia, hypernatremia, and anemia.
Prescribed drug therapy is administered; the patient suffering from colitis is evaluated for desired and adverse effects and is taught about the particulars of his or her regimen, which usually includes sulfasalazine (5-ASA), prescribed for its antibiotic and anti-inflammatory effects. Studies have shown that, in high-risk patients, 5-ASA given both orally and by enema appears to sustain remission better than oral therapy alone. Since 5-ASA interferes with folate metabolism, use of a folate supplement is encouraged. Corticosteroids such as prednisone often are prescribed to reduce inflammation. The patient is taught that once clinical remission is achieved, steroid therapy can be tapered gradually and discontinued, but should never be summarily stopped. If the patient requires prolonged steroid therapy, he or she must report gastric irritation, edema, personality changes, moon face, and hirsutism. Corticosteroids given chronically may produce many side effects, including bone loss, diabetes mellitus, and cataract, among others. Antispasmodic and antidiarrheal agents (tincture of belladonna, diphenoxylate, loperamide) are used rarely and with great caution because they can precipitate colonic dilation (toxic megacolon). Measures to prevent perianal skin breakdown are reviewed (e.g., cleaning the rectal area thoroughly but gently following each bowel movement, applying a moisture barrier such as petroleum jelly, and changing position frequently).
