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SOEPLE – 4ULCERATIVE COLITIS AHMAD AL-DHLAWIY

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CONTENTS …

SOPEPEL

•Subjective •Objective Ulcer

ative colitis

•Definition •epidemiology•pathogenesis •Sign / symptomTREAT

MENT•Diagnose •Treatment

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SOEPEL …

SUBJECTIVE :

A MIDDLE AGE MALE PATIENT ENTER THE HOSPITAL WITH LEFT LOWER ABDOMINAL PAIN .

HISTORY:

MR.A 30 YEARS OLD, HAVE ABDOMINAL PAIN SINCE 3

DAYS AGO, BLOODY DIARRHEA, AND LOSS OF WEIGHT.

PAIN ANALYSIS

1. SITE: L. ILEAC FOSSE.

2. ONSET:GRADUATE.

3. CHARACTER: SHARP.

4. RADIATION: --

5. ASSOCIATED FACTORS: DURING DEFECATION.

6. TIME/DURATION: ONE WEEK.

7. EXAGGERATED AND RELIEVING FACTORS: --

8. SEVERITY: MODERATE.

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SOEPEL …

•OBJECT: GENERAL ABDOMINAL EXAMINATION

•EVALUATION “DD, CROHN’S DISSEASE, INFLAMMATORY

BOWEL SYDROME .

•PLAN: BLOOD TEST, STOOL CULTURE, COLONOSCOPY, X-RAY.

•ELABORATION: DRUG THERAPY .

•LEARNING GOAL: ULCERATIVE COLITIS.

DEFINITION …

COLITIS IS AN  AUTOIMMUNE DISEASE OF AN UNKNOWN CAUSE CAUSING INFLAMMATION OF THE MUCOSA OF THE RECTUM, IS CONFINED TO THE COLON, WITH OCCASIONAL INVOLVEMENT OF THE  ILEUM.

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EPIDEMIOLOGY …

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SITES …

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HISTOLOGY …

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PATHOGENESIS …

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CLINICAL FEATURES • DIARRHEA

• RECTAL BLEEDING

• TENESMUS

• PASSAGE OF MUCUS

• ABDOMINAL PAIN

• OTHER SYMPTOMS: ANOREXIA, NAUSEA, VOMITING, FEVER, WEIGHT LOSS

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SEVERITY …

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COMPLICATION …

• SEVERE BLEEDING

• A HOLE IN THE COLON (PERFORATED COLON)

• SEVERE DEHYDRATION

• OSTEOPOROSIS

• INFLAMMATION OF SKIN, JOINTS AND EYES

• AN INCREASED RISK OF COLON CANCER

• A RAPIDLY SWELLING COLON (TOXIC MEGACOLON)

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EXTRA-INTESTINAL MANIFESTATIONS

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DIAGNOSIS

EXAMINATION:

ABDOMEN SLIGHTLY DISTANT OR TENDER PALPITATION

RECTAL PRESENCE OF BLOOD

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INVESTIGATION …

• BLOOD TEST: IRON DEFICIENCY ANEMIA WBC AND

PALTELET ARE RAISED.

• STOOL CULTURE AND CLOSTRIDIUM DIFFICILE TOXIN: TO EXCLUDE INFECTIVE CAUSES OF COLITIS.

• COLONOSCOPY

• X-RAY: TO EXCLUDE COLONIC DILATATION

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MANAGEMENT …

MEDICATION:

•5-AMINO SALICYLIC ACID (5-ASA)/MESALAMINE

•DIFFERENT PREPARATIONS OF 5-ASA INCLUDE:

ASACOL, ROWASA, PENTASA (TRADENAMES)

•5-ASA IS A TOPICALLY ACTIVE ANTI-INFLAMMATORY AGENT FOR INFLAMED INTESTINAL MUCOSA.

•CHRONIC 5-ASA REQUIRES FOLATE THERAPY.

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REFERENCES …

• KUMAR AND CLARLK 8TH EDITION.

• OXFORFD OF GENERAL PRACTICE 2ND EDITION.

• ULCERATIVE COLITIS “ DR. MHD SEDDIQUE “ LECTURE