Page 197 - Critical Care Notes

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■ Administer bulk hydrophilic agents.
■ Prepare patient for surgery as needed (partial or complete colectomy with
ileostomy of anastomosis.
Complications
■ Small bowel obstruction
■ Right-sided hydronephrosis
■ Cholelithiasis
■ Arthritis and erythema nodosum

Ulcerative Colitis
Ulcerative colitis is an inflammatory autoimmune disease of the bowel. It is
characterized by ulcers or open sores in the colon that affect the mucosal layer.
The patient experiences remissions and exacerbations and has an increased
risk of colorectal cancer.
Pathophysiology
Multiple ulcerations of the colon → bleeding → mucosa becomes edematous
and inflamed → abscesses → narrowing, shortening and thickening of the bowel.
Clinical Presentation
■ Diarrhea mixed with blood and mucus (as many as 10–20 liquid stools/day)
and an urgent need to defecate
■ Crampy abdominal pain in the left lower quadrant and rebound tenderness
in the right lower quadrant
■ Intermittent tenesmus: Constant feeling of the need to defecate with little or
no fecal output
■ Rectal bleeding
■ Pallor, anemia, and fatigue
■ Anorexia, weight loss, vomiting, and dehydration
■ Fever and tachycardia
Diagnostic Tests

■ Sigmoidoscopy, colonoscopy, intestinal biopsies, and testing for C. difficile
■ Stool analysis for occult blood and steatorrhea and stool C&S

GI