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colitis(ko-lit'is) [ col- + -itis]
collagenous colitisAbbreviation: CC
E. coli 0157:H7 colitis
lymphocytic colitisAbbreviation: LC
microscopic colitisAbbreviation: MC
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.
Aminosalicylate drugs and corticosteroids decrease symptoms and improve inflammation. Patients with refractory disease may require colectomy.
The patient is prepared for diagnostic studies (sigmoidoscopy, colonoscopy, barium enema, CT scan) and is told that the procedure can be uncomfortable and fatiguing. He is taught 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, nonspicy, 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 or parenteral nutrition 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 is evaluated for desired and adverse effects and is taught about the particulars of his 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 must report gastric irritation, edema, personality changes, moon face, and hirsutism. Corticosteroids given chronically may produce many serious side effects, including bone loss, diabetes mellitus, and cataracts. 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.
While surgery is considered only for patients who do not respond to pharmacological therapies, several surgical procedures are available to attempt to preserve rectal evacuation. Bowel surgeries require a special antibiotic preparation, and postoperative care includes all general patient care concerns. In addition, a temporary nasogastric tube is usually inserted, and a diet is gradually advanced after removal of the tube. The patient may have a permanent or temporary stoma or a pouch ileostomy and requires ongoing teaching and support from a stomal therapist and support groups for help and management.