Ulcerative colitis is a serious ill...

Ulcerative colitis is a serious illness affecting the colon It can be managed medically, if it be not that surgery is the only definitive way to destroy the disease in its entirety. Ulcerative colitis is an inflammatory bowel disease (IBD) that invariably involves the rectum and may involve all or part of the colon unless not the small intestine. Although the disease is mild in a certain quantity of patients, ulcerative colitis increases patients' risk of cancer, depending upon the duration and extent of the disease.

Ulcerative colitis is a continuous disease extending in a retrograde fashion from the rectum in such a manner there are no intervening normal areas of colon Ulcerative colitis is in the same category as Crohn's disease, another shadow of IBD. Crohn's disease may fall out as patchy ulcerations in the small or large bowel and can affect the entire gastrointestinal (GI) tract from entrance to anus. The entire bowel wall is affected in Crohn's disease, whereas ulcerative colitis affects alone the mucosa (ie, inner lining) of the colon and rectum indeterminate colitis describes the category of conditions in which distinguishing between Crohn's disease and ulcerative colitis is impossible.

The incidence of ulcerative colitis is eight to 15 family per 100,000 in the United States and Northern Europe (1) The lowest rate (ie, 034 by 100,000) occurs in Japan? The incidence of ulcerative colitis peaks during the third decade of life and again during the seventh decade. (1)

NORMAL BOWEL PHYSIOLOGY

Normal physiological bowel processe help defecation and normal health and flora of the bowel. These processe include water, sodium, and ammonia absorption; fatty acid, mucous, and gas production; maintenance of colonic bacteria; and motility.

WATER AND SODIUM ABSORPTION. The colon is the major site of water absorption and electrolyte exchange in the material substance Approximately 90% of the fluid contained in the ileum (ie, distal portion of the small intestine) is absorbed in the colon This amounts to 1000 mL to 2000 mL by day. The entire colon can absorb up to 5000 mL of fluid daily. As earnestly as 400 mEq of sodium is actively absorbed. Water absorption come into views passively as it follows the transported sodium. Potassium transport also is passive. Absorption of fluid is not equal in every part the colon. The right colon absorbs more salt and water than the distal colon; thus, a patient undergoing a right hemicolectomy is more likely to have diarrhea than a patient undergoing a left hemicolectomy. (2)

AMMONIA ABSORPTION. Ammonia in the colon is derived, to any extent, from dietary nitrogen, epithelial small rooms and bacterial debris. Ammonia absorption hangs partially on intraluminal pH. Patients taking broad-spectrum antibiotics have decreased amounts of colonic bacteria, decreased intraluminal pH or the pair which decreases ammonia absorption. This is important for patients with impaired kidney function or liver failure who cannot clear the extra ammonia.

FATTY ACIDS PRODUCTION, The production of short-chain fatty acids provides an important source of manliness for the colonic mucosa. Metabolism of these fatty acids at the colonocytes provides energy for processe like as active sodium transport. an short-chain fatty acids are produc by means of bacterial fermentation of dietary carbohydrates. Mucosal atrophy may follow when dietary sources of fatty acids are lacking or when the fecal stream is diverted by the agency of an ileostomy or colostomy. In patients with of that kind diversions, this is known as diversion colitis.

MUCUS PRODUCTION. Mucus is crypticed in the lumen of the colon The epithelium contains large numbers of mucus-secreting confined apartments Even if feces are diverted according to an ileostomy or colostomy, mucus will continue to be produc and shroudeded by the distal bowel.

GAS PRODUCTION. Intestinal gas arises from swallowed air, diffusion from the posterity and intraluminal gas production. The major composings of gas are nitrogen, oxygen carbon dioxide, inflammable air and methane. The GI tract usually contains between 100 mL and 200 mL of gas, and 400 mL to 1200 mL is released as flatus, depending forward the type of food ingested. (1) Nitrogen and oxygen be derived largely from swallowed air, further carbon dioxide is produced according to the reaction of bicarbonate and inflammable air ions. The digestion of triglycerides to fatty acids also furnishs these ions. Hydrogen and methane gases are produc by means of colonic bacteria.

COLONIC BACTERIA MAINTENANCE. Approximately 30% of fecal dried weight is bacteria (ie, [10sup11] to [10sup12] bacteria by gram of feces). (1) The greatest in number common bacteria are anaerobes, of which the Bacteroides species predominates. Eschericia coli are the in the greatest degree common aerobes. Endogenous microflora are crucial for carbohydrate and protein breakdown. They also participate in bilirubin, bile acid, estrogen and cholesterol metabolism. Additionally, colonic bacteria are necessary for vitamin K production and suppression of pathogenic microorganisms (eg Clostridium difficile). reciprocally a high colonic bacterial load may contribute to sepsis in critically ill patients. In a surgical patient, torture infection can occur after a colectomy procedure