Question

A 24- year old female was admitted to the hospital complaining of having a repeated episode of severe abdominal pain with bloody diarrhea up to 20 times/day for the past 2 days.

1. What are some investigations that you would ask to be done?
2. What could be the diagnosis?
3. What causes the diagnosis that you have picked?
4. How would you treat this acute case?
5. Is there a way to prevent this episode from happening again?

NOTE: Please help me to write an answer based on when doing the diagnosis the patient is suffering from Chronic Stress and all these symptoms are due to her continuous Stress.

Answer 1

Ans :- ulcerative colitis or bacterial infection or bowel infection

1] Investigation to be done "gestrointestinal test"

Gestro intestinal refer to diseases involving the gastrointestinal tract, namely the oesophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

• Constipation
• Diarrhea
• Heartburn
• Nausea & Vomiting
• Abdominal Pain
• Bloating and excess gas

2] Diagnose ulcerative colitis and rule out other conditions, include:

• Blood Tests - Your doctor may order these to check for anemia and infection.
• Stool Analysis - This can rule out conditions that may be mistaken for ulcerative colitis, such as infections caused by bacteria or parasites. White blood cells in your stool can also be a sign of ulcerative colitis.
• Colonoscopy - A colonoscopy is a procedure that uses a flexible tube with a camera to view the inside of your colon and obtain tissue samples for analysis.
• Flexible Sigmoidoscopy - Similar to a colonoscopy but less extensive, this procedure uses a flexible tube with a light to view just the lower portion of the colon. A definitive diagnosis of ulcerative colitis is generally made using endoscopy — that is, a colonoscopy or a sigmoidoscopy.
• X-Ray - A type of imaging, X-ray may be used on your abdominal area to look for serious complications.
• Barium Enema - This is an X-ray in which the colon is filled with liquid barium before images are taken.
• CT Scan - A computerized tomography, or CT scan, is a type of imaging that may be used on your abdomen or pelvis to see how much of the colon is inflamed and whether serious complications have developed.

3]. Cause the diagnosis that you have picked - stool and blood test , colonoscopy , X-ray and CT scan , sigmoidoscopy.

Blood and Stool Tests -

A blood test can show if you have anemia, which is a symptom of ulcerative colitis. Anemia happens when your red blood cells decrease and there aren’t enough of them to carry adequate oxygen to your tissues. A blood test will also help identify or rule out other infections.

The blood test can also detect an increase in white blood cells, a low level of the protein albumin, and an elevated C-reactive protein level - all indications of inflammation in your body.

Colonoscopy -

Another way to diagnose ulcerative colitis is a colonoscopy.

This is also an outpatient procedure, which means you can go home when it’s done. It usually takes between 30 minutes to an hour. You’ll have to drink a liquid laxative the night before to clean out your bowels. This is because your large intestine must be clear for a successful test. Your doctor will give you instructions on how to prepare the day before.

Use a flexible tube called a colonoscope to look at your entire colon. He can also take a biopsy, or tissue sample if he needs to.

During the test, a long, thin colonoscope is inserted into your rectum and moved up through your large intestine. You may get a sedative to help you relax.

Sigmoidoscopy -

A sigmoidoscope is a long, flexible tube about a half-inch in diameter. It has a light and a small camera on the end of it. A doctor inserts it into your rectum so he can look at parts of the large intestine. You may be given medicine to help you relax .

Doctor will be able to see the intestinal tissue immediately, detecting inflammation and bleeding, and may be able to tell if you have ulcerative colitis or another problem.

X-ray and CT scan -

X-ray to make sure you don’t have another kind of problem, like a perforated colon.Or you might need a CT scan. It helps detect any complications from ulcerative colitis or rule out other conditions that are similar.

4] Ulcerative Colitis Treatment

1. Antibiotics - These fight infections and let your large intestine heal.
2. Aminosalicylates - These drugs have something called 5-aminosalicylic acid (5-ASA) that fights inflammation and helps control symptoms
3. Corticosteroids
4. Immunomodulators
5. Biologics
6. Loperamide
7. Diet

Diet :- Some foods can make your symptoms worse. You might find that soft, bland food doesn’t bother you as much as spicy or high-fiber dishes. If you can’t digest the sugar in milk called lactose.doctor may tell the pt. to stop eating dairy products. A balanced diet with plenty of fiber, lean protein, fruits, and veggies should provide enough vitamins and nutrients.

Medicine :- Your doctor may prescribe a few different kinds of drugs, including:

• Antibiotics. These fight infections and let your large intestine heal.
• Aminosalicylates. These drugs have something called 5-aminosalicylic acid (5-ASA) that fights inflammation and helps control symptoms. You might get pills to swallow or an enema or suppository to put in your bottom.
• Corticosteroids. If aminosalicylates don’t work or your symptoms are severe, your doctor might give you these anti-inflammatory drugs for a short time.
• Immunomodulators. These help stop your immune system’s attack on your colon. They can take a while to take effect. You might not notice any changes for up to 3 months.
• Biologics. These are made from proteins in living cells instead of chemicals. They’re for people with severe ulcerative colitis.
• Loperamide. This can slow or stop diarrhea. Talk to your doctor before taking it.

Others

Surgery :- If other treatments don’t work or your UC is severe, you might need surgery to remove your colon (colectomy) or colon and rectum (proctocolectomy). If you have a proctocolectomy, your doctor might make a small pouch out of your small intestine and attach it to your anus. This is called ileal pouch-anal anastomosis (IPAA). It lets your body expel waste normally, so you don’t need to wear a bag to collect stool.

• Bleeding :-This can lead to anemia.
• Osteoporosis :- Your bones might become weak because of your diet or if you take a lot of corticosteroids.
• Dehydration :- You might need to get fluids through a vein (intravenous, or IV) if your large intestine can’t absorb enough.
• Inflammation :-This can affect your joints, skin, or eyes.
• Fulminant colitis :-If your UC attack is severe, your colon might burst, or infection could spread through your body. Your intestines stop moving waste, and your belly swells.
• Megacolon :- Fulminant colitis can cause your large intestine to swell or burst. This is a dangerous complication, and you’ll probably need surgery.
• Liver disease :- Your bile ducts or liver could become inflamed, or you could get scar tissue in your liver.
• Colon cancer :- Ulcerative colitis puts you at higher risk of getting colon cancer, especially if the whole large intestine is affected.

5]

*Smoking cessation

*Nutritional

*Screening for malnutrition and micronutrient deficiencies

*Anemia

*Bone health - # Prevention of osteoporosis and osteopenia

# Calcium and vitamin D supplementation.

*Eye health

*Screening for sleeping disorder

* Psychological health