2. Erosion in the lining of colonErosion in the lining of colon
(mucosa and sub mucosa)(mucosa and sub mucosa)
3. It is characterized by inflammation andIt is characterized by inflammation and
ulceration of colon resulting in frequent passageulceration of colon resulting in frequent passage
of stools with blood and mucus.of stools with blood and mucus.
It is confined to colon and rectum.It is confined to colon and rectum.
4. INCIDENCEINCIDENCE unknown causeunknown cause
at any ageat any age
predominates in middlepredominates in middle
and higher incomeand higher income
groups.groups.
6. Nitric oxide synthesis is increased in U.CNitric oxide synthesis is increased in U.C
NO is produced from arginine by nitric oxideNO is produced from arginine by nitric oxide
synthase.synthase.
U.C is assosiated with increase in mucosalU.C is assosiated with increase in mucosal
vasodilation.vasodilation.
7. CLINICAL FINDINGSCLINICAL FINDINGS
Mucosa becomes fragile.Mucosa becomes fragile.
In early stages mucosa is edematous andIn early stages mucosa is edematous and
hyperemic.hyperemic.
In severe stage, necrosis and frank ulceration ofIn severe stage, necrosis and frank ulceration of
mucosa occur.mucosa occur.
8. SymptomsSymptoms
Attack of dysentery.Attack of dysentery.
Exacerbations and remissions.Exacerbations and remissions.
Loss of water, electrolytes, blood and protein.Loss of water, electrolytes, blood and protein.
Weight lossWeight loss
DehydrationDehydration
FeverFever
AnemiaAnemia
Abdominal painsAbdominal pains
9. AnorexiaAnorexia
Metabolic rate is increasedMetabolic rate is increased
Liver damageLiver damage
Constipation-distal irritability and spasm.Constipation-distal irritability and spasm.
10. CAUSES OF NUTRITIONCAUSES OF NUTRITION
PROBLEMSPROBLEMS
MECHANISMMECHANISM
Decreased nutritional intakeDecreased nutritional intake
Increased nutritional lossesIncreased nutritional losses
Nutritional interference by drugsNutritional interference by drugs
CONTRIBUTINGCONTRIBUTING
FACTORFACTOR
Anorexia, nausea, painAnorexia, nausea, pain,,
restrictive/unbalanced diet.restrictive/unbalanced diet.
Malabsorption, intestinal resection,Malabsorption, intestinal resection,
bacterialbacterial over growth, bile saltover growth, bile salt
deficiency, drugs.deficiency, drugs.
DiarrheaDiarrhea
BleedingBleeding
Protein-losing enteropathyProtein-losing enteropathy
Intestinal lymphangiectasiaIntestinal lymphangiectasia
Corticosteroids, sulfasalazine,Corticosteroids, sulfasalazine,
cholestyraminecholestyramine
11. NEED FOR NUTRITIONALNEED FOR NUTRITIONAL
CARECARE
MalnutritionMalnutrition
insufficient food consumptioninsufficient food consumption
excessive nitrogen lossesexcessive nitrogen losses
- blood, mucus and necrotic- blood, mucus and necrotic
colonic mucosacolonic mucosa
-electrolyte loss in feces-electrolyte loss in feces
Absorptive areas are destroyedAbsorptive areas are destroyed
ulcerations of mucosa and scar tissuesulcerations of mucosa and scar tissues
Tissue repair and restore normal functioningTissue repair and restore normal functioning
12. DIETARY PRINCIPLESDIETARY PRINCIPLES
Individual attentionIndividual attention
Diet- highly individualized, nutritionally adequateDiet- highly individualized, nutritionally adequate
Small 6 to 8 feedingsSmall 6 to 8 feedings
Based up on severity of disease it ranges fromBased up on severity of disease it ranges from
TPNTPN
nasogastric feeding of E.Fnasogastric feeding of E.F
oral ingestion of E.Doral ingestion of E.D
exclusion of regular foodsexclusion of regular foods
fiber supplementationfiber supplementation
high fiber diet.high fiber diet.
14. Small intestine is not involved.Small intestine is not involved.
Oral or Enteral feedingOral or Enteral feeding
- integrity of intestinal epithelium- integrity of intestinal epithelium
Prep. – protein concentratePrep. – protein concentrate
eg. Complan.eg. Complan.
15. Low residue dietLow residue diet
- high in protein and energy.- high in protein and energy.
Exclusion of Irritating foods –nuts, legumes,Exclusion of Irritating foods –nuts, legumes,
raw fruits, etc.raw fruits, etc.
In acute U.C – Strict low residue dietIn acute U.C – Strict low residue diet
- fecal stasis.- fecal stasis.
Fiber content – high fiber diet.Fiber content – high fiber diet.
Soluble fibers and pectinsSoluble fibers and pectins
17. Carbohydrates : soups, etcCarbohydrates : soups, etc
Fats : normalFats : normal
fried foods are notfried foods are not
easily digested.easily digested.
Vitamins : commercial prep.Vitamins : commercial prep.
(orally or injections)(orally or injections)
18. MineralsMinerals
Mineral loss must be marked.Mineral loss must be marked.
Unless marked – fatal outcomeUnless marked – fatal outcome
Sodium : large volume of fecesSodium : large volume of feces
extra salt in food, saline infusion.extra salt in food, saline infusion.
Potassium :Potassium :
Symptoms- weakness, hypotonia, abdominalSymptoms- weakness, hypotonia, abdominal
distension, E.C changes.distension, E.C changes.
potassium citrate orallypotassium citrate orally
19. Iron : 30g/dayIron : 30g/day
oral route if not toleratedoral route if not tolerated
AnemiaAnemia
Intra muscular injectionsIntra muscular injections
Blood transfusionBlood transfusion
Fluids : liberal intakeFluids : liberal intake
1200 – well hydrated1200 – well hydrated
20. Calcium : Rapid bone lossCalcium : Rapid bone loss
-milk exclusion-milk exclusion
-steroid therapy-steroid therapy
calcium salts – orallycalcium salts – orally
FOODS TO BE AVOIDEDFOODS TO BE AVOIDED
spices, stale foods,spices, stale foods,
irritant foods - legumes, nuts etc.irritant foods - legumes, nuts etc.
21. Psychological aspectsPsychological aspects
They are significantThey are significant
Therapy for depression, relaxation can benefitTherapy for depression, relaxation can benefit
the patient.the patient.
Exercise is important adjunct.Exercise is important adjunct.
22. U.C AND CANCERU.C AND CANCER
Constipated patients – lump in right colon.Constipated patients – lump in right colon.
Risk of cancer is increased in cases lasting moreRisk of cancer is increased in cases lasting more
than 7 years.than 7 years.