Treatment of Ulcerative Colitis: Medical Management Overview
Primary treatment for ulcerative colitis involves the use of antidiarrhoeals, antibiotics, corticosteroids, diet, vitamins, and general support. Medical management strategies for mild, moderate, and severe attacks are outlined, including medication regimens and indications for surgery. Immunosuppressive drugs like azathioprine may be utilized in cases with an autoimmune background.
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Presentation Transcript
TREATMENT OF TREATMENT OF ULCERATIVE COLITIS ULCERATIVE COLITIS
Primary treatment is medical Primary treatment is medical The components of therapy are: The components of therapy are: Antidiarrhoeals Antidiarrhoeals ( (lomotil Antibiotics ( Antibiotics (sulfasalazine sulfasalazine) ) Corticosteroids Corticosteroids Diet Diet Vitamin and minerals Vitamin and minerals General support General support lomotil) )
The medical management for mild The medical management for mild and mod attack is as follows: and mod attack is as follows: Prednisolone Prednisolone 5 mg 4x a day, 5 mg 4x a day, sulfasalazine sulfasalazine 0.5g 4x a day and and predsol predsol retention enema retention enema shd shd be cont. be cont. Remission Remission- - cont the cont the treatment treatment If relapse breaks out If relapse breaks out- -medical management management fr fr severe attack shd shd be adopted. be adopted. 0.5g 4x a day medical severe attack
M Medical management for severe edical management for severe attack is as follows: attack is as follows: IV fluids, Blood transfusion IV fluids, Blood transfusion Vitamin supplement and maintenance Vitamin supplement and maintenance of nutrition. of nutrition. iv iv Prednisolone Prednisolone 60 mg/day in divided 60 mg/day in divided doses, doses, hydrocort hydrocort sod sod succinate 120 ml rectal drip twice a day. 120 ml rectal drip twice a day. Parenteral Parenteral feeding by feeding by aminosol fructose or ethanol fructose or ethanol Broad spectrum antibiotic Broad spectrum antibiotic Metronidazole Metronidazole, morphine or , morphine or lomotil succinate 100 mg in 100 mg in aminosol with with lomotil. .
Immunosuppressive drug like Immunosuppressive drug like azathioprine azathioprine can be used as the can be used as the disease has a autoimmune disease has a autoimmune background. background. Dose of 2 Dose of 2- -2.5 mg/kg body wt. 2.5 mg/kg body wt. 25% of the pts have shown clinical 25% of the pts have shown clinical improvement. improvement.
S Surgical treatment urgical treatment- - 75 75- -80% cases managed by medical t/t 80% cases managed by medical t/t Only 10% need surgery. Only 10% need surgery. INDICATIONS for emergency surgery: INDICATIONS for emergency surgery: 1) 1) Massive and unrelenting Massive and unrelenting haemorrhage 2) 2) Toxic Toxic megacolon megacolon with impending with impending perforation perforation 3) 3) Fulminating acute ulcerative colitis Fulminating acute ulcerative colitis haemorrhage
INDICATIONS for elective surgery: INDICATIONS for elective surgery: 1. partial intestinal obstruction partial intestinal obstruction 2. 2. Confined perforation with Confined perforation with abcess formation formation 3. 3. Chronic disease Chronic disease 4. 4. Pararectal Pararectal complications such as complications such as fistula and fistula and abcesses abcesses 5. 5. Serious systemic or distant Serious systemic or distant complications not resp. to medical complications not resp. to medical t/t t/t 6. 6. In long cont. colitis which carries In long cont. colitis which carries higher risk of colonic cancer. higher risk of colonic cancer. abcess
The main t/t is single staged TOTAL The main t/t is single staged TOTAL PROCTOCOLECTOMY. PROCTOCOLECTOMY. This procedure is performed through This procedure is performed through midline incision midline incision colon is examined carefully with part colon is examined carefully with part reference to any adhesions to the reference to any adhesions to the neighbouring neighbouring structures structures If so, colon is mobilized to prevent the If so, colon is mobilized to prevent the contamination of contamination of abd abd. Cavity by spillage of the of the faeces faeces Asc Asc and des colon are and des colon are mobilised . Cavity by spillage mobilised
ureters ureters are identified and nylon tape is are identified and nylon tape is passed round each one . passed round each one . DISSECTION OF THE RECTUM DISSECTION OF THE RECTUM- - surrounding tissue is distended by surrounding tissue is distended by 1:200,000 NA in normal saline. 1:200,000 NA in normal saline. Small intestine is divided 8 inches above Small intestine is divided 8 inches above the the ileocaecal ileocaecal valve, valve, prox with the purse string suture. with the purse string suture. Colon and rectum are now removed. Colon and rectum are now removed. Peritoneum in pelvis is sutured, Peritoneum in pelvis is sutured, perineal skin is sutured with a pelvic drain in skin is sutured with a pelvic drain in middle of the middle of the perineal perineal wound. prox end is sutured end is sutured perineal wound.
ileostomy opening is made by cutting a ileostomy opening is made by cutting a disc of skin & disc of skin & subcut subcut. Tissue 3 cm in diameter from ant diameter from ant abd Cruciate Cruciate incision is made on the rectal incision is made on the rectal sheath sheath The ends of a purse string suture of The ends of a purse string suture of ileum are used to pull the ileum out ileum are used to pull the ileum out through hole in through hole in abd abd wall until it protrudes protrudes abt abt 3 inches. 3 inches. Ileum is anchored to the post. Rectal Ileum is anchored to the post. Rectal sheath by a no. sheath by a no. interuppted interuppted sutures to prevent prevent prolapse prolapse. . . Tissue 3 cm in abd wall wall wall until it sutures to
The purse string suture on the end of The purse string suture on the end of ileum is removed, ileum is removed, ileum is turned inside out & the edge of ileum is turned inside out & the edge of the mucosa is anchored to the edge of the the mucosa is anchored to the edge of the skin and a suitable ileostomy appliance skin and a suitable ileostomy appliance is immediately fixed. is immediately fixed.
Early postoperative care: Early postoperative care: care of ileostomy care of ileostomy- - nowadays a ileostomy bag is fitted to the nowadays a ileostomy bag is fitted to the ileostomy spout and is supported by a waist ileostomy spout and is supported by a waist strap and is adhered to skin by adhesive strap and is adhered to skin by adhesive plaster. plaster. The lower rim of the bag should not press on The lower rim of the bag should not press on the lower margin of the ileostomy spout. the lower margin of the ileostomy spout. complications complications- -prolapse prolapse, retraction, stenosis stenosis, bleeding and , bleeding and paraileostomy hernia. hernia. , retraction, paraileostomy
Other methods include: Other methods include: 1. 1. Continent ileostomy(Koch) Continent ileostomy(Koch)- - Ileostomy reservoir is made from which the terminal ileum opens the surface by a one way valve. It doesn t require a bag or appliance and can be emptied at the time pt desires to do so. 2. 2. End ileostomy(Brooke) End ileostomy(Brooke)- - Ileum is brought out through the lateral edge of rectus abdominis msc, spout of ileum is made to project 4cm from the skin surface.
Post opertive complications: Post opertive complications: Infection Infection- - Gm Gm ve ve septicaemia 2. 2. Paralytic Paralytic ileus ileus 3. 3. Intestinal obstruction Intestinal obstruction 4. 4. A persistent A persistent perineal perineal sinus 5. 5. Ileostomy Ileostomy prolapse prolapse 6. 6. Skin problems Skin problems septicaemia 1. 1. sinus Other alternative operations are Other alternative operations are subtotal subtotal colectomy colectomy with anastomosis anastomosis, , colectomy colectomy, mucosal proctectomy proctectomy and and endorectal ileoanal ileoanal anastomosis anastomosis. . with ileorectal ileorectal , mucosal endorectal
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