amebic colitis


a·me·bic co·li·tis

inflammation of the colon in amebiasis.

a·me·bic col·i·tis

(ă-mē'bik kō-lī'tis) Inflammation of the colon in amebiasis.

colitis

(ko-lit'is) [ col- + -itis] Inflammation of the colon. See: dysentery; gay bowel syndrome; Crohn disease

amebic colitis

Amebiasis.

antibiotic-associated colitis

Antibiotic-induced diarrhea. See: pseudomembranous colitis

collagenous colitis

Abbreviation: CC
Chronic watery diarrhea of unknown cause, in which the appearance of the bowel during endoscopy is normal. Biopsies of the bowel wall reveal thickening of the collagen layer beneath the colonic epithelium. CC is ten times more common in women than in men and is usually diagnosed in people aged 40 to 60.

E. coli 0157:H7 colitis

An infectious, bloody diarrhea caused by Escherichia coli 0157:H7. See: E. coli 0157:H7.

infectious colitis

Colitis caused by pathogens such as amebas, bacteria, and protozoa. It may be caused by Campylobacter, Cryptosporidium, Escherichia coli, Entamoeba histolytica, Giardia, Salmonella, , and Shigella.

lymphocytic colitis

Abbreviation: LC
Chronic watery diarrhea of unknown cause, in which the endoscopic and radiological appearance of the bowel wall is normal. Biopsies of the bowel wall reveal excessive numbers of lymphocytes within the intestinal epithelium. LC is equally common in men and women and is usually diagnosed in people aged 40 to 60.

microscopic colitis

Abbreviation: MC
Either of two forms of colitis (collagenous and lymphocytic), in which people have chronic, watery diarrhea despite having normal-appearing bowels during endoscopy or radiologic study.

pseudomembranous colitis

Colitis associated with antibiotic therapy and, sometimes, with chronic debilitating illnesses in adult patients in the community. It is caused by one of two exotoxins produced by Clostridium difficile, which is part of the normal intestinal flora. Broad-spectrum antibiotics disrupt the normal balance of the intestinal flora and allow an overgrowth of strains that produce toxins. The exotoxins damage the mucosa of the colon and produce a pseudomembrane composed of inflammatory exudate. The symptoms (foul-smelling diarrhea with gross blood and mucus, abdominal cramps, fever, and leukocytosis) usually begin 4 to 10 days after the start of antibiotic therapy. The disease is treated by discontinuing previously prescribed antibiotics and beginning therapy with oral metronidazole; use of vancomycin should be limited to patients who do not respond to metronidazole. Diarrhea may reappear in approx. 20% of patients after treatment, necessitating a second course of therapy.

radiation colitis

Colitis due to damage of the bowel by radiation therapy. The symptoms are those of an inflamed bowel (pain, cramps, diarrhea, and rectal bleeding). Malabsorption may develop as a result of permanent injury to the mucosa.

ulcerative colitis

Colitis marked pathologically by continuous inflammation of the intestinal mucosa, which typically involves the anus, rectum, and distal colon, and sometimes affects the entire large intestine. It occurs most often in patients during the second or third decade of life, although a second cluster of cases occurs in patients in their sixties. The disease is associated with an increased incidence of cancer of the colon. Crohn disease; inflammatory bowel disease;

Symptoms

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.

Treatment

Aminosalicylate drugs and corticosteroids decrease symptoms and improve inflammation. Patients with refractory disease may require colectomy.

Patient care

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.