COLITIS - there are three main types of colitis:
Ischemic Colitis: Inflammation of the colon resulting from an interruption of the colonic blood supply that did not lead to full-thickness loss of the colonic wall. -- may result from occlusion of a major artery, small vessel disease, venous obstruction, low flow states (eg, cardiogenic shock), or intestinal obstruction. The typical patient is over 50 and presents with acute left-sided abdominal pain that began in the left iliac fossa. There may be associated symptoms of cardiovascular disease or collagen vascular disease.
Antibiotic-Associated Colitis: Acute inflammation of the colon caused by Clostridium difficile and associated with antibiotic use. Various antibiotics may alter the balance of normal colonic flora and allow overgrowth of C. difficile, an anaerobic gram- positive bacillus. Diarrhea and colitis are caused by toxins produced by pathogenic strains of C. difficile. May result from using ampicillin, amoxicillin, erythromycin, sulfonamides, tetracyclines, and quinolones. Susceptibility increases with age.
Ulcerative Colitis: A chronic, inflammatory, and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea. -- cause unknown. Evidence suggests that a genetic predisposition leads to an unregulated intestinal immune response to an environmental, dietary, or infectious agent. However, no inciting antigen has been identified. The evidence for a specific mocrobial etiology is even less convincing than for Crohn's disease, and the familial tendency is less pronounced. Bleeding is the most common local complication. Another particularly severe complication, toxic colitis, occurs when transmural extension of ulceration results in localized ileus and peritonitis. As it progresses, the colon loses muscular tone and begins to dilate. The incidence of colon cancer is increased when the entire colon is involved and the disease last for more than 10 years. Extracolonic problems include peripheral arthritis, ankylosing spondylitis, sacroiliitis, anterior uveitis, erythema nodosum, pyoderma gangrenosum, episcleritis, and retarded growth and development in children.
TREATMENT: Avoiding raw fruits and vegetables limits mechanical trauma to inflamed colonic mucosa and may lessen symptoms. A milk-free diet may help. An anticholinergic drug, loperamide, diphenoxylate, deodorized opium tincture, or codeine may be prescribed. These antidiarrheal drugs must be used with extreme caution in more severe cases because they may precipitate toxic dilation. In mild cases, hydrocortisone may be prescribed, and because of side effects with oral corticosteroids, enema preparations of new corticosteroid analogs such as budesonide are becoming more widely used.
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