Colostomy products

DIFFERENT TYPES OF PRODUCTS FOR COLOSTOMY

Pouch
There are a variety of sizes and styles of colostomy pouches. Pouches are lightweight and odor-proof. Pouches have a special concealment that prevents the pouch from sticking to the body. Some pouches also have charcoal filters which release pedal tardily and support to decrease pedal odor. The mass is general aggregation most types of colostomy pouches



Stoma covers and caps
Stoma caps or covers crapper be placed on the aperture when the aperture is not active (draining). People with descending or colon colostomies who wet may use aperture covers or caps. The cover or cap is attached to the wound in the same artefact as a pouch.



COLOSTOMY CARE



Psychic activity of the enduring for the necessity of colostomy is a daylong first step toward his adjustment to experience with an artificial anus. Proper surgical positioning of the activity module assist tending of the bowel. Control of fecal property and peristaltic rate should ideally display degradation susceptible exclusive to habit or enemata. 


The goal of the enema is to display an evacuation thorough enough to prevent soiling for a day or two. The goal of fare variations is to display a manageable volume and property of fecal stream. The framework of enemas and pick of diet can be personalised when the underlying principles are understood.



COMPLICATIONS OF COLOSTOMIES



Prolapse , Retraction ,Necrosis of distal ends , Stenosis of orifice , Colostomy of hernia , Bleeding ( usually from granulomas around the margin of colostomy ) Colostomy diarrhea ( usually an infective enteritis responds to metronidazole )



Recovery at home is mostly most six weeks, although it haw be longer for patients who are very ill before surgery or who hit complications. Activity module be limited at first, and lifting, housework, and driving are not recommended. The infirmary staff module advise you most your diet when you prototypal get home, which haw be limited to low fiber. Regular appointments with your surgeon module help ensure that your cavum and the surface  around the aperture are sanative well........read more

Here's another head scratcher Acute appendicitis

ACUTE APPENDICITIS

 

Scientist theorize that appendix is a remnant of an ancient digestive tract .They believe that it might have been used by early man to digest tough leaves and bark.But it can create lot of trouble by causing Acute appendicitis.

The appendix is a worm like extension of the cecum and for this reason,has been called the Vermiform appendix.The average length of the appendix is 8-10 cm ( ranging from 2-20 cm ).The appendix appears during the fifth month of gestation and  several lymphoid follicles are scattered in its mucosa.Such follicle increase in number when individuals are aged 8-20 years.

 

LOCATION

1.Base of appendix:

       it is found attached to posteromedial surface of cecum about 2.5 cm below the ileicecal junction.

2.Body and tip of appendix:

   a. Retrocecal  (74 %)

   b. Pelvic  (21 %)

   c. Paracecal (2 % )

   d .Subcecal  ( 1.5 % )

   e. Periileal  (1 %)

   f. Postileal (0.5 % )

Vermiform appendix has a complete peritoneal covering, which is attached to lower layer of mesentry of small intestine to form a short mesentry of its own.the mesoappendix,but there is some variations.distal 1/3 of its may be bereft of mesoappendix.

 

ETIOLOGY

 

SEX: Males are more commen than female.

SOCIAL STATUS: Upper and middle class

DIET: One relatively rich in meat,& devoid of simple diet rich in cellulose

Familial susceptibility.

OBSTRUCTION OF LUMEN OF APPENDIX:Fecoliyh ,a stricture,a foriegn body,a rond worm.or thread worms.

DISTAL OBSTRUCTION OF COLON: Carcinoma of right colon.

Abuse of purgatives.

BACTERIA: a mixture of E coli,enterococci,non hemolytic streptococci,anaerobic streptococci,Cl welchi,& bacteroids.

 

PATHOLOGY

 

NON OBSTRUCTIVE ACUTE APPENDICITIS

Inflammation usually begins in mucosa,& less often in ymph follicles,but on reaching the loose submucosa it progresses rapidly.Organ becomes turgid and dusky red with mucosal hemmorrhages.Vascular supply of distal part of appendix is at risk.because here is the artery is inframural & liable to occlusion by in inflammation or thrombosis,this may lead to gangrene of  tip.

Inflammation may progress sufficiently slowly for protective barriers to form ,& the resulting peritonitis is localized .It can terminate in one of the following ways:

Resoluton

Ulceration

Suppuration

Fibrosis

Gangrene

 

OBSTRUCTIVE ACUTE APPENDICITIS

Products of inflammation becomes pent up,so that it proceeds more rapidly & more certainly to gangrene or perforation.Often within 12-18 hrs,appendix distal to obstruction become gangrenous.Perforation occurs most often at the site of an impacted fecolith before protective adhesions have had time to form-Escaping purulent & gaseous contents are under high pressure ,& early widespread peritonitis is liable to ensue -Subphrenic & pelvic abcesses are a later sequel if patient survives the initial peritonitis.

 

CLINICAL FEATURES

 

Age incidence : Increasingly common during childhood & adolescence ,maximum incidence is between 20 & 30 years.

 

NON-OBSTRUCTIVE ACUTE APPENDICITIS 

SYMPTOMS

Abdominal pain which shift : Initially there is constant, vague pain around umblicus,in epigastrium,or it may be generalized.After a few hours pain become intense .& shift to the point where inflammed appendix irritates partial peritoneum ( usually in right iliac fossa ).

Gastric function Upset : Anorexia, nausea, infrequent vomiting & stops as soon as stomach is empty.Usually constipation is present ,but occasionally diarrhea occur.

SIGNS

GENERAL SIGNS :  Pyrexia ( 99 - 100 F )

                          Tachycardia  ( 80 - 90 per min ) 

                          Tongue  ( white & furred )

                          A special fetor oris

LOCAL SIGNS

Localized tenderness after the pain shifts, either at McBurney's point or elsewhere ( determined by the site of appendix ).

Muscle guarding & rigidity in right iliac fossa .

Rebound tenderness at McBurney's point in right iliac fossa.

Pressure on left iliac fossa may cause pain in right iliac fossa.

Release of pressure on left iliac fossa may cause pain in right iliac fossa.

Last three manoeuvres cause pain because they move the inflamed appendix.

 

OBSTRUCTIVE ACUTE APPENDICITIS

Sequence of clinical events occurs much more quickly:

Onset is abrupt .& there may be severe generalized abdominal colic from start.However ,the pain shifts in the usuall way.

Vomiting is common

Temperature can be normal

Local signs are as mentioned above.

 

INVESTIGATIONS

 

Appendicitis is essentially a clinical diagnosis.

The following may be useful.

• Urine analysis may exclude urinary tract infection.
• Pregnancy test to exclude ectopic pregnancy.
• Abdominal x-ray is of little value.
• A normal white cell count does not exclude appendicitis.
• Ultrasound may be helpful in the assesment of an appendix mass or abcess.
• Ultrasound adds little to the clinical diagnosis of acute appendicitis.
• Scoring system and computer-aided diagnosis may be helpful.
• Meta analysis suggest the following  to be useful predictor of appendicitis in patients with abdominal pain. 

              Raised inflammatory markers '

              Clinical signs of peritoneal irritation.

              Migration of abdominal pain.

Treatment for acute appendicitis

THE APPENDIX DOES NOT APPEAR TO HAVE ANY FUNCTION IN THE HUMAN BODY ...SO HOW CAN WE PANIC THROUGH NON FUNCTION ORGAN ???

TREATMENT

INDICATION FOR SURGICAL CONSULTATION AND SURGERY
A surgeon should evaluate any patient with classic migrating abdominal  tenderness. Because only a little more than half of patients with appendicitis present with a classic history and physical findings, acute appendicitis should be on the list of possible diagnoses for any patient with abdominal pain. Thus, a surgeon should also evaluate patients with focal RLQ tenderness or progressively worsening abdominal pain.
To minimize the time between show and appendectomy, obtain surgical conference prior to performing additional diagnostic studies, such as CT scan, ultrasound, and technetium (Tc)-labeled WBC scan.3

Indications for operation
Any patient with suspected appendicitis who has
(1) persistent discompose and becomes febrile,
(2) an increasing WBC count, or
(3) worsening clinical examination findings should undergo extirpation or at least diagnostic laparoscopy. In patients with an atypical presentation, the most important determination for extirpation is serial physical examinations. The WBC count often does not process after the patient is admitted and hydrated; therefore, any patient sent home from the emergency department should undergo a follow-up evaluation the incoming day.3

APPENDICECTOMY
Open by giving INCISION

• Grid-iron incision.
• Paramedian incision.
• Rutherford Morison's incision.

REMOVAL OF APPENDIX
A retractor is placed under the medial side of peritoneum & abdominal wall is lifted up.Any pus or serous exudate is removed with a sucker & a pack is inserted into wound on medial side.Using a a swab,cecum is withdrawn.A finger may be inserted into wound to aid delivery of appendix.Cecum is grasped by an assistant. Atissue -holding forceps is applied around the appendix in such a way as to encircle the organ & yet not damage it .Base of mesoappendix is clamped in a hemostat,tied & severed.when mesoappendix is broad,procedure must be repeated with a 2nd or a 3rd hemostat.Appendix ,now completely freed,is crushed near its junction with cecum in a hemostat,which is removed & reapplied just distal to crushed portion.A catgut ligature is tied around crushed portion close to cecum,& an atraumatic catgut purse-string suture is inserted into cecum about 1.25 cm frombase  & is left  untied until appendix has been amputated with a scalpal below hemostat.Stump is invaginated while purse -string suture is tied,thus burying the appendix stump.

PERITONEAL LAVAGE
Peritoneum is washed out with antibiotic laden irrigating fluids.

ANTIBIOTICS
Prophylactic antibiotics active against aerobic & an aerobics organism are given in 2 doses ( one at the time of surgery & next 8-12 hours later )

DRAINAGE OF PERITONEAL CAVITY
Unnecessary, provided adequate peritoneal lavage has been done.However ,performed if there is considerable purulent fluid in retrocecal space or pelvis, or if there is persistent oozing.

DRAINAGE OF PARIETES
Indicated if there is any soiling of wound ,especially in obese & in children.


COMPLICATIONS OF APPENDICECTOMY

EARLY

• ILeus
• Wound sepsis
• Residual abscess
• Intestinal obstruction from adhesins
• Fecal fistula
• Pyelophlebitis
• Postoperative thrombosis & embolism
• Actinomycosis
• Pulmonary complications (pulmonary collapse or pneumonia )

LATE

• Intestinal obstruction from adhesions
• Incisional hernia
• Right inguinal hernia following grid iron incision
• Sterility in female from frozen pelvis.

Cholecystitis acute

INCIDENCE RATE APPROXIMATELY SAME IN WORLDWIDE

5 TO !0 % MORTALITY OCCURS IN PATIENTS OLDER THAN 60 YEARS.

ACUTE CHOLECYSTITIS : is an inflammation of the gall bladder ,and is usually associated with stones. Occasionally it occurs without stones,i.e. acalculous cholecystitis.The later may be due to infection with E coli .Clostridia,or rarely Salmonella typhi. Acalculous cholecystitis may occur after prolonged starvation or total parenteral nutrition. Stasis is probably a contributing factor in the latter conditions .

The gall bladder becomes oedematous ,with mucosal ulceration ,and a fibrinopurulent exudate .Acute inflammatory cells infiltrate the wall . Even in the presence of thrombosis of the cystic artery ,gangrene is rare ,as the gall bladder gains a blood supply directly from the liver via the gall bladder bed .However ,gangrene does occasionally occur with perforation of the gall bladder ,resulting in generalised bile peritonitis or a localised abscess depending on whether the gall bladder has been walled off by adhesions or not .An empyema of the gall bladder may also result, suppuration occuring within the gall bladder and the gall bladder becoming distended with pus. Occasionally the gall bladder may fistulate into the duodenum.

Factors that haw initiate the inflammatory process include the manufacture of inflammatory mediators (eg, lysolecithin and prostaglandins); an increase in intraluminal pressure in association with compromise of the murder supply; and chemical botheration by bile acids. 

90 % calculous and 10 % acalculous, Acalculous cholecystitis associated with higher complication rate and associated with acute illness ( i.e. burns ,trauma, major surgery ) ,fasting ,hyperalimentation leading to gall bladder stasis ,vasculitis ,carcinoma of gall bladder or common bile duct ,some gall bladder infections ( Leptospira ,Streptococcus,Parasitic ,etc.) but in >50% of cases an underlying explanation is not found.

In patients who hit emphysematous cholecystitis, ischemia of the gall bladder surround is followed by infection with gas-forming organisms that display pedal in the bladder lumen, in the gall bladder wall, or both. In 30-50% of patients, preexisting diabetes mellitus is present; the male-to-female ratio is 5:1.1 Gas haw be confined to the gall bladder; however, in 20% of cases, pedal is also seen in the rest of biliary tree. Gallstones are not inform in 30-50% of cases, and the mortality rate is 15%.1  There is a predisposition for gangrene formation and perforation, but clinical symptoms are mild; much symptoms can be deceptive. Emphysematous cholecystitis haw occur after chemoembolization performed as palliation for hepatocellular carcinoma; after fat embolism during aortography; and after gall bladder hypoperfusion during viscus resuscitation.

CLINICAL FINDINGS

Acute cholecystitis usually occurs with correct upper quadrant discompose and tenderness. The abdominal discompose increases with time. The place of discompose is usually the correct subcostal region, though the discompose haw begin in the epigastrium or the mitt upper quadrant and then shift to the correct subcostal region to the area of the gallbladder  inflammation. Referred discompose to the correct shoulder or the interscapular region haw be experienced. Approximately greater than half of patients hit had preceding attacks of similar discompose that spontaneously resolved. Anorexia, nausea, and vomiting haw occur, but vomiting is seldom severe. Most patients are symptom and hit no leukocytosis.

When feverishness occurs, the patient's temperature is seldom higher than 38°C. Chills are unusual; their proximity suggests a case of complicated cholecystitis (abscess or associated cholangitis).

In some patients with acute cholecystitis  hit mild jaundice, which haw be related to ordinary hepatic edema, bile duct edema, or both, or to the proximity of calculi within the common bile duct.1 In most patients, improvement occurs within 24 hours after hospitalization, and signs and symptoms gradually subside. Persistent pain, feverishness and leukocytosis, chills, and more nonindulgent localized or generalized compassionateness haw indicate complicated disease, much as abscess manufacture or GB perforation. The utilization of empyema of the GB haw display systemic toxicity, and it haw be predictive of GB perforation.

Acute acalculous cholecystitis  is difficult to diagnose clinically. It often occurs in children  and in patients who are critically ill or who hit fresh undergone pronounce from nonindulgent trauma, burns, or surgery. Predisposing factors allow prolonged fasting, immobility, and hemodynamic instability. Often, these patients cannot impart pain; however, fever, jaundice, vomiting, abdominal tenderness, leukocytosis, and hyperbilirubinemia are highly suggestive findings.

In approximately 1/3rd of patients, a distended, tender gall bladder haw be palpable as a distinct mass. This is an important clinical finding and haw confirm the diagnosis.

LABORATORY TEST Shows mild leukocytosis ,serum bilirubin alkaline phosphatase and AST may be mildly elevated.

DIAGNOSTIC INVESTIGATIONS

CHEST AND PLAIN ABDOMINAL X-RAYS it can help to exclude other causes ,and show radio-opaque stones .

ORAL CHOLECYSTOGRAPHY it is unreliable during acute attack , and is postponed until patients has recovered.

ULTRASONOGRAPHY confirm the diagnosis.

RADIOISOTOPE SCANNING confirm the diagnosis .

TREATMENT

CONSERVATIVE TREATMENR FOLLOWED BY CHOLECYSTECTOMY 

No oral intake ,nasogastric suction .IV fluids and electrolytes ,analgesia ( mepridine or NSAIDS ). and antibiotics ( ureidopenicillins ,ampicillin sulbactam ,third generation cephalosporins ,anaerobic coverage should be added if gangerous or emphysematous cholecystitis is suspected , consider combination with aminoglycosides in diabetic patient or others with signs of gram-negative sepsis.Acute symptoms will resolve in 70% of patients.

SURGERY  Optimal timing of surgery depends on patients stabilization and should be performed as soon as feasible. Urgent cholecystectomy is appropriate in most patients with a suspected or confirmed complication. Delayed surgery is reserved for patients with high risk of emergent surgery and where the diagnosis is in doubt.

Recurrent symptoms are common in patients with acute cholecystitis who are treated expectantly; most patients need elective cholecystectomy.

Percutaneous cholecystostomy is a minimally invasive procedure that can goodness patients with serious comorbidity who are at broad venture from major surgery. Percutaneous cholecystostomy can be performed at the bedside low local drug and is suitable for patients in qualifier care units and those with burns. It is the expressed treatment in patients with acalculous cholecystitis , or it may be used as a temporising measure—to pipage pussy bile and retard the requirement for expressed treatment.

Treatments for ulcerative colitis

TREATMENT

Both medications and surgery have been used to treat ulcerative colitis. However, surgery is reserved for those with severe rousing and life-threatening complications. There is no medication that can cure ulcerative colitis. Patients with ulcerative redness will typically undergo periods of relapse (worsening of inflammation) followed by periods of remission (resolution of inflammation) lasting months to years. 

During relapses, symptoms of abdominal pain, diarrhea, and rectal injury worsen. During remissions, these symptoms subside. Remissions usually occur because of communication with medications or surgery, but occasionally they occur spontaneously, that is, without some treatment.

Medications treating ulcerative redness allow 1) anti-inflammatory agents such as 5-ASA compounds, systemic corticosteroids, topical corticosteroids, and 2) immunomodulators.

Anti-inflammatory medications that modification intestinal rousing are analogous to arthritis medications that modification render rousing (arthritis). The anti-inflammatory medications that are used in the communication of ulcerative redness are:

Immunomodulators are medications that suppress the body's insusceptible system either by reaction the cells that are responsible for immunity, or by interfering with proteins that are important in promoting inflammation. Immunomodulators increasingly are becoming important treatments for patients with severe ulcerative redness who do not move adequately to anti-inflammatory agents. Examples of immunomodulators allow 6-mercaptopurine (6-MP), azathioprine (Imuran), methotrexate (Rheumatrex, Trexall), cyclosporine (Gengraf, Neoral).

SURGERY

If fasting and lifestyle changes, drug therapy or other treatments don't assuage your signs and symptoms, your doctor may propose surgery.
Surgery can often decimate ulcerative colitis. But that usually means removing your whole colon and rectum (proctocolectomy). In the past, after this surgery you would dress a small bag over an opening in your cavum (ileostomy) to collect stool. But a procedure titled ileoanal anastomosis eliminates the need to dress a bag. Instead, your doc constructs a pouch from the modify of your small intestine. The pouch is then attached directly to your anus. This allows you to expel squander more normally, although you may hit more-frequent viscus movements that are soft or watery because you no individual hit your colon to absorb water.

If you hit surgery, communicate your doctor whether an ileostomy or an ileoanal pouch is correct for you. Between 25 and 40 proportionality of people with ulcerative colitis eventually need surgery.

COMPLICATIONS 


These include toxic dilatation .haemmorrhage ,stricture and perforation .Carcinomas may occur ,the overall incidence being around 2% .However ,in patients who have had the disease for over 25 years this rises to 10 %.Factors associated with higher risk inclde onset in childhood , a severe first attack ,total colonic involvement ,and contineuos rather that intermittent symptoms .Extracolonic complications include seronegative arthritis ( sacroilitis ,ankylosing spondylitis) sclerosing cholangitis ,cirrhosis ,pericholangitis ,iritis uveitis ,episcleritis erythema nodosum ,pyodera gangrenosum ,and apthous stomatitis .Rarely , systemic amloidosis may occur.

ULCERATIVE COLITIS 

CAUSES

SYMPTOMS

DIAGNOSIS

TREATMENT

SURGERY

COMPLICATIONS

Ulcerative colitis diagnosis

DIAGNOSTIC INVESTIGATIONS 

Many tests are utilised to diagnose ulcerative colitis. A fleshly communicating and medical history are usually the first step.Blood tests haw be done to check for anemia, which could indicate injury in the colon or rectum, or they haw uncover a high white murder radiophone count, which is a sign of rousing somewhere in the body

.

A crap distribution can also reveal white murder cells, whose presence indicates ulcerative redness or inflammatory disease. In addition, a crap distribution allows the student to detect injury or infection in the colon or rectum caused by bacteria, a virus, or parasites.

A colonoscopy or endoscopy are the most accurate methods for making a diagnosis of ulcerative redness and ruling-out another doable conditions, much as Crohn’s disease, diverticular disease, or cancer. For both tests, the student inserts an endoscope—a long, flexible, aflame tube adjoining to a computer and TV monitor—into the arsehole to wager the exclusive of the colon and rectum. The student will be healthy to wager some inflammation, bleeding, or ulcers on the colon wall. During the exam, the student haw do a biopsy, which involves attractive a distribution of tissue from the covering of the colon to view with a microscope.

A colonoscopy or endoscopy are the most accurate methods for making a diagnosis of ulcerative redness and ruling-out another doable conditions, much as Crohn’s disease, diverticular disease, or cancer. For both tests, the student inserts an endoscope—a long, flexible, aflame tube adjoining to a computer and TV monitor—into the arsehole to wager the exclusive of the colon and rectum. The student will be healthy to wager some inflammation, bleeding, or ulcers on the colon wall. During the exam, the student haw do a biopsy, which involves attractive a distribution of tissue from the covering of the colon to view with a microscope.

A colonoscopy or endoscopy are the most accurate methods for making a diagnosis of ulcerative redness and ruling-out another doable conditions, much as Crohn’s disease, diverticular disease, or cancer. For both tests, the student inserts an endoscope—a long, flexible, aflame tube adjoining to a computer and TV monitor—into the arsehole to wager the exclusive of the colon and rectum. The student will be healthy to wager some inflammation, bleeding, or ulcers on the colon wall. During the exam, the student haw do a biopsy, which involves attractive a distribution of tissue from the covering of the colon to view with a microscope.

Sometimes x rays much as a barium enema or CT scans are also utilised to diagnose ulcerative redness or its complications.

ULCERATIVE COLITIS 

CAUSES

SYMPTOMS

TREATMENT

SURGERY

COMPLICATIONS

Disease ulcerative colitis

AROUND 100,000 HAVE THIS DISASE IN UK

CURRENT HYPOTHESIS ,

HIGHER CONCORDANCE RATE IN MONOZYGOTIC TWINS

ULCERATIVE COLITIS 

Ulcerative colitis is a inflammatory disease which involves the whole part of the colon .The inflammation is initially confined to the mucosa and nearly always involves the rectum .extending to involve the distal or whole colon.In severe cases the inflammation may extend into the muscle coats .Acute complications include toxic dilatation , haemorrhage and perforation .

AETIOLOGY 

The cause of ulcerative colitis is not known.Current hypotheses includes immunological ,dietary and genetic factors .Familial clustering occurs . There is an association with HLA-DR2.Other evidence of a genetic role includes a higher concordance rate in monozygotic twins  ,and increased prevalence in certain ethnic groups and an association with disease that are known to have a genetic predisposition .e.g ankylosing spondylitis and sclerosing cholangitis . Immunological mechanism may be important .Under normal circumtances the mucosal immune system is tolernt of luminal forign antigens and this is dependent upon the relationship between colonic epithelium and suppressor T cells .

Changes in epithelial cell antigen presentation consequent upon an acquired expression of class II major histocompatibility mlecules activate helper T lymphocytes and induce a sustained mucosal immune reaction .Antigens from gut flora may be responsible for this .This may explain the well-known triggering of ulcerative colitis by enteric infections. Dietary factors may also provide a triggering factor.

MORPHOLOGY ulcerative colitis is a diffuse inflammatory disease confined initially to the mucosa.Unlike Crohn's disease it is confined to the large intestine and is continuous in its distribution.In some cases it is confined to the rectum ( proctitis ) ,or to the rectosigmoid (distal proctitis ).

Abcesses form in the crypts of Lieberkuhn ,penetrate the superficial mucosa ,spread horizontally and cause the overlying mucosa to slough.The margins of the ulcers are raised as mucosal tags that project into the lumen ( inflammatory pseudopolyps ) Except in the most seere forms the muscle layers are spared .Occasionally the last few centimeters o the terminal ileum is ulcerated ,i.e the so called condition of 'backwash ' ileitis .

CLINICAL FEATURES  More common in women ,aged 3rd ,4th and 2nd decade ,in that order .

SYMPTOMS

IN CHRONIC TYPE initially watery diarrhea occuring day and night ,in a person of previously normal bowel habit.Later a rectal discharge of mucus ,sometimes blood stained and purulent is very common .Severe bloody diarrhea upto 20 times daily may occur .pain is unusual ,initially,relases and remissions.

IN ACUTE FULMINATING TYPE

Incessant diarrhea containing blood ,mucus and pus .fever Abdominal distension ( due to toxic dilatation of colon ) ,Abdominal pain

SIGNS

IN CHRONIC TYPE depending upon severity of attacks dehydration ,Anemia

IN ACUTE FULMINATING TYPE pyrexia ,100-102 F .dehydration ,anemia and abdominal distension.

ULCERATIVE COLITIS 

CAUSES

SYMPTOMS

DIAGNOSIS

TREATMENT

SURGERY

COMPLICATIONS