CLINICAL MANIFESTATIONS
The
clinical presentation is of abrupt onset in about one-third
and may run a fulminant course in 10%.
*
Persistent diarrhoea, preceded by
lower abdominal cramps is
the usual complaint.
*
Small stools recurring 20 to 30 times per day.
The diarrhoea produces
*
Dehydration
*
Hypokalemia
*
Anaemia
*
Hypoproteinemia
*
Marked weight loss
*
Relapsing form with remissions is
also common. Recurrences
are associated with
emotional stress, physical
fatigue,
respiratory infections and other acute illness.
*
Lower abdominal cramping is always present.
COMPLICATIONS
*
Electrolyte deficiencies
*
Microcytic anaemia
*
Arthritis
*
Arthralgias
*
Spondylitis
Colonic complications include gross
haemorrhage
*
Stricture formation
*
Partial obstruction
*
Perforation may occur in the course of the disease
LATE COMPLICATIONS
Late complications also include toxic
megacolon and carcinoma of
the colon.
DIAGNOSIS
Sigmodoscopy including
rectal biopsy and
Barium enema are
important in arriving at a diagnosis
(Fig. 19.2).
TREATMENT
PRIMARY TREATMENT
Antidiarrhoeal agents,
most frequently lomotin,
kaolin and
pectin.
Steroids are used to induce a remission and
salazopyrin is used
to continue the remission.
The steroids can be local acting in
the form of suppositories in
rectal
disease. Oral steroid are
required for colonic disease.
Salazpyrin is
poorly absorbed and acts
locally by reducing
inflammation and
thus preventing relapse. Those
who cannot
tolerate the side effects should try
mesalazine.
OPERATIVE THERAPY
Indications for emergency surgical
intervention include:
*
Uncontrollable haemorrhage
*
Intestinal obstruction
*
Perforation
*
Toxic megacolon
The procedure of choice is total
proctocolectomy with a terminal
ileostony.
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