QUESTIONS AND ANSWERS
(INTESTINAL DISEASE)
Question -1-:
Is the cause of ulcerative colitis known? What explanation has medicine provided for this disease so far?
Answer-1-:
Ulcerative colitis disease is chronic. ) is an inflammatory disease. In studies conducted for many years to explain the reason, it is thought to be an abnormally exaggerated response of the immune mechanism against antigens thought to be of intestinal origin in a person with a genetic predisposition. As a result of this exaggerated immune response, it emerges as a disease that involves both the large intestine and systemic involvement.
Question-2-:
Which age groups are more frequently affected by ulcerative colitis? What is the frequency of occurrence in the world and in Turkey?
Answer-2-:
Although it can be encountered as a disease that concerns childhood as well as from the age of 15, it can also occur especially in the 20-40 age group. It affects both men and women and constitutes a significant health problem. As seen in Picture-1, it occurs in certain regions of the world. It is especially common in developed countries. It is located in a high-risk area in Turkey in terms of its frequency of occurrence.
High incidence of ulcerative colitis in the world (number of new cases occurring every year)
The number of cases is reported between 2-10/100,000 for regions, and prevalence is reported as (the number of cases present in that society in any given time period)/100,000. The frequency of occurrence in Turkey is close to these figures. It is witnessed that the frequency of occurrence is increasing day by day due to problems in nutritional conditions and difficulties in accessing the products required for healthy nutrition. It is inevitable that this risk will increase as environmental pollution and drinking water pollution increases and environmental awareness cannot be established in society. Question-3-:
You are talking about genetic predisposition. Is there a possibility that a sibling or child of a patient with ulcerative colitis will develop this disease?
Answer-3-:
Nowadays, genetic predisposition is mentioned in the formation of many diseases. Ulcerative colitis is one such disease. Our knowledge about the occurrence of the disease in other family members or children of a patient with ulcerative colitis is not clear. In some families, ulcerative colitis may occur in more than one sibling. Inheritance conditions may be different in different societies.
It is observed that inflammatory bowel disease (ulcerative colitis and Crohn's disease) occurs frequently in societies such as Jews, where consanguineous marriages occur frequently.
Question-4-:
What are the first complaints seen in the patient? What are the symptoms and reasons for consulting a doctor at the first application?
Answer-4-:
The complaints that bring the cases to the doctor are often abdominal pain, Complaints such as bloody, mucous (slimy, phlegmy) defecation, diarrhea and fever. Abdominal pain can vary from mild to very severe, and may also present with acute abdomen
(requiring urgent surgical intervention).
Diarrhea may be mild bleeding 1-2 times a day, or it may reach up to 25-30 times a day, and may cause excessive blood loss, causing people to get out of bed at night. Fever may be 37.5 degrees Celsius, or intestinal perforation in the abdomen or In the case of toxic megacolon, it can reach up to 40 degrees. Is ulcerative colitis a disease that should come to mind?
Answer-5-:
Of course, the first thing that should come to mind is ulcera. tive colitis. When we think that Turkey is rich in parasitic diseases and that bacillary dysentery is an important problem in areas where healthy, clean water and food consumption is not available, the first thing that should come to our mind is infectious diarrhea. Among parasites, amoeba is still an important problem. E. coli called Escherichia coli, which is the causative agent of bacillary dysentery, is frequently encountered as the cause of bloody mucus diarrhea.
Infectious bloody diarrhea often continues to be a problem due to many reasons such as sewage or septic tank water mixing with drinking water, eating foods, vegetables and fruits washed with these waters without adequate cleaning, inadequate post-toilet cleaning and lack of the habit of using toilet paper. It does. One of the important points that should not be forgotten here is that ulcerative colitis should come to mind first if bloody diarrhea recurs. In addition, because the amoeba parasite is likely to be encountered frequently in cases with ulcerative colitis, ulcerative colitis must be taken into consideration in cases with frequent amoeba colitis. Diseases that should be considered in the differential diagnosis of bloody diarrhea are shown in table-1.
DIFFERENTIAL DIAGNOSIS
• Bacillary dysentery
• Amoebic dysentery • Histoplasmosis
• Infectious enterocolitis
• Regional ileitis (Crohn's disease)
• Congenital polyposis (Familial adenomatosis polyposis coli-FAP)
• Pseudomembranous enterocolitis (bloody diarrhea after antibiotic use)
• Ischemic colitis (clinical condition due to problems in the vessels feeding the intestine)
• Colon cancers: Diffuse polyps in FAP case.
Question-6-:
Since it is seen that so many diseases are included in the differential diagnosis, what should be done to diagnose ulcerative colitis?
Answer-6-:
All these details must be examined one by one during the diagnosis stage. It is not possible to diagnose ulcerative colitis with a single examination method. Ulcerative colitis can be diagnosed by evaluating the patient's clinical picture, radiology, endoscopic examinations and laboratory tests together. For these reasons, the doctor must be extremely careful when making a diagnosis. When making a careful decision when making this diagnosis, which may last for years and is important in many aspects, the diagnosis must be reviewed again and again.
Question-7-:
How long does it take to get rid of ulcerative colitis after it starts? Is it a recurring disease? Is it possible for it to go away completely?
Answer-7-:
Ulcerative colitis is a chronic disease that can present in different ways. It progresses with sedation (remission) and exacerbations (exacerbation). The clinical picture and complaints, which are mild at first, may continue for 4-12 weeks. There may be a partial remission or this process may last up to 6 months. This picture is called recurrent type. As this process subsides, the disease may calm down. Then, attacks may occur and the disease may pass into what we call chronic persistent type. In patients with ulcerative colitis, which we call chronic persistent type, remission may last for months, years (for a long time such as 10-15 years), or exacerbations may occur in a short time.
Colitis ulcerosa (ulcerative colitis), which we call recurrent or chronic continuous type, can turn into its most inflammatory form, which we call fulminant type, at any stage of its course. When the disease first begins, it may present with what we call the fulminant type. Among all ulcerative colitis cases, the fulminnate colitis form can be observed at a rate of 5%.
Clinical and laboratory findings in fulminant state:
Abdominal pain may be present, painless abdomen is more common. Previous pain It has eased or disappeared,
While the diarrhea is initially bloody and profuse, the diarrhea may disappear and constipation may occur.
Abdominal swelling and decreased bowel sounds are observed.
Fever can reach 39-40 degrees .
Blood pressure decreases, pulse accelerates (120 or more per minute is at tachycardic level).
The patient may be dehydrated and dry.
In the standing plain abdominal radiograph, the transverse (middle) colon gas shadow may be enlarged (wider than 6 cm).
The leukocyte count can reach as high as 14,000 - 20,000.
If the intestine is perforated, free air can be observed on the liver directly in the foot.
Question-8-:
While stating that ulcerative colitis disease affects the intestines, especially the large intestine, you said that it causes systemic involvement. .What is meant by systemic involvement? What other problems affect the ulcerative colitis patient?
Answer-8-:
Systemic involvement means involvements related to ulcerative colitis disease outside the large intestine. These involvement sites are summarized in Table 5.
SYSTEMIC COMPLICATIONS
1-Arthritis
2- Skin lesions
3- Mucosal lesions
4- Liver pathologies
5- Thrombophlebitis
6- Kidney
7- Eye
8- Autoimmune hemolytic anemia, amyloidosis.
Let's explain these a little.
Arthritis:
Especially large joints are involved. Joints such as ankles, knees, and hips may be affected when ulcerative colitis is in the active (flare-up) phase, or it may occur when the disease is in partial remission. The complaint of arthritis classically presents with symptoms such as pain, swelling and redness in the joint. If the patient has an arthritis attack in his knee or foot, he may not be able to pray, bend his knee, go up and down stairs, or step on his foot. They are known as arthritis that cannot cause deformity. Seronegative rheumatoid spondylitis (disease with rheumatoid factor negative lumbar involvement) and rheumatoid arthritis are more common than cases without ulcerative colitis.
We would like to inform our patients about this issue in advance. Orthopedic surgery when he had no knowledge
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