| Colitis is defined as any inflammation of the lining of the large intestine (colon). There are many causes and variants of colitis. Colitis may be due to infection caused by virus, protozoa, or bacteria (such as Campylobacter) that produce toxins that irritate the lining of the intestine. Bacteria directly infecting the inner lining of the colon may also cause colitis.
Antibiotics may cause colitis secondary to an overgrowth of a type of bacterium (Clostridium difficile), which may then proliferate and produce a toxin that irritates the colon. The antibiotic itself may also have an irritating effect that can cause colonic inflammation.
Two variants of unknown etiology, ulcerative colitis and Crohn's disease, are generally described by the term inflammatory bowel disease (IBD). Ulcerative colitis is a serious intestinal disorder that usually begins in young adulthood. This condition is characterized by inflammation and ulceration that is limited to the colon and rectum. Ulcerative colitis contrasts with Crohn's disease, the other major type of IBD, in that colitis affects only the colon and involves only the inner lining, whereas Crohn's disease may also involve the lower small intestine and can affect all layers of the intestinal wall.
In the elderly, ischemic colitis may occur when narrowing of the blood vessels (atherosclerosis) impairs the blood supply to the intestinal wall.Risk: Individuals who take antibiotics are at risk of developing colitis secondary to overgrowth of nonsusceptible bacteria. Colitis occurs at all ages, but inflammatory bowel disease has a higher incidence among young adults and individuals of Jewish descent (Singh). Both sexes are affected equally.
Family members of an individual with IBD have a 7% to 22% greater risk of getting the disease; a child will be 35% more likely to be affected when both parents have IBD (Singh). |
Source: Medical Disability Advisor
| History: Individuals may report watery diarrhea containing mucus, pus, or blood; abdominal pain, tenderness, or spasm (colic); and intermittent or irregular fever. Physical exam: A digital exam of the rectum with a gloved finger may be performed to detect irregularities. A stethoscope may be used to listen to bowel sounds (auscultation). The abdomen may be tender on examinations. Tests: A sample of feces is examined for parasites, and a culture or stained smear is microscopically analyzed to identify bacteria. A flexible viewing scope (colonoscope or sigmoidoscope) may be used to examine the inside of the rectum and colon for inflammation or ulceration of the lining (colonoscopy). Small samples (biopsies) of inflamed areas of the large intestine may be taken for examination with a microscope. A radiographic procedure to visualize the colon (barium enema) may help identify areas of narrowing or severe inflammation. |
Source: Medical Disability Advisor
| Most infections that cause acute colitis resolve without treatment. However, infections caused by Campylobacter or Clostridium may need to be treated with antibiotics specific for those organisms. Amebic infections are treated with anti-amebic medication (amebicides).
When colitis is caused by low blood flow (ischemia), it may be treated by surgical removal of the diseased section of the colon (colectomy). Ulcerative colitis may be treated with combinations of systemic or locally acting corticosteroid anti-inflammatory drugs, nonabsorbable sulfa-based antibiotics, locally acting nonsteroidal anti-inflammatory drugs, a special diet, and vitamin supplements. Newer agents modify the inflammatory cascade responsible for the tissue destruction. If surgical intervention is necessary for ulcerative colitis, the entire colon and rectum are commonly removed (total proctocolectomy).
Following surgery, the individual may require an artificial opening (stoma) of the colon through the abdominal wall to enable bowel emptying (colostomy). A colostomy may be temporary or permanent depending on the portion of bowel surgically removed. If the entire colon and rectum are removed, the individual will require a permanent stoma of the lower small intestine (ileum) through the abdominal wall (ileostomy). |
Source: Medical Disability Advisor
| Colitis caused by infection may resolve without treatment. If treatment is necessary, however, the infection usually responds well to medication. Antibiotic-associated colitis normally clears up once the offending antibiotic therapy is discontinued and antibiotic therapy that targets the causative bacteria is initiated. Ulcerative colitis is a chronic condition requiring long-term management. The predicted outcome for ischemic colitis depends on the extent of damaged colon removed. |
Source: Medical Disability Advisor
| A regular exercise routine may be useful in reducing the risk of ischemic colitis. Aerobic exercise such as walking, jogging, or swimming is usually beneficial. For individuals who do not engage in regular exercise, a consultation with a physical therapist may be useful. Individuals learn how to properly warm up all muscle groups, stretch to prevent injury, and gradually increase the amount of exercise performed.
Individuals learn progressive relaxation and deep breathing techniques to reduce postoperative pain and speed up recovery. These may be performed several times a day until pain from inhalation/exhalation is less noticeable. Stretching exercises help decrease the risk of blood clots and promote ease in walking. These exercises are valuable during the first 48 hours after surgery and should continue until recovery from surgery is complete and pain is no longer noticeable while walking or breathing. |
Source: Medical Disability Advisor
| Prolonged diarrhea may result in dehydration and electrolyte imbalance. In severe cases of colitis, intestinal bleeding (hemorrhage) and perforation of the colon can occur. |
Source: Medical Disability Advisor
| Work restrictions and accommodations are not usually associated with this condition, although ready access to bathroom facilities may be necessary. Following a prolonged episode of colitis, the individual may need to limit strenuous activities until physical stamina returns. If treatment involves surgery, return to work will be delayed for several weeks and may then be limited to modified duty until recovery is complete. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual recently been on antibiotic therapy?
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Does individual have atherosclerosis? Ulcerative colitis?
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What is the individual's ethnic background? Age?
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Does individual report watery diarrhea containing mucus, pus, or blood; abdominal pain, tenderness, or spasm (colic); and intermittent or irregular fever?
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Did individual have a digital examination of the rectum?
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Was auscultation of the abdomen done?
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Has individual had comprehensive stool testing done?
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Has individual had a sigmoidoscopy or colonoscopy? Biopsies?
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Has individual had a barium enema?
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Have conditions with similar symptoms been ruled out?
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Has the individual recently traveled out of the country?
Regarding treatment:
- Is individual being treated with broad-spectrum antibiotics or amebicides?
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Is individual being treated with corticosteroids, special diet, and vitamin supplements?
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Was it necessary for the individual to have a colectomy or total proctocolectomy?
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Does the individual have a colostomy or ileostomy?
Regarding prognosis:
- Does individual exercise regularly?
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Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Does individual have any complications such as dehydration, electrolyte imbalance, intestinal hemorrhage or perforation of the colon?
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Source: Medical Disability Advisor
| Singh, J. "Colitis." eMedicine. Eds. Robert Baldassano, et al. 11 Mar. 2004. Medscape. 16 Dec. 2004 <http://emedicine.com/ped/topic435.htm>. |
Source: Medical Disability Advisor