Ulcerative Colitis Essay

Soap Note (Ulcerative Colitis) is the chronic disease that I have to analyze in the job.

Grading Rubric

Student______________________________________
This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up. Ulcerative Colitis Essay

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1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number. Ulcerative Colitis Essay

2) Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).
b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).
c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner. Ulcerative Colitis Essay

3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).
b) Pertinent positives and negatives must be documented for each relevant system.
c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately. Ulcerative Colitis Essay

5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified. Ulcerative Colitis Essay

7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

Comments:

Total Score: ____________ Instructor: __________________________________

Guidelines for Focused SOAP Notes
· Label each section of the SOAP note (each body part and system).
· Do not use unnecessary words or complete sentences.
· Use Standard Abbreviations
S: SUBJECTIVE DATA (information the patient/caregiver tells you). Ulcerative Colitis Essay
Chief Complaint (CC): a statement describing the patient’s symptoms, problems, condition, diagnosis, physician-recommended return(s) for this patient visit. The patient’s own words should be in quotes.
History of present illness (HPI): a chronological description of the development of the patient’s chief complaint from the first symptom or from the previous encounter to the present. Include the eight variables (Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity-OLDCARTS), or an update on health status since the last patient encounter.
Past Medical History (PMH): Update current medications, allergies, prior illnesses and injuries, operations and hospitalizations allergies, age-appropriate immunization status. Ulcerative Colitis Essay
Family History (FH): Update significant medical information about the patient’s family (parents, siblings, and children). Include specific diseases related to problems identified in CC, HPI or ROS.
Social History(SH): An age-appropriate review of significant activities that may include information such as marital status, living arrangements, occupation, history of use of drugs, alcohol or tobacco, extent of education and sexual history.
Review of Systems (ROS). There are 14 systems for review. List positive findings and pertinent negatives in systems directly related to the systems identified in the CC and symptoms which have occurred since last visit; (1) constitutional symptoms (e.g., fever, weight loss), (2) eyes, (3) ears, nose, mouth and throat, (4) cardiovascular, (5) respiratory, (6) gastrointestinal, (7) genitourinary, (8) musculoskeletal, (9-}.integument (skin and/or breast), (10) neurological, (11) psychiatric, (12) endocrine, (13) hematological/lymphatic, {14) allergic/immunologic. The ROS should mirror the PE findings section. Ulcerative Colitis Essay
0: OBJECTIVE DATA (information you observe, assessment findings, lab results).
Sufficient physical exam should be performed to evaluate areas suggested by the history and patient’s progress since last visit. Document specific abnormal and relevant negative findings. Abnormal or unexpected findings should be described. You should include only the information which was provided in the case study, do not include additional data.
Record observations for the following systems if applicable to this patient encounter (there are 12 possible systems for examination): Constitutional (e.g. vita! signs, general appearance), Eyes, ENT/mouth, Cardiovascular, Respiratory, GI, GU, Musculoskeletal, Skin, Neurological, Psychiatric, Hematological/lymphatic/immunologic/lab testing. The focused PE should only include systems for which you have been given data.
NOTE: Cardiovascular and Respiratory systems should be assessed on every patient regardless of the chief complaint.
Testing Results: Results of any diagnostic or lab testing ordered during that patient visit. Ulcerative Colitis Essay
A: ASSESSMENT: (this is your diagnosis (es) with the appropriate ICD 10 code)

List and number the possible diagnoses (problems) you have identified. These diagnoses are the conclusions you have drawn from the subjective and objective data.
Remember: Your subjective and objective data should support your diagnoses and your therapeutic plan. Ulcerative Colitis Essay
Do not write that a diagnosis is to be “ruled out” rather state the working definitions of each differential or primary diagnosis (es).
For each diagnoses provide a cited rationale for choosing this diagnosis. This rationale includes a one sentence cited definition of the diagnosis (es) the pathophysiology, the common signs and symptoms, the patients presenting signs and symptoms and the focused PE findings and tests results that support the dx. Include the interpretation of all lab data given in the case study and explain how those results support your chosen diagnosis.
P: PLAN (this is your treatment plan specific to this patient). Each step of your plan must include an EBP citation.
1. Medications write out the prescription including dispensing information and provide EBP to support ordering each medication. Be sure to include both prescription and OTC medications.
2. Additional diagnostic tests include EBP citations to support ordering additional tests
3. Education this is part of the chart and should be brief, this is not a patient education sheet and needs to have a reference.
4. Referrals include citations to support a referral
5. Follow up. Patient follow-up should be specified with time or circumstances of return. You must provide a reference for your decision on when to follow up. Ulcerative Colitis Essay

Symptom analysis/HPI:
The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month. Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

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Review of Systems (ROS)
CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizziness as describe above. Denies changes in LOC. Denies history of tremors or seizures. Ulcerative Colitis Essay
HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.
RESPIRATORY: Patient denies shortness of breath, cough or hemoptysis.
CARDIOVASCULAR: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal
dyspnea.
GASTROINTESTINAL: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or
diarrhea.
GENITOURINARY: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.
MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.
SKIN: No change of coloration such as cyanosis or jaundice, no rashes or pruritus. Ulcerative Colitis Essay

Objective Data:
VITAL SIGNS: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 2/10.

GENERAL APPREARANCE: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.
HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,. Lids non-remarkable and appropriate for race. Ulcerative Colitis Essay

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.
CARDIOVASCULAR: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.
RESPIRATORY: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.
GASTROINTESTINAL: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation
MUSKULOSKELETAL: No pain to palpation. Active and passive ROM within normal limits, no stiffness.
INTEGUMENTARY: intact, no lesions or rashes, no cyanosis or jaundice. Ulcerative Colitis Essay

ASSESSMENT:
Main Diagnosis
Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed (Codina Leik, 2015). Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease (Domino et al,. 2017).Ulcerative Colitis Essay

Differential diagnosis:
 Renal artery stenosis (ICD10 I70.1)
 Chronic kidney disease (ICD10 I12.9)
 Hyperthyroidism (ICD10 E05.90)
PLAN:

Labs and Diagnostic Test to be ordered:
• CMP
• Complete blood count (CBC)
• Lipid profile
• Thyroid-stimulating hormone (TSH)
• Urinalysis with Micro
• Electrocardiogram (EKG 12 lead)

Pharmacological treatment:
• Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily. Ulcerative Colitis Essay
• Lisinopril 10mg PO Daily

Non-Pharmacologic treatment:
• Weight loss
• Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat
• Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults
• Enhanced intake of dietary potassium
• Regular physical activity (Aerobic): 90–150 min/wk
• Tobacco cessation
• Measures to release stress and effective coping mechanisms.
Education Ulcerative Colitis Essay
• Provide with nutrition/dietary information.
• Daily blood pressure monitoring log at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP
• Instruction about medication intake compliance.
• Education of possible complications such as stroke, heart attack, and other problems.
• Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all
Follow-ups/Referrals
• Follow up appointment 1 weeks for managing blood pressure and to evaluate current hypotensive therapy.
• No referrals needed at this time. Ulcerative Colitis Essay

References
Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.).
ISBN 978-0-8261-3424-0
Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017
(25th ed.). Print (The 5-Minute Consult Series).

Critically appraise the diagnosis of Crohn’s Disease and Ulcerative Colitis

Assess the value or quality of….

Inflammatory bowel disease (IBD) affect more than 300,000 people in the UK (Fakhoury et al, 2014.) IBD is known as a chronic intestinal inflammation that is a result of host-microbial interactions (Fakhoury et al, 2014.) These diseases are autoimmune and cause inflammation in the small and large intestines. Ulcerative Colitis Essay

Two main forms of inflammatory bowel disease are Crohn’s Disease (CD) and Ulcerative Colitis (UC). They cause symptoms such as abdominal pain, bloody stools, diarrhea and vomiting (Fakhoury et al, 2014.) Both conditions share similar characteristics however differentiation can be made when it comes to the location and the type of inflammation. Crohn’s Disease causes inflammation anywhere along the lining of the digestive tract whereas ulcerative colitis causes a long-lasting inflammation in some parts of the tract, mainly the colon (Garud and Pppercorn, 2009.) These diseases normally occur during adulthood however there has been an increase in the diagnosis of children. As both conditions share symptoms diagnosis can be difficult so a proper examination has to be conducted to ensure the correct disease is identified helping to provide effective treatment. To do this, special diagnostic techniques need to be conducted, some techniques that are used are discussed in further depth below accompanied by brief methods, results gained and their efficacy in the role of diagnosis for both CD and UC. Ulcerative Colitis Essay

Table 1- The difference in the findings of patients with CD and UC (Adapted from Zhang et al, 2018.)

A simple presentation of the differences found between both conditions upon examination. Ulcerative Colitis Essay

Key features

Crohns’ disease

Ulcerative colitis

Histologic findings

Presence of Granulomas

Transmural inflammation

Mucosal and submucosal inflammation

Polymorphonuclear cell aggregate

Endoscopic findings

Strictures Ulcerative Colitis Essay

Liner ulcerations

Discontinues lesions

Presence of crypts

Formation of residual mucosal tissue

Continuous lesions

There are many techniques and tests which can be used to identify IBD however the family history of the patient can be looked at. Some studies have shown that UC patients hafve a family history of IBD in comparison to patients with Crohns disease (Childers et al, 2014.) This could be a good start to help diagnose the patient as a little background information is provided. Ulcerative Colitis Essay

Crohn’s Disease can be effectively diagnosed using a capsule endoscopy however the clinical use of this technique in patients with ulcerative colitis is unclear. Research conducted on patients with UC showed small bowel finding which are normally consistent in Crohn’s Disease (Mehdizadeh et al, 2008) which suggest this method should be used less, if UC is suspected or along with this test further examination should be done for confirmation. The patient is made to drink a formulation so that the colon is clean prior the endoscopy. The capsule is orally ingested and takes images of the inner layer of the gastrointestinal tract (Fakhoury et al, 2014.) The images captured help to highlight any ulcerations as shown in figure 1, erosions, cankers, fistulas or pseudopolyps which can help identify the location of the inflammation (Fakhoury et al, 2014.) Ulcerative Colitis Essay

Figure 1- Crohn’s Disease patients suffering from lesions. (Lujan- sanchis et al, 2016.)

Capsule endoscopy was done capturing 3 different types of lesions. Image A shows the presence of Edema. This is the inflammation of the tract lining which is due to the small blood vessels leaking fluid into the nearby tissues of the digestive tract. Image B shows the ulcers created in the lining. The immune system of the patient attacks the lining causing the formation of ulcers. Ulcers can go onto create fistulas if they manage to break through the intestinal wall. The presence of a fistula can cause food to bypass areas of the bowel which results in inefficient absorption of the nutrients (Soloman, 1996.) Lastly, image C shows strictures. This is the buildup of scar tissue in the wall of the small or large intestines. Long term inflammation causes damage which the body tries to repair but only leads to the buildup of the damaged tissue (Chang et al, 2015.) This lesion can cause a narrowing anywhere in the digestive tracts which will need opening by surgery. Ulcerative Colitis Essay

Blood tests are good laboratory tests used to help with the identification of both UC and CD. Any abnormal levels of a particular component can help to identify the presence of a problem. Erythrocyte sedimentation rates (ESR) is an indicator of inflammation. ESR helps to reflect the change of various acute phase proteins. The usefulness of this test has decreased however it is still widely used (Cioffi, 2015.)

The full blood count of the patient can be reviewed and if signs of anemia caused by vitamin B12 deficiency is revealed then further investigation can be conducted to specifically identify the reason behind the anemia (Fakhoury et al, 2014.). Furthermore, any abnormal levels of serological markers can be used to differentiate between both conditions making it easier to diagnose (Fakhoury et al, 2014) which are spoken about below in more detail. Ulcerative Colitis Essay

Antibody tests can be done to help differentiate between both diseases. Anti-Saccharomyces cerevisiae antibodies (ASCA) is a protein that is present in people who have Crohn’s Disease whereas Perinuclear anti-neutrophil cytoplasmic antibody (pANCA) is the protein which is present when individuals have ulcerative colitis (Quinton et al, 1998.). The presence of ASCA is not clear so a family study was conducted which showed that the presence of ASCA may be due to genetic influence along with the influence of environmental factors (Seibold, 2001.) The presence of pANCA is still controversial however research has shown that this protein is sensitive and specific to the diagnosis of UC (Yamamoto-Furusho, 2006.) Ulcerative Colitis Essay

Presence of these proteins can help to push the doctors in the correct direction when it comes to the patient’s diagnosis.

Elevated white blood cell level and C-reactive protein along with a decrease in albumin help to suggest a diagnosis. Other specific serum markers for each disease can be looked into for the presence of inflammation and acute phase response (Cioffi, 2015.) For UC the stool of the patient can be cultured to rule out the presence of any infection (Collins, Paul and Rhodes, 2006.) Ulcerative Colitis Essay

Another diagnostic tool is radiology tests. Fluoroscopic examinations are infrequently performed but can help to suggest the possible cause of the problem. A barium enema is conducted. For this test the patient is either required to consume a solution of barium sulfate and then an x-ray is conducted, or an enema tube is inserted into the rectum which flows through the colon and takes x-rays (Eliakim et al, 2003.) The barium appears white when an X-ray is conducted helping to easily view the problematic areas to see any ulcers, narrowed areas or any fistulas (Eliakim et al, 2003) which are visible in figure 2. Further examination of the X-rays can be done to help identify the spread of the disease however this technique is not used often as the positive oral contrasting agent can obstruct the presentation of mucosal enhancement or any hemorrhage (IIangovan, 2012.) Ulcerative Colitis Essay

Figure 2- the presence of Aphthous ulcers.

Barium Enema examination was conducted on a patient with Crohn’s Disease which showed the presence of many ulcers. (https://emedicine.medscape.com/article/367666-overview)

As technology has advanced radiology techniques such as X-ray computed tomography (CT) and magnetic imaging scans (MRI) are used to look for abnormalities caused by the IBD’s. Ulcerative Colitis Essay

The preferred imaging tests to help with the diagnosis are cross-sectional CT and MR Enterography. CT enterography is preferred when an adult is examined because it is less dependent on bowel and respiratory motion and it is noninvasive however high-quality MR Enterography eliminates radiation exposure and is as sensitive as CT enterography which suggests it’s a better method to use (IIangovan et al, 2012.) Both techniques are performed after an oral contrast liquid is consumed by the patient so a high-resolution image is produced (IIangovan et al, 2012.) Ulcerative Colitis Essay

CTs utilize multi detector scanners with high spatial and temporal resolution to allow the visualization of the mucosa, small bowel wall and lumen to help detect the severity of the inflammation, fibrofatty proliferation, sacculations and submucosal fat deposition which is a good indicator of chronic inflammation (Ilangovan, 2012.) This technique is known to provide complementary diagnosis after the use of MRI and capsule endoscopy. Low-density oral contrast media helps to create a good quality scan as they maximize contrast between the lumen and enhancing small bowel wall along with helping with the assessment of the wall thickening or any enhancement (Ilangovan, 2012.) Ulcerative Colitis Essay

Magnetic resonance imaging (MRI) is a technique which helps to produce high quality images identifying any abscess or fistulas without exposing the patient to radiation (Eliakim et al, 2003.) It has spatial and temporal resolution of images which can help to evaluate the bowel wall changes, thickening and any edema which can be useful to assess the IBD activity.

Figure 3- CT scan conducted on a patient with Crohn disease. https://emedicine.medscape.com/article/367666-overview#a1 Ulcerative Colitis Essay

This scan shows mesenteric inflammation in the lower right of the ileum along with thickening of the wall and narrowing of the terminal ileum.

Another technique used to diagnosis is transabdominal ultrasound. This can help to detect complications being caused by the inflammatory bowel diseases and it is said that the ultrasound can help to distinguish between UC and CD purely based on the thickness and the change of layered structure of the intestines (Kimmey et al, 1990.) The ultrasound appears to be accurate in being able to differentiate between a normal and inflamed colon however this technique cannot be used solely to diagnose an individual so further tests should be conducted. Ultrasounds are good at detecting the build up of fluids along with helping to show up fistulas and abscessed which maybe present. Ulcerative Colitis Essay

Enteroscopy is a major tool which is used to detect and manage IBD. It plays a crucial part in the diagnosis as it can help to distinguish between CD and UC along with helping with long term management. The procedure for this method is the insertion of a tube containing a camera through the mouth to observe the GI tract, this is defined as upper enteroscopy. Lower enteroscopy is used to view the colon and the camera is inserted through the anus. This procedure is relatively pain free however cause discomfort. Ulcerative Colitis Essay

Colonoscopy is the first line endoscopic investigation when CD is suspected whereas for UC flexible sigmoidoscopy is used then accompanied by colonoscopy. Colonoscopy plays many roles when used to investigate IBD such as: assessment of the extent and activity of the disease, surveillance of dysplasia or neoplasia, diagnosis and then to help with the correct treatment (Rameshshanker and Arebi, 2012.) Ulcerative Colitis Essay

Endoscopic findings of active UC consist of loss of the vascular pattern due to oedema, ulceration, bleeding and erythema (Rameshshanker and Arebi, 2012.) The findings can help to show the distribution of inflammation which furthermore help to conclude if it’s CD or UC. Chronic UC can be diagnosed with the presence of polyps, scarring and shortening of the tubular colon as shown in figure 4. Ulcerative Colitis Essay

Whereas on the other hand, CD can cause inflammation anywhere along the GI tracts so when an endoscopy is conducted the inflammation pattern is observed. Other identification pointers are the presence of heterogeneous patchy nature of inflammation or skip lesions, along with presentation of polycyclic ulcers (Rameshshanker and Arebi, 2012.) The ulcers are deeps as shown in figure 5 when compared to the UC ulcers in figure 4. Ulcerative Colitis Essay

Figure 4- The endoscopic finding consisting of a shortened tubular colon in a patient with UC.

It is clearly visible that as the patient is suffering from the disease as a huge amount of inflammation has taken place which reduces the surface area of the colon, making it difficult for the colon to function. This will reduce the amount of fluid reasorption and there will be an incomplete production of waste that the body needs to eliminate causing further build up of waste. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377861/ Ulcerative Colitis Essay

Patients suffering with UC have the possibility to develop colorectal cancer. By conducting an endoscopy to provide the correct diagnosis, the treatment needed can be provided, monitoring the progression of the patients condition and determining colonoscopy markers for cancer risk can decrease the risk of the patient (Rutter et al, 2004.)

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Figure 5- Deeps ulcers are observed along with sub mucosal oedema and haemorrhages in the colon of a patient with Crohn’s Disease. CD has caused an immune response in the individual resulting in the production of ulcers along with swelling. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377861/ Ulcerative Colitis Essay

Figure 6- The endoscopic findings of a patient which was diagnosed with Crohn’s disease.

Image A shows erythema along with the loss of vascular with image B demonstrating the presence of aphthous ulcers in the colon and C showing the presence of discrete ulcers (Moka, Ahuja and Makharia, 2017.) Image D and E show the presence of multiple deep ulcers and finally F shows a cobblestone apprearnce of the colon (Moka, Ahuja and Makharia, 2017.) http://www.jdeonline.in/article.asp?issn=0976-5042;year=2017;volume=8;issue=1;spage=1;epage=11;aulast=Moka

Figure 7- The images captured after endoscopy is performed on patients with ulcerative colitis (Lange, Larsen and Aabakken, 2004.) Ulcerative Colitis Essay

5 patients who were suffering from ulcerative colitis at different degrees underwent an endoscopic examination. The amount of inflammation that was ongoing in the patient was recorded as shown above, to present the different stages of ulcerative colitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC434504/

Figure 8- The examination of a specimen in UC which is a presentation of chronic inflammation along with the production of abnormal mucosa. Ulcerative Colitis Essay

A shows the granular appearance of the mucosa along with ulceration occurring in the tissue, B shows extensive ulceration and the rise of inflammatory polyps. C shows the long-lasting effect of the disease as the mucosa is lacking haustration and it is atrophic lastly, D shows the start of adenocarcinoma highlighted in the figure. (Langner et al, 2014.) https://www.ncbi.nlm.nih.gov/pubmed/24487791 Ulcerative Colitis Essay

Endoscopic findings as spoken about above are important to help evaluate the activity of both diseases. Figure 6 and 7 especially highlight the value of endoscopy to help diagnose a patient as they clearly demonstrate the difference in the findings of both conditions. The images captured during the examination can help to ease doctors in the diagnosis of a patient. There is potential for the condition of the patient to overlap and make it harder for diagnosis hence why other tests should be considered. Ulcerative Colitis Essay

A histology approach can be taken towards inflammatory bowel diseases. Biopsies of the colon can be conducted during an endoscopy test to take a look at the change in the structure of the tissue. An effective technique used to both, differentiate between the types of inflammation and diagnose the disease (Fakhoury et al, 2014.) Specific aspects of the pathology can help to identify the inflammation that occurs when an individual has CD or UC. Multiple samples can be taken along the lining to examine inflammation which can suggest CD and then samples of the colon can be taken which can suggest UC. The samples can be stained then viewed under a microscope as shown in figure 9. The biopsy samples should be taken before the start of any treatment as this can induce a morphological change in the structure of the tissue. Ulcerative Colitis Essay

Figure 9- the identification of Granulomas in Crohn’s Disease when a sample from the stomach is taken and stained.

After the biopsy sample was stained using the Hematoxylin and eosin stain, further analysis helps to highlight mucosal damage which is due to the infiltration of leukocytes into the epithelium along with the presence of macrophage Granulomas (Fakhoury et al, 2014.) As mentioned in Table 1, one of the biggest identification pointers of CD being present is the presence of granulomas which has been identified in this patient’s case providing the correct diagnosis. Ulcerative Colitis Essay

Figure 10- The images captured after the examination of tissue from a patient suffering from ulcerative colitis. Image A and B show architectural distortion, variation when it comes to the size of the crypts and basal lymphoplasmacytosis along with C showing metaplasia in the Paneth cell and pyloric gland in the left colon (Deroche, Xiao and Liu, 2014.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124271/ Ulcerative Colitis Essay

The differences captured after the microscopy of the patient’s sample is done helps to show some key markers such as granulomas as shown in figure 9 or the distortion shown in figure 10 can help to clarify any confusion there may be in the diagnosis of the condition. Ulcerative Colitis Essay