RLQ = right lower quadrant; S cerevisiae = Saccharomyces cerevisiae. Data from Friedman, 201n5; Lichtenstein, 2009; Podolsky, 2002.
Ulcerative Colitis and erythema nodosum. Another serious problem is that the risk of colon cancer approaches 1 percent per year. With either
This is a mucosal disorder with inflammation confined to the ulcerative colitis or Crohn disease, there is also concern for possuperficial luminal layers of the colon. It typically begins at the sible increased risks for venous thromboembolism (Kappelman, rectum and extends proximally for a variable distance. In approx2011; Novacek, 2010).
imately 40 percent of cases, disease is conined to the rectum and rectosigmoid, but 20 percent have pancolitis. For unknown reasons, prior appendectomy protects against development of ulcerative coli tis (Friedman, 2015). Endoscopic indings include Also known as regional enteritis, Crohn ileitis, and granulomucosal granularity and friability that is interspersed with mucomatous colitis, Crohn disease has more protean manifestations sal ulcerations and a mucopurulent exudate (Fig. 54-2). than ulcerative colitis. It involves not only the bowel mucosa but
Major symptoms of ulcerative colitis include diarrhea, rectal also the deeper layers, and sometimes involvement is transmural bleeding, tenesmus, and abdominal cramps. The disease can be (see Fig. 54-2). Lesions can be seen throughout the entire gasacute or intermittent and is characterized by exacerbations and trointestinal tract, from the mouth to the anus, but it typically remissions. Toxic megacolon and catastrophic hemorrhage are is segmental (Friedman, 2015). Approximately 30 percent of particularly dangerous complications that may necessitate colpatients have small-bowel involvement, 25 percent have isolated ectomy. Extraintestinal maniestations include arthritis, uveitis, colonic involvement, and 40 percent have both, usually with the terminal ileum and colon involved. Perianal fistulas and abscesses develop in a third of those with colonic involvement.
Symptoms depend on which bowel segment(s) is involved. Thus, complaints may include lower-right-sided cramping abdominal pain, diarrhea, weight loss, lowgrade fever, and obstructive symptoms. The disease is chronic with exacerbations and remissions, and importantly, it cannot be cured medically or surgically. Approximately a third of patients require surgery within the first year ater diagnosis, and thereater, 5 percent per year. Reactive arthritis is common, and the gastrointestinal cancer risk, although not as great as. with ulcerative colitis, is increased substantially.
FIGURE 54-2 Causes of colitis. A.Chronic ulcerative colitis with diffuse ulcerations and exudates. B. Crohn colitis with deep ulcers. (Reproduced with permission from Song LM Topazian M: Gastointestinal endoscopy. Kasper DL, Fauci AS, Hauser SL, et al (eds): Harrison's Principles of Internal Medicine, 19th ed. New York: McGraw-Hili Education; 201o5.)