Ulcerative Colitis Background X.P is a 24-year-old man, who presents to the urgent care clinic with complaints of rectal bleeding and weakness. Five days ago, he noticed bright red blood in his stools. Furthermore, daily bowel movements have increased to five or six with significant diarrhea. He states that urges to move his bowels have rapid onset, but there has been no incontinence. He has been weak for approximately 2 ½ days. He has not traveled outside of the city, been hospitalized, or received antibiotics recently. 1. Pathophysiology and most common signs and symptoms: Ulcerative colitis is a chronic inflammatory condition with the colon and the cause is unknown. Ulcerative colitis starts in the distal region within the rectum and continues to the descending colon. The inflammation is continuous beyond the surface of the mucosa; colitis remains throughout the entire colon. Common signs and symptoms: - Diarrhea, blood passing with stool and/or rectal bleeding, cramping and pains within the abdomen, the passing of mucus with stool, Tenesmus (constant urge to have a bowl movement even if it is empty), Urgency to have a bowel movement, weight loss, fatigue, and fever in children (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). 2. Explain the pathophysiologic and anatomic features involved. - Pathophysiologic features involved are autoimmune diseases affecting the gastrointestinal tract and causing the pains such as the abdominal pains along with the diarrhea, fever, and blood. - Anatomic features involved are colon, rectum, and anus. 3. What are the predisposing conditions and risk factors in the case study? - Genetics- X. P’s family has a history of autoimmune disease. With ulcerative colitis, you have a higher risk if a close relative has had the disease. - Gender- There are no risk factors and predisposing conditions for gender. Ulcerative colitis has been proven to affect the same number of men and women (Mayo Clinic, 2021). - Ethnicity- X.P. is a Caucasian male. It has been proven that Caucasians have the highest risk of ulcerative colitis (Mayo Clinic, 2021). Age- X.P. is 24 years old. Ulcerative colitis typically begins before the age of 30 (Mayo Clinic, 2021). Behavior- There were no behaviors exhibited to be identified as predisposing conditions and risk factors. 4. List discriminating features you would find in the history and physical exam compared to the patient in the case study. - Rectal bleeding and weakness, bright red blood in stool noticed five days ago, increased bowel movements with diarrhea, the urges to have bowel movements with rapid onset, 2 ½ days of weakness, maternal side has a strong family history for autoimmune diseases, occasional malaise, abdominal cramps, loss of appetite, weight loss within the last month, and X. P’s age and ethnicity (Bruyere, 2009). 5. Define key diagnostics related to the diagnosis. Hb 10.8 g/dL HCO3- 18 meq/L Hct- 36% ESR- 24 mm/hr ALT- 41 IU/L Low hemoglobin count, which explains the patient’s skin pallor. Low bicarbonate in blood; inadequate oxidation of bacterial fatty acids by mucosa in ulcerative colitis. Low HCT levels are shown when there is inflammation in the digestive tract. High ESR levels are shown in patients with extensive colon involvement. Symptoms for high ALT levels can be fatigue, fever, and abdomen pains. 6. Patient teaching: - The patient teaching for X.P. should include the following: teaching and demonstrating how to do proper perineal care after each bowel movement, encouraging the patient eat a diet that is high in protein but low in fiber and fat, and to take his medication as prescribed. 7. Are there possible barriers? - Potential barriers could be the patient’s age and his social alcohol use. At his young age, X.P. might not be as willing to be consistent with his medication intake, which could harm his treatment process. X.P.’s social drinking could be a barrier because, he might skip medication if he knows he wants to drink for the weekend. Facilitators? Providing patient education, demonstrating perineal care, refer him to a dietary specialist, discussing medication management, and refer him to patient education centers that specialize in ulcerative colitis.