Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?
A. Fistula
B. Bowel perforation
C. Bowel obstruction
D. Abscess
Correct Answer: B. Bowel perforation
An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications. Colonic perforations are usually a complication of a toxic megacolon. However, perforation can also present in severe ulcerative colitis even in the absence of toxic megacolon. Most perforations occur in the left colon, commonly in the sigmoid colon.
Option A: Fistulas can occur anywhere in the bowel. The longer the client has Crohn’s, the more likely he is to develop a fistula. In ulcerative colitis the inflammation doesn’t spread through the full thickness of the bowel wall, so fistulas are less likely to form. The symptoms the client experiences depend on where the fistula is.
Option C: Crohn’s disease affects the entire thickness of the bowel wall. This makes strictures more common in people who have ulcerative colitis, which typically affects only the inner lining of the bowel. Bowel obstructions with strictures may either be temporary or permanent.
Option D: The typical histological (microscopic) lesion of ulcerative colitis is the crypt abscess, in which the epithelium of the crypt breaks down and the lumen fills with polymorphonuclear cells. The lamina propria is infiltrated with leukocytes.
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