1. In order to understand the difference between ulcerative colitis (UC) and Crohn’s disease, it is essential to first recognize that both are chronic inflammatory bowel diseases (IBD). However, they differ in several important ways.
Ulcerative colitis primarily affects the colon and rectum, leading to continuous inflammation and ulceration of the inner lining of the large intestine. This inflammation usually begins in the rectum and can extend upwards, affecting different portions of the colon. In contrast, Crohn’s disease can involve any part of the digestive tract, from the mouth to the anus, but most commonly affects the small intestine and the beginning of the large intestine. Furthermore, while UC typically involves only the innermost lining of the colon, Crohn’s disease can penetrate through multiple layers of the bowel wall, leading to complex complications such as fistulas and abscesses.
From a practical standpoint, distinguishing between UC and Crohn’s disease can be challenging. Key differences lie in the symptoms and patterns of inflammation. Typically, UC presents with symptoms such as bloody diarrhea, abdominal pain, and urgency to move bowels. The inflammation tends to be continuous and affects the rectum and colon in a uniform manner. In contrast, Crohn’s disease often presents with symptoms such as abdominal pain, diarrhea, weight loss, and fatigue. The inflammation in Crohn’s disease can skip segments of the bowel, leading to “skip lesions” and areas of healthy tissue in between affected areas.
To differentiate between UC and Crohn’s disease, medical practitioners rely on a combination of clinical evaluation, endoscopic procedures such as colonoscopy or sigmoidoscopy, imaging studies such as CT scans or MRIs, and laboratory tests. These diagnostic tools help to assess the location, extent, and pattern of inflammation, allowing for an accurate diagnosis.
2. Dr. Holly explains to Mr. Enson that he will undergo surgical resection of the most severely damaged segment of his colon, followed by the creation of an artificial anus on his abdominal wall. She mentions that there are two procedural options for the resection, but she believes that the option she has chosen is better suited for his condition.
The two surgical options typically considered for a resection in a case like Mr. Enson’s are a primary anastomosis and a temporary diverting loop ileostomy. A primary anastomosis involves removing the damaged or diseased portion of the colon and then reconnecting the remaining healthy sections. This option allows for the restoration of normal bowel continuity, but it may be contraindicated if there is concern about the integrity of the anastomosis or risk of leakage.
On the other hand, a temporary diverting loop ileostomy involves creating an artificial opening on the abdominal wall, with a loop of the small intestine brought to the surface. The stool is then diverted through this loop, bypassing the resected portion of the colon. This option provides temporary relief, allowing the resection site to heal without the passage of stool.
Considering Dr. Holly’s choice to create an artificial anus on Mr. Enson’s abdominal wall, it can be inferred that she has chosen the temporary diverting loop ileostomy. This option is likely selected due to the extensive inflammation and damage observed in Mr. Enson’s gastrointestinal tract, which increases the risk of complications at the anastomosis site. The temporary diversion allows for healing and stabilization of the bowel before potentially undergoing another surgical procedure to restore bowel continuity.
3. If Dr. Holly had chosen to remove a portion of Mr. Enson’s small intestine instead of his colon, he would have been at an increased risk for developing a condition known as short bowel syndrome (SBS). Short bowel syndrome refers to a condition in which the small intestine is abnormally shortened, resulting in a reduced functional surface area for absorption of nutrients and fluids. This can lead to malabsorption, malnutrition, and dehydration.
The small intestine plays a crucial role in the absorption of essential nutrients and fluid. Removal of a significant portion of the small intestine, as might occur in surgical resection for Crohn’s disease, can disrupt this process. The risk of developing SBS increases with the extent of small bowel removed. Individuals with SBS may require ongoing nutritional support, including specialized diets, oral supplementation, and intravenous fluids.
In Mr. Enson’s case, removing a portion of his small intestine for surgical resection would have potentially exposed him to the risk of developing short bowel syndrome. Given the extent of inflammation and damage in his large intestine, Dr. Holly’s decision to choose colon resection with an artificial anus seems more appropriate in addressing his immediate concerns without exposing him to the additional risk of SBS.