Tuesday, September 27, 2022

Ulcerative Colitis And Gallbladder Problems

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Conditions Related To Ulcerative Colitis

Key Biliary Tract / Cholestatic Diseases & Labs Explained

Ulcerative colitis is an autoimmune disease that results in damage to the inner lining of the colon, or large intestine, and rectum. The cause of UC is believed to be an abnormal immune response that causes the body to attack itself. Like Crohns disease, it is a type of inflammatory bowel disease . Unlike Crohns, the primary disease is limited to the colon and rectum and does not involve the small intestine.

Gastrointestinal symptoms of IBD can have a significant impact on quality of life these symptoms include abdominal pain and cramping, diarrhea, and intestinal bleeding. However, UC affects more than just the digestive tract. Like many autoimmune diseases, its effects can be felt throughout the body.

Many different medical conditions frequently occur alongside UC, including:

  • Arthritis
  • Blood clots
  • Anemia

About 43 percent of people with UC have extraintestinal manifestations of IBD, or conditions related to IBD that occur outside of the intestines. Some of these conditions are related to UC by underlying genetic factors or disease mechanisms, while others can occur as a side effect of treatments for UC. The symptoms of many of these related disorders worsen with UC flare-ups and resolve during periods of remission.

Sometimes these related diseases can develop before intestinal symptoms of UC appear. Here are some of the most common extraintestinal manifestations of UC.

Talk With Others Who Understand

MyCrohnsAndColitisTeam is the social network for people with IBD. On MyCrohnsAndColitisTeam, more than 147,000 members come together to ask questions, give advice, and share their stories with others who understand life with IBD.

Are you living with gallstones and IBD? Share your experience in the comments below, or start a conversation by posting on your Activities page.

How Are Gallstones Diagnosed

In addition to getting a medical history and physical examination, health care professionals can run blood work and use an ultrasound, which is the best imaging study to diagnose gallstones. Other imaging procedures like computed tomography scan, magnetic resonance imagining, magnetic resonance cholangiopancreatography, cholescintigraphy scan, or endoscopic retrograde cholangiopancreatography can also be used for diagnosis.

Having IBD can somewhat complicate diagnosing gallstones. Because upper abdominal pain is common in both Crohns disease and gallbladder disease, several members of MyCrohnsAndColitisTeam have reported difficulty discerning if their pain orginiates from IBD, gallstones, or both.

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How Is Crohns Disease Diagnosed

Most people with Crohns first see a healthcare provider because of ongoing diarrhea, belly cramping or unexplained weight loss. If you have a child who has been experiencing the symptoms of Crohns disease, reach out to your pediatrician.

To find the cause of your symptoms, your healthcare provider may order one or more of these tests:

  • Blood test: A blood test checks for high numbers of white blood cells that may indicate inflammation or infection. The test also checks for low red blood cell count, or anemia. Approximately one in three people with Crohns disease have anemia.
  • Stool test: This test looks at a sample of your stool to check for bacteria or parasites. It can rule out infections that cause chronic diarrhea.
  • Colonoscopy: During a colonoscopy, your doctor uses an endoscope to examine the inside of your colon. Your doctor may take a tissue sample from the colon to test for signs of inflammation.
  • Computed tomography scan: A CT scan creates images of the digestive tract. It tells your healthcare provider how severe the intestinal inflammation is.
  • Upper gastrointestinal endoscopy: Your doctor threads a long, thin tube called an endoscope through your mouth and into your throat. An attached camera allows your doctor to see inside. During an upper endoscopy, your doctor may also take tissue samples.
  • Upper gastrointestinal exam: X-ray images used during an upper GI exam allow your doctor to watch as a swallowed barium liquid moves through your digestive tract.

Uncommon Hepatobiliary Manifestations Of Ibd

Fecal DPP

Primary sclerosing cholangitis and pericholangitis are two relatively uncommon manifestations of IBD. These hepatobiliary diseases are characterized by inflammation and/or scarring of the bile ducts within the liver and outside of the liver . Primary sclerosing cholangitis occurs in approximately 1-5% of patients with IBD. It is more common in males than females, and is more frequently associated with ulcerative colitis than Crohns disease. Primary sclerosing cholangitis may cause narrowing of the bile duct and the development of jaundice. On the other hand, pericholangitis occurs in approximately 30% of patients with IBD. This consists of inflammatory cells surrounding the small bile ducts within the liver but there is no damage to the liver cells or to the bile ducts, and does not usually progress to more serious disease.

Cirrhosis may occur in up to 20% of patients and many factors may contribute to the cause. Some of the causes include viral hepatitis from blood transfusion, malnutrition, drug toxicity, autoimmune hepatitis, and sclerosing cholangitis. Cirrhosis is often well compensated and liver function is well preserved. Cirrhosis is becoming less frequent due to better therapy and the prevention of viral hepatitis transmission in blood products.

Natalie Rock, BSN, RN, Hepatology Clinical Research NurseUBC Department of Medicine

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Plan A Relaxing Activity

Whether with your partner, friend, or family, planning a relaxing activity like a couples massage, manicure/pedicure, or other spa-like treatment can work wonders on your fatigue. Or, if you prefer, plan an activity like watching a movie with a close friend. Taking time to do something relaxing and slow-paced still provides you with time to be with your friend or loved one but doesnt become too taxing for you. And your friend could probably use a relaxing activity, too!

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Why Is Inflammatory Bowel Disease Linked With Gallstones

There are several reasons that people with Crohn’s disease are at risk for gallstones:

  • Bile salts are not reabsorbed in your ileum. This can happen if the ileum has been removed surgically or it is very inflamed. Instead, the bile salts pass into your colon. Bile salts mix with bilirubin in the colon, changing the bilirubin into a form that can be reabsorbed. Once the bilirubin is reabsorbed, it travels back to the liver to be added into bile. Because there is extra bilirubin in the bile, gallstones start to form. The extra bilirubin makes these gallstones black.4
  • If the bile salts are not reabsorbed in the ileum, they pass out of the body. The loss of bile salts means that the liver has fewer bile salts to put into new bile. The new bile becomes overloaded with cholesterol. This can lead to cholesterol gallstone formation.4
  • When you have active Crohns disease, you may eat less to limit your Crohns disease symptoms. Rapid weight loss is a risk factor for gallstones.2
  • Your digestive tract is filled with bacteria. One explanation for the link between Crohns disease and gallstones is that certain bacteria become overgrown. These extra bacteria might change bilirubin into a form that can be reabsorbed. The extra bilirubin gets added into bile in the liver. The result is that black gallstones form.4
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    Understanding Crohns Disease & Ulcerative Colitis Symptoms

    Fatigue is a non-specific symptom of many diseases and conditions. Feeling tired could be the result of not getting enough sleep, or not getting enough quality sleep. In the U.S., we are constantly shortchanging ourselves on sleep, and most children and adults do not get enough. Fatigue, however, is more than being tired and it cant necessarily be overcome by getting some sleep. Fatigue is a symptom often associated with inflammatory bowel disease and tends to be one that is brought up frequently as being most problematic in lowering quality of life.

    Chronic fatigue can lead to a host of other problems, including poor performance at work and school, drowsy driving, and feelings of depression. Figuring out that fatigue is a problem is not difficult, but determining what is causing it and what to do about it is no easy task. The reasons people with IBD may feel fatigued include medication side effects, sleep disturbances, related conditions such as anemia, and a flare-up.

    Other Complications And Related Biliary Tract Conditions

    Incurable Ulcerative Colitis Healed Miraculously

    Gallbladder Cancer

    Gallstones are present in about 80% of people with gallbladder cancer. However, this cancer is very rare, even among people with gallstones. There is a strong association between gallbladder cancer and cholelithiasis, chronic cholecystitis, and inflammation. Symptoms of gallbladder cancer usually do not appear until the disease has reached an advanced stage and may include weight loss, anemia, recurrent vomiting, and a lump in the abdomen.

    When the cancer is caught at an early stage and has not spread beyond the mucosa , removing the gallbladder can cure many people with the disease. If the cancer has spread beyond the gallbladder, other treatments may be required.

    Gallbladder Polyps

    Polyps are sometimes detected during diagnostic tests for gallbladder disease. Small gallbladder polyps pose little or no risk, but large ones pose some risk for cancer, so the gallbladder should be removed. Patients with polyps 10 to 15 mm have a lower risk. But they should still discuss gallbladder removal with their doctor.

    Primary Sclerosing Cholangitis

    Primary sclerosing cholangitis is a rare disease that causes inflammation and scarring in the bile duct. It is associated with a lifetime risk of 7% to 12% for gallbladder cancer. The cause is unknown, although it tends to affect younger men with ulcerative colitis. Polyps are often detected in this condition and have a very high likelihood of being cancerous.

    Porcelain Gallbladders

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    Who Is At Risk For Cholangitis

    If you have had gallstones you are at greater risk for cholangitis. Other risk factors include:

    • Having autoimmune diseases such as inflammatory bowel disease
    • Recent medical procedures involving the bile duct area
    • Having human immunodeficiency virus
    • Traveling to countries where you might be exposed to worms or parasites

    Symptoms Of Stones In The Common Bile Duct

    Stones lodged in the common bile duct can cause symptoms that are similar to those produced by gallbladder stones. But they may also cause symptoms such as:

    • Jaundice .
    • Dark urine, lighter stools, or both.
    • Fever, chills, nausea and vomiting, and severe pain in the upper right abdomen. These symptoms suggest an infection in the bile duct .
    • Rapid heartbeat and abrupt blood pressure drop.

    As in acute cholecystitis, patients who have these symptoms should seek medical help immediately. They may require emergency treatment.

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    Colectomy Linked To Increased Risk For Gallstone Disease In Uc

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    Patients with ulcerative colitis may have an increased risk for gallstone disease after undergoing colectomy, according to the results of a Danish national cohort study.

    This finding led researchers to call for further studies to identify high-risk patients to minimize the negative effects of gallstones after colectomy.

    For years, we have known that a colectomy induces changes to the composition of bile, but it has been unclear whether these changes are reflected in a greater risk of gallstone disease,Anders Mark-Christensen, MD, of the department of surgery, section of coloproctology, Aarhus University Hospital, Denmark, told Healio Gastroenterology. We found that individuals with ulcerative colitis who had a colectomy had a 63% higher risk of being hospitalized for gallstone disease compared to those with ulcerative colitis without colectomy.

    Anders Mark-Christensen

    To evaluate the associations between the risk for gallstone disease after colectomy and ileal pouch-anal anastomosis , Mark-Christensen and colleagues used a Danish national registry to identify 4,548 UC patients who had a colectomy and 44,372 matched controls with UC who did not have a colectomy. Over a median follow-up of 11.9 years, 1,963 patients were hospitalized for gallstone disease.

    Sensitivity analyses showed the adjusted HR for cholecystectomy after colectomy was 1.55 .

    What Is The Prognosis For People With Crohns Disease

    Treating Challenging Moderate to Severe Crohn Disease With IL

    Most people with Crohns disease enjoy healthy, active lives. While there isnt a cure for Crohns disease, treatments and lifestyle changes can keep the disease in remission and prevent complications.

    Lifestyle changes can include changes to your diet. People with Crohns disease often need to adapt their diets so that they get enough calories each day. Lactose intolerance can also be an issue for those with Crohns disease. You may need to avoid certain dairy products if you find that youre having issues with this dietary intolerance. You should also avoid smoking if you have Crohns disease. Smoking can only make your condition worse.

    Your healthcare provider might recommend you receive preventative colonoscopies after youre diagnosed with Crohns disease. Talk to your provider about how often you should have colonoscopies and what your risks are for other medical conditions.

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    Management Of Common Bile Duct Stones

    Common bile duct stones pose a high risk for complications and nearly always warrant treatment. There are various options available. It is not clear yet which one is best.

    • Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is now the most frequently used procedure for detecting and treating common bile duct stones. The procedure involves the use of an endoscope , which is passed down the throat to the bile duct entrance.
    • Laparoscopic common duct exploration has taken a secondary role in the detection and removal of common bile duct stones. This is an approach through the abdomen, but it uses small incisions instead of one large incision. It is used in combination with ultrasound or a cholangiogram .
    • During percutaneous transhepatic cholangiography , bile duct stones can also be diagnosed and removed. A needle is inserted through the skin, liver and bile duct to deliver a dye for imaging. A catheter can also be inserted to drain the bile duct.
    • Open surgical bile duct exploration requires a wide abdominal incision. It is not routinely performed, but may be necessary in some cases.

    Experts are currently debating the choice between laparoscopy and ERCP. Many surgeons believe that laparoscopy is becoming safe and effective, and should be the first choice. Still, laparoscopy for common bile duct stones should only be performed by surgeons who are experienced in this technique. In skilled centers, endoscopic techniques are becoming the gold standard.

    Liver Conditions Linked To Ulcerative Colitis

    There’s more than just proximity between your colon and your liver. Find out about ulcerative colitis and liver disease risks.

    Yaroslav Danylchenko/Stocksy Everyday Health

    Liver disease can be a complication of inflammatory bowel disease , such as ulcerative colitis or Crohns disease. The liver, which processes the food you ingest, can develop inflammation if IBD isnt treated appropriately. Unfortunately, some drugs used to treat IBD may also damage the liver.

    According to a study published in 2019 by the American Gastroenterological Association, the prevalence of nonalcoholic liver diseases in patients with UC was more than double that of the general population. Considering the increased risk, it makes sense to take precautions. Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota, recommends that people with UC have their liver enzymes checked annually. Its also wise to be aware of the common symptoms of liver disease so you can address the problem before it gets worse. According to the Crohns & Colitis Foundation, these symptoms include the following:

    • Fatigue or low energy
    • Jaundice
    • Pain or a feeling of fullness in the upper right abdomen
    • Fluid retention
    • Easy bruising

    Here are five conditions related to the liver or ducts that transport bile that may develop alongside ulcerative colitis.

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    Successfully Reversing Chronic Digestive Disorders For 45 Years

    The following case studies include those who have been medically diagnosed with a variety of Chronic Digestive Disorders including Ulcerative Colitis, Crohns Disease, Irritable Bowel Syndrome, Chronic Constipation, GERD / Acid Reflux, SIBO, Eosinophilic Esophagitis etc. Many of these patients had previously been to medical and alternative medical physicians and undergone drug therapy which failed to bring about improvement in their condition and generally resulted in a further decline in their state of health. Improvements in each case resulted from addressing causal factors and employing health promoting nutritional and Bio-Hygienicsteps to Re-Create the Body, not through the treatment of any medical condition.

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    When To See A Healthcare Provider

    Crohn’s Disease Nursing | Crohns Symptoms, Pathophysiology, Treatment, Diet NCLEX

    If you have any symptom that is troubling you, you should speak to a healthcare provider.

    In particular, you should see a healthcare provider if you have symptoms like:

    • Abdominal pain that does not improve
    • Blood in the stools
    • Diarrhea that does not go away
    • Vomiting that does not go away
    • Distended abdomen

    Persistent abdominal pain is not normal, and bleeding from the rectum is not normal. If you have any doubts about your health, you should speak with your healthcare provider.

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    Symptoms Of Chronic Cholecystitis Or Dysfunctional Gallbladders

    Chronic gallbladder disease involves gallstones and mild inflammation. In such cases, the gallbladder may become scarred and stiff. Symptoms of chronic gallbladder disease include the following:

    • Complaints of gas, nausea, and abdominal discomfort after meals are the most common symptoms. But they may be vague and difficult to distinguish from similar complaints in people who do not have gallbladder disease.
    • Chronic diarrhea .

    Expectant Management Of Asymptomatic Gallstones

    Guidelines from the American College of Physicians state that when a person has no symptoms, the risks of both surgical and nonsurgical treatments for gallstones outweigh the benefits. Experts suggest a wait-and-see approach, which they have termed expectant management, for these patients. Exceptions to this policy are people at risk for complications from gallstones, including those at risk for gallbladder cancer, such as Pima Native Americans and patients with porcelain gallbladder or with stones larger than 3 cm.

    Very small gallstones may increase the risk for acute pancreatitis, a serious condition.

    There are some minor risks with expectant management for people who do not have symptoms or who are at low risk. Gallstones almost never spontaneously disappear, except sometimes when they are formed under special circumstances, such as pregnancy or sudden weight loss. At some point, the stones may cause pain, serious complications, or both, and require treatment. Some studies suggest the younger the patient is at diagnosis, the higher the probability of future surgery.

    The slight risk of developing gallbladder cancer might encourage young adults who do not have symptoms to have their gallbladder removed.

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