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Reason for Consultation: The patient is a 55-year-old white man referred by the gastroenterologist at his local hospital. Suitability of patient for total colectomy and ileal reservoir procedure to be evaluated. Past History: The patient carries a diagnosis of ulcerative colitits. His history includes chronic mild to severe acute exacerbations characterized by bloody diarrhea and lower abdominal pain. Recently patient’s stool output has increased (10 to 15 stools/day with blood and mucus) and he complains of malaise, nausea, tenesmus, and weight loss, despite attempts to manage the illness pharmacologically (with corticosteroids and sulfasalazine). Symptoms increasingly interfere with work and activities of daily living. Family history of ulcerative colitis (sister). Examination: Physical examination reveals pallor, dry mucous membranes, and uvulitis. Evidence of anorectal excoriation. Auscultation reveals hyperactive bowel sounds; abdominal tenderness to palpation over colon noted. Diagnostic Studies: Blood studies, stool cultures, barium enema, colonoscopy, and sigmoidoscopy. Blood studies show iron definciency anemia and low serum albumin. Biopsy results reveal friable epithelium and superficial ulcerations of colon. No evidence of colon cancer. Impression: Diagnosis of ulcerative colitits confirmed; patient meets selection criteria for surgical procedure: good physical stamina, competent anal-rectal spincter, good motivation, and ability to undertand self-care instructions. Plan: Confer with patient, family, and referring physician to schedule procedure. 1.) The patient in the preceding case study was undergoing surgical evaluation for what condition ? a. chronic inflammation of the ileum b. inflammation of the colon with formation of ulcers c. an obstruction of the intestine d. backward flow in GI contents into the esophagus 2.) Explain the difference between a colonoscopy and a sigmoidoscopy. Why were both the procedures done on the case study patient? 3.) Name another condition that a colectomy would need to be performed. Explain why the procedure would need to be performed.

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