Ulcerative Colitis
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ULCERATIVE COLITIS |
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Limited to colon and rectum |
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HLA-DR2, HLA DR103 |
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Morphology |
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Continuous lesions |
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Thin bowel wall |
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Rare |
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Limited to mucosa |
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No granulomas |
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Marked number of Pseudopolyps (tips fuse to form mucosal bridges) |
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Superficial broad-based ulcers |
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Mild to none |
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Absent |
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Rectum always involved |
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Clinical features |
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Relapsing disorder with attacks of bloody diarrhea (usually nocturnal/postprandial), cramps, fecal urgency |
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Infrequent |
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Increased incidence of perforation |
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Absent |
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Malignant potential (UC > CD) |
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Rare |
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Toxic megacolon seen (diameter > 6 cm) |
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Investigations |
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75% pANCA positive 10% ASCA +ve |
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Barium enema
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Treatment |
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Exam Question
- The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscess, and hemorrhage or inflammatory cells in the lamina propria.
- Crohn’s disease is frequently associated with “skip lesions,” discontinuous areas of active disease in the colon and small intestine with intervening segments that appear normal.
- Pseudopolyps are more commonly found in ulcerative colitis than Crohn’s disease.
- For patients of ulcerative colitis associated with primary sclerosing cholangitis :They may develop biliary cirrhosis , may have raised alkaline phosphatase ,increased risk of hilar Cholangiocarcinoma.
- Ulcerative Colitis is associated with:
- Dermatologic: Erythema nodosum ,Pyoderma gangrenosum
- Rheumatologic: Peripheral arthritis, Ankylosing spondylitis, Sacroiliitis
- Ocular:Conjunctivitis ,Anterior uveitis/iritis ,Episcleritis
- Hepatobiliary: Hepatic steatosis ,Fatty liver ,Cholelithiasi ,Primary sclerosing cholangitis
- Urologic: Calculi ,Ileal bladder fistulas
- Metabolic bone disorders
- Thromboembolic disorders.
- Ulcerative colitis (UC) is a chronic inflammatory condition causing continuous mucosal inflammation of the colon without granulomas on biopsy, affecting the rectum and a variable extent of the colon in continuity, characterised by relapsing and remitting course.
- Distal colitis with respect to ulcerative colitis refers to Left sided colon distal to splenic flexure is only involved.
- Parameters of truelove witts criteria : Bloody stools/day ,Pulse, Temperature, Haemoglobin, ESR, CRP.
- In clinical practice, ‘remission’ mean a stool frequency ≤3/day with no bleeding and no urgency. Sigmoidoscopy to confirm mucosal healing is generally unnecessary.
- Steroid refractory ulcerative colitis is said to be present in a patients who have active disease despite Prednisolone up to 0.75 mg/kg/day over a period of 4 weeks.
- Baron Endoscopic scores for ulcerative colitis
- Score 0: Normal: matt mucosa, ramifying vascular pattern clearly visible, no spontaneous bleeding, no bleeding to light touch
- Score 1: Abnormal, but non-haemorrhagic: appearances between 0 and 2
- Score 2: Moderately hemorrhagic: bleeding to light touch, but no spontaneous bleeding seen ahead of the instrument on initial inspection
- Score 3: Severely haemorrhagic: spontaneous bleeding seen ahead of instrument at initial inspection and bleeds to light touch.
- Occasional severe constipation is seen in ulcerative colitis patients with Proctitis.
- Pancolitis and Pseudopolyps may be seen in Ulcerative Colitis.
- Ulcerative colitis involves the rectum and extends proximally in a retrograde fashion to involve the entire colon (pancolitis) in more severe cases.
- Malabsorption may be seen in ulcerative colitis.
- Sulfasalazine is used in ulcerative colitis.
- Pyoderma gangrenosum is seen in Ulcerative Colitis.
- Rx of choice in case of chronic ulcerative colitis is Proctocolectomy with Ileo-Anal Anastomosis.
- Surgical treatment of Ulcerative Colitis :Done in cases where medical treatment fails & Pouch surgery done.
- Complications of ulcerative colitis : Perforation ,Toxic megacolon, Carcinoma.
- As the inflammation is purely mucosal in ulcerative colitis, strictures are highly uncommon. Any stricture diagnosed in a patient with ulcerative colitis is presumed to be malignant until proven otherwise.
- Ulcerative colitis involves mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease.
- Pt with recurrent diarrhoea, pseudopolyp, lead pipe appearance on Ba enema has Ulcerative Colitis.
- Risk of Malignancy in Ulcerative Colitis is more in :Onset in childhood ; Extensive involvement of colon,Takes atleast 10 years to develop,Associated with dysplasia of the rest of the colon.
- Primary sclerosing cholangitis is the most serious extraintestinal manifestation of ulcerative colitis and it does not resolve with colectomy.
- Most common post operative complication of ileo anal pouch anastomosis in ulcerative colitis is Pouchitis.
- Sulphonamide is used for the treatment of ulcerative colitis is Salazopyrin,Sulfasalazine.
- Procedure of choice in ulcerative colitis with acute perforation is Total Colectomy with Ileostomy.
- Best treatment for Remission of Acute ulcerative colitis is Prednisolone.
- A 20 year old male presents with mucus and repeated gastrointestinal bleeding. Patient is positive for ANCA. The most likely diagnosis is Ulcerative Colitis.
- A 25 year old male presents with a history of chronic diarrhea. Pathological examination reveals cryp. titis and crypt abscesses. The likely diagnosis is Ulcerative Colitis.
- 5-amino salicylic acid is drug of choice for ulcerative colitis.
- Methotrexate has not been shown to be effective for treating active ulcerative colitis or for maintaining remission.
- Malignant potential is seen in both ulcerative colitis and Crohn’s disease, but ulcerative colitis is a more important risk factor than Crohn’s.
- First radiological sign of ulcerative colitis is loss of Haustrations.
- Pipe stem colon is seen in Ulcerative Colitis.
- Agents that may be used for treatment of ulcerative colitis
- 5-ASA
- Glucocorticoids
- Azathioprine and 6 mercaptopurine
- Cyclosporine or TNF alpha therapy (Infliximab).
- Tacrolimus
Don’t Forget to Solve all the previous Year Question asked on Ulcerative Colitis
