Ulcerative Colitis Flashcards
What is Ulcerative Colitis?
-it is a necrotizing diffuse inflammation of rectal and colon mucosa
Etiology and Pathogenesis of Ulcerative Colitis
- Possible factors are ;
- infectious
- dysbacteriosis
- drug and food allergy
- stress
- immunological disturbance
- genetic factors
- environmental pollution
in the Pathogenesis dysfunction of hypophyseal-adrenal system -influences of metabolic products of intestinal flora-autoantibodies on epithelium of the colon -energy insufficiency in the intestinal epithelium
The spread of the disease is proximal, only mucosa and submucosal layer are involved in the pathological process
The ulcers have different sizes, their borders are regular, can be covered with fibrin
Combination of the ulcers with edematic mucosa looks like pseudopolyposis
Classification of U.C
According to Localisation
- ulcerous proctitis and proctosigmoiditis
- left sided ulcerative colitis
- total ulcerative colitis
- regional ulcerative colitis
According to clinical course
- acute ulcerative colitis
- chronic ulcerative colitis
- recurrent ulcerative colitis
according to severity of clinical course
- mild
- moderate
- severe
According to Complication
-local
-systemic
-concomitant
Local complications are perforation of the colon, acute toxic dilatation, intestinal hemorrhages, strictures, Malignization
Systemic are involvements of articulations, eye symptoms, skin and mucosal lesions, chronic hepatitis, pyelonephritis, hypovitaminosis,thrombophlebitis
Concomitant-intercurrent diseases as a result of host defenses weakening
Clinical picture of U.C
- liquid stool with blood, mucus
- abdominal pain
- diarrhea to 20-40times a day
- exhaustion
Diagnosis of U.C
- CBC and urine
- biochemical blood analysis
- feces analysis
- Digital rectal analysis
- Fibre optic colonoscopy - minimal ,temperate, full blown degrees of activity
- irrigoscopy- jaggy boarders, dissappearance of haustration, thickening of the folds, shortening of the colon, its uneven constriction, pseudo polyps-filling defects
- Abdominal US-for moderate and severe forms of the disease
- pathomorphologic methods -inflammatory infiltrations, decrease number of goblet cells, injury of the glands , formation of microabsesses
- determination of perinuclear cytoplasmatic antibodies in blood
Differential diagnosis is from;
- bacillary and amebic dysenteries
- tuberculosis
- cancer of the bowels
- non ulcerative chronic colitis
- ischemic colitis
- chrons disease
Treatment of U.C
Conservative treatment
-aminosalicyclates(mesalazin, salofalc, Pentax’s) and glucocorticoids
-Hormonotherapy for treatment of acute forms of the disease, in severe clinical course when aminosalicyclates are ineffective during 10-14days incase of systemic lesions and intolerance to aminosalicyclates immunosuppressors are used
Daily dose of prednisone is 40-60mg, I’m severe cases up to 1kg, after the effect is achieved the dose requires gradually tapering to 5mg a week and withdrawal
Infusion therapy incuding transfusion of saline ,glucose,blood plasma, protein prepations, solution of amino acids, haemodesum, desensitizing drugs , correction of dysbacteriosis etc
Blood components are transfused incase of anemia and continuos hemorrhage
Antidiarrheal therapy , protective regimen, minor tranquilizers
Surgical treatment
Absolute indications are perforation,acute toxic intestinal dilatation which doesn’t respond to conservative therapy , profuse continuous intestinal hemorrhages, cicatrical strictures, resulting in disturbance of passage , cancer with ulcerative colitis
Relative indications incase of acute and rapid progressing form of the disease when conservative methods are ineffective
Two main methods of radical surgeries are subtotal colectomy and colproctectomy
Operation of choice is subtotal colectomy combined with raising of an ileostomy
Prognosis depends on timely diagnosis and adequacy of the treatment
Approximately 6-8% patients need surgical treatment
