Ulcerative Colitis

Question 1

Epidemiology of Ulcerative Colitis

Answer 1

Ulcerative colitis is 3 times more common than Crohn disease.
occurs more frequently in whites

2-4 times higher in Ashkenazi Jews
slightly more common in women than in men

Age of onset follows a bimodal pattern, with a peak at 15-25 years and a smaller one at 55-65 years, although the disease can occur in people of any age

Question 2

Aetiology of Ulcerative Colitis

Answer 2

genetic factors, immune system reactions, environmental factors, nonsteroidal anti-inflammatory drug (NSAID) use, low levels of antioxidants, psychological stress factors, a smoking history, and consumption of milk products.

Question 3

Pathogenesis

Answer 3

UC usually begins in the rectum. Spreads through LARGE COLON,

Early in the disease, the mucous membrane is erythematous, finely granular, and friable, with loss of the normal vascular pattern and often with scattered hemorrhagic areas. Large mucosal ulcers with copious purulent exudate characterize severe disease.

Repeated episodes of inflammation lead to thickening of the wall of the intestine and rectum with scar tissue.

Death of colon tissue or sepsis may occur with severe disease.

Question 4

Natural History

Answer 4

chronic with repeated exacerbations and remissions.

Question 5

Clinical Manefestations

Answer 5

Diarrhoea of between 10 and 25 times a day,
blood and pus may be present

abdominal pain and cramping that usually
subsides after a bowel movement

Borborygmus,
Fever
Weight loss
Foul smelling stools
Tenesmus

Additional symptoms that may be associated
with this disease:
•  nausea & vomiting
•  joint pain
•  gastrointestinal bleeding

Question 6

Symptoms

Answer 6

Bloody diarrhea of varied intensity and duration is interspersed with asymptomatic intervals.

Usually an attack begins insidiously, with increased urgency to defecate, mild lower abdominal cramps, and blood and mucus in the stools.

Question 7

Signs

Answer 7

abdominal pain and cramping that usually
subsides after a bowel movement

• colonoscopy with biopsy
• barium enema

Question 8

Complications

Answer 8

The risk of cancer increases in each decade
after the diagnosis.

Toxic or fulminant colitis occurs when transmural extension of ulceration results in localized ileus and peritonitis. Within hours to days, the colon loses muscular tone and begins to dilate

Toxic or fulminant colitis manifests initially with sudden violent diarrhea, fever to 40° C (104° F), abdominal pain, signs of peritonitis (eg, rebound tenderness), and profound toxemia.

Toxic colitis is a medical emergency that usually occurs spontaneously in the course of very severe colitis but is sometimes precipitated by opioid or anticholinergic antidiarrheal drugs. Colonic perforation may occur, which increases mortality significantly.

Question 9

Prognosis

Answer 9

The course of the disease varies with remissions and exacerbations over a period of years, or the disorder can present as a fulminant disease. A permanent and complete cure is unusual.

In about 10% of patients, an initial attack becomes fulminant with massive hemorrhage, perforation, or sepsis and toxemia. Complete recovery after a single attack occurs in another 10%.

The cumulative likelihood of cancer is about 3% at 15 yr, 5% at 20 yr, and 9% at 25 yr
About one third of patients with extensive UC ultimately require surgery