This document provides information on ulcerative colitis (UC), including: - UC most commonly affects individuals aged 15-30 and 60-80, with equal rates in males and females. - Colonic manifestations include diarrhea, rectal bleeding, tenesmus, passage of mucus, and crampy abdominal pain. Disease severity ranges from mild to severe. - Extraintestinal manifestations occur in 6-10% of cases and include uveitis, primary sclerosing cholangitis, and ankylosing spondylitis. - Complications include toxic megacolon, perforation, colorectal cancer, and strictures. Treatment involves medications and may require surgery.

5. 50% 30% 20%

8.  Age of onset 15-30, 60-80
 Male: Female 1:1
 Colonic manifestation
 Extracolonic manifestation

9. Colonic manifestation:
Insidious onset with
 Diarrhea
 Rectal bleeding
 Tenesmus
 Passage of mucus
 Crampy abdominal pain
 Weight lose

10. Presentation
 mild in more than 50% of patients
 25% of patients have a moderately
severe first attack of UC
 Approximately 20% of patients
experience more severe disease

11.  The outcome of an initial attack of UC
usually correlates with the extent of
disease and the severity of symptoms
Bleeding per rectum and
fewer than 4 bowel
motions per day
Mild
Bleeding per rectum with
more than 4 bowel motions
per day
Moderate
Bleeding per rectum, more
than 4 bowel motions per
day, and a systemic illness
with hypoalbuminemia (< 30
g/L)
Severe

12. In some cases, UC has a fulminant
course marked by:
 Severe diarrhea and cramps
 Fever
 Leukocytosis
 Abdominal distention

13. Extra colonic manifestations
6.2%
3.8
%
Uveitis
3%
Primary sclerosing
cholangitis
2.7Ankylosing spondylitis

14.  Local (intestinal)
 Systemic (extraintistinal)
o Related to extracolonic manifestation
o Related to treatment

15. Local (Intestinal):
 Toxic Megacolon less than 2%,
Exposure of the muscularis propria and neural plexus to
fecal material, may lead to complete shutdown of
neuromuscular function, the colon progressively swells and
becomes gangrenous
Suspect toxic megacolon in a patient with fulminant
ulcerative colitis, especially if the number of daily stools has
declined sharply without a corresponding improvement in
symptoms.
 Perforation can occur in the presence of fulminating
disease, even in the absence of toxic megacolon.
 Malignancy 10- to 30-fold increase in development of colon
cancer, risk of colorectal cancer increases by 0.5-1% per
year
 Strictures colonic strictures are of significant concern and
should be presumed to be malignant unless proven
otherwise
 Fistulae and Abscesses They are observed in about 20%
of patients with ulcerative colitis.

16.  Radiological imaging play a large
role, in diagnosis, follow up, and
detection of complication those
include
 Plain abdominal x-ray
 Barium enema
 Ultrasound
 CT scan

17. Chronic stageSubacute stageAcute stage
Loss of haustrations
on left side of colon
(lead-pipe colon)
Inflammatory polypsFine mucosal
granularity
Shortening of the colonCoarser, more granular
mucosa
Collar button ulcers
Widening of the pre-
sacral space
Double-tracking
Post-inflammatory
polyps=filiform polyps
Thumbprinting
Backwash ileitisPseudopolyps
Mural thickeningTarget sign

18.  Non specific
but may show
evidence of
mural
thickening
(more
common), with
thumb printing
seen in severe
cases.

19.  Double contrast barium enema allows
for detail of the colonic mucosa, and
also allows bowel proximal to strictures
to be assessed.
 It is however contraindicated if acute
severe colitis is present due to the risk
of perforation.

20. • Fine mucosal
granularity= barium
precipitating in colon
due mild edema,
hyperemia and
alteration of colonic
mucus, granularity is
due to ruptured crypt
abscesses filled with
contrast

21. • Ulcerations= Two types
a) Button type = deep ulcer penetrating
the muscularis mucosae undermining the
submucosal fat
Flask like ulcers with flat base
b) Double tracking = is spreading of
these ulcer result in large round or linear
ulcers paralleling the course of
longitudinal muscle (taenia coli) these
are longitudinal ulcers in submucosa.

22. BUTTON TYPE

23. DOUBLE TRACKING

24. Pseudopolyps
(inflammatory
polyps)= Raised area
of inflamed tissue
resembles
polyps and sever
ulcerations caused
denuded area.

25. Widening of the pre-
sacral space:
 is one of the diagnostic
indicators of the
diseases involving
pelvic pathology and
rectal involvement. It is
ideally measured on
barium studies at the
level of S3/4 disc level
on lateral radiographs
and the normal value
of the presacral space
is <15 mm in adults

26.  A widened
presacral
space due to
fibrofatty
proliferation

27. Chronic stage
 Loss of
haustration
Demage to
muscularis
propria results in
colonic dilation
and loss of
haustra

28. 3D VC 3D VC transparensy

29. W
 Adventage
 For
assement of
intraluminal
polyps
 Strictures
 masses
3D VC endoluminal

30. Chronic stage
 Filiform polyps (post
infamatory polyps)
When an acute attack
remits, the granulation
tissue forming at the ulcer
base undermines the
residual oedematous
mucosal flap at the ulcer
edge – this is therefore
prevented from sealing
down, resulting in sessile,
filiform, frond-like polyps

31. Chronic stage
 Backwash ileitis
When the entire colon is
involved, changes in the
terminal ileum may be
seen; this involves 4-25
cm of the terminal ileum.
Wide ileocecal valve and
dilated terminal ileum
The mucosa is granular
and is usually associated
with the absence of
peristalsis.

33.  US features are nonspecific and
include bowel wall thickening >4cm,
which may involve both the
hypoechoic muscular coat and the
echogenic mucosa.
 Wall thickening extends longitudinally,
and there is decreased echogenicity
and luminal narrowing.

34.  Abdominal US Longitudinal and transverse section in UC
patient show longitudinal wall thickening and absent haustration

36.  Acute /su
bacute stage
Target sign:
Disproportionate
edema in various
layers of the bowel
wall result in series
of concentrated
rings of varied
attenuation

37.  Chronic stage
Thickening of
colonic and
rectal wall=
deposition of fat in
submucosa and
edema and
Infiltration of
inflammatory cells
in lamina propria

39.  Fluorodeoxyglucose
positron tomography
has been used in
the diagnosis of
pediatric IBD. This
technique appears
to provide adequate
information for
patients suspected
of having IBD.
PET/CT

40. DIFFERENTIAL DIAGNOSIS
In addition to excluding Crohn disease,
guidelines from the World
Gastroenterology Organization
recommend ruling out the following in the
differential diagnosis of ulcerative colitis:
 Chronic schistosomiasis
 Amebiasis
 Intestinal tuberculosis
 Ischemic colitis
 Radiation colitis

41. TREATMENT
 The treatment of ulcerative colitis relies
on initial medical management with
corticosteroids and anti-inflammatory
agents, such as sulfasalazine, in
conjunction with symptomatic treatment
with antidiarrheal agents and
rehydration.
 Surgery is contemplated when medical
treatment fails or when a surgical
emergency (eg, perforation of the
colon) occurs.

42. CASE 1

43. CASE 2

44. CASE 3
This patient
presenting with
worsening
abdominal pain
with history of
recurrent bloody
diarrhea