1. IBD
Ulcerative
Colitis
Ulcerative Proctosigmoiditis
Lecture 13
By Dr Mohammad Manzoor

2. Ulcerative Colitis
• Ulcerative Colitis is an ulceroinflammatory
disease affecting the colon, which is limited
to
the mucosa and submucosa, except
in the most severe cases.

3. UC
• It begins in the rectum and extends
proximally in a continuous fashion
sometimes involving the entire colon
(Pancolitis).

6. Epidemiology
• More common in USA & Western countries.
The incidence has risen in recent decades.
More common among whites. Females are
affected slightly more. A peak incidence
between ages 20-25 years. Has a familial
association.

7. Morphology
• Gross:
• Rectum & Sigmoid --may involve entire colon.
• The lesions are continuous.
• inflammatory destruction of the mucosa with
macroscopic appearance of :
• Hyperemia, edema, and granularity with
friability and easy bleeding.

9. Morphology
• With severe active disease:
• Extensive and broad based ulceration in the distal
colon.
• Pseudopolyps
• Toxic megacolon
Pseudopolyps are projecting masses of scar tissue
that develop from granulation tissue during the
healing phase in repeated cycle of ulceration
(especially in inflammatory bowel disease).

11. Morphology
• A diffuse, predominantly mononuclear
inflammatory infiltrate in the lamina propria
and Crypt abscesses.

12. Complications:
•
•
•
•
•
•
Perforation,
peritonitis,
abscess
Toxic megacolon
Venous thrombosis
Carcinoma

13. Clinical features
• Bloody mucoid diarrhea
• Cramps ( a painful & involuntary muscular contraction)
• Tenesmus (painful spasm of the anal sphincter along with the urgent desire to defecate
without the significant production of feces)
• Colicky lower abdominal pain
• Fever
• Weight loss

14. Extra-intestinal symptoms
•
•
•
•
•
•
•
Migratory polyarthritis,
Sacroilitis,
Ankylosing spondilitis,
Uveitis,
Erythema nodosum and
Hepatic involvement (pericholangitis and
Primary sclerosing (cholangitis).

15. Diagnosis
• Endoscopy
• Biopsy

16. Comparison of CD &UC
• Crohn disease and ulcerative colitis differ in
many respects, including the natural history of
the disease, pathological aspects, and in the
types of therapies and responses to
treatment.

17. Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's Disease
Involves terminal ileum
Involves colon?
Involves rectum?
Ulcerative Colitis
Commonly
Seldom
Usually
Seldom
Sometimes
Always
Usually
Bile duct involvement?
Not associated
Higher rate of Primary
sclerosing cholangitis
Distribution of Disease
Patchy areas of
inflammation
Continuous area of
inflammation
Endoscopy
Linear and serpiginous
(snake-like) ulcers
Continuous ulcer
Depth of inflammation
May be transmural, deep
into tissues
Shallow, mucosal

18. Comparisons of various factors in Crohn's disease and UC
(Cont.)
Fistulae, abnormal
Commonly
Seldom
Biopsy
Can have granulomata
Crypt abscesses and
cryptitis
Surgical cure ?
Often returns
Usually cured by
removal of colon,
passageways between
organs
following removal of
affected part
Smoking
Higher risk for smokers Lower risk for smokers
Autoimmune disease
Generally regarded as
an autoimmune
disease
No consensus
Cancer risk?
Lower than ulcerative
colitis
Higher than Crohn's
Lymphoma
Carcinoma

19. Features
UC
CD
Morphologic
Distribution
Diffuse,mucosal Focal, trans&submucosal, mural, right
left sided
sided
Mucosal atrophy
Marked
Minimal
Cytoplasmic mucin
↓
Preserved
Lymphoid aggregate Rare
Common
Edema
marked
Minimal

20. Features
UC
CD
Morphologic
Hyperemia
Granuloma
Fissuring
Crypt abscess
Extreme
Absent
Absent
Common
Minimal
60% present
Present
Rare
Lymph nodes
Reactive
Granulomas

21. Indeterminate Colitis
• Histopathologic and clinical overlap between
ulcerative colitis and Crohn disease is common, and
it is not possible to make a distinction in up to 10%
of patients with IBD. In such cases, termed
indeterminate colitis, the small bowel is not
involved, and the continuous pattern of colonic
disease typically would indicate ulcerative colitis.