2. Ulcerative colitis
• It is an inflammatory condition of rectum and
colon of unknown aetiology perhaps related to
stress, westernized diet, autoimmune factor,
familial tendency, allergic factor.
• Disease commonly starts in the rectum,
spreads proximally to the colon and often into
the terminal part of ileum as back wash ileitis
(5%).
3. Aetiology
• Westernized diet, red meat; less common in
vegetarians.
• Defective mucin production in the colonic mucosa
and mucosal immunological reaction.
• Autoimmune factors— cytotoxic T lymphocytes
against colonic epithelial cells and presence of
anticolon antibodies.
• Appendicectomy and smoking withdrawal, protects
ulcerative colitis especially from extraintestinal
features and from postoperative complications.
• Familial in nature.
4. • Allergy to milk (cow milk) and other dietary factors.
• Psychological aspects, stress, life style, personality
disorders.
• Carcinoma in ulcerative colitis is more prevalent than in
Crohn‘s disease.
6. PATHOLOGY
• Ulcerative colitis is a disease confined to
mucosa & submucosal layer.
• Rectum is mostly involved in (90 to 95%).
• This disease is always in continuity & there is no
skip lesion (wound or Patchy lesions)as seen in
crohn’s disease.
7. MACROSCOPICALLY
The mucosal surface demonstrates superficial
fissures, small & regular PSEUDOPOLYPS
(projecting masses of scar tissue which develop
during healing phase).
Irregular, shallow, linear, anastomosing ulcers
scatter b/w islands of swollen mucosa-
pseudopolyps, which is a characteristic feature
of this disease.
8.
9. MICROSCOPICALLY
The earliest lesion starts in the bases of the
crypts of lieberkuhn (intestinal glands which
lie b/w villus), where neutrophils pass b/w the
lining cells to accumulate inside the crypt
lumen forming crypt abscesses along with
eosinophil, serum & red blood cells.
12. CHRONIC & CONTINOUS
• Onset is gradual in this stage.
SYMPTOMS :
Lower abdominal cramp
Cramping is followed by urgency & tenesmus,
painful passage of small watery stool
consisting of stool, mucus, blood, pus.
13. CHRONIC RELAPSING REMITTING
Commonest form seen in ulcerative colitis.
Bloody diarrhea is predominant symptom.
Diarrhea, abdominal pain more or less occur in
the same fashion as the chronic variety.
14. ACUTE FULMINANT
• Onset is very acute & fulminant (Severe and sudden
in onset) colitis.
• Severe diarrhoea, preceded by severe lower
abdominal cramps takes place day & night.
• Tenesmus & urgency are marked.
• No.of stools are about 30-40 per day.
• Fever goes up to 39-40 C.
15. • Extreme dehydration, hypocalcaemia, anemia,
hypoproteinaemia and marked weight loss are
features of this form.
• The face's are lean with shrunken eyeballs.
16. PHYSICAL FINDINGS
1. Pallor & weight loss
2. Tenderness on affected colon may be revealed.
3. Abdominal tenderness, with the distension is very
characteristic of toxic megacolon.
4. RECTAL EXAMINATION: may reveal perianal
inflammation in the form of fissure, abscess or
fistula in ano.
26. Treatment
1. General
• Correction of anemia.
• Fluid and electrolyte supplimentation.
• Nutrition (high protein, carbohydrate, vitamin, but low
fat diet), TPN (Triphosphopyridine Neucleotide).
• Sedatives and tranquillisers.
• Psychological counselling.
2. Drugs
• In active disease, drugs are used to induce remission.
Later drugs also for maintenance of remission and to
prevent relapses.
27. Surgical Treatment
• Total proctocolectomy (surgical removal of the
colon and rectum) with ileo-anal anastomosis
(surgical connection)
It is ideal curative procedure for ulcerative
colitis.
