Ulcerative colitis

Inflamatory of The Bowel

Inflammatory bowel disease (IBD) –
Ulcerative colitis •
Crohn's disease •
Diverticulitis •
Infeksi –
bakteri, parasit •
Food allergy –
Disease distribution
Ulcerative Colitis

Left sided
cloitis

Proctosigmoiditis
Proctitis
 Clinical Features

rectal passage of
diarrhea
bleeding mucus

abdominal
tenesmus urgency
pain
Systemic manifestations

Fever Weight loss

Peripheral edema Anorexia/vomiting

 Clinical Features

The onset of UC typically is slow and insidious.

Symptoms have usually been present for weeks or months by the time the
patient seeks medical attention.

The median interval between the onset of symptoms and diagnosis of UC is

approximately 9 months.

Some patients with UC may present much more acutely, with symptoms
mimicking infectious colitis.
 Physical findings
• mild or even moderately severe disease:
- few abnormal physical signs
• severe attacks :
-tachycardia
-fever
-orthostasis
-weight loss
• fulminant colitis:
- the abdomen often becomes distended and
firm, with absent bowel sounds and signs of
peritoneal inflammation.
 Natural history & Prognosis
80% of patients with UC have a disease course characterized by
intermittent flares interposed between variable periods of
remission.

The duration of relapse-free periods varies greatly from patient to

patient.

> 50% of patients present with mild disease at their first attack

6% to 19% of patients have severe disease at presentation.

 Natural history & Prognosis

Disease extent may progress over time.

In patients initially presenting with proctitis or

proctosigmoiditis, disease extension occurs in approximately
10% to 30% of patients at 10 years after diagnosis.

Less commonly, extensive colitis regresses over time with

treatment
 Colectomy in Ulcerative colitis
The probability of colectomy is highest in the first •
year of diagnosis
the overall colectomy rate is 24% at 10 years and •
30% at 25 years
The probability of colectomy is related to the •
extent of disease at diagnosis.
 Exacerbating factors

bacterial and viral

infections

the use of non-

steroidal anti-
psychosocial stress.
inflammatory drugs
(NSAIDs) antibiotics

seasonality smoking
 Endoscopic findings

The hallmark of UC is symmetrical

and continuous inflammation that
begins in the rectum and extends
proximally without interruption for
the entire extent of disease.
 Endoscopic findings

The earliest endoscopic sign of UC is a decrease or loss of the normal

vascular pattern, with erythema and edema of the mucosa

As the disease progresses, the mucosa becomes granular and friable

With more severe inflammation, the mucosa may be covered by yellow-

brown mucopurulent exudates associated with mucosal ulcerations.

severe UC is associated with mucosa that bleeds spontaneously, and there may
be extensive areas of denuded mucosa from severe mucosal ulcerations with
diffuse colitis. Marked edema may at times lead to luminal narrowing.
 Radiology: Barium enema

less frequently used in the care of patients •

with UC
may be superior to colonoscopy for certain •
indications
Stricture

Location Length Diameter

 Differentiating crohn’s disease from
ulcerative colitis
Variable Crohn’s disease Ulcerative colitis
Distribution Often discontinuous and asymmetric Continuous, symmetric, and diffuse,
with skipped segments and normal with granularity or ulceration found
intervening mucosa, especially in throughout the involved segments of
early disease colon; periappendiceal inflammation
(cecal patch) is common even when
the cecum is not involved

Rectum Completely, or relatively, spared Typically involves the rectum with

proximal involvement to a variable
extent
Ileum Often involved (≈75% of cases of Not involved, except as “backwash”
Crohn's disease ileitis in ulcerative pancolitis
Depth of Submucosal, mucosal, and Mucosal; not transmural except in
inflammation transmural fulminant disease
 Differentiating crohn’s disease from
ulcerative colitis
Ulcerative colitis Crohn’s disease Variable
Rarely present; suggestive of Often present Strictures
adenocarcinoma

Not present, except rarely for Perianal, enterocutaneous, Fistulas

rectovaginal fistula rectovaginal, enterovesicular, and
other fistulas may be present
Generally not present Present in 15-60% of patients Granulomas
(higher frequency in surgical
specimens than in mucosal pinch
biopsies)
pANCA positive in 60-65%; ASCA positive pANCA positive in 20-25%; ASCA Serology
in 5% positive in 41-76%
Extraintestinal manifestations of IBD

Extraintestinal
manifestations

Related to Unrelated to
disease activity colitis
 Serological markers in IBD

CRP, P-ANCA, ASCA May be useful in •

predicting the phenotype of crohn’s disease
Patient with positive serology and high titer •
are more likely to have complications:

surgery
strictures
requirements

perforating
disease
 DRUGS & DIET

Corticosteroids : budesonide 9 mg once daily. [76] •

Probiotics : effective at maintaining remission. •
Escherichia coli strain Nissle 1917 & mesalazine –
No specific diet restrictions are required for patients with ulcerative •
colitis, but concider lactose intolerance.
No specific diet can maintain remission. •
parenteral nutrition is often used in patients who are severely ill as •
effective nutritional support