ULCERATIVE

COLITIS
CONTENTS:
Introduction
Etiology
Pathophysiology
Types
Symptoms & complications
Diagnosis and evaluation
Management
INTRODUCTION:
•Idiopathic inflammatory condition of the colon which
results in superficial erosions on the wall of colon.
•Often asscociated with bleeding.
•Most common form of inflammatory bowel disease
which begins in rectum and extends proximally in a
continuous manner.
•Involves inflammation restricted to mucosa and
submucosa of the colon.
ETIOLOGY:
•Specific cause is unknown : but common cause of this inflammatory bowel
disease includes
Genetic predisposition
Environmental factors (diet, viral or bacterial pathogens)
Immunological imbalance
Defect in intestinal barrier causing hyper sensitive mucosa and
increased permeability
Defect in repair of mucosal injury
PATHOPHYSIOLOGY
Includes defects in
Epithelial barrier – defect in colonic mucin and tight junctions which leads to
increased uptake of antigens
Immune response – immune related factors like TNF, interleukin 13, NK cells
Microflora of colon – plays a major role in increasing the severity of
inflammation and disease.
May also result from homeostatic imbalance between enteric microflora and
host’s mucosal immunity
Inflammation is confined to rectum and
sigmoid colon

Leads to mucosal haemorrhages and

abscess formation which leads to necrosis
and shedding od mucosa
Mucosa becomes red, friable and ulcerated

Chronic inflammation leads to atrophy,

narrowing and shortening of colon
 TYPES:
ULCERATIVE PROCTO LEFT SIDED PANCOLITIS
PROCTITIS SIGMOIDITIS COLITIS

Inflammation in Rectum and sigmoid Inflammation Affects entire colon;

anus (rectum); rectal colon inflammation; extends from rectum causes bloody
bleeding is the only symptoms – bloody up through sigmoid diarrhoea, abdominal
sign diarrhea, abdominal & descending colon; cramps, pain, fatigue,
cramps, urgency to weight loss
defecate
 SYMPTOMS & COMPLICATIONS:
SYMPTOMS COMPLICATIONS
• Major symptom - bloody diarrhoea, • Severe bleeding & dehydration
with or without mucus.
• Tenesmus / urgency to defecate • Perforated colon
• Abdominal pain and cramps • Inflammation of skin, joints and eyes
• Malaise (feeling of discomfort, illness, • Osteoporosis
or uneasiness)
• Weight loss • Increased risk of colon cancer
• Fever • Toxic megacolon
DIAGNOSIS & EVALUATION:
Diagnosis is made with the support of endoscopy, biopsy and by negative stool
examination.
STOOL STUDIES – WBC’s or certain proteins like faecal calprotein confirms
ulcerative colitis.
ENDOSCOPIC PROCEDURES –
Colonoscopy: allows to view the entire colon using a thin, flexible, lighted
tube with a camera on the end.
IMAGING PROCEDURES –
like X-RAY, CT – scan can
identify complications such as
toxic megacolon ; CT scan
reveals colon wall thickening.

BARIUM ENEMA – useful for

detecting active ulcerative
disease; colon appears granular
& shortened.
MANAGEMENT:
GENERAL MEASURES –
Bed rest, IV fluid replacement, clear liquid diet
For patients with severe dehydration and excessive diarrhoea, fluid may be
recommended to restore the nitrogen balance
DRUG THERAPY:
SULFASALAZINE (Azulfidine) – for acute and maintenance therapy; orally
administered
ORAL SALICYLATES – Melasmine, Alsalazine
CORTICOSTEROIDS – treated with 5- amino salicylic acid preparations
benefit from steroid effects
IMMUNOSUPRESSIVE DRUGS – purine analogues like 6- mercapto purine,
azothiopurine
ANTI DIARRHOEAL – to control diarrhoea , rectal urgency, cramping and
abdominal pain
 SURGICAL MEASURES:
i. Non – curative approaches – possibly
curative, reconstructive at later phase;
3 types: Temporary loop colostomy,
Sub total colectomy, ileostomy
Colectomy with ileorectal
anastomosis
ii) Reconstructive procedure – curative
•Goal is to remove the entire colons and rectum to cure the patient
•Total proctocolectomy with permanent end ileostomy
•Total colectomy with ideal reservoir; J- shaped pouch is easiest to construct
THANK YOU